Which of the following specimens requires a chain of custody form?

Choice A Reason:
Covering the spill until maintenance arrives is not an appropriate response to a blood spill. This action does not neutralize any potential pathogens present in the blood, which could pose a risk of infection to others. Immediate cleanup is necessary to prevent the spread of infectious diseases, and simply covering the spill does not meet the Occupational Safety and Health Administration (OSHA) guidelines for bloodborne pathogens, which require the spill to be cleaned with an appropriate disinfectant.

Choice B Reason:
Pouring bleach on the spill and allowing it to soak for 60 seconds is the recommended action because bleach is a powerful disinfectant that can kill a wide range of pathogens, including those that might be present in venous blood. The Centers for Disease Control and Prevention (CDC) recommends a 1:10 dilution of household bleach for effectively disinfecting blood spills. After pouring the bleach, it is important to let it soak for an adequate amount of time, usually around 10 minutes, to ensure that all pathogens are killed.

Choice C Reason:
Evacuating the laboratory is not a necessary action for a blood spill unless the spill is extensive and poses additional risks that cannot be mitigated by standard cleanup procedures. In most cases, following the proper spill cleanup protocol, which includes wearing personal protective equipment (PPE) and using an EPA-registered disinfectant, is sufficient to handle the situation without needing to evacuate the area.

Choice D Reason:
Applying a liquid thickening agent on top of the spill is not a standard practice for blood spill cleanup. While a thickening agent might contain the spill, it does not disinfect the area. The priority in such situations is to disinfect and remove any potential infectious agents. Therefore, the use of a thickening agent would not be in compliance with the recommended procedures for blood spill cleanup by OSHA and the CDC.

Choice A reason:
Capturing the initial stream of urine, also known as the "first catch," is not recommended for a urine culture. This part of the urine stream can contain contaminants from the urethral opening and is not ideal for culture testing, which requires a clean sample.

Choice B reason:
Cleaning the genital area prior to collection is crucial for obtaining a clean-catch urine specimen. This reduces the risk of contamination from bacteria that are normally present on the skin around the urinary opening. Patients should be instructed to use antiseptic wipes to clean the area before collecting the urine sample.

Choice C reason:
Filling the container to capacity is not necessary and is not a specific instruction for urine culture collection. The focus should be on obtaining a midstream sample after the genital area has been cleaned, which provides a more accurate representation of the urine for culture purposes.

Choice D reason:
Labeling the lid prior to collection is an important step in the process to ensure proper identification of the specimen. However, it is not the primary instruction related to the actual collection of the urine sample. The label should include the patient's name, date, and time of collection and should be done after the sample is collected to avoid confusion or contamination.