A lot goes into the proper care and handling of surgical specimens: clear communication, correct identification of patient and specimen and proper labeling, packaging and transporting once the specimen has been removed. To avoid errors during any of these steps, you must understand proven procedures for safe specimen care. Use this quiz, based on recommended standards of practice issued by the Association of Surgical Technologists, to see if you do.

1. Before surgery that demands the handling of specimens, what information should you coordinate and confirm?
a. specimen type
b. types of diagnostic studies to be performed
c. anticipated number of specimens
d. type and size of needed containers
e. all of the above

e: Proper planning before cases involving specimen removal demands communication among all involved in the chain of custody, from surgeons to certified surgical technologists (CST) to circulating nurses to pathologists. Let your pathology department know which cases will require specimen removal or establish a consistent pick-up schedule if you outsource specimens to a lab.

2. Specimen containers should be all of the following, except ________ .
a. rigid, impermeable, unbreakable and non-reactive to fixative solutions
b. transparent
c. topped with a secure, tight-fitting lid
d. the correct size to hold the required specimens

b: Containers should be opaque so specimens cannot be viewed during transport to the pathology department or outside lab. In addition, affix labels to containers in a way that ensures patient confidentiality. Maintain an inventory of various-sized containers to ensure you're able to properly package different sized specimens. Make sure lids fit containers securely to prevent noxious fumes from escaping during transport.

3. It's OK to keep specimens in a sterile basin until they can be passed off the sterile field.
a. true
b. false

a: This one comes with a condition. Ideally, you should immediately place specimens in a proper container with fixative. If that's not possible, keep specimens moist with sterile saline solution or by wrapping them in saline-soaked sponges until they can be passed from the sterile field. Use aseptic technique to place small specimens on sterile, non-adherent pads. Specimens should be passed from the surgeon to a CST to the circulator. Avoid using instruments to pass specimens. If instruments must be used, atraumatic clamps or tissue forceps are acceptable options. When manually handling specimens, hold them lightly so as to not crush the tissue.

4. Specimen labels should be placed on the container's ________ .
a. lid
b. side
c. both

b: Place labels on the sides of containers so they're not lost when lids are removed in the pathology department or lab. Always use permanent black or blue ink to write required information on labels (see "Take Note"). Be sure to clearly mark the presence of biohazardous materials so handlers take extra care.

5. When a preservative solution is used, you should pour it over the specimen in the specimen container.
a. true
b. false

b: Pouring preservative solution over specimens can cause splashing, which puts handlers in harm's way. Formalin, a common preservative containing formaldehyde, is a dangerous substance that should not be inhaled, absorbed through the skin or accidentally swallowed. When pouring formalin, always wear proper PPE equipment, including eye protection, mask, face shield, and impervious gloves and gown. The face shield does not make eye protection unnecessary — both should be worn. Always thoroughly wash your hands after handling formalin.

6. Specimens designated for frozen section should be passed off the sterile field using any of the following, except ________ .
a. sterile towel
b. sterile container
c. counted radiopaque sponge
d. medicine cup

c: Specimens designated for frozen section (in order to provide the surgeon with a quick diagnosis during the case) must be passed off the sterile field immediately using aseptic technique for timely transport to the pathologist. They should be received from the surgeon by the first scrub CST, passed off to the circulator and placed in a properly labeled container that does not contain a preservative solution.

Upon diagnosing the specimen, the pathologist should provide a verbal report directly to the surgeon in person, over the phone or using an intercom system. Confirm the surgeon-pathologist communication in the patient's OR record. Important note: Be sure to inform the pathologist of the patient's level of consciousness before he issues a verbal report that could include sensitive information.

When verbal communication between the surgeon and pathologist isn't possible, a written report issued by the pathologist should include the date, time the report was given and the pathologist's signature. Place the report in the patient's record.

7. The best specimen handling policies include ________ .
a. pre-printed requisition forms and checklists
b. chain-of-custody tracking
c. established pick-up and delivery schedules
d. periodic training sessions covering proper handling techniques
e. all of the above

e: This one's clear-cut. A systems approach should include all of the elements listed above in order to create consistent specimen handling methods and safeguards. Creating and following standardized policies reduces the risk of errors and, if an error does occur, lets you quickly track where the breakdown happened.