Shipping: Preparing the Shipping Box (Diagnostic)

1. Cover the specimens in the frozen Styro(s) with dry ice (see diagram 1c; frozen Styro)
   • Wear safety glasses and cloth gloves when handling dry ice.
   • If no frozen specimens are being shipped, carefully transfer the dry ice from the frozen Styro to the dry ice container and ship that Styro empty.
   • The courier may wish to dispose of the extra dry ice after topping off the frozen Styro(s). The last client on the run may have a place to do this.
     Never leave dry ice where people might burn themselves on it. Do not dump it in a parking lot, a drinking fountain, or a restroom sink.
2. Put the Specimen Control Document in the Refrigerate/Ambient Styro.
   • First, total the columns on each Specimen Control Document. Remove and keep the yellow copy for your records. This will be very important if there should be any questions about the shipment.
   • Put the Specimen Control Document inside of the Styro before closing the box.
   • If more than one box is being shipped, be sure to enclose the correct Specimen Control Document in each box.
3. Close the shipping box and seal it with packaging tape.
   • If shipping an Infectious Substance, fold down the handles of the box and tape it closed before leaving the lab. Open and reseal the box at each additional stop.
   • If shipping a Diagnostic Specimen, do not fold the handles down and tape the box until finished with all pickups.
   • Do not seal all the edges of the box. Dry ice emits a gas, which must be allowed to escape. Do not tape the Styro lids.
4. On the outside of the box, write the weight (in kilograms) of dry ice being shipped.
   • Usually shipments include some frozen specimens. The Mayo Medical Laboratories’ shipping box has the words "Dry Ice" and a special dry ice symbol printed on it and includes a place to write in the weight of the dry ice (in kilograms) on the box.
     If the shipment does not include dry ice, the dry ice label must be completely covered either with tape, paper, or a marker.
   • If a shipment containing dry ice is being transported on a passenger airline, write "2.2 kilograms" on the appropriate line on the label. Make sure that there is no more than 2.2 kilograms (5 lb) in the frozen Styro inside the box.

This is a Mayo Medical Laboratories box properly labeled for a Category B Diagnostic Specimen shipment.

Always ship both Styros in the Mayo Medical Laboratories box set, even if one Styro is empty. Never take one or both Styros out and put specimens directly in the box. Wear exam gloves any time you reach into a Styro that contains specimens.

Shipping by Air

Filling out the airbill

Mayo Medical Laboratories will provide couriers with preprinted "airbills" for shipments and instructions for filling them out.

Mayo Medical Laboratories’ policy is that Infectious specimens must be shipped by FedEx. That procedure will be covered in the section on Infectious specimens.

Dropping off and reporting your shipment

The end of the courier’s route is the airline's drop-off location. Take the shipping boxes inside and hand them over to the airline's receiving person. Give the airline representative the airbill and one copy for records.

If shipping via FedEx on Friday, make certain to check the "Saturday Delivery" box on the airbill, and in addition, affix some "SDR" (Saturday Delivery Required) stickers to the outside of each box.

After delivering the shipment to the airline, phone Mayo Medical Laboratories to report the shipment. If no phone is handy at the airline's office, couriers can do this later from another phone. Mayo Medical Laboratories’ "AUDIX call-in system" makes it very easy to report the shipment. These instructions have been printed on a handy wallet card as well.

1. Call 877-508-9797.
2. After the recording, clearly and slowly state your name, company, city, state, flight number, airbill number, name of the airline, and the number of boxes sent on each airbill.
3. Hang up.

It is important to make this call within a few hours. Mayo Medical Laboratories will need this information urgently if the shipment doesn't arrive on time.

Shipping by Ground

Mayo Medical Laboratories provides our contracted couriers with combination packaging comprised of two Styro containers inside a raspberry-colored outer cardboard box, as well as packaging tape to seal those boxes closed.

Biological Substance, Category B packaging

These containers have been tested and certified to legally and safely transport Biological Substance, Category B medical specimens with the box in the "handles up" configuration while the courier travels from site to site.

Infectious packaging

The packaging certified to legally and safely transport infectious specimens is a combination package consisting of inner and outer containers that have passed all of the tests required by IATA/DOT (Mayo Medical Laboratories provides the inner containers to our clients).

This package is certified to legally transport Category A Infectious Specimens only if it is used properly. The box and the inner containers by themselves are not considered certified. They are tested as a combination package and must be shipped as a combination package. The only box combination that has been tested and certified is the 10-lb double berry box (MC1977-2 1b) with 1 of the 3 inner containers inside. (Refer to Picture A, page 20).

The top of the box must be taped all the way across where the flaps meet in order to comply with the testing and certification requirements. Written instructions are on the top of the box as to which flaps to fold down first and last.

