Q&A column

Editor: Frederick L. Kiechle, MD, PhD

Submit your pathology-related question for reply by appropriate medical consultants. CAP TODAY will make every effort to answer all relevant questions. However, those questions that are not of general interest may not receive a reply. For your question to be considered, you must include your name and address; this information will be omitted if your question is published in CAP TODAY.

Submit a Question

Q. Does a histotechnologist need a bachelor’s degree to run in situ hybridization? Is there a minimum educational requirement to run (not interpret) ISH testing in an anatomic pathology laboratory?

A. November 2019—The educational requirements to perform ISH, as well as such high-complexity testing activities as quality control interpretation and grossing, are a minimum of an associate’s or bachelor’s degree in a course of study defined in laboratory general checklist requirement GEN.54750 Nonwaived Testing Personnel Qualifications. More specifically, an associate’s or bachelor’s degree in a chemical or biological science or medical laboratory technology is required, as is specific laboratory training, which is also noted in the checklist requirement. Histotechnology is an acceptable course of study, according to the Centers for Medicare and Medicaid Services, because it is considered a biological science.

Clinical and Laboratory Standards Institute. QMS03: Training and Competence Assessment; Approved Guideline. 3rd ed. 2009.

College of American Pathologists. GEN.54750 Nonwaived testing personnel qualifications. In: Laboratory general checklist. Sept. 17, 2019.

U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Clinical Laboratory Improvement Amendments of 1988; final rule. Fed Regist. 1992:7175 [42CFR493.1423], 7183 [42CFR493.1489].

Cynthia McGurn, MHA, MT(ASCP)
Technical Specialist, Laboratory Accreditation
College of American Pathologists, Northfield, Ill.

Q. Does using an alcohol swab affect the results of an ethanol blood test?

A. There have been case reports in the scientific literature suggesting that use of an alcohol swab can influence blood testing for ethanol (ETOH).¹ However, recent studies that examined the issue directly demonstrated that there is not a significant impact from using alcohol swabs prior to blood ethanol testing.

One such study analyzed 56 paired venous blood samples from healthy volunteers for ethanol.² Prior to blood draw, each volunteer was swabbed with 70 percent isopropyl alcohol on one arm and saline on the other. There was no statistically significant difference between the groups. A more recent study involved swabbing alcoholic antiseptic (0.5 percent chlorhexidine, 70 percent ethanol) on both arms of 23 healthy volunteers and then collecting blood from each arm.³ The alcohol was not allowed to dry prior to phlebotomy on one arm, and it was properly dried using a cotton ball prior to blood draw on the other arm. In both sets of samples, the ethanol concentrations were undetectable by an enzymatic assay and a reference gas chromatography method. Based on these studies, it is unlikely that use of an alcohol swab will affect the results of an ETOH blood test.

1. Yigit O, Arslan S. Swabbing skin with alcohol could change the blood alcohol level significantly. J Emerg Med. 2012;
43(4):718–719.
2. Tucker A, Trethewy C. Lack of effect on blood alcohol level of swabbing venipuncture sites with 70% isopropyl alcohol. Emerg Med Australas. 2010;22(1):9–12.
3. Lippi G, Simundic AM, Musile G, Danese E, Salvagno G, Tagliaro F. The alcohol used for cleansing the venipuncture site does not jeopardize blood and plasma alcohol measurement with head-space gas chromatography and an enzymatic assay. Biochem Med (Zagreb). 2017;27(2):398–403.

William Clarke, PhD, MBA, DABCC
Director, Clinical Toxicology, Johns Hopkins Hospital
Professor of Pathology, 
Johns Hopkins University School of Medicine 
Baltimore
Member, CAP Toxicology Committee

In this “Best of Q&A” series, we reprint select coagulation-related questions and answers. All have been chosen for their timeliness and relevance today. The following question and answer were published in November 2015.

Q. Is there a recommended procedure for or reference article about checking APTT reagent sensitivities (for the identification of factors VIII and IX) when changing lot numbers and reference range?