**SPECIMEN COLLECTION**

The individual clinical sections have developed specimen collection and
handling instructions that reflect the requirements of the diagnostic
tests performed. The specific instructions for specimen collection are
available on the Laboratory of Pathology Web Site for all Clinical
Center Clinicians. Specific instructions for the proper collection and
handling of specimens are updated regularly and reviewed annually. These
are available at either:

-   [Laboratory of Pathology Web
    Site](http://home.ccr.cancer.gov/LOP/Clinical/clinops.asp)

-   [Clinical Center Formulary of
    Services](http://ccln1.cc.nih.gov/formulary/form2.nsf/Index?OpenPage&Start=1&Count=1000&Expand=6)

LP employees do not collect blood specimens for clinical tests or
controls. Phlebotomists from the Clinical Center have been trained in
the proper selection and use of equipment/supplies and collection
techniques, and have evaluated the effectiveness of its engineering and
work practices to significantly reduce or eliminate exposure to
bloodborne pathogens during phlebotomy.

If blood collection is needed for controls LP employees may contact
phlebotomy at 496-3105 for assistance. Prior to collection, the
employee/volunteer must be registered as a patient in CC Admissions and
sign an informed consent. The electronic order can be placed in the MIS
by a clinician with ordering privileges under an appropriate
IRB-approved protocol.

Trained/credentialed personnel collect all other types of specimens
(e.g., fine needle aspirates, biopsies, bone marrow specimens, surgical
specimens).

Laboratories may receive specimens from outside NIH. Individuals wishing
to send samples must contact specific labs for additional shipping and
documentation requirements (e.g., reason for consult, specific questions
to be answered, referring pathologist, working diagnosis, pertinent
clinical information, etc).

**SPECIMEN HANDLING**

Follow standard Universal Precautions procedures and General Lab Safety
precautions when handling all specimens including low-level radioactive
specimens. Because of the low risk of radiation exposure to Pathology
staff, Universal Precautions adequately cover radioactive specimen
handling. Personnel monitoring devices (film badges) are not necessary
for Pathology staff because of the low levels of radioactivity, rapid
decay, and limited time of exposure. Contact the Radiation Health
Physicist at extension 6-5774 for precautions for handling specimens in
which the radiation level is in question.

Radioactive Specimens

This procedure describes the safe handling of radioactive pathology
specimens obtained from surgical procedures conducted in the operating
rooms of the NIH Clinical Center or collected from patients exposed to
nuclear medicine or radiation therapy procedures. These guidelines are
established in accordance with the Radiation Safety Branch regulations,
surgical procedures and review of current literature. The procedure is
designed to keep radiation exposure to employees as low as reasonably
achievable. This procedure is directed at handling specimens obtained
from surgery in which the radiation level is low, and not tissues that
contain radioactive implant devices or radiation therapy patient
specimens that may have significantly higher radiation levels. The
Radiation Health Physicist must be contacted at extension 6-5774 for
handling precautions for any specimen that is suspected of having high
radiation levels.

*Specimen Labeling & Transportation*

1.  In addition to normal specimen labeling requirements, all
    radioactive specimens should be sealed into containers and labeled
    with:

    -   Radioactive label -- "Caution Radioactive Material"

    -   Type of radioisotope

    -   Date and time the patient received radioisotope

2.  All radioactive tissue specimens are placed inside the refrigerator
    in the Frozen Section Room (2C533). This refrigerator must remain
    locked at all times.

3.  Some radioactive specimens (blood, fluids, etc) might also be
    transported by Patient Escort service.

4.  Specimens are not to be left unattended in unsecured holding areas
    before transport to the Frozen Section Room or Histology Lab.

5.  Specimens are transported from the Frozen Section Room directly to
    the Histology Lab by Histology staff on a transport cart.

> *Specimen Monitoring*

1.  The Histology Lab will monitor all surgical specimens for
    radioactivity when they are labeled as such, or if they are
    suspected of being radioactive (e.g., receive part of a case labeled
    radioactive and the other half not, or if radioactivity is suspected
    because of the information given on the request form. Survey meters
    are available in the Frozen Section Room, and specimens are checked
    prior to transport to the Histology Lab. Other sections may borrow
    the survey meter in the unlikely event they receive a radioactive
    specimen.

