Courier for medical and lab specimens in Ontario: chain of custody and what to ask

What category your specimens are

Canada regulates the transport of infectious substances under the Transportation of Dangerous Goods Act and Regulations. Specimens are classed by risk. Category B covers infectious substances that do not meet the criteria for Category A, where an exposure is not expected to cause permanent disability or death. They are shipped as UN3373, with the shipping name BIOLOGICAL SUBSTANCE, CATEGORY B. Routine patient specimens such as blood, urine and swabs sent for diagnosis usually fall here; your lab or your biosafety lead decides the category, not the courier.

How Category B specimens must be packed

Transport Canada requires Category B substances to travel in Type P650 packaging, a three-layer system: a leak-proof primary receptacle, a leak-proof secondary packaging, and an outer packaging with at least one external dimension of 100 mm. Either the secondary or the outer packaging must be rigid. Absorbent material goes between the primary and secondary layers for liquids.

• Primary receptacle: the tube or container, sealed and labelled with the patient identifiers your lab requires.
• Secondary packaging: a sealed specimen bag or canister that would contain a leak, with absorbent for liquids.
• Outer packaging: a rigid box or cooler with the UN3373 mark, the shipping name and a 24-hour phone number.
• Requisitions and paperwork: outside the secondary packaging so they stay clean if a tube leaks.

The section 1.39 exemption, in plain terms

Section 1.39 of the Transportation of Dangerous Goods Regulations relieves Category B shipments from several parts of the regulations, including most documentation and safety mark rules and the training requirements in the parts it lists, provided three conditions are met. One external surface of the package must measure at least 100 mm by 100 mm. The package must comply with the means of containment rules and show the Category B mark with the shipping name next to it in letters at least 6 mm high on a contrasting background. And the 24-hour telephone number must be displayed next to the shipping name.

Transport Canada's guidance is direct about training: assume training is required unless you are using an exemption, and only rely on the exemption when every condition is met. In practice, that means the people packing specimens should know the P650 system and the marking rules, and someone in the clinic or lab should own the process.

Temperature and time

Each test has its own handling requirements. Public Health Ontario publishes a Test Information Index with specimen collection, handling, requisitions and turnaround information for the tests it performs; private and hospital labs publish their own. Common transport conditions are room temperature, refrigerated or frozen, and many tests have a maximum time from collection to the lab. Pack to the condition the test requires, for the full door-to-door time, and tell the courier what the box needs.

Chain of custody

Chain of custody is the record of who had the specimens and when, from collection to the lab. A gap in that record can mean a rejected specimen and a patient called back. The fewer hands a package passes through, the shorter and cleaner the record. A direct run, where one driver collects the package and delivers it without a sorting hub, has two custody events: the handoff at pickup and the handoff at delivery.

• Time-stamped pickup and delivery records.
• Photo proof at each stop, showing the package was delivered to the right place.
• A signature from the receiving lab when you need one, naming who accepted the package.
• A tracking link the sender and the lab can both see.

PrimeRoutes runs work this way: one driver carries the package door to door, every stop is photographed, and the recipient signs when the order requires a signature.

Questions to ask any courier

1. 01Do you carry UN3373 Category B specimens, and are your drivers briefed on what the mark means and what to do if a package is damaged?
2. 02Is the run direct, or does the package go through a sorting facility?
3. 03What records do you provide: pickup time, delivery time, photo, signature?
4. 04How long is the run door to door for our route, and how do you handle a delay?
5. 05Will the package travel in a closed vehicle, away from heat and sun?
6. 06Who do we call during the run, and is that line answered during our collection hours?
7. 07Can you run a standing schedule, for example a daily pickup at fixed times, for our collection sites?

Who is responsible for what

A courier cannot fix a package that was packed wrongly, and should refuse one that is leaking or unmarked. Getting the packaging right at the clinic is what makes everything after it work.