Safe use of pneumatic air tube transport systems for pathology specimens

HSE information sheet Safe use of pneumatic air tube transport systems for pathology specimens

Introduction l giving staff the right information and training so that the proper operating and control procedures are This information sheet provides advice for people who always followed. use pneumatic air tube transport systems to deliver pathology specimens around a hospital site. It aims to The law provide practical help in ensuring safe use of this method of transporting specimens and supplements more When using pneumatic air tube transport systems, detailed guidance on the design, use and management employers and employees have various duties under of pneumatic air tube systems (see the Further health and safety law. All pathology specimens may information section at the end of the sheet). contain substances that are 'hazardous to health'. Many may contain harmful biological agents, including those The advice given here has been produced with help from the Department of Health, including its Executive samples not necessarily sent for microbiological Agencies NHS Estates and the Medical Devices Agency, identification; others may contain hazardous chemicals, the Public Health Laboratory Service, the Microbiology eg specimens for histopathology contained in formalin Advisory Committee and users of pneumatic air tube fixative solutions. transport systems. The Management of Health and Safety at Work Background Regulations 1992 (MHSWR 1992) and the Control of Substances Hazardous to Health Regulations Pneumatic air tube transport systems can provide a safe, 1999 (COSHH 1999) require employers to: efficient and rapid means of sending certain types of pathology specimens between hospital departments; for l assess the risks to employees, the self-employed example, from operating theatres and out-patient clinics and the public from use of the system and from to the pathology laboratories. The use of these systems exposure to hazardous substances including is increasing because they can improve specimen biological agents (the risk assessment/COSHH turnaround time, so patients and hospital staff can assessment); and receive test results quicker. They also allow for more effective time-management of messenger staff by l take action to prevent or adequately control that reducing the need to physically take specimens from one department to another. exposure.

The system is made up of a network of tubing typically Assessing the risk constructed of steel or uPVC, connecting a minimum of two (but more usually several) station terminals where When making an assessment, first look for, and identify, specimens may be received or placed for transfer. The the hazards. Then decide who might be harmed, how this specimens are put into special carriers for dispatch might occur, and evaluate the likelihood of those hazards through the tubing. Transportation is effected by a blower causing harm. The significant findings of the assessment unit which determines the flow of the carrier. Depending need to be recorded and subsequently regularly on the size of the hospital site, the network may be many reviewed and revised if necessary. Thinking about the thousands of metres long, with a number of send-and- following issues can help form the basis of your COSHH receive stations. The system can also be split into assessment: zones, sometimes incorporating means to divert carriers to certain destinations, and all under the control of a l Infectious, chemical or radiation hazards which may central microprocessor or stand-alone computer. be present in pathology specimens. The safe use of pneumatic air tube transport systems is l Scale of risk. Liquid specimens will present the most fundamentally reliant on: significant danger and so some may not be suitable l the types of specimen suitable for dispatch; for transfer in a pneumatic air tube transport system. More 'solid' samples are less likely to leak from the l its design, notably of the specimen carrier; and containers.

l Routes of transmission. Specimens which can Suitability of specimen type present a danger include: Your local risk assessment needs to determine which - blood - may contain blood-borne viruses such as types of specimen may present a significant risk to the HIV, Hepatitis B and C (possible transmission by health and safety of those using the pneumatic air tube exposure through broken skin or inoculation); transport system or other people who may be affected by its use. You need to decide whether to prohibit certain specimens from being sent in the tube system, or whether - sputum - may contain the bacterium that causes the measures required to ensure adequate control of tuberculosis (possible transmission by inhalation exposure are both practical and sufficient. Generally, of aerosol); and swabs, urines, whole blood, serum and plasma are acceptable samples to transfer. Culture specimens, - biopsies - may contain formalin (possible including glass blood culture bottles and respiratory exposure to harmful vapours). disease specimens, may not be suitable. The size or mass of the specimen may also need to be considered; heavy l Risks from using different specimen containers. The samples might get stuck in the tubing and cause type of container, whether plastic or glass, and how blockages. it is packaged in the tube system carrier (in a transport bag or any other form of secondary Carrier design containment), may present hazards of leakage or The safe use of a pneumatic air tube transport system is breakage, thereby generating spills, aerosols and fundamentally reliant on the design of the specimen sharps dangers. Several specimens may be placed carrier. Carriers need to be suitably constructed, robust in a carrier, but to prevent spillage of contents, enough to withstand being sent through the pneumatic should not be packed too tightly or too loosely. tubing and able to deliver a specimen without damage or deterioration. If any leakage or spill from the primary l The suitability of carrier design. The possibility of specimen container occurred the aim is to prevent that inadvertent opening, leakage or damage in transit leakage escaping from the carrier. Many designs are may create a number of significant dangers. available and their suitability will need to be assessed. The carrier needs to be positively secured before being l How to deal with incidents and decontamination. put into the tube system. 'Snap-top' types may be more If the specimen contents of a carrier were to be spilt suitable than those with fastenable straps, or screw tops into the tubing system or at a station terminal you which may be more prone to accidental opening in would need to assess: transit or incorrect fitting before dispatch. Ideally, the contents of the carrier should be visible, so that any leakage can be seen. - the hazards of both specimen/carrier retrieval; Carriers need to be constructed from materials that can - containment of any spillage; be easily decontaminated and withstand the effects of cleaning. Damaged or defective carriers should not be - decontamination of that spill; and used.