2.  The procedure for use of the survey meter is as follows:

    1.  Turn knob from "off" position to "BAT" to test battery. Needle
        indicator should read in the "BAT TEST" area of the gauge.
        Replace battery if needed.

    2.  Turn knob to the most sensitive scale (0.1X).

    3.  Place Audio toggle to "ON" and F/S (Fast/Slow) toggle to "F".

    4.  Confirm meter operation by checking radioactive check source
        (attached to the side of the meter).

    5.  Press "res" (reset) button to re-zero if needed.

    6.  Survey specimens by slowly moving the detectors several inches
        over the surface of each specimen container.

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1.  The operating room will be notified if radiation is detected in a
    specimen that is not labeled as such. Place a radioactive label on
    the specimen container and obtain the appropriate information
    regarding radioisotope and date of administration to the patient, if
    known. It is possible that patients may have had radioactive studies
    that were not performed at the NIH, and the operating room was
    unaware of them.

2.  Wet submitted samples from outside institutions should also be
    surveyed in the same manner. It is not necessary to survey paraffin
    embedded blocks unless they are designated radioactive by the
    shipper.\
    \
    *Cryostat Monitoring*

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1.  Limited contamination may be present in the cryostat immediately
    after cutting a frozen radioactive specimen. The Pathologist should
    survey the interior and exterior of the cryostat after processing a
    radioactive specimen, and decontaminate if readings are \> 300 cpm
    above background. If decontamination is needed, prepare the backup
    cryostat for subsequent use for other frozen sections. Close the lid
    and place an "Out of Service" sign on the instrument and ask the
    Histology Lab to decontaminate the instrument. Turn off and unplug
    the cryostat if the contamination is on the interior of the
    instrument. The Histology Lab will decontaminate the instrument
    according to the following procedure:

2.  Let the cryostat reach room temperature if interior decontamination
    is required.

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```
1.  Wearing gloves, gown or lab coat, and goggles or glasses, carefully
    remove the knife. Dispose of knife in sharps container and label
    with a Radiation Waste Tag and call for Radiation Waste pickup at
    6-4451.

2.  Spray the contaminated area of the interior of the cryostat with
    foam RadCon™ or other brand of decontaminating cleaner.

3.  Wipe clean with paper towels, gauze or sponge.

4.  Dispose of towels, gauze or sponge in a MPW box.

5.  Recheck to verify contamination is removed. Check interior and
    exterior of the instrument. Repeat cleaning if needed.

6.  Wipe all exposed surfaces inside and outside the cryostat chamber
    with 95 % alcohol.

7.  Drain cryostat through the drainage pipe. Transfer all waste to the
    same MPW box that was used in step "e". Attach a Radiation Waste tag
    and call for Radiation Waste pickup at 6-4451.

8.  With gauze soaked in absolute alcohol, wipe the inside of the
    crostat chamber again and let it evaporate with the lid open.

9.  Allow cryostat to dry.

10. Replace knife and perform daily maintenance.

11. Plug in the cryostat and power up the instrument.

12. Allow it to equilibrate at the desired temperature before removing
    the "Out of Service" sign.\
    \
    *Specimen Processing & Storage*

13. The Radiation Health Physicist must be contacted at extension 6-5774
    for handling precautions for any specimen that is suspected of
    having high radiation levels.

14. Hold specimens for 24 hrs before processing or until radioactivity
    decreases to a level of 300 cpm above background.

15. Activity levels that exceed 300 cpm above background should be
    quarantined until they are within acceptable limits.

16. Radioactive specimens are held in the Histology Lab under the hood.
    The lab is to be secured (locked) when employees are not present. Be
    sure to place a note for the appropriate person so that the
    specimens are not forgotten.

17. When disposing of tissue fixative, record the volume of liquid and
    isotope type on the radioactive waste disposal tag (e.g., "x ml of
    formalin with Tc-99m"). If the isotope is unknown, record " x ml of
    'type of fixative' from clinical sample with unknown radionuclide".
    Call 6-4451 for waste pick-up when waste container is about ¾ full.

