**Module 14: Blood Collection and Handling -- DBS**

+----------------+-----------------------------------------------------+
| **Purpose**    | To provide the participants with skills to collect  |
|                | and handle dried blood spots (DBS) for EQA purposes |
+----------------+-----------------------------------------------------+
| **P            | -   Module 6: Safety at HIV Rapid Testing Site      |
| re-requisite** |                                                     |
|                | -   Module 8: Blood Collection -- Fingerprick       |
| **Modules**    |                                                     |
|                | -   Module 13: EQA                                  |
+----------------+-----------------------------------------------------+
| **Module       | 1 ½ hours                                           |
| Time**         |                                                     |
+----------------+-----------------------------------------------------+
| **Learning     | At the end of this module, participants will be     |
| Objectives**   | able to:                                            |
|                |                                                     |
|                | -   Collect dried blood spots (DBS)                 |
|                |                                                     |
|                | -   Package and store DBS in a way to maintain      |
|                |     specimen integrity                              |
|                |                                                     |
|                | -   Maintain DBS records                            |
|                |                                                     |
|                | -   Distinguish between valid and invalid DBS       |
+----------------+-----------------------------------------------------+

**Module Overview**

+-----+-------+--------------+---------------------+-------------------+
| **  | **T   | **Activity/\ | **Content**         | **Resources\      |
| Ste | ime** | Method**     |                     | Needed**          |
| p** |       |              |                     |                   |
+-----+-------+--------------+---------------------+-------------------+
| **  | 5 min | >            | Module introduction | Slides 1-7        |
| 1** |       | Presentation |                     |                   |
+-----+-------+--------------+---------------------+-------------------+
| **  | 20    | > P          | Procedures for      | Slide 8-20; DBS   |
| 2** | min   | resentation; | collecting, drying, | supplies (for     |
|     |       | >            | packaging, and      | display and       |
|     |       | > Activity;  | storing DBS         | demonstration)    |
|     |       | >            |                     |                   |
|     |       | > D          |                     |                   |
|     |       | emonstration |                     |                   |
+-----+-------+--------------+---------------------+-------------------+
| **  | 10    | > P          | Valid vs. invalid   | Slides 21-29      |
| 3** | min   | resentation; | DBS                 |                   |
|     |       | >            |                     |                   |
|     |       | > Discussion |                     |                   |
+-----+-------+--------------+---------------------+-------------------+
| **  | 50    | > De         | Collecting DBS      | Slide 30-32; DBS  |
| 4** | min   | monstration; |                     | supplies (for     |
|     |       | >            |                     | practice)         |
|     |       | > Practice   |                     |                   |
|     |       | >            |                     |                   |
|     |       | > Exercise   |                     |                   |
+-----+-------+--------------+---------------------+-------------------+
| **  | 5 min | > Q&A        | Summary             | Slide 33          |
| 5** |       |              |                     |                   |
+-----+-------+--------------+---------------------+-------------------+

**Material/Equipment Checklists**

-   PowerPoint slides or transparencies

-   Overhead projector or computer w/LCD projector

-   Prepared Flipchart -- content outline

-   One-pager job aid for finger prick

-   Handout: [Example Specimen Transfer Log for Re-Testing]{.underline}

-   Materials and supplies required for collecting and handling DBS.
    Have enough sets for participant inspection, demonstration and
    hands-on practices.