- re-commissioning of the system. Specimen packing

Preventing and controlling the risk Most currently available specimen carriers are not 'leakproof'. Therefore, specimens should be packed in After you have evaluated the likelihood of these the carrier to prevent any leakage and so avoid dangers, focus risk control on the following five points: contaminating the tubing system. One suitable method is to place each specimen in a plastic transport bag, which has an integral sealing strip and a separate l suitability of specimen type; pocket for enclosing the request form. This is also a useful way of separating specimens. If, for example, l carrier design; several blood tubes are put in a carrier and one is damaged, the others will not then necessarily be l specimen packing; spoiled. Another useful precaution is to place absorbent wadding inside the carrier between the specimen bags. l spillage containment/clean-up procedures; and If enough wadding is used, it will absorb any leak and so prevent contamination of the outside of the carrier or l information, instruction and training on proper use of of the tubing. It will also help to stop any specimen the system. movement which might otherwise increase the possibility of damage.

Spillage containment/clean-up procedures know the risks created by its use and of the precautions which are to be taken to control those risks. A procedure The aim of using a pneumatic air tube specimen for supervision of the system's proper use in accordance transport system is to transport those specimens safely, with local Standard Operating Procedures (SOPs) also ie to prevent damage, leakage or a spill of the potentially needs to be set up. This will help ensure that specimens infectious or harmful contents from contaminating the are properly contained in a suitable, fastened carrier with tubing system. Adequate disinfection of soiled tubing sufficient packing if needed. would be difficult and in many cases not possible without some or complete dismantling of the system. Fumigation Further information of the tubing with formaldehyde vapour is not recommended because it is not generally thought NHS Estates, an Executive Agency of the Department of practical to ensure that the tubing network is sealable for Health, have produced detailed publications on the vapour disinfection. There would also be complicated design, use and management of pneumatic air tube considerations of how to safely evacuate the transport systems. They are entitled: Health Technical formaldehyde before recommissioning the system and Memorandum 2009 Pneumatic air tube transport also validating the effectiveness of the procedure to systems, Design considerations and Good practice ensure adequate contact, time and concentration of guide and Management policy (1995). disinfectant. HSE priced and free publications are available by mail If specimen carriers are received with indications of order from: broken or leaking specimen contents, the reception staff should notify a senior member of the department to HSE Books, PO Box 1999, Sudbury, Suffolk CO10 2WA assess the nature of any damage and decide how best Tel: 01787 881165 Fax: 01787 313995 to deal with it. Staff need to wear disposable gloves of suitable material when they deal with known or HSE priced publications are also available from good potentially contaminated specimens. If the carrier booksellers. contains a damaged specimen of unknown origin, it is best dealt with and opened within the confines of a For other enquiries ring HSE's InfoLine Tel: 0541 microbiological safety cabinet. This will help ensure that 545500, or write to HSE's Information Centre, Broad any hazardous aerosols present are safely contained. Lane, Sheffield S3 7HQ Staff also need to take care with any hazardous sharp fragments. The damaged contents and carrier will need HSE home page on the World Wide Web: to be suitably disinfected or discarded as appropriate. In http://www.open.gov.uk/hse/hsehome.htm some instances it may be better to request a repeat specimen, although this might not always be possible. The local risk assessment may prohibit the use of the This leaflet contains notes on good practice which pneumatic air tube transport system for irreplaceable or are not compulsory but which you may find helpful 'one-off' specimens such as CSFs. in considering what you need to do.

Information, instruction and training This publication may be freely reproduced, except for It is essential that all users of a pneumatic air tube advertising, endorsement or commercial purposes. The transport system receive suitable and sufficient information is current at 9/99. Please acknowledge the information, instruction and training to enable them to source as HSE.

Printed and published by the Health and Safety Executive 9/99 MISC186 C30