Laboratory Testing Services Manual - Guidelines for Specimen Collection and Submission

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General Information:

Guidelines for Collecting and Handling Specific Types of Specimens:

Telephone Inquiries

Telephone inquiries should be directed to:

(512) 776-7578 for lab results

(512) 776-7598 for inquiries about guidelines for the submission, collection, and handling of specimens.

We examine specimens as carefully and rapidly as possible; however, we do not sacrifice accuracy for speed. Please consider the following information before making a telephone inquiry:

  • Lab reporting results are given only to the original submitter.
  • Upon receipt of the specimen at the Laboratory, most testing will be completed in one to three days; however, newborn screening tests take 3-6 days.
  • Confirmation of findings in certain bacteriological examinations may necessitate a short delay in reporting results.
  • If specimens must go to another reference center, the report will be delayed for a minimum of  two weeks. 

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Reference Services

If reference services are needed but are not provided at this laboratory system, the Laboratory uses the services of the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia or in Ft. Collins, Colorado. When a particular test is only available at CDC, submitter's send the specimen TDSHS requisition form, along with a patient history, to the Texas Department of State Health Services for forwarding to the CDC.

Submitting Specimens

Please exercise care when submitting specimens and requesting tests. Services are offered only in keeping with departmental policies, licensure, and mission; therefore, services may be withdrawn in case of misuse or improper specimen submission. Submission of proper specimens under optimum conditions is very important. Accurate tests rarely can be performed on inadequate or substandard specimens.

The Laboratory enforces the principles of Good Laboratory Practices. The submitter is responsible for ensuring expiration dating on media. We will monitor the interval between the collection and the receipt of time-sensitive specimens (newborn screening, bacteriological water, gonorrhea).

Specimen Identification Guidelines

  • DSHS requires positive identification for all clinical specimens submitted for testing.
  • A submission form is required for each specimen submitted.
  • Each specimen must have at least two patient-specific identifiers attached to the primary specimen container at the time of collection.
  • Patient-specific identifiers on specimen and submission form must match.

Note: The primary specimen container is the innermost container that holds the original specimen before processing and testing (e.g., specimen collection tube, swab, or cup).

Acceptable specimen identifiers include but are not limited to:

  • Patient Name
  • CDC Number
  • Unique Random Number
  • Medical Record Number
  • Medicaid Number
  • Newborn Screening Kit Number
  • Date of Birth

Note: Location based identifiers are NOT acceptable (e.g., hospital room number or street address).

Submission Forms must contain:

  • Two patient-specific identifiers, at minimum
  • Date of Collection
  • Test(s) Requested
  • Billing information

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Serological Testing

The DSHS Laboratory does not provide blood collection tubes, except for those who are under contract or are eligible under the Texas Health Steps (THSteps) Program; therefore, physicians should have a supply of vacuum tubes for the collection of blood specimens for serological testing. They may either be serum tubes, silicon coated (red-top tubes), or Serum Separator tubes with clot activator and gel for serum separation (red gray or “tiger” top tubes). Assays will require at least 5mls of whole blood in a tube. General specimens handling requirements are listed below, however, they differ with each assay, so please refer to the test requested in the Lab Tests for Diseases/Agents section of this manual.

Serum samples that are to be tested fresh may be stored for up to two hours at 2-8°C in the presence of clots. Serum may be separated from the clot by centrifugation and transferred to a sterile tube with a screw-cap (make sure that the seal is tight to prevent leakage). Serum separated from the clot may be stored at 2-8°C up to 48 hours. After 48 hours, or for shipping, the serum must be frozen at -20°C and sent on dry ice. Temperature level during entire shipment should be no warmer than –20°C. Pack specimens in compliance with government regulations covering the transportation of etiologic agents. To prevent hemolysis in the specimens, avoid bacterial contamination, the presence of water or chemicals in syringes or tubes, or rough treatment. Avoid extremely high temperatures, such as may occur in mail vans and drop boxes in the summer and never freeze whole blood.

How to collect serum sample using serum separator tubes with clot activator:

  1. Gently invert tube 5 times to mix clot activator with blood.
  2. Allow blood to clot for a minimum of 30 minutes in a vertical position. Observe a dense clot.
  3. Centrifuge at full speed (between 1100 and 1300g) for 10 minutes for swing-head unit or 15 minutes for fixed angle units. Barrier will form, separating serum specimen from clot.
  4. Transport spun tube to the laboratory. 

A single result is significant in a few serological tests, such as immune status testing. In many cases, single results will be more misleading than helpful. Therefore, the Laboratory’s policy requires paired specimens, that is two blood specimens collected from two to three weeks apart for most diseases. Collecting the first specimens as soon as possible after the onset of the disease is essential. Single specimens will be accepted for syphilis and HIV serology, immune status testing (i.e. rubella in pregnant women), and IgM antibody tests. Single specimens may also be submitted for systemic mycoses when a chronic infection is underway.

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When submitting sputum, be certain that it is from the deeper portion of the lungs. Often saliva only is submitted, and this is usually unsatisfactory. The Laboratory in Austin provides reference and primary culturing work in mycobacteriology and mycology.

Fecal specimens for bacteriological culturing

Fecal specimens for bacteriological culturing will be accepted only under special circumstances and with prior approval (512-458-7318). When approved, these specimens must be submitted in Cary-Blair transport medium.  Instruction sheet and medium available upon request.  Call (512) 458-7661.