**Teaching Guide**

+-----------------+-----------------------------------------------------+
| **Slide         | **Teaching Points**                                 |
| Number**        |                                                     |
+=================+=====================================================+
| ![](me          | SIMPLIFY this module if participants already know   |
| dia/image1.wmf) | how to collect and handle DBS. But make sure they   |
| {width="0.49166 | all follow the standard procedures outlined in this |
| 666666666664in" | module.                                             |
| heigh           |                                                     |
| t="0.4416666666 |                                                     |
| 6666665in"}***C |                                                     |
| ustomization*** |                                                     |
|                 |                                                     |
| ***Notes***     |                                                     |
+-----------------+-----------------------------------------------------+
| **1**           | **[Module 14: Blood Collecting and Handling         |
|                 | (DBS)]{.underline}**                                |
|                 |                                                     |
|                 | DISPLAY this slide before you begin the module.     |
|                 | Make sure participants are aware of the transition  |
|                 | into a new module.                                  |
+-----------------+-----------------------------------------------------+
| **2**           | **[What Is a Dried Blood Spot (DBS)?]{.underline}** |
|                 |                                                     |
|                 | STATE the bullets on the slide.                     |
|                 |                                                     |
|                 | EXPLAIN why DBS samples are useful for re-testing.  |
|                 | They are:                                           |
|                 |                                                     |
|                 | -   Easy to collect                                 |
|                 |                                                     |
|                 | -   Easy to store                                   |
|                 |                                                     |
|                 | -   Easy to transport                               |
+-----------------+-----------------------------------------------------+
| **3**           | **[EQA Re-testing]{.underline}**                    |
|                 |                                                     |
|                 | REMIND participants that two types of specimens may |
|                 | be collected at the site for referral to a          |
|                 | reference lab for re-testing: serum/plasma or dried |
|                 | blood spots (DBS).                                  |
|                 |                                                     |
|                 | This module focuses on DBS.                         |
|                 |                                                     |
|                 | REVIEW EQA re-testing.                              |
+-----------------+-----------------------------------------------------+
| **4**           | **[Learning Objectives]{.underline}**               |
|                 |                                                     |
|                 | STATE the objectives on the slide.                  |
+-----------------+-----------------------------------------------------+
| **5**           | **[Content Overview]{.underline}**                  |
|                 |                                                     |
|                 | EXPLAIN the topics that will be covered in this     |
|                 | module.                                             |
+-----------------+-----------------------------------------------------+
| **F             | WRITE the content outline on a flipchart prior to   |
| lipchart**![](m | training.                                           |
| edia/image2.wmf |                                                     |
| ){width="0.8423 | REFER to it frequently to orient participants to    |
| 611111111111in" | where they are in the module.                       |
| height="0.84236 |                                                     |
| 11111111111in"} |                                                     |
+-----------------+-----------------------------------------------------+
| **6**           | **[What Are Your Responsibilities?]{.underline}**   |
|                 |                                                     |
|                 | STATE the tester's (or lab technician's) job        |
|                 | responsibilities related to collecting and handling |
|                 | EQA specimens.                                      |
|                 |                                                     |
|                 | EMPHASIZE the importance of the specimen quality -- |
|                 | a test result is only as good as the specimen       |
|                 | collected.                                          |
+-----------------+-----------------------------------------------------+
| **7**           | **[EQA Specimen Transfer Log]{.underline}**         |
|                 |                                                     |
|                 | REFER participants to form in their manual.         |
|                 |                                                     |
|                 | EMPHASIZE the importance of accurate data entry.    |
|                 |                                                     |
|                 | PROVIDE examples of typical transcription errors.   |
|                 |                                                     |
|                 | -   Care should be taken in transferring            |
|                 |     information from test records to EQA transfer   |
|                 |     log. Errors that are typically made include:    |
|                 |                                                     |
|                 | -   Specimen ID on transfer log sheet doesn't match |
|                 |     specimen ID filter paper                        |
|                 |                                                     |
|                 | ```{=html}                                          |
|                 | <!-- -->                                            |
|                 | ```                                                 |
|                 | -   Final result at testing site incorrectly        |
|                 |     transcribed from test records                   |
+-----------------+-----------------------------------------------------+
