AUBF LECTURE
OUR LADY OF FATIMA UNIVERSITY
CSMLS
PRELIMS 2. Urine contains information, which can be obtained by
LESSON 1: HISTORY, inexpensive laboratory tests, about many of the body’s
QA/QC AND SAFETY IN major metabolic functions
THE CLINICAL LABORATORY
CLSI defines urinalysis as:
“The testing of urine with procedures commonly performed
INTRODUCTION in an expeditious, reliable, accurate, safe, and cost-
Analyzing urine was actually the beginning of laboratory effective manner.”
medicine.
Reasons for performing urinalysis identified by CLSI
PHYSICAL EVIDENCE include:
Drawings of cavemen aiding in the diagnosis of disease
Egyptian hieroglyphics screening asymptomatic populations for undetected
disorders
BASIC OBSERVATION: monitoring the progress of disease and the effectiveness of
Color therapy
Turbidity
Odor QUALITY CONTROL AND
Volume QUALITY ASSESSMENT
Viscosity DEFINITION
Sweetness Quality Assessment - refers to the overall process of
guaranteeing quality patient care and is regulated
INTRODUCTION throughout the total testing system.
modern urinalysis has expanded beyond physical Quality system - refers to all of the laboratory’s policies,
examination of urine include: processes, procedures, and resources needed to achieve
o chemical analysis quality testing.
o microscopic examination
Quality Assessment program includes:
HISTORY Testing of controls
5th century BC – Hippocrates wrote a book on “uroscopy.” Pre-analytical factors
1140 AD - color charts had been developed that described Analytical factors
the significance of 20 different colors. Post-analytical factors
1627 - Thomas Bryant published a book about “pissed
prophets.” o QA is the continual monitoring of the entire test process
1694 - Frederik Dekkers discover albuminuria. from test ordering and specimen collection through
17th century - invention of the microscope reporting and interpreting results.
1827- concept of urinalysis as part of a doctor’s routine
patient examination LIST OF LABORATORY ACCREDITATION
AGENCIES:
Joint Commission on the Accreditation of Healthcare
Organizations
College of American Pathologists
American Association of Blood Banks
American Osteopathic Association
American Society of Histocompatibility and
Immunogenetics
Commission on Laboratory Assessment
URINALYSIS PROCEDURE MANUAL
A procedure manual containing all the procedures
performed in the urinalysis section must be available and
must comply with the CLSI guidelines.
The following information is included for each procedure
clinical significance
patient preparation
specimen type
method of collection
1930 - Urinalysis began to disappear from routine specimen acceptability and criteria for rejection
examinations. Reagents
step-by-step procedure
Two unique characteristics of a urine specimen recording of results
1. Urine is a readily available and easily collected specimen
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PREANALYTICAL FACTORS QC procedures are performed to ensure that acceptable
Specific information on specimen collection and handling standards are met during the process of patient testing.
should be stated at the beginning of each procedure. Control results must be recorded in a log, either paper or
electronic.
REQUISITION FORM CONTENT:
Actual date and time TYPE OF QUALITY CONTROL
Preservation technique EXTERNAL QUALITY CONTROL
Time received and performed Are used to verify the accuracy and precision of a test and
Tests requested are exposed to the same conditions as the patient samples.
Patient identification External controls are tested and interpreted in the
laboratory by the same person performing the patient
testing.
INTERNAL QUALITY CONTROL
Consists of internal monitoring systems built in to the test
system.
ANALYTICAL FACTORS
The analytical factors are the processes that directly affect
the testing of specimens.
o It include:
reagents Competency of Personnel and Facilities
Instrumentation Quality control is only as good as the personnel performing
Procedure and monitoring it.
QC Personnel must understand the importance of QA.
Competency of personnel performing the tests Documentation of continuing education must be
maintained.
Reagents
An adequate, uncluttered, safe working area is also
All reagents and reagent strips must be properly labeled essential for both quality work and personnel morale.
with the date of preparation or opening, purchase and
received date, expiration date, and appropriate safety
POST-ANALYTICAL FACTORS
information.
Postanalytical factors are processes that affect the
Reagents are checked daily or when tests requiring their
reporting of results and correct interpretation of data.
use are requested
It include:
INSTRUMENTATION AND EQUIPMENT Reporting of Results
The most frequently encountered instruments: o Standardized reporting formats
o Refractometers o Electronic transmission is now the most common
o Osmometers method for reporting results.
o Automated reagent strip readers Interpretation of Results
o Automated microscopy instruments
o All known interfering substances should be listed for
o Refrigerators
evaluation of patient test data.
o Centrifuges
o Microscopes
o Water baths.
