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• Regulatory bodies for clinical laboratories

  • US Department of Labor's Occupational Safety and Health Administration (OSHA)
  • Clinical and Laboratory Standards Institute (CLSI)
  • Centers for Disease Control and Prevention (CDC)
  • College of American Pathologist (CAP)
  • Joint Commission International Accreditation (JCIA) formerly Joint Commission on Accreditation of Healthcare Organization (JCAHO)
• BHFS is the accrediting body for the hospitals
• St. Lukes QC BGC is a medical city
• Non profit education organization providing a forum for development, promotion and use of national and international standards


  Part of the US Department of Health and Human Services Public Health Services
• Required PPE


  1. Laboratory coat and gloves must be worn when handling body fluids

  2. Mask and goggles or face shields should be worn when appropriate
• To minimize aerosol


  1. Specimen needing centrifugation are capped and placed into a centrifuge with a sealed dome

  2. A gauze square is used when opening rubber-stoppered test tubes to minimize aerosol production

  3. Autodilutors or safety bulbs are used for pipetting. Pipetting of any clinical material by mouth is strictly forbidden
• Standard precautions (according to CDC)

  All human blood and other body fluids are treated as potentially infectious for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other blood-bored microorganisms that can cause disease in humans
• Infectious diseases that can be transmitted

  • HIV
  • Hepatitis B
  • Hepatitis C
  • Malaria
  • Syphilis
• Protective Techniques for Infection Control

  1. Use sterile gloves for procedures involving contact with normally sterile areas of the body or during procedures where sterility has been established and must be maintained. Use non sterile examination gloves for procedure that do not require the use of sterile gloves

  2. Wear gloves when processing blood specimens, reagents or blood products including reagent red blood cells

  3. Do not wash or disinfect latex or vinyl gloves for reuse. Rubber gloves maybe decontaminated and reused but disinfectant may cause deterioration
• Proper donning and removal of PPE

  1. Donning: Gown, Hair cap, Shoe cover, Mask, Goggles, Gloves

  2. Removal: Gloves, Goggles, Gown, Hair cap, Shoe cover, Mask
• Handwashing


  The most important way to prevent cross contamination and the spread of the disease
• Handwashing procedure


  1. Wet your hands with clean, running water (warm or cold), turn off the tap and apply soap

  2. Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers and under your nails

  3. Scrub your hands for at least 20 seconds (happy birthday song twice)

  4. Rinse your hands well under clean running water

  5. Dry your hands using clean towel
• Disposal of Biohazards


  1. All non-disposable pipettes should be soaked in 10% bleach solution between washings. All disposable pipettes should be disposed of in the proper containers with a biohazard symbol on the container

  2. Paper or gauze that is contaminated with body fluids should be placed in a container that is marked biohazard so it can be either incinerated or autoclaved

  3. When the contaminated bags are full, they must be placed in another biohazard bag. This is termed double bagging. The bags must be securely fastened at the top

  4. There are special containers for broken galls and sharps. Sharps are defined as all material with sharp or jagged edges, such as needles, syringes, lancets, pipettes, broken glass, and slides. These containers are rigid and disposable and are marked with the biohazard symbol
• Proper soiled gloves removal

  1. Grasp the gloves to be removed on the palm side of your hand just below the cuff, being careful not to touch bare skin on your wrist

  2. Pull the glove off by rolling it inside out. As you continue to roll up with your fingers of the gloved hand, place the two fingers of your bare hand inside the cuff of the second glove

  3. Pull the second glove off turning it inside out over the first glove

  4. Touching only the inside surface of the glove removed in step 3, dispose the glove appropriately

  5. Wash your hands
• Decontamination of work surfaces, equipment and spills

  1. While wearing gloves, all work surfaces should be cleaned and sanitized at the beginning and end of work with a 1:10 dilution of household bleach

  2. Disposable materials contaminated with blood must be placed in containers marked "biohazard" and properly discarded
• Managing spills in a clinical laboratory