Fecal specimens for intestinal parasites

The examination of fecal specimens for intestinal parasites is still viewed as a reference service and will be offered to any public health clinic, but prior arrangement is required for all other specimens (512-458-7318). The specimens must not be sent in the bacteriological preservative. The specimen should be divided into two portions, one being placed into a vial of 10% Formalin, the second being placed into a vial of PVA (polyvinyl alcohol). The Laboratory provides kits to qualified providers. Call (512) 458-7661.

Fecal specimens for viral isolation

Fecal specimens for viral isolation must not be chemically preserved. Instead, fresh, unpreserved stools must be submitted. Any viral isolation specimen should be maintained at refrigerator temperatures (4-8° C) between the time of collection and the time of receipt in the laboratory. If the expected time between collection and receipt in the laboratory will be greater than 72 hours, freeze specimens after collection and ship on dry ice. 

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Rabies specimens

The DSHS Laboratory recommends delivering rabies specimens by hand to the laboratory, or shipping via a courier of your choice. Guidelines for shipping rabies specimens are as follows:

  • Specimens must be shipped and arrive at the laboratory at refrigeration temperatures.

  • Per 49 CFR regulations, rabies specimens must be labelled as Biological Substance, Category B UN3373.

  • Rabies specimens need to be triple-contained and to be shipped in a rigid outer packaging (fiberboard box). A polystyrene container inside a cardboard box works well
    • Place the completed Rabies Submission Form (G-9) in a separate sealable plastic bag to keep the form dry.
    • Enclose sufficient absorbent material with the specimen to keep all moisture within the container and prevent leaks.
    • Specimens should not be frozen because freezing delays testing and frequently compromises the examination
    • Use sufficient cold packs to maintain a cool environment, even with a delay of one full day. Wet ice is not recommended. If wet ice must be used, double bag it in sealable plastic bags to prevent leaks. 

A tutorial on how to submit rabies specimens to the laboratory (pdf) on can be found here: Submitting Rabies Specimens to the Laboratory.

State law requires submitters to notify the Rabies Laboratory 
by telephone or email of their specimen submission
at the time of shipping the specimen(s):

Toll free Rabies Notification Number: 

Email Notification : Electronic Rabies Specimen Submission Notification Form

Note: A completed G-9 Rabies Submission Form is still required to accompany each specimen. Advance notification is critical for the Laboratory to monitor the arrival of specimens and to be able to notify the submitter if a specimen does not arrive as expected. The toll-free number also has instructions on shipping a specimen and how to reach someone after hours in the event of an emergency. 

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Specimen management for infrequently encountered organisms

Organism (disease) Specimen of choice Transport issues Comments
Bartonella sp (cat scratch fever) Blood, tissue, lymph node aspirate 1 wk at 4°C; indefinitely at -70°C May see organisms in or on erythrocytes with Giemsa stain.  Use Warthin Starry silver stain for tissue.  SPS is toxic
Borrelia burgdorferi (Lyme disease) Skin biopsy at lesion periphery, blood, CSF Keep tissue moist and sterile; hand carry to laboratory if possible Consider PCR in addition to culture.  Culture yield is low.  Warthin-Starry silver stain tissue.  AO and Giemsa for blood and CSF
Borrelia sp. (relapsing fever) Blood smear (blood) Hand carry to laboratory if possible Use direct wet mount in saline for dark-field microscopy.  Stain with Wright's or Giemsa stain.  Blood culture is unreliable.
Brucella sp.b Blood bone marrow Transport at room temperature; pediatric lysis-centrifugation tube is helpful Routine blood culture bottles are useful if held 30 days.  Blind subculture may be necessary.  Joint fluid culture in arthritis.  Notify laboratory if Brucella suspected
Klebisella granulomatis (granuloma inguinale; donovanosis) Tissue, subsurface scrapings Transport at room temperature Mostly a tropical disease.  Stain with Wright's or Giemsa stain.  Epithelium alone is adequate.  Organism cannot be cultured.
Coxiella (Q fever), b Rickettsia (spotted fevers; typhus) Serum, blood, tissue Blood and tissue are frozen at -70°C Refer isolation to reference laboratory.  Serologic diagnosis is preferred.
Organism (disease) Specimen of choice Transport issues Comments
Ehrlichia sp. Blood smear, skin biopsy, blood (with heparin or EDTA anticoagulant), CSF, serum Material for culture sent on ice; keep tissue moist and sterile; hold at 4 to 20°C until tested or a t  -70°C for shipment; transport on ice or frozen for PCR test Serologic diagnosis preferred.  Fix smear in methanol.  Tissue stained with FA or Gimenez stain.  Refer isolate to reference laboratory.  CSF for direct examination and PCR. 
Francisella sp. (tularemia)b Lymph node aspirate, scrapings, lesion biopsy, blood, sputum Rapid transport to laboratory or freeze; ship on dry ice Send to reference laboratory.  Serologic testing helpful.  Gram stain of tissue is not productive.  IFA available.  Culture effective 10% of the time.
Leptospira sp. Serum, blood (citrate containing anticoagulants should not be used), CSF (1st wk), urine (after 1st wk) Blood <1 h; urine, <1 h or dilute 1:10 in 1% bovine serum albumin and store at 4-20°C or neutralize with sodium bicarbonate Serologic testing most helpful.  Acidic urine is detrimental.  Dark-field microscopy and direct FA available.  Warthin-Starry silver stain for tissue.
Streptobacillus sp. (rat bite fever; Haverhill fever) Blood, aspirates of joint fluid High-volume bottle preferred Do not refrigerate.  Requires blood, serum, or ascitic fluid for growth.  SPS is inhibitory.  AO staining is helpful.

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Last updated June 21, 2022