*SoftPath Laboratory Information System*

-   The Histology Lab will flag all specimens in the computer for
    quality improvement tracking. The following codes are used:

    -   RD = Radioactive Specimen

    -   RDR = Radioactive Specimen Rejected

    -   RDL = Radioactive --No Radiation Label

-   The procedure for case flags is found in the SoftPath™ user manual.

*Radioactive Specimen Storage and Disposal*

-   Radioactive specimens are held in a secure location (locked room
    when staff is not present) to prevent unauthorized access and
    premature disposal. Store these materials away from personnel.

-   Radioactive specimens are disposed of in a MPW box to which a
    Radiation Waste tag is attached. These containers are to be kept in
    a locked or occupied room at all times. Call for Radioactive Waste
    pick-up at 6-4451 the next day. Radioactive Waste will not be
    stored.

-   Housekeeping will not be allowed to remove MPW boxes labeled as
    Radioactive Waste.

*Transportation of Paraffin Blocks prepared from radioactive specimens*

Radioactive tissues are not processed and embedded in paraffin blocks
unless radiation is below background level; therefore, no additional
precautions are required.

**SPECIMEN TRANSPORTATION**

Specimens within NIH are transported by personnel from Patient Escort
Services (6-9295) who are trained in the appropriate safety and
packaging procedures suitable to specimen type and distance transported.
All specimens must be properly labeled to meet the NIH requirements for
transportation of biohazards. Escort Services have a tracking system to
ensure that all specimens submitted to the laboratory are actually
received. Electronic orders are placed in the Medical Information System
(MIS) or are FAXed to the individual laboratories and individual
laboratory sections/units record specimen receipt in either a logbook or
the Laboratory Information System. These systems can be used to track
specimens when needed.

The nurses transporting specimens to the Frozen Section Room from the
operating room enter these into a logbook. Histology personnel review
the logbook and initial each entry when specimens are transported from
the Frozen Section Room to the Histology Laboratory. They confirm that
all specimens are properly labeled and placed in sealed containers prior
to transporting materials on a laboratory cart.

All specimens will be submitted in appropriately labeled and
well-constructed containers with secure lids (or sealed bags) to prevent
leakage during transport.

Specimen Transportation From Outside of Building 10

All specimens must be properly packaged and labeled to indicate the
general nature of the materials transported. All shipments received must
comply with all applicable local, state, and federal laws governing
packing, labeling, and transportation.

The following web resources are available for procedures for handling
suspicious packages.

-   Handling NIH mail
    <http://www.nih.gov/od/ors/security/mailsecurity.htm>

-   Guidelines for Identifying Suspicious Mail
    <http://www.nih.gov/od/ors/security/idmail.htm>

Occasionally, specimens may be hand carried by personnel from other
buildings, (e.g., Suburban Hospital or Navy Hospital). When doing so,
make sure the packages are double bagged (or placed in a secondary
sealed container) to prevent any potential leakage. A Nalgene leakproof,
sealable, puncture-proof container available through most catalogs to
transport materials between buildings is recommended. Specimens should
be labeled "Diagnostic Specimen." Hand carried materials must have
sufficient absorbent material to absorb all specimens, if the primary
container breaks or leaks. If using a courier, follow the packing
instructions provided by the courier. If the specimen is known to be
infectious, then it becomes a regulated dangerous good and must be
packaged following the guidelines for infectious substances (see Freight
Forwarding Section instructions on page 12 for more details or contact
the Clinical Laboratory Manager).

If it is necessary to transport a deceased patient for autopsy, contact
Admissions (6-3315) to arrange transportation using a licensed funeral
home or service.

**RESOLUTION OF PROBLEMS WITH SPECIMEN PROCUREMENT, TRANSPORTATION, OR
HANDLING**

If a problem is identified in specimen transportation or quality, notify
the Section Chief or Supervisor of the laboratory. It is the
responsibility of the Section Chief or Supervisor to attempt to improve
performance of clients or offices that frequently submit specimens
improperly. Problems and corrective actions should be documented in the
Quality Improvement report of the individual section/unit involved.

