For convenience, biohazard color-coded by temperature bags are provided to you and client laboratories by Mayo Medical Laboratories:

Medical samples being transported to testing laboratories must be maintained at an appropriate temperature: ambient, refrigerate, or frozen.

• Refrigerate Bag – pink (T229)
• Ambient Bag – white (T027)
• Frozen Bag – yellow (T121)

Specimens must be separated by temperature, and each of these temperature bags must be packaged in a specific manner. Mayo Medical Laboratories provides a raspberry-colored shipping box which holds two Styrofoam (Styro) containers inside. Styro transportation coolers provided by Mayo Medical Laboratories have corresponding color-coded labels and contain appropriate labeling for dry ice and biohazards. One of the Styro containers holds the cool-packs needed to keep refrigerate/ambient specimens cool up to 48 hours.

Some specimens must remain at room temperature or they could be ruined. Examples of these are specimens needed for fertility and bone marrow tests. Mayo Medical Laboratories has provided special bone marrow containers to clients who ship these types of specimens. These containers must be placed at the top of the Styro to keep them away from the cold cool-pack.

All specimens must be shipped in a leak-proof container, regardless of transport temperature. The color-coded bags also contain material that can absorb the full liquid content of the specimen(s) placed inside.

The following pages provide couriers with detailed instructions for packaging specimens for shipping. This includes preparing the Styros, packing specimens at the appropriate temperature (refrigerated, ambient, and frozen), completing shipping documents, and shipping specimens. In addition, the guide includes information about shipping infectious substances, safety in the laboratory, and cleaning up leaks and spills.

Completing the Mayo Medical Laboratories Specimen Control Document
(Courier use only)

The following information needs to be filled out completely on the Specimen Control Document we provide for you:

Client Name

Account Number

Number of Frozen Bags

Number of Refrigerate Bags

Number of Ambient Bags

Other Material number and Description

Time of Pick Up

Client Initial

1. On the top section of the control document, on the specified line, print:
   • complete name of the courier company
   • date of the run
   • name of the person making the run
   • city and state
2. Fill in the Client name: the name(s) of the hospitals, clinics, or laboratories from which specimens were picked up.
3. Fill in the account number: Each client is given an account number by Mayo Medical Laboratories. If you do not know the account number, our Transportation Department can provide you with that information.
4. Mark down the number of bags you picked up for each temperature as well as any other material you may get, such as X-rays or envelopes.
5. Log the time you picked up the specimen(s) and have a lab employee initial the Specimen Control Document stating you have picked up everything.

"On-Call" Clients

Check with your dispatch department for any "on-call" clients who may have called in requesting a pick up. "On-Call" clients are those clients not on your regular daily route.

1. Determine the most efficient way to include the on-call clients into your scheduled route.
2. Add the on-call client information to the control document as you would for a regular pick up.

The Specimen Control Document is a two-part form. If you ship more than one box, please place a copy in each box. Also be sure to keep a copy for your records for future reference.

Preparing the Styros

Prepare to pack the refrigerated/ambient specimens in the same Styro. The lid of the Styro has a pink label to indicate Refrigerate Specimens and a white label to indicate Ambient Specimens. Specimens should be in temperature color-coded bags that should match the color of the label on the Styro lid. Put on gloves prior to placing the specimen bags into the Styros.

Packing Refrigerated Specimens

1. Place a cold cool-pack brick in the bottom of a Styro.
2. Place three to four paper towels (for insulation) over the brick.
3. Locate the refrigerated specimens and count the bags. Make sure all the bags have pink labels.
4. Record the number of refrigerated bags on the Specimen Control Document.
5. Open the lid of the refrigerated/ambient Styro. Remove any ambient specimens from previous pickups.
6. Insert the pink refrigerated specimen bags in the Styro. Place two paper towels over the refrigerated specimens, separating them from the ambient specimens. Replace the ambient specimens.
7. Immediately replace the Styro lid.

Packing Ambient Specimens

Use the same refrigerated Styro, however:

1. Locate the ambient specimens and count the bags. Make sure all the bags have white labels.
2. Record the number of ambient bags on the Specimen Control Document.
3. Open the lid of the refrigerated/ambient Styro and place three to four more paper towels over the top of the pink refrigerated bags (for further insulation).
4. Insert the white ambient specimen bags. Ambient specimens go on top of the refrigerated specimens, separated by paper towels.
5. Fill the remaining space inside the Styro with packing material such as paper towels or newspapers.
6. From November through March, also place a non-refrigerated cool-pack brick at the top of the Styro.
7. Immediately replace the Styro lid.

