[Histonet] CAP checklist ANP.11680 Cross Contamination

[Terri Braud]

In response to the request to post the new phase II CAP requirement on cross contamination : 
**NEW**       08/21/2017
ANP.11680	Cross Contamination	Phase II
There is a written procedure to prevent cross-contamination of specimens during grossing.
NOTE:  At a minimum, cleaning (e.g. wiping or rinsing) of forceps and scalpel blades between cases is required. In addition, if a laboratory processes both small specimens (e.g. biopsies) and large specimens (e.g. surgical resections), cleaning of instruments and cutting surfaces must be performed between cases. Avoid re-using cotton swabs/applicator sticks on multiple specimens or "double-dipping" the cotton swab/applicator in the ink. Some laboratories may choose to use disposable surfaces (e.g. formalin absorbent pads, butcher paper, etc.) for large cases. Grossing of similar types of specimens sequentially should be avoided, if feasible.
REFERENCES
1) 	Lott R, et al. Practical Guide to Specimen Handling in Surgical Pathology. College of American Pathologists, November 2015. Available at http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/practical-guide-specimen-handling.pdf, Accessed November 4, 2016.
2) 	Gephardt GN, Zarbo RJ. Extraneous tissue in surgical pathology: A College of American Pathologists study of 275 laboratories. Arch Pathol Lab Med. 1996;120:1009-14

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal
   2. Re: Cross Contamination CAP policy (Bob Richmond)

Message: 2
Date: Sat, 13 Jan 2018 14:32:45 -0500
From: Bob Richmond <rsrichmond at gmail.com>
To: "Histonet at lists.utsouthwestern.edu"
        <histonet at lists.utsouthwestern.edu>
Subject: Re: [Histonet] Cross Contamination CAP policy
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        <CAOKsRH50bP+FbdNf3FNj_RgeNc9thT1WA6wKBBAAE3KAE414-Q at mail.gmail.com>
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Terri L. Braud, HT(ASCP), Anatomic Pathology Supervisor at Holy Redeemer Hospital in Meadowbrook PA notes:

>>Our policy calls for wiping of forceps with gauze between cases at 
>>gross
and at embedding. At gross, we use a disposable absorbent lined pad on the cutting board for each larger case, and just a fresh c-fold paper towel between small biopsy cases. We do not allow double-dipping of swabs into ink, but instead, pour out small amounts into a large plastic weigh boat which is also discarded after the case. We use disposable safety scalpels, with a 70 blade (love 'em) for each case. For excessively bloody/fatty cases, we put the dirty forceps into an enzyme pre-soak (Aseptizyme) to remove all tissue debris. Then they are scrubbed with a brush, then rinsed in a disinfectant before being re-used.<<

I've never seen a pathology service (and I've worked in 80 of them) do any of these things, all of them good ideas. I'm glad to see the CAP taking the issue up. Carry-overs from case to case are common, particularly when the grosser is overworked and working too fast. I've never seen a serious error made as a result of such contamination, but I've seen a few close calls.

Terri Braud, could you copy us the actual text in the CAP inspection form?

Bob Richmond
Samurai Pathologist
Maryville TN