Occurrences may be reported to the Clinical Center Quality Assurance
(QA) Department and Nursing Department Administration using the
web-based Occurrence Reporting System (ORS). This system provides a
mechanism for communication and problem resolution of occurrences.
Occurrence reporting and analysis are intended to prevent damage/risk
from occurring, to reduce damage when adverse events have already
occurred, and to prevent future adverse events. Occurrence reporting and
analysis are integral components of the Nursing Department Quality
Assurance program. When occurrences are reported, a copy of the report
is automatically sent to Clinical Center QA Department. The Clinical
Center QA Coordinator makes a request for follow up from nursing to the
Head Nurse. When this occurs, the Head Nurse completes follow up and
circulates the information to the Service Chief and sends a copy to the
Nursing QA Specialist. See <http://www.cc.nih.gov/nursing/ocurpanl.html>
for more details and procedures for reporting an occurrence. A password
and training on the system is required to initiate a report. The
Clinical Laboratory Manager may initiate a report for anyone without a
password.

**PACKAGING AND SHIPPING LABORATORY SPECIMENS TO OUTSIDE LOCATIONS**

All shipments must comply with all applicable local, state, and federal
laws governing packing, labeling, and transportation. Either Fed EX or
U.S. Mail may be used to ship non-infectious diagnostic material to
domestic locations. Blood, urine, fluids and other liquid diagnostic
specimens must be shipped via FedEx. All other specimens (e.g.,
international shipments, infectious substances, toxic materials, dry
ice, carbon dioxide, liquid nitrogen, and hazardous material), including
a clinical specimen that is known or reasonably believed to contain an
infectious substance (etiologic agent), must be sent through the Freight
Forwarding Section in Building 13.

Marking and Labeling

All markings must be visible on the package or overpacks and not located
with other package markings that could substantially reduce their
effectiveness. All markings must be written (or affixed) in English and
be plain, durable, visible, legible, and weather proof.

Federal Express Small Package Delivery (Including non-infectious
diagnostic material)

Call the Freight Forwarding Section on 496-5921 to establish a NIH
Federal Express account number to ensure that you will receive the
discounted contract rates. Call FedEx at 1-800-463-3339 to schedule a
pickup or establish routine pickups. On the Federal Express USA Airbill
only select \"FedEx Priority Overnight\" for next business day delivery
service or \"FedEx 2Day\" for second business day delivery service. For
shipments to Puerto Rico use the FedEx International Air Waybill. Select
only \"FedEx International Priority\" for next business day service or
\"FedEx International Economy\" for second business day service. FedEx
will permit shipments of diagnostic materials to international
locations, however; the shipper should call 1-800-463-3339 in advance to
determine if there are any restrictions for the final destination and
coordinate the shipment through the Freight Forwarding Section, if
necessary.

**Federal Express Domestic Non-infectious Diagnostic Material that is
not shipped with carbon dioxide, solid (dry ice) or liquid nitrogen.**

By definition, a diagnostic specimen is any human or animal material,
including excreta, secreta, blood, and its components, tissue, and
tissue fluids being transported for diagnostic or investigational
purposes, but excluding live infected humans or animals.

If a specimen must be shipped with carbon dioxide, solid (dry ice) or
liquid nitrogen contact the Freight Forwarding Section at 496-5921.

If a specimen is infectious or suspected of containing pathogens which
can be readily transmitted from one individual to another, directly or
indirectly, and for which effective treatment and preventative measure
are not usually available, as determined by medical staff, contact the
Freight Forwarding Section at 496-5921.

Non-infectious (e.g., fixed) Diagnostic specimens must be packed in
triple packaging, consisting of:

-   A primary receptacle (e.g., block or slide box).

    -   For solids, the primary receptacle must be sift-proof with a
        capacity of not more than 500g (1.1 pounds).

    -   For liquids, the primary receptacle must be leak proof with a
        volume not to exceed 500 ml (16.9 ounces). For liquids,
        absorbent material must be used in sufficient quantity to absorb
        the entire contents of the primary receptacles.

    -   If several fragile primary receptacles are placed in a single
        secondary container, they must be individually wrapped or
        separated to prevent contact between them.

    -   If screw caps are used these must be reinforced with adhesive
        tape.

