AORN Guideline in Focus: Specimen Management

The AORN Guideline for Specimen Management provides evidence-based recommendations to help perioperative teams safely manage surgical specimens from collection through disposal. The guideline covers processes for labeling, containment, preservation, documentation, transport, and communication, including special considerations for specimens like explanted devices, radioactive materials, and forensic evidence.

Some Key Specimen Safety Practices for the Perioperative Environment

Establish a standardized specimen handling process with embedded quality controls. (4.1)

Reduce the number of people and steps in the specimen handling process. (4.2)

Use automation technology or memory aids during specimen handling, when possible. (4.3)

Use safe transfer practices to minimize risk of specimen compromise. (3.1–3.2)

Verify patient and specimen identification with a read-back method before transfer. (3.3)

Use containers that are leakproof, puncture-resistant, and large enough to prevent compression. (5.2–5.3)

Labeling, Requisition, and Containment

Contain and label the specimen immediately upon receiving it from the sterile field. (5.4)

Place the specimen container into a bag if the exterior is contaminated. (5.5)

Label containers with biohazard and chemical hazard information as needed. (6.1–6.2)

Securely affix specimen identification labels to the container, not the lid. (6.4)

Complete the pathology requisition form according to facility policy. (6.5)

Preservation and Refrigeration

Confirm the use of preservatives with the physician and fully immerse the specimen in the lowest effective formalin volume ratio. (7.2–7.3)

Vacuum sealing with refrigeration at 4°C may be used for specimens 2 cm and larger. (5.6–5.7)

Clean and disinfect vacuum-sealing containment devices according to IFU and policy. (5.8)

Transport and Temporary Storage

Establish a standardized process for timely transport of specimens to the lab. (8.1)

Immediately transport specimens when possible and confirm receipt at the receiving department. (8.3, 8.5)

Confirm critical and time-sensitive information when delivering specimens. (8.4)

Label transport devices to indicate chemical and biohazard contents. (8.6)

Temporarily store specimens in a way that maintains integrity when immediate transport is not possible. (9.1)

Special Specimen Considerations

Radioactive specimens must be handled according to regulation and in collaboration with the RSO. (12.1–12.2)

Track and handle explanted medical devices according to regulation, IFU, and facility policies. (13.1–13.2)

Use standardized kits and follow chain-of-custody protocols for forensic evidence. (14.2, 14.5)
Refrigerate placentas not immediately sent to pathology and ask about patient preferences for disposition. (15.2–15.3)

Develop policies for handling highly infectious or prion-related specimens with interdisciplinary teams. (16.1, 17.1)

Training, Documentation, and Quality

Document specimen management per regulations and facility policy. (18.1–18.2)

References

• Steelman  VM, Williams  TL, Szekendi  MK, Halverson  AL, Dintzis  SM, Pavkovic  S. Surgical specimen management: a descriptive study of 648 adverse events and near misses. Arch Pathol Lab Med. 2016;140(12):1390–1396. [IIIA]  [PubMed: 27610645]
• Makary  MA, Epstein  J, Pronovost  PJ, Millman  EA, Hartmann  EC, Freischlag  JA. Surgical specimen identification errors: a new measure of quality in surgical care. Surgery. 2007;141(4):450–455. [IIIA]  [PubMed: 17383521]
• Bixenstine  PJ, Zarbo  RJ, Holzmueller  CG  et al. Developing and pilot testing practical measures of preanalytic surgical specimen identification defects. Am J Med Qual. 2013;28(4):308–314. [IIIB]  [PubMed: 23322909]
• Zervakis Brent  MA. OR specimen labeling. AORN J. 2016;103(2):164–176. [VB]  [PubMed: 26849982]
• Cooper  K. Errors and error rates in surgical pathology: an Association of Directors of Anatomic and Surgical Pathology survey. Arch Pathol Lab Med. 2006;130(5):607–609. [IIIC]  [PubMed: 16683871]
• Novis  DA. Detecting and preventing the occurrence of errors in the practices of laboratory medicine and anatomic pathology: 15 years’ experience with the College of American Pathologists’ Q-PROBES and Q-TRACKS programs. Clin Lab Med. 2004;24(4):965–978. [VB]  [PubMed: 15555751]