Refrigerate/Ambient Shipping Container
November through March

Diagram 1a

Refrigerate/Ambient Shipping Container
April through October

Diagram 1b

Frozen cool pack helps keep specimens from becoming too warm

Reminder – Do not use dry ice to freeze the cool pack; if dry ice is your only option, then remove the cool pack from the dry ice three hours before use.

Packing Frozen Specimens

Note: Pellet dry ice is preferred. Block dry ice must be reduced to small pieces (1"-2") to minimize the chance of damage to bags and vials.

1. Prepare the frozen Styro. The lid of the Styro will have a yellow label to indicate frozen specimens.
2. Locate the frozen specimens and count the bags. Make sure all the bags have yellow labels.
3. Record the number of frozen bags on the Specimen Control Document.
4. Open the lid of the frozen Styro and place a 2-inch layer of dry ice in the bottom of the frozen Styro. To avoid burns, always wear cloth gloves and safety glasses when handling dry ice.
5. Insert the yellow specimen bags on top of the dry ice. Add bags only up to the line marked on the yellow sticker inside of the Styro. Cover them with more dry ice. Do not overfill, leaving enough room at the top to put the lid on securely.
6. Immediately place the yellow-labeled "Frozen" cover onto the Styro.

Under normal conditions, 5 lb, or 2.2 kg, of dry ice will keep the specimens frozen until they arrive at the laboratory.

Frozen Shipping Container

Diagram 1c

Reminder – Do not fill the frozen Styrofoam shipping container too full of specimen bags. Leave room for dry ice on top of the topmost specimen shipping bag and make sure the Styrofoam lid fits tightly. On passenger aircraft, such as Northwest or American, put 2kg (4.4 lb) of dry ice in the Styro. FedExp or AirNet allow more, as there is a higher maximum weight for dry ice on a cargo aircraft.

Packing Stool Specimens

Mayo Medical Laboratories provides clients with special containers for stool specimens. We prefer that stool specimens be packed in these containers. Any substitute containers must have a screw cap and be leakproof. A special 10-lb Styro in its own box is used for shipping one or two stool containers. Large-volume stool containers must not be mixed with other specimens. They must be shipped in a separate Styro. Special stool containers may be located in the client’s freezer or refrigerator.

The procedure for packing stool containers is as follows:

1. After packing all other specimens, couriers should discard exam gloves, wash their hands, and prepare a 10-lb Styro out in the transport vehicle (if there are more than two stool containers to pick up, use both Styros in a full-sized double 10-lb box set.)
2. If the stool containers are in the freezer, put a 2-inch layer of dry ice in the bottom of the Styro. If the stool containers are in the refrigerator, put a cold cool-pack in the Styro with two paper towels on top.
3. Bring the stool container box into the lab. Put on a fresh pair of exam gloves before entering the lab.
4. Prepare a Specimen Control Document for this Styro. Fill out the top portion of the document (company name, the name and city shipping from, and the date). Fill in the client’s name and account number.
5. Write the number of containers packed in this Styro under the appropriate column: frozen or refrigerated.
6. Pack the stool containers in the 10-lb Styro. Remember, no other type of specimen can be packed in the same Styro with stool containers.

Packing "Other Materials"

Sometimes materials that do not fit into Mayo Medical Laboratories specimen bags or specimen containers must also be packed and transported. Examples include a box of glass slides or X-ray films in a large envelope. Following are instructions for preparing these materials:

1. Write the number of items and a description of each item on the Specimen Control Document under "Other Material."
2. Place the materials in the appropriate Styro, usually ambient/refrigerated. It may be necessary to use an extra box.
3. Place envelopes inside of the Styro if they fit. Do not place envelopes alongside the Styros in the box.
4. Ship X-ray films or envelopes that do not fit in the Styro via FedEx in a separate X-ray envelope. Mayo Medical Laboratories provides special X-ray envelopes to couriers and clients who request them. The supply number is T533.