    -   If shipping lyophilized substances, the primary receptacle must
        be either flame-sealed glass ampoules or rubber-stoppered glass
        vials.

-   A secondary leak-proof package must be used which is in compliance
    with IATA package insert 650. Several flexible secondary containers
    may be used and may be purchased through multiple vendors, some
    options are listed below:

    -   Saf-T-Pak Products
        [www.chem-tran.com](http://www.chem-tran.com/)

        -   STP-700 6.5 x 6.75" Tyvek envelope \$ 1.64 each

        -   STP-710 9.5 x 7.5" Tyvek envelope \$ 1.99 each

        -   STP-740 12 x 14" Tyvek envelope \$ 4.54 each

    -   Other products are available at:

        -   Cargo Pak [www.cargopak.com](http://www.cargopak.com/)

        -   Dangerous Goods Supplies
            [www.dgsupplies.com](http://www.dgsupplies.com/)

        -   Exakt-Pak Diagnostics
            [www.exaktpak.com](http://www.exaktpak.com/)

        -   JIT Certified, Inc.
            [www.jitcertified.com](http://www.jitcertified.com/)

        -   Polyfoam Packers
            [www.polyfoam.com](http://www.polyfoam.com/)

-   If several fragile primary receptacles are placed in a single
    secondary container, they must be individually wrapped or separated
    to prevent contact between them. For liquid shipments, absorbent
    material must be placed between the primary receptacle and secondary
    packaging.

    -   Write the words "DIAGNOSTIC SPECIMEN" on the secondary package.

    -   An itemized list of contents must be enclosed between the
        secondary packaging and the outer packaging.

    -   If wet ice, or prefrozen packs are used, place them outside the
        secondary packaging or alternatively in an overpack with one or
        more completed packages. Interior support must be provided to
        secure the secondary package in the original position after the
        ice has melted. If ice is used the packaging must be leak proof.

    -   After January 1, 2004, you must write the words "AIR ELIGLIBLE"
        on the secondary package. You must also mark the package with a
        symbol consisting of an aircraft within a circle as shown below:

![](media/image1.jpeg){width="1.28125in" height="1.2291666666666667in"}

-   Outer packaging (FedEx Clinical Pak): The FedEx Clinical Pak is a
    new product available February 2003. You may still use the
    Diagnostic Specimen Pak, but this product was discontinued and
    replaced by the FedEx Clinical Pak. The Diagnostic Specimen Pak may
    be may be ordered by calling FedEx at 800-633-7019.

-   On the Air Bill, in section 2 or somewhere visible on the document,
    write "DIAGNOSTIC SPECIMEN, PACKAGED IN COMPLIANCE WITH IATA PACKAGE
    INSERT 650". When properly packed, the FedEx package will in IATA
    compliance:

-   Capable of successfully passing a drop test at a drop height of 1.2
    meters (3.9 feet) and the outer packaging may not exceed 4 kg (8.8
    pounds) capacity.

-   For shipments by aircraft, the primary receptacle or the seconday
    packaging must be capable of withstanding without leakage an
    internal pressure producing a pressure differential of 95 kPa (0.95
    bar, 14 psi).

Domestic U.S. Postal Service

Do not use U.S. Postal Service to mail specimens to military or Veterans
Administration (VA) hospitals. These hospitals may irradiate mail and
have reported delays in shipments and damage to specimens such as melted
blocks and/or burned slides. Use the U.S. Postal Service only for
domestic shipping locations; use Fed Ex or Freight Forwarding for
international shipments.

You may ship clinical specimens that are not infectious using the US
Postal Service. Any human materials, known or reasonably believed to not
contain an infectious substance, that have been collected and are being
shipped for the purpose of diagnosis are defined as "Clinical
(diagnostic) specimens." Glass slides or cover slips that were in
contact with an infectious agent are defined as "sharps." Please contact
the Freight Forwarding section if you are shipping slides prepared from
potentially infectious material, biological products, or other medical
devices.

A sender's declaration of dangerous goods is not required for Clinical
Specimens, however, specific quantity limits and packaging conditions
are specified below:

-   Mailpieces must be marked on the address side as "Clinical Specimen
    --(specify type); e.g., "Clinical Specimen-Blood Sample," "Clinical
    Specimen-Tissue Block", "Clinical Specimen-Slides (non-infectious),
    etc.

