1. Procedures for
providing specimens must allow reasonable privacy but may require a witness to
prevent substitutions, contamination or adulteration of the specimen to be
provided. Employers must take precautions to ensure that a specimen has not
been adulterated, contaminated, or substituted during the collection procedure
and that all information on the collection container and in the chain of
custody form can be identified as belonging to a given individual. To ensure
that unadulterated specimens are obtained, the following procedures outline the
minimum precautions that shall be taken during the collection of specimens, in
noncritical, ambulatory accident related testing.
a. At the collection site, if the specimen to
be collected is urine, toilet bluing agents shall be placed in the toilet
tanks, wherever possible, so that the reservoir of water in the toilet bowl
always remains blue. The possibility of adulteration, substitution or
contamination from other sources of water (e.g., shower, sink, etc.) in the
enclosure where urination occurs should be prevented whenever
possible.
b. Upon arrival at the
collection site, the collector shall request the individual to present some
type of photo identification. If the individual does not have proper
identification, this shall be noted on the chain of custody form.
c. The collector shall ask the individual to
remove any unnecessary outer garments (e.g., coat, jacket) that might conceal
items or substances that could be used to tamper with or adulterate his/her
specimen. Also, all personal belongings (e.g., purse, briefcase) must remain
with the outer garments; the individual may, however, retain his/her wallet.
The collector shall note any unusual behavior or appearance.
d. After washing his/her hands, the
individual shall remain in the presence of the collector and not have access to
water fountains, faucets, soap dispensers, or cleaning agents.
e. In a nonwitnessed collection, the
individual may provide his/her specimen in the privacy of a stall or otherwise
partitioned area that allows for individual privacy. The collector shall note
any unusual behavior by the individual.
f. After the specimen has been provided and
submitted to the collector, the individual should be allowed to wash his/her
hands.
g. If the collection is
nonwitnessed, immediately after collection, the collector shall measure the
temperature of the specimen and conduct an inspection to determine the
specimen's color and signs of contaminants. Any unusual findings resulting from
the inspection must be included on the chain of custody form. If the
temperature of the specimen is outside the range of
32.5-37.7°C/90.5-99.8°F, this gives rise to reasonable suspicion of
adulteration/substitution, and another specimen should be collected, and both
specimens shall be properly labeled and forwarded to the laboratory.
h. Both the individual being tested and the
collector should keep the specimen in view at all times prior to its being
sealed and labeled. If the specimen is transferred to a second container, the
collector shall request the individual to observe the transfer of the specimen
and the placement of a tamperproof seal over the container cap and down the
sides of the container. The collector will place the identification label
securely on the container.
i. The
identification label should contain the date, employee's name, and any other
identifying information provided/required by the employer. The tested
individual shall initial the label on the specimen container. If the individual
refuses to initial the label, this fact must be noted by the collector on the
chain of custody form.
j. The
collector shall complete the appropriate chain of custody form. The individual
shall be asked to read and sign a certification statement regarding his/her
specimen and be given an opportunity to provide notification of any information
which the individual considers relevant to the test, including identification
of currently or recently used prescription or nonprescription drugs, or other
relevant medical information.
k.
After the above procedures, the specimen and chain of custody form are now
ready for shipment. If the specimen is not immediately prepared for shipment,
it must be appropriately secured during temporary storage.
l. In the event blood is required, it should
be collected in a tube containing sodium fluoride as a preservative. To insure
no adulteration of the blood specimen, alcohol shall not be used as a
disinfectant, but betadine, or its nonalcoholic equivalent, shall be
used.
2. Note: During
the performance of any part of the chain of custody procedures, it is essential
that the specimen and custody documents be under the control of the involved
collector.
a. If the collector must leave
his/her work station momentarily, the specimen and custody form must be taken
with him/her, or must be secured. After the collector returns to the work
station, the custody process will continue. If the collector is leaving for an
extended period of time, he/she should package the specimen for mailing prior
to leaving the site.
b. If the
specimen is to be collected from a critical, nonambulatory or unconscious
employee, the collection procedures shall be left to the discretion of the
treating medical provider, and shall reasonably preclude adulteration,
contamination or substitution. After the patient's condition is stabilized and
the patient is conscious, he/she shall be asked to read and sign a
certification statement regarding his/her specimen, and be given an opportunity
to provide notification of any information which the individual considers
relevant to the test, including identification of currently or recently used
prescription or nonprescription drugs, or other relevant medical
information.