| **8**           | **[Required Supplies for DBS]{.underline}**         |
|                 |                                                     |
|                 | DESCRIBE the supply items on the slide and what     |
|                 | each is used for.                                   |
|                 |                                                     |
|                 | EMPHASIZE that while the collection card may        |
|                 | include 5 circles, only one patient/client's blood  |
|                 | may be collected on one card.                       |
|                 |                                                     |
|                 | MENTION other supplies required:                    |
|                 |                                                     |
|                 | -   Safety supplies including discard bins          |
|                 |                                                     |
|                 | -   Supplies for performing a fingerprick           |
+-----------------+-----------------------------------------------------+
| **Activity**    | PASS around the supply items for all participants   |
|                 | to examine.                                         |
| **3 minutes**   |                                                     |
+-----------------+-----------------------------------------------------+
| **9**           | **[How to Collect DBS]{.underline}**                |
|                 |                                                     |
|                 | REVIEW Universal Safety Precautions.                |
|                 |                                                     |
|                 | > ASK "What are some key safety practices you need  |
|                 | > to keep in mind when collecting blood?"           |
|                 | >                                                   |
|                 | > WRITE their answers on a flipchart.               |
|                 | >                                                   |
|                 | > ENSURE the following items are covered:           |
|                 |                                                     |
|                 | -   Treat all blood samples as though they are      |
|                 |     infectious                                      |
|                 |                                                     |
|                 | ```{=html}                                          |
|                 | <!-- -->                                            |
|                 | ```                                                 |
|                 | -   Wash hands                                      |
|                 |                                                     |
|                 | ```{=html}                                          |
|                 | <!-- -->                                            |
|                 | ```                                                 |
|                 | -   Wear gloves and apron/lab coat                  |
|                 |                                                     |
|                 | -   Take precaution to avoid needle injury          |
|                 |                                                     |
|                 | -   Dispose of contaminated sharps and waste        |
|                 |     appropriately                                   |
+-----------------+-----------------------------------------------------+
|                 | EMPHASIZE the importance of labeling all blood      |
|                 | collection cards. It is unacceptable to submit a    |
|                 | blood card for testing that has not been properly   |
|                 | labeled.                                            |
|                 |                                                     |
|                 | EMPHASIZE AGAIN that while the collection card may  |
|                 | include 5 circles, only one patient/client's blood  |
|                 | may be collected on one card.                       |
+-----------------+-----------------------------------------------------+
|                 | STATE DBS collection is usually done through finger |
|                 | prick.                                              |
|                 |                                                     |
|                 | REVIEW finger prick procedures                      |
|                 |                                                     |
|                 | > ASK participants to recall the steps in the       |
|                 | > procedures.                                       |
|                 | >                                                   |
|                 | > REFERENCE the job aid for finger prick.           |
+-----------------+-----------------------------------------------------+
|                 | DESCRIBE the procedure for collecting DBS.          |
|                 |                                                     |
|                 | -   Apply gentle pressure to the finger and allow a |
|                 |     large drop of free flowing blood to collect at  |
|                 |     the puncture site.                              |
|                 |                                                     |
|                 | -   Working quickly, hold the filter paper by the   |
|                 |     edges and touch the filter paper gently against |
|                 |     the large drop of blood and in one step allow a |
|                 |     sufficient quantity of blood to soak through    |
|                 |     and completely fill or saturate a circle. A     |
|                 |     completed saturated spot will contain 100 µl of |
|                 |     blood.                                          |
|                 |                                                     |
|                 | -   Repeat, until you have collected enough blood   |
|                 |     to fill at least 3 circles on the blood         |
|                 |     collection card.                                |
|                 |                                                     |
|                 | -   Completing filling the circle is important      |
|                 |     because the laboratory will need to use a hole  |
|                 |     puncher to punch a section of the circle of     |
|                 |     blood for testing                               |
|                 |                                                     |
|                 | -   If collecting spots using a pipette, collect    |
|                 |     100 µl of blood and gently apply to filter      |
|                 |     paper.                                          |
|                 |                                                     |