The box must be taped correctly before being transported by air or ground, even if traveling a short distance. It must also have affixed to the outer side in the space provided, Mayo Medical Laboratories current 6.2 hazard label, which contains our UN certification as part of the label. These steps must be taken prior to leaving the client site with infectious substances.

It is not up to the courier driver to decide what is "infectious" or "diagnostic" – the physician or send-out staff at the hospital lab will perform that function. Couriers will know that they are handling and transporting an infectious specimen if a specimen bag has affixed to it Mayo Medical Laboratories’ small orange "sent infectious" label, and the bag contains 1 of the 3 Mayo Medical Laboratories-certified inner containers. (See next section, Picture A.)

Infectious Substance (Category A) Containers

Infectious substances must be shipped in certified containers. Mayo provides clients with 3 types of infectious substance containers (large and small infectious containers and culture containers) for frozen, refrigerated, or ambient specimens. Each infectious container shown below is placed into a Mayo Medical Laboratories shipping bag by our clients.

The client places the specimen in a primary receptacle (such as a tube or a vial) and puts the primary receptacle into 1 of the 3 certified containers shown in the photo. After the specimen is in 1 of the certified containers, the container is placed in 1 of Mayo Medical Laboratories’ color-coded bags. The client will write the name of the infectious substance on an orange label (see picture below) and put it on the bag. The label includes the information needed to fill out the paperwork and mark the box.

"Sent Infectious" Label

• The client will place this label on the outside of the color-coded bags if the specimen is infectious.
• The client will write the name of the infectious agent on the label so that you may fill out your shipper’s declaration and mark the box correctly.

Packing Infectious Substances (Category A)

It is not legal to transport infectious substance specimens with noninfectious specimens. These infectious specimens must be shipped in certified packaging. Because many passenger airlines have restrictions or exclusions on shipping Dangerous Goods, Mayo Medical Laboratories recommends that any infectious shipments sent to our laboratories be made via FedEx.

If FedEx is not the courier’s "scheduled" carrier (for example, if the courier utilizes AirNet or a passenger airliner), the infectious specimens must be packaged in separate shipping box and shipped to Mayo Medical Laboratories via FedEx.

Please follow this procedure:

• When making a pickup at a hospital, place the certified containers with infectious specimens inside a separate Styro and box.
• After completing that pickup, apply the white "Infectious Substance" 6.2 hazard label to the outside of the box (refer to properly labeled box photo). Fold down the carrying handles and tape the box with packaging tape. This must be done prior to driving to the next stop or to the airport.
• Remember that shipping the infectious box via air will involve filling out a Shipper’s Declaration as well as a FedEx airbill. (Refer to Shipper’s Declaration example).
• The non-infectious specimens may be shipped as usual via the courier’s "scheduled" carrier.

Documenting Infectious Substances (Category A)

Let the air carrier know the following on the Shipper’s Declaration:

1. What infectious substances are included in the shipment?
   • The name of the infectious substance (also called the Technical Name), is written by the client on the orange label.
2. How much of each infectious substance is being shipped?
   • One vial typically has 3 to 6 milliliters (mL)
   • The large infectious mailer holds 5 to 6 vials
   • The small infectious mailer holds 2 to 6 vials

Labeling Infectious (Category A) Shipments

Two special labels are put on a shipping box containing infectious substances:

1. The orange Danger label is used ONLY when there is more than 50 mL of an infectious substance	2. The white Infectious Substance label. Order number T148.

The courier must enter the following information on the white label:

1. Check "blood/plasma/serum" or "other." The infectious substance will usually be in the form of a "slant" or a "plate," which is a culture; thus the courier would typically check the "other" box.
2. Write in the total volume of the infectious material in milliliters or grams.
3. Write the courier’s name and address on the space provided on the box.

Airbill and the Shipper’s Declaration for Dangerous Goods

• Mayo Medical Laboratories provides a Shipper’s Declaration for Dangerous Goods.
• An Airbill must accompany the Shipper’s Declaration.
• The Shipper’s Declaration must be in the new format as seen on the image below (the UN Number is in the left column)

To properly complete the form, couriers should refer to the instructions below and to the example:

1. Enter the FedEx Airbill number.
2. Enter the Airport of Departure.
3. Enter the technical name of the specimen.
   (Information from the "Sent Infectious" orange label)
4. Enter the quantity of the infectious substance.
5. Fill in the courier’s name, job title, the city being shipped from, and the date. Next, sign the Shipper’s Declaration.
6. If the Shipper’s Declaration is not filled out completely and correctly, FedEx will not accept the package.

The remaining information will be pre-printed on the Shipper’s Declaration for you.