Children

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Childrens Hospital Sexual Assault Kit

• Robert A Shapiro, MD
• Charles J Schubert, MD
• Patricia A Myers, MSW
• Childrens Hospital Medical Center
• Cincinnati, Ohio
• 513-636-7966

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Childrens Hospital Medical Center

• Childrens Hospital
• 300 Beds
• Emergency Department
• 90,000 visits/year
• Sexual Abuse Evaluations
• 900 / year

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Problems with existing kits

• Instructions
• too verbose, not followed
• difficult to comply with in a busy ED
• air drying specimens
• not correct for pre-pubertal children
• specimen collection and exam techniques differ
• Supplies
• not applicable to pre-pubertal children

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Rape Kit Design Objectives

• One kit for all victims
• newborn to 21 years old
• Self guided, clear instructions
• Efficient
• Excellent specimen collection/storage
• Accurate documentation/chain of evidence

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CHMC Rape Kit

• Designed with Coroners lab serologist
• addressed existing problems
• limited specimen collection to essentials
• Written for victims from newborn - 21 y/o
• Text clear, short, illustrated
• printed on collection envelopes and bags
• On-site tested prior to implementation

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What was left out

• Debris collection
• Routine finger nail scraping
• Plucked hair

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Chain of Evidence

• secured to outside of box
• of evidence containers
• duplicate form
• unambiguous chain
• clear instructions

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Instructions taped onto a large brown bag
OUTER CLOTHING
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Directions Place into this bag, any of the
patient's clothing that is stained with blood,
semen or saliva. Seal the bag using one sealing
tape ( tape can be found in the box )
o
COLLECTED
o
NONE TO COLLECT
list the clothing articles collected below
1)
2)
3)
Step 1
4)
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Instructions taped onto a small bag
UNDERWEAR
COLLECT FROM ALL PATIENTS
addressograph stamp
Directions Place patient's underwear into this
bag. Seal the bag using one sealing tape (tape
can be found in the box).Collect even if
patient has changed underwear since the assault.


Step 2
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• Saliva specimen
• complete instructions on envelope
• proper specimen handling labeling
• self sealing envelope

SALIVA SPECIMEN FOR SECRETOR STATUS
COLLECT FROM ALL PATIENTS
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Using exam gloves, pick up the enclosed filter
paper.Do not touch the filter paper with your
bare hands.Ask the patient to moisten an area
with his/her tongue.Indicate the dampened area
with a pen (see diagram).Place the moistened
filter paper into this envelope.
Contents 2x2 piece of filter paper

Step 3
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• Oral specimens
• instructions for collection
• cultures also done at this time
• specimen handling

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• Stain collection
• moist gauze used for collection
• explanation of Woods lamp use
• body location documentation

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• Rectal specimens
• instructions for collection
• cultures also done at this time
• specimen handling

RECTAL SPECIMEN FOR SEMEN
COLLECT FROM ALL PATIENTS
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Procedure one Lightly moisten BOTH swabs with
sterile saline and insert them into patient's
rectum.Wait 5-10 seconds, withdraw swabs and
then place both swabs into this
envelope. Procedure two Rectal cultures for GC
and chlamydia should be obtained at this time
when indicated. Use new, separate swabs for each
culture and discard these swabs after inoculating
the culture media. Send cultures to the CHMC
lab. DO NOT place cultures into the evidence box.


Step 6
Contents 2 large cotton tipped swabs
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• Perpetrator Hair Collection
• adolescent procedure
• pre-adolescent procedure

COLLECT PUBIC HAIRS
addressograph stamp
COMBED HAIRS (adolescent victim) STRAY HAIRS (if
found on the pre-adolescent victim)
Adolescent patient Place the enclosed paper
towel under the patient's buttocks.Comb pubic
hair onto the towel with the enclosed comb.Wrap
comb in the paper towel and place the wrapped
towel into this envelope. Pre-adolescent patient
If stray hairs are found near the child's
genitalia or rectum, collect them and wrap the
hairs in the paper towel. Place the wrapped
towel into this envelope.If hairs were not
found, do not return the towel to this envelope.

Contents paper towelcomb
Step 7
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• Patient Hair Collection
• adolescent victim only

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• Genital specimens
• adolescent / pre-adolescent / sex
• semen collection (internal Vs. external)
• cultures (endocervix Vs. mucosa)

GENITAL SPECIMEN FOR SEMEN
COLLECT FROM ALL PATIENTS
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Procedure one If adolescent female, use BOTH
enclosed swabs to collect vaginal secretions. If
male or a pre-pubertal female, lightly moistened
the enclosed gauze with sterile saline swab the
external genitalia. Return only used swabs or
used gauze into this envelope. Procedure two
Genital cultures for GC and chlamydia should be
obtained at this time when indicated.Culture the
vaginal mucosa in pre-pubertal children, and the
endocervix in adolescents.Use new, separate
swabs for each culture and discard these swabs
after inoculating the culture media. Send
cultures to the CHMC lab. DO NOT place cultures
into the evidence box.

Contents 2 large cotton tipped swabs2x2
sterile gauze
Step 9
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WET PREP FOR SPERM TRICHOMONAS
addressograph stamp
Using swabs and test tubes from this evidence
box, collect specimens for sperm and
Trichomonas.In females, collect a vaginal
specimen unless, because of the child's age,
collection would be traumatic.If semen is
suspected in the rectum, mouth or other sites,
obtain specimens from these areas as well.Place
each swab into a separate test tube, add sterile
saline to the tube to cover the tip of the swab.
Record the collection site onto each tube.
Carry red-topped tube(s) with the evidence box
STAT to the lab for sperm Trichomonas
examination.Remain in the lab with the specimens
until results have been recorded by the lab tech
in the spaces below.Any slides that show sperm
should be photographed by the lab tech, placed
into a cardboard slide holder,labeled, and
placed into the evidence box. Do not save
red-topped tubes.Photographs should be labeled
and kept with the medical record they should not
be put into the evidence box.

LAST STEP MD NOW COMPLETES THE REPORTING FORM
AND THE EVIDENCE FORMRN CHECKS THAT BOX IS
COMPLETE AND TRANSFERS BOX TO PROTECTIVE SERVICES
( see box lid
Step 10
The following can be found in this evidence box
red-topped tubes, cotton tipped swabs vial of
saline
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Checklist taped onto the inside lid of the
evidence box

• Prior to sealing the Assault Kit
• items to include
• items to exclude

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Evidence Formincluded in the evidence box

• General Instructions
• Check list Assault History
• Check list Victim History
• Summary Exam findings
• Check list Discharge instructions