|                 | ADD the following tips:                             |
|                 |                                                     |
|                 | -   DO NOT press the filter paper against the       |
|                 |     puncture site.                                  |
|                 |                                                     |
|                 | -   Apply blood to only one side of the filter      |
|                 |     paper.                                          |
|                 |                                                     |
|                 | -   Do not layer successive drops of blood or apply |
|                 |     blood more than once in the same collection     |
|                 |     circle.                                         |
|                 |                                                     |
|                 | ```{=html}                                          |
|                 | <!-- -->                                            |
|                 | ```                                                 |
|                 | -   Do not "milk" the finger as excessive milking   |
|                 |     or squeezing the puncture site might cause      |
|                 |     hemolysis of the specimen or result in          |
|                 |     collection of tissue fluids with the specimen,  |
|                 |     which might adversely affect the test result.   |
|                 |     (NOTE: "*hemo*-" means red cells, "-*lysis*"    |
|                 |     means destruction, "*hemolysis*" means          |
|                 |     destruction of red cells.)                      |
|                 |                                                     |
|                 | INFORM participants they are going to practice at   |
|                 | the end of the module.                              |
+-----------------+-----------------------------------------------------+
| **10**          | **[How to Dry DBS]{.underline}**                    |
|                 |                                                     |
|                 | EXPLAIN the DBS should be dried at room temp        |
|                 | horizontally. In addition to keeping away from      |
|                 | direct sunlight, the spots should be protected from |
|                 | dust and in some cases flying insects.              |
|                 |                                                     |
|                 | Care should be taken to avoid exposing DBS to       |
|                 | environmental conditions that may compromise the    |
|                 | integrity of the specimen. An example might be      |
|                 | drying the spots near an open window. Why? Sunlight |
|                 | and dust may come in contact with the DBS during    |
|                 | the drying procedure.                               |
+-----------------+-----------------------------------------------------+
| **11**          | **[Dry Completely Before Packaging]{.underline}**   |
|                 |                                                     |
|                 | PROVIDE the following points:                       |
|                 |                                                     |
|                 | -   There are several ways in which you can         |
|                 |     effectively dry DBS                             |
|                 |                                                     |
|                 | -   The image on the left is one that was taken in  |
|                 |     India. DBS are dried horizontally between       |
|                 |     bamboo.                                         |
|                 |                                                     |
|                 | -   The image on the right can be obtained from     |
|                 |     Schleicher & Schuell Bioscience, Inc.           |
|                 |     (Manufacturer of DBS collection cards)          |
|                 |                                                     |
|                 | ```{=html}                                          |
|                 | <!-- -->                                            |
|                 | ```                                                 |
|                 | -   DBS change from bright red to dark red as they  |
|                 |     dry.                                            |
+-----------------+-----------------------------------------------------+
| **12**          | **[How to Package DBS for storage]{.underline}**    |
|                 |                                                     |
|                 | PROVIDE an overview of the steps.                   |
+-----------------+-----------------------------------------------------+
| **              | DEMONSTRATE each step with actual items as you show |
| Demonstration** | each slide.                                         |
|                 |                                                     |
| **13-17, 19**   |                                                     |
+-----------------+-----------------------------------------------------+
| **13**          | **[1. Stacking DBS]{.underline}**                   |
|                 |                                                     |
|                 | EXPLAIN placing weighing or glycine paper between   |
|                 | DBS cards before transport prevents                 |
|                 | cross-contamination.                                |
+-----------------+-----------------------------------------------------+
| **14**          | **[2. Insert Into Sealable Plastic                  |
|                 | Bag]{.underline}**                                  |
|                 |                                                     |
|                 | STATE you can typically place up to 15 DBS cards in |
|                 | each plastic bag. The bag should be just the right  |
|                 | size to hold the cards. Avoid using bags that are   |
|                 | too big as the cards will shuffle inside the bag.   |
|                 |                                                     |
|                 | EMPHASIZE that sandwich bags will not work as many  |
|                 | of these are of the type where you fold the top.    |
|                 | The bag should be a sealable heavy duty plastic     |
|                 | bag, one that will prevent moisture from entering.  |
+-----------------+-----------------------------------------------------+
| **15**          | **[3. Add Desiccant Packets]{.underline}**          |
|                 |                                                     |
|                 | Desiccant packets serve as a drying agent.          |
|                 |                                                     |