  1. Wear gloves and a laboratory coat

  2. Absorbs the blood with disposable towels. Bleach solutions are less effective in the presence of high concentration of protein

  3. Using a diluted bleach (1:10) solution, clean the spill site of all visible blood

  4. Wipe down the spill site with paper towels soaked with diluted bleach

  5. Place all disposable materials used for decontamination into a biohazard container
• Disposal of infectious laboratory waste

  • Orange
  • Orange and black
  • Red
• Modes of transmission of infectious diseases


  • Occupational
  • Environmental
  • Accidental
  • Injection
  • Ingestion
  • Inhalation

  
• Prevention of infectious diseases


  • Proper hand hygiene is the best way to break the chain of infection
  • Proper waste disposal must be labelled with BIOHAZARD SYMBOL
• Colour coding for waste disposal

  • Black - Non infectious waste/ general waste
  • Red - Infected waste (recyclable)
  • Yellow - Infected waste (anatomical waste)
  • Blue - Sharp waste (recyclable)
  • White - Sharp waste
  • Black with radioactive symbol - Radioactive waste
  • Green - food waste
• Chemical Hazards (Chemical Spills)

  • BEST FIRST AID: Flush the area with large amounts of water for at least 15 mins then seek medical attention
  • Do not neutralize chemicals that come in contact with the skin
  • Disinfection of contaminated table tops/ working area using 1:5 or 1:10 dilution should be performed daily (stored in plastic bottles protected from light can be effective for 1 month)
• NFPA HAZARDOUS MATERIALS CLASSIFICATION

  Yellow Quadrant: Reactive/ Stability Hazard

  Blue Quadrant: Health Hazard

  Red Quadrant: Flammability Hazard

  White Quadrant: Specific Hazard

  
• Radioactive hazards present a danger to the fetus during pregnancy
• Electrical Hazards


  • Ungrounded or wet equipments, frayed cords
  • Do not operate equipment with wet hands
  • All electrical equipment must be grounded with three-pronged plugs
  • If electrical shock occurs, never touch the person or the equipment involved. Turn off the circuit breaker, unplug the equipment, move the equipment using a nonconductive glass or wood object
• Fire/Explosive hazards


  1. Flammable chemicals should be stored in safety cabinets and explosion-proof refrigerators

  2. When fire is discovered: R-A-C-E

  3. To operate a fire extinguisher: P-A-S-S
• Physical hazards require precautionary measures
• Quiz next Friday! Online go items
• Phases of analysis in the laboratory

  1. Preanalytical

  2. Analytical

  3. Post Analytical
• Preanalytical phase


  Any process involved with collecting and handling the specimen prior to analysis
• Analytical phase


  The processes involved in the actual specimen analysis
• Post Analytical phase


  How data is assessed and reported after analysis
• In the clinical setting, the pre-analytical phase is where the majority of errors occur
• Specimen procurement


  The gathering of any laboratory specimen in a safe and appropriate manner
• Specimen procurement


  • Consider any special conditions to ensure the specimen's integrity
  • Temperature requirements
  • Special containers
  • Special fluids (10% neutral buffered formalin for tissues)
• Phlebotomy


  The process of drawing blood
• Hippocrates (460 - 377 BC)


  Theory - disease was the result of excess substances in the body, remove excess to restore balance
• Phlebotomy


  • Ridding body of evil spirits
  • Cleansing body of impurities
  • Bringing body back into balance
• Blood letting practices


  • Egypt 1400 BC - painting on tomb walls shows applications of leeches
  • Middle ages - Barber Surgeons with blood letting as their specialty
  • 17th and 18th century - Phlebotomy thought of as a major therapeutic process
• George Washington's death in 1799 was likely due to excessive phlebotomy
• Leeches


  • Localized blood letting
  • Hirudo Medicinalis - European medicinal leech
  • Engorges with blood and drops off skin
  • Used today to reduce hemostatic swelling after microsurgery
  • Saliva has vasodilator, anesthetic and anticoagulant (hirudin)