-   The outer packaging of shipments of "Clinical (diagnostic)
    specimens" may bear the international biohazard symbol (below) on
    the address side.

Black

![](media/image2.png){width="0.40625in"
height="0.14583333333333334in"}![](media/image3.png){width="3.125e-2in"
height="0.53125in"}![](media/image2.png){width="0.40625in"
height="0.14583333333333334in"}![](media/image4.png){width="0.53125in"
height="0.14583333333333334in"}

Fluorescent Orange

Or Red Background

![](media/image4.png){width="0.53125in"
height="0.14583333333333334in"}![](media/image5.png){width="1.625in"
height="1.5208333333333333in"}

-   Sufficient shock-resistant material to withstand shock and pressure
    changes and absorbent material must surround the primary receptacle,
    or be otherwise configured to take up the content in case of
    leakage. The primary receptacle and the absorbent cushioning must be
    enclosed in a secondary packaging having a leakproof barrier that
    can prevent failure of the secondary packaging should there be
    leakage of the primary receptacle during shipment. The secondary
    packaging may serve as the out packaging if the specimen is less
    than 50 ml.

-   If the specimen exceeds 50ml, a single primary receptacle must not
    contain more than 1,000 ml of specimen; two or more primary
    receptacles whose combined volume does not exceed 1,000 ml may be
    enclosed in a single secondary package.

-   If the specimen exceeds 50ml, the secondary package must be enclosed
    in a fiberboard box or container of equivalent strength.

-   Ship specimens Priority Mail or First-Class Mail, using Certified
    Mail Receipt, (green PS Form 3800) and Domestic Return (green PS
    Form 3811). Certified mail service provides the sender with a
    mailing receipt. Return receipt service provides a mailer with
    evidence of delivery (to whom the mail was delivered and the date of
    delivery). A return receipt also supplies the recipient\'s actual
    delivery address if it is different from the address used by the
    sender. Follow the instructions on the USPS forms.

**Radioactive Specimens**

Radioactive tissues are not processed and embedded in paraffin blocks
unless radiation is below background level; therefore, no additional
precautions are required. Call Radiation Safety at 301-496-3277 if
additional information is required.

**Freight Forwarding Section**

All other shipments (e.g., infectious substances, toxic materials, dry
ice, and hazardous material), including a clinical specimen that is
known or reasonably believed to contain an infections substance
(etiologic agent), or whole organs, must be sent through the Freight
Forwarding Section in Building 13, Platform E, before 2:30 PM. Dry ice
shipments must be received before 10:30 am to permit expeditious
delivery. Both the NIH Form 1884, \"Request for Shipment,\" and NIH Form
1884-1 \"Commercial Invoice,\" must be completed for all shipments. The
NIH Form 1884 is available in the Self Service Store. Form 1884 cannot
be done in electronic format because each form has a unique serial
number, but shipping requests will soon be done via DelPro. Form 1884-1
is available at
<http://forms.cit.nih.gov/adobe/procurement/NH1884_1.PDF>. You may
direct any questions to the Division of Safety/ORS at 301-496-2346.

**TRAINING REQUIREMENT FOR PACKING AND SHIPPING**

Anyone who packs or ships diagnostic (clinical) specimens must review
this safety manual, including the directions above and complete the
Shipping Diagnostic Specimens Training Evaluation, in Appendix L. The
safety manual outlines measures to protect employees from hazards
associated with hazardous materials to which they may be exposed in the
workplace including measures the LP or NIH has implemented to protect
employees from exposure. The Shipping Diagnostic Specimens Training
Evaluation must be completed by all new employees before they ship
specimens and repeated on an annual basis to document awareness and
familiarization with the regulatory requirements pertaining to shipping
diagnostic specimens.

At least one person should be trained for handling dangerous goods by an
IATA approved training program. This person should be available to
assist LP employees with shipping documents, packing, marking and labels
in the unlikely event that we must send dangerous goods (e.g., toxic or
infectious substances, toxic materials, dry ice, hazardous material,
explosives, gases, flammable materials, oxidizing substances,
radioactive material, or corrosives). Please contact the Clinical
Laboratory Manager or ORS if someone in your area needs to ship
dangerous goods or if someone requires additional training.