|                 | STATE at least 5 desiccant packs should be placed   |
|                 | in each bag. Some sites may need more or fewer      |
|                 | packets in each bag depending on environmental and  |
|                 | storage conditions.                                 |
|                 |                                                     |
|                 | POINT OUT that desiccant packets vary in size. The  |
|                 | ones seen here are the smaller ones.                |
+-----------------+-----------------------------------------------------+
| **16**          | **[4. Add Humidity Cards and Seal                   |
|                 | Bag]{.underline}**                                  |
|                 |                                                     |
|                 | STATE - Often humidity cards must be recharged      |
|                 | before use.                                         |
|                 |                                                     |
|                 | EXPLAIN what to do if the humidity card is pink at  |
|                 | the 30% level.                                      |
|                 |                                                     |
|                 | -   Recharge card and desiccant pack by heating at  |
|                 |     50-60^○^C for 3-4 hours in a drying oven.       |
|                 |                                                     |
|                 | -   Cool 10 minutes.                                |
|                 |                                                     |
|                 | -   IMMEDIATELY RETURN card and desiccant pack to   |
|                 |     sealable plastic bag.                           |
|                 |                                                     |
|                 | -   Note: If a drying oven is not available, place  |
|                 |     cards and excessive number of desiccant packets |
|                 |     in a sealable bag or envelope                   |
+-----------------+-----------------------------------------------------+
| **17**          | **[5. Label Outside of Plastic Bag with             |
|                 | Contents]{.underline}**                             |
|                 |                                                     |
|                 | STATE permanent marker should be used to clearly    |
|                 | label the contents on the bag.                      |
+-----------------+-----------------------------------------------------+
| **18**          | **[How to Store DBS]{.underline}**                  |
|                 |                                                     |
|                 | STATE the points on the slide.                      |
|                 |                                                     |
|                 | It is also acceptable to store DBS in a Styrofoam   |
|                 | box.                                                |
|                 |                                                     |
|                 | Avoid placing spots in an malfunctioning            |
|                 | refrigerator where water may drip on or soak the    |
|                 | spots                                               |
+-----------------+-----------------------------------------------------+
| **19**          | **[How to Package DBS for Shipping]{.underline}**   |
|                 |                                                     |
|                 | DESCRIBE the steps on the slide.                    |
|                 |                                                     |
|                 | POINT OUT the sealable plastic bag has a label on   |
|                 | the outside indicating bio-hazardous contents.      |
+-----------------+-----------------------------------------------------+
| **20**          | **[EQA Specimen Transfer Log]{.underline}**         |
|                 |                                                     |
|                 | STATE the transfer log is sent out with the         |
|                 | specimens.                                          |
+-----------------+-----------------------------------------------------+
| ![](m           | Use interactive teaching technique for these        |
| edia/image3.gif | slides. Facilitate group discussions about what     |
| ){width="0.4479 | makes a specimen valid or invalid. For example,     |
| 166666666667in" | when showing an invalid DBS specimen, ask:          |
| height="0.54166 |                                                     |
| 66666666666in"} | -   "Why do you think this specimen is not          |
| ***TIPS***      |     acceptable?"                                    |
|                 |                                                     |
| **21-30**       | -   "What do you think may have caused it to become |
|                 |     invalid?"                                       |
+-----------------+-----------------------------------------------------+
| **21**          | **[Valid DBS Specimen]{.underline}**                |
|                 |                                                     |
|                 | EXPLAIN the specimen is valid because:              |
|                 |                                                     |
|                 | -   100 µl of blood has been collected in each      |
|                 |     circle completely saturating or filling the     |
|                 |     circle                                          |
|                 |                                                     |
|                 | -   The filter paper card has been labeled with     |
|                 |     appropriate identification.                     |
|                 |                                                     |
|                 | -   If you look at the other side of the card, you  |
|                 |     will see blood soaked through to the other      |
|                 |     side.                                           |
+-----------------+-----------------------------------------------------+
| **22**          | **[Valid DBS Specimen]{.underline}**                |
|                 |                                                     |
|                 | DISCUSS why this specimen is valid:                 |
|                 |                                                     |
|                 | -   On the card with MB/KP/120, the blood is        |
|                 |     spreading from one circle to another due to the |
|                 |     anemia (anemic blood is more fluid)             |
|                 |                                                     |
|                 | -   This is still considered a valid specimen.      |
|                 |     Blood has completely filled the circle.         |
|                 |                                                     |