General Instructions for Packing Specimens

• Never take the lids off both Styros at the same time. When both lids are removed, it is easy to mistakenly place the lids on the wrong Styros.
• Never overfill a Styro or compress the specimens. If the lid will not fit securely on a Styro, use another box.
• Complete a specimen control document for each box, logging only the specimens in that box.
• Count the number of bags and enter that number on the Specimen Control Document.
• If specimens are not in Mayo Medical Laboratories bags or containers, ask a lab staff person to repackage them. Couriers should pack extra bags in case clients have used up their supplies. (Clients may order supplies by following their normal reorder process.)
• If the temperature of a specimen does not match its label (for example, if a specimen with a pink refrigerated label is in the freezer), ask a laboratory staff person how it should be transported. If it is in the wrong bag or container, ask the person to repackage it.
• Do not leave a box containing specimens in an unlocked car. Always enter a facility carrying the box.

When the appropriate packing instructions have been followed, place the pink- and white-labeled cover onto the Styro. Place the Styro(s) into the appropriate Mayo Medical Laboratories raspberry-colored box and tape the lid closed. The box is ready for transport to Mayo Medical Laboratories.

General Instructions for Handling Cool-Packs

Important Safety Information: Do not place cool-packs in a refrigerator or freezer containing food items. Use the cool-packs only for their intended purpose: transporting medical specimens.

Cool-packs lose their coldness more quickly in warm weather, so during the summer they should be stored in the freezer. During the winter, when they stay cold longer, they should be stored in the refrigerator. A cool-pack that is too cold can damage specimens, so when a cool-pack is stored in the freezer, it should be taken out about an hour before the courier leaves for the run. Specimens can freeze if they come in direct contact with a cool-pack, so always put a barrier (paper towels) between the specimens and the cool-pack. A cool-pack that is kept on dry ice MUST be removed 3 hours before the run.

• From April to October (during warm weather) put a frozen cool-pack on the bottom of the refrigerate/ambient Styro.
• From November to March (during cold weather) put a refrigerate cool-pack on the bottom of the refrigerate/ambient Styro and a room-temperature cool-pack on top of the ambient specimens. This will help protect the ambient specimens from the cold air.

Pack extra cool-packs

Put at least 3 extra cold cool-packs and a dozen paper towels in the refrigerate/ambient Styro of another express box. It may be necessary to ship more than one refrigerated Styro.

Refrigerated specimens cannot be shipped without a cold cool-pack, so it is very important to have extras.

Reminder: Do not use dry ice to freeze the cool-pack; if that is the only option, remove the cool-pack from the dry ice 3 hours before use.

For additional assistance or questions regarding specimen packaging, supplies, or shipping, please contact Mayo Medical Laboratories at 800-533-1710 or visit our Web site at www.mayomedicallaboratories.com.

Safety in the Lab

Mayo Medical Laboratories packaging materials are designed to protect everyone who handles them. However, couriers should always take special precautions in a laboratory:

• Wear exam gloves in the laboratory. Cover any cuts or scrapes with a bandage.
• Wash hands before leaving each laboratory.
• Do not eat, drink, chew gum, or put anything in the mouth, touch the lips, or apply cosmetics while in the laboratory.
• Wear shoes that cover the entire foot.
• Do not put the box down in a spill (wet) area.
• Do not touch any specimen bag or container that appears soiled. Ask a laboratory staff to place the specimen(s) in another bag for safe transportation.
• In the event of a cut or puncture to the skin in the lab, tell laboratory staff immediately. They may recommend a trip to the emergency room. Couriers should notify their employer as soon as possible.

Packing the Courier Vehicle

Pack the courier vehicle with the following items (more about some of these items later):

• Extra dry ice with cloth gloves and safety glasses
• Box of exam gloves (provided by Mayo Medical Laboratories)
• Paper towels
• B.A.S.K. brand or other clean-up kit
• Packaging tape
• "Infectious Substance" and "Danger" packaging stickers
• Extra frozen, refrigerated, and ambient color-coded specimen bags
• Mayo Medical Laboratories stool containers in a 10-lb Styro
• Double 10-lb box sets with cool-pack and dry ice

Dry ice should be transported in a secure container with a lid, such as a Styro. Be sure to stow the container in a secure place (the trunk is a good place) to prevent the possibility of a burn if it is necessary to make a sudden stop.

Always pack the boxes with the cool-packs and dry ice just before leaving. Cool-packs can freeze if left in a very cold car and dry ice can evaporate if left in a very warm car.