**REFERENCES**

-   [CC Isolations Guidelines
    ("flipchart")](http://www.cc.nih.gov/hes/CC/flipchrt/flipchrt.html)

-   [CC Universal Precautions Web
    site](http://www.cc.nih.gov/hes/CC/up_book.html)

-   [Clinical Center Safety
    Committeel](http://www.cc.nih.gov/ccc/safety/index.html)

-   Code of Federal Regulations. Part III, Department of Transportation,
    Research and Special Programs Administrations. 49 CFR Part 171 et.
    al. Hazardous Materials: Revision to Standards for Infectious
    Substances; Final Rule. August 14, 2002.

-   College of American Pathologists. General Checklist and Commentary.
    June 21, 2001.

-   Communications with Barbara Fahey, RN, Nurse Consultant, HES.

-   Communications with Cynthia Crews, CC/DLM Phlebotomy Supervisor.

-   Communications with Diane Diane Jenifer, Project Manager, Patient
    Escort Service, NIH-FOCUS AMC.

-   Communications with John Jacobus, Radiation Health Physicist,
    Radiation Safety Branch, Division of Safety, OD/ORS.

-   Communications with Karen Kaczorowski, Director of CC Admissions.

-   Communications with Christina Vargas, Safety Specialist, OD/ORS.

-   Conversations with Maureen George, RN, MSEd, CNOR, OCN, Nurse
    Coordinator, Department of Anesthesia and Surgical Services,
    CC/SURG/NIH

-   [Division of Safety](http://www.nih.gov/od/ors/ds/index.htm)

-   [Fed Ex Government
    Shipping](http://www.fedex.com/us/services/government/)

-   [Fed Ex Packaging and
    Marking](http://www.fedex.com/us/services/termsandconditions/marking.html)

-   [Fed Ex
    Restrictions](http://www.fedex.com/us/services/termsandconditions/restrictions.html#Note12)

-   Fitzgibbons, P.L, LiVolsi, V.A, the Surgical Pathology Committee of
    the CAP, & the Association of Directors of Anatomic and Surgical
    Pathology. Recommendations for the handling radioactive specimens
    obtained by sentinel lymphadenectomy. The American Journal of
    Surgical Pathology. 24(11): 1549-1551,2000.

-   [International Air Transportation Association Dangerous Goods
    Information Online](http://www.iata.org/cargo/dg/index.htm)

-   International Air Transportation Association Dangerous Goods 2003
    Dangerous Goods Regulations, 44 th Edition.

-   NCCLS guidelines GP17A: Clinical Laboratory Safety; Approved
    Guideline (1996)

-   [NIH policy Manual. Domestic Express Delivery Services
    Contract](http://www1.od.nih.gov/oma/manualchapters/acquisitions/26101-43-F/)

-   [NIH policy Manual. Permits for Import or Export of Biological
    Material](http://www1.od.nih.gov/oma/manualchapters/management/1340-1/)

-   [NIH policy Manual. Shipping Policies and
    Procedures](http://www1.od.nih.gov/oma/manualchapters/acquisitions/26101-42-F/)

-   [Office of Logistics and Acquisition Operations/ Transportation
    Management
    Division/Shipping](http://www.olao.od.nih.gov/transport/shipping.html)

-   [ORS How to Ship Biological
    Materials](http://www.nih.gov/od/ors/ds/shipping/biologic.html)

-   [ORS How to Ship Diagnostic
    Material](http://www.nih.gov/od/ors/ds/shipping/diagnostic.html)

-   [ORS How to Ship Infectious
    Materials](http://www.nih.gov/od/ors/ds/shipping/infectious.html)

-   [OSHA Bloodborne Pathogens
    Rule](http://www.osha-slc.gov/SLTC/bloodbornepathogens/index.html)

-   [United States Post Office. Domestic Mail Manual, Hazardous
    Materials (4/3/03)](http://pe.usps.gov/text/dmm/C023.htm#Rap27033)