[Histonet] Specimens lost in process

[Shelly Coker]

Steven,
Here are some thought I have on each of these from the perspective of managing a large GI lab:
1.  I have only had one specimen that was lost by the grossers, and it wasn't lost.  The cassette went into the bin with the specimen containers for the day.  This is where I found the non-viable specimen the following morning, all dried up.  We don't lose them to the biotrash because we don't use paper towels at all.  We use Lab Wipes which are thicker and it is harder for items to get accidentally thrown away.  Another trick we do is to wrap ALL specimens in perm papers.  The papers are more porous than regular filter paper, and we have a Fuji paper dispenser that works like a tissue box does.  The gross techs love them.  And they fold the paper so that the techs only have to pull on two corners to open when embedding.
2.  The perm papers completely alleviated not only lost specimens, but also all cross contamination from processing, which we saw frequently with esophageal tissue.
3.  You do not want to use micromesh....We did without knowing it was not advisable.  All of our small bowel specimens showed  what our pathologist called "a blown up effect" because the water stays trapped in the cassette because the holes are so small.  Then the water super heats and boils out, tearing the epithelium from the other layers, making a clear diagnosis difficult.
4.  We do have this problem, but have found that upon checking the gross, the specimen was so small it was not likely to survive processing.  Now, that does not include if the tech accidentally opens the cassette too quickly and the tissue flips off somewhere.  This can happen with perm paper, but it is much less likely.
5.  The microtomy problem is what it is .  Encourage staff to seek help before it comes to that.
We have less than .05% of specimens per month that we call "did not survive processing".  I always communicate directly with the surgery center manager if the specimen started of inadequate, but if the error is ours I call the physician directly with the explanation.  We also do an incident report with requires investigation on my part as well as a root cause analysis.
Hope this helps...if you are interested in the perm paper solution, head down to Sally's Beauty supply and look for Fuji Perfect Paper End Wrappers and the Hands Free Dispenser.  You can also find them on Amazon.
Regards,Shelly CokerLab ManagerAustin Gastroenterology
Looking for help in analyzing the entire scope of the process. There is not much published data (that I can find) and I am hoping this group can lend some expertise.
Our rate is higher than we would like it to be. There is no consistent size at risk although GI and Derm biopsies are the biggest involved group. We have broken it down into steps.

1.      Can be lost at grossing- either never loaded into the cassette at all, or cassette was discarded. Thus we hold on to our waste and can search for misdirected cassettes if need be.

2.      Lost in the processor itself. Most are wrapped. If large enough not to be wrapped, we would not expect the processor to eat them, so assume cassette lid not properly closed. Frankly the highest number of losses we're seeing is no tissue found in cassette by embedders.

3.      I am being told that we can't use micromesh cassettes in our microwave processors (Milestone Pathos) and want to know if anyone is.

4.      Tissue not seen at embedding. Again no way to tell when the tissue disappeared. We know that tiny tissue can spring out during the opening at embedding but I don't know how else to examine or limit this step.

5.      Tissue can be exhausted during microtomy. Rare but noteworthy.
I am hoping people can tell me about their procedures for dealing with "specimens that don't survive processing", what safeguards they have in place, and to some extent what your own lab percentage  or experience is.
Apologies in advance for the length of the message, but could really use your help.


Steven Pinheiro, MBA, MLS(ASCP)DLMCM
Manager Anatomic Pathology and Cytology
Loyola University Medical Center
2160 S First Ave, Bldg 110 Rm 2214
Maywood, IL 60153
708-327-2642 (O)
708-327-2620 (F)
spinheiro at lumc.edu<mailto:spinheiro at lumc.edu>