|                 | POINT OUT to the participants that the third and    |
|                 | fifth circles have been punched (hence the white    |
|                 | area in the middle).                                |
+-----------------+-----------------------------------------------------+
| **23**          | **[Invalid DBS Specimen]{.underline}**              |
|                 |                                                     |
|                 | DISCUSS why this specimen is invalid --             |
|                 | insufficient quantity for testing.                  |
|                 |                                                     |
|                 | DISCUSS what may have caused it:                    |
|                 |                                                     |
|                 | -   Removing filter paper before blood has          |
|                 |     completely filled circle or before blood has    |
|                 |     soaked through to the other side                |
|                 |                                                     |
|                 | -   Applying blood to filter paper with a capillary |
|                 |     tube                                            |
|                 |                                                     |
|                 | -   Filter paper coming in contact with gloved or   |
|                 |     ungloved hands or substances such as hand       |
|                 |     lotion or powder, either before or after blood  |
|                 |     specimen collection                             |
+-----------------+-----------------------------------------------------+
| **24**          | **[Invalid DBS Specimen]{.underline}**              |
|                 |                                                     |
|                 | DISCUSS why this specimen is invalid -- specimen    |
|                 | appears scratched or abraded.                       |
|                 |                                                     |
|                 | DISCUSS what may have caused it -- applying blood   |
|                 | with a capillary tube or other device.              |
+-----------------+-----------------------------------------------------+
| **25**          | **[Invalid DBS Specimen]{.underline}**              |
|                 |                                                     |
|                 | DISCUSS why this specimen is invalid -- specimen    |
|                 | not dry before mailing.                             |
|                 |                                                     |
|                 | DISCUSS what may have caused it -- mailing specimen |
|                 | before drying for a minimum of 4 hours.             |
+-----------------+-----------------------------------------------------+
| **26**          | **[Invalid DBS Specimen]{.underline}**              |
|                 |                                                     |
|                 | DISCUSS why this specimen is invalid -- specimen    |
|                 | appears clotted or layered.                         |
|                 |                                                     |
|                 | DISCUSS what may have caused it:                    |
|                 |                                                     |
|                 | -   Touching the same circle on the filter paper to |
|                 |     blood drop several times                        |
|                 |                                                     |
|                 | -   Filling circle on both sides of filter paper    |
|                 |                                                     |
|                 | The volume of specimen will not be uniform between  |
|                 | spots resulting in errors during the testing        |
|                 | process.                                            |
+-----------------+-----------------------------------------------------+
| **27**          | **[Invalid DBS Specimen]{.underline}**              |
|                 |                                                     |
|                 | DISCUSS why this specimen is invalid -- specimen    |
|                 | appears hemolyzed, discolored, or contaminated.     |
|                 |                                                     |
|                 | DISCUSS what may have caused it:                    |
|                 |                                                     |
|                 | -   Squeezing or "milking" of area surrounding the  |
|                 |     puncture site                                   |
|                 |                                                     |
|                 | ```{=html}                                          |
|                 | <!-- -->                                            |
|                 | ```                                                 |
|                 | -   Allowing filter paper to come in contact with   |
|                 |     glove or ungloved hands or substances either    |
|                 |     before or after blood collection                |
|                 |                                                     |
|                 | -   Exposing blood spots to direct heat             |
+-----------------+-----------------------------------------------------+
| **28**          | **[Invalid DBS Specimen]{.underline}**              |
|                 |                                                     |
|                 | DISCUSS why this specimen is invalid. The specimen  |
|                 | exhibits serum rings, in other words, serum becomes |
|                 | separate from cells.                                |
|                 |                                                     |
|                 | DISCUSS what may have caused it:                    |
|                 |                                                     |
|                 | -   Not allowing alcohol to dry at puncture site    |
|                 |     before making skin puncture                     |
|                 |                                                     |
|                 | ```{=html}                                          |
|                 | <!-- -->                                            |
|                 | ```                                                 |
|                 | -   Allowing filter paper to come in contact with   |
|                 |     alcohol, hand lotion, etc.                      |
|                 |                                                     |
|                 | -   Squeezing area surrounding puncture site        |
|                 |     excessively                                     |
|                 |                                                     |
|                 | -   Drying specimen improperly                      |
|                 |                                                     |
|                 | -   Applying blood to filter paper with a capillary |
|                 |     tube                                            |
+-----------------+-----------------------------------------------------+
| **29**          | **[Invalid DBS Specimen]{.underline}**              |
|                 |                                                     |
|                 | DISCUSS why this specimen is invalid -- no blood.   |
|                 |                                                     |
|                 | DISCUSS what may have caused it -- failure to       |
|                 | obtain blood specimen.                              |
+-----------------+-----------------------------------------------------+
| **30**          | **[DBS Collection: Demonstration]{.underline}**     |
|                 |                                                     |
| **              | PROVIDE an overview of the steps.                   |
| Demonstration** |                                                     |
|                 | REFERENCE the fingerprick steps using the job aid.  |
| **10 Minutes**  |                                                     |
|                 | REMIND participants of the tips                     |
|                 |                                                     |
|                 | DEMONSTRATE the DBS procedure step by step.         |
+-----------------+-----------------------------------------------------+
| ![](m           | Depending on the number of participants you have    |
| edia/image3.gif | and the number of instructors available, you may    |
| ){width="0.4479 | want to break the participants into smaller groups  |
| 166666666667in" | for the demonstration.                              |
| height="0.54166 |                                                     |
| 66666666666in"} | When demonstrating,                                 |
| ***TIPS***      |                                                     |
|                 | -   Show each step slowly and methodically.         |
|                 |                                                     |
|                 | -   Talk out loud as you perform, but keep your     |
|                 |     statements brief.                               |
|                 |                                                     |
|                 | -   Repeat the procedure a few times, making sure   |
|                 |     each time you do exactly the same thing so you  |
|                 |     don't confuse participants.                     |
|                 |                                                     |
|                 | -   Share tips from your experience.                |
+-----------------+-----------------------------------------------------+
| **31**          | **[DBS Collection: Hands-on Practice]{.underline}** |
|                 |                                                     |
| **Practice**    | CONDUCT the practice session.                       |
|                 |                                                     |
| **35 minutes**  | > INFORM participants what they are going to do.    |
|                 | >                                                   |
|                 | > DISTRIBUTE to all participants the supplies       |
|                 | > required to perform DBS collection.               |
|                 | >                                                   |
|                 | > POINT OUT the instructions on the slide.          |
|                 | >                                                   |
|                 | > SIGNAL when it is time to switch (every 15        |
|                 | > minutes).                                         |
|                 | >                                                   |
|                 | > MONITOR the practice and provide necessary        |
|                 | > assistance to participants.                       |
|                 |                                                     |
|                 | DEBRIEF by:                                         |
|                 |                                                     |
|                 | -   POINTING out the commonly-made mistakes you     |
|                 |     have observed during the practice session.      |
|                 |                                                     |
|                 | -   ASKING participants to share their experience   |
|                 |     and key learning from the practice.             |
|                 |                                                     |
|                 | -   REASSURING participants that they will improve  |
|                 |     as they gain more experience                    |
+-----------------+-----------------------------------------------------+
| ![](m           | Be prepared to provide plenty of personal attention |
| edia/image3.gif | to participants during hands-on practice. This is   |
| ){width="0.4479 | particularly important when teaching people without |
| 166666666667in" | health or lab background.                           |
| height="0.54166 |                                                     |
| 66666666666in"} | Set up the groups in such a way that you are able   |
| ***TIPS***      | to monitor 3 or 4 groups at a time.                 |
+-----------------+-----------------------------------------------------+
| **32**          | **[Exercise: Valid vs. Invalid DBS]{.underline}**   |
|                 |                                                     |
| **Exercise**    | LAY on a table all the DBS samples collected from   |
|                 | the hands-on practice.                              |
| **5 minutes**   |                                                     |
|                 | ASK participants to examine these samples,          |
|                 | determine whether each is valid or not, and write   |
|                 | their answers on a piece of paper.                  |
|                 |                                                     |
|                 | DISCUSS the answers as a group.                     |
+-----------------+-----------------------------------------------------+
| **33**          | **[Summary]{.underline}**                           |
|                 |                                                     |
|                 | ASK participants to answer the questions on the     |
|                 | slide.                                              |
|                 |                                                     |
|                 | ANSWER any questions participants may have.         |
+-----------------+-----------------------------------------------------+