Procedure
concise testing instructions are written in a step-bystep
manner
Quality Control
Refers to the materials, procedures, and techniques that
monitor the accuracy, precision, and reliability of a
laboratory test.
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BIOLOGICAL HAZARDS
The health-care setting provides abundant sources of
potentially harmful microorganisms.
Understanding how microorganisms are transmitted is
essential in preventing infection.
The CHAIN OF INFECTION is a continuous link between a
source, a method of transmission, and a susceptible host.
Preventing completion of the chain of infection is a primary
objective of biological safety.
Proper handwashing and wearing personal protective
equipment are important.
In 1987 the CDC instituted Universal Precautions.
SAFETY IN THE CLINICAL
LABORATORY
INTRODUCTION
The clinical laboratory contains a variety of safety hazards, UNIVERSAL PRECAUTIONS
many of which are capable of producing serious injury or
Under UP all patients are considered to be possible carriers
life threatening disease.
of blood-borne pathogens.
To work safely in the laboratory you must learn: o guideline recommends:
o hazards exist wearing gloves in collection of specimen
o basic safety precautions wearing face shields (mask)
o How to apply the basic rules of COMMON SENSE Puncture resistant containers.
required for everyday safety.
BSI GUIDELINES
TYPES OF SAFETY HAZARDS
Consider all body fluids and moist body substances to be
TYPE SOURCE POSSIBLE INJURY
potentially infectious.
Biological Infectious agents Bacterial, fungal,
o guideline recommends:
viral, or parasitic
Wear gloves at all times
infections
Do not require hand washing following removal of
Sharps Needles, lancets, Cuts, punctures,
gloves unless visual contamination is present.
broken glass or blood-borne
pathogen
BIOLOGICAL HAZARDS
exposure In 1996 the CDC create the new guideline called
Chemical Preservatives and Exposure to toxic, STANDARD PRECAUTIONS.
reagents carcinogenic, or Standard Precautions are as follows
caustic agents Handwashing
Gloves
Radioactive Equipment and Radiation
Mask, eye protection, and face shield
radioisotopes exposure
Laboratory Gown
Electrical Ungrounded or Burns or shock
Patient care equipment
wet equipment;
Environmental control
frayed cords
Linen
Fire/Explosive Bunsen burners, Burns or Occupational health and blood-borne pathogens
organic chemicals dismemberment Patient placement
Physical Wet floors, heavy Falls, sprains, or
boxes, patients strains
The Occupational Exposure to Blood-Borne Pathogens
Standard is a law monitored and enforced by OSHA.
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Specific requirements of this OSHA standard include the CHEMICAL HANDLING
following: Chemicals should never be mixed together unless specific
o 1. Requiring all employees to practice UP/Standard instructions are followed and they must be added in the
Precautions order specified.
o 2. Providing PPE to employees
o 3. Providing sharps disposal containers and prohibiting CHEMICAL HYGIENE PLAN
recapping of needles Required by OSHA
o 4. Prohibiting eating, drinking, smoking, and applying
cosmetics, lip balm, and contact lens in the work area Purpose of the plan:
o 5. Labeling all biohazardous material and containers o 1. Appropriate work practices
o 6. free immunization for HBV o 2. Standard operating procedures
o 7. daily disinfection protocol for work surfaces o 3. PPE
o 8. Providing medical follow-up for employees who have o 4. Engineering controls (fume hoods, safety cabinets,
been accidentally exposed to blood-borne pathogens etc…)
o 9. Documenting regular training in safety standards for o 5. Employee training requirements
employees. o 6. Medical consultation guidelines
PERSONAL PROTECTIVE EQUIPMENT CHEMICAL LABELING
PPE includes: o Hazardous chemicals should be labeled with a
o gloves description of their particular hazard.
o fluid-resistant gowns o The NFPA has developed the Standard System for the
o goggles and mask Identification of the Fire Hazards of Materials
o This symbol system is used to inform fire fighters of the
HANDWASHING hazards they may encounter with fires in a particular
Hand contact is the primary method of infection area.
transmission.
Correct hand washing technique includes the following
steps:
o 1. Wet hands with water
o 2. Apply soap
o 3. Rub to form a lather, create friction, and loosen
debris.
o 4. Clean between fingers, including thumbs, under
fingernails and rings, and up to the
o wrist, for at least 15 seconds.
o 5. Rinse hands in a downward position
o 6. Dry with a paper towel
o 7. Turn off faucets with a clean paper towel
DISPOSAL OF BIOLOGICAL WASTE
All biological waste, except urine, must be placed in
appropriate containers labeled with the biohazard symbol.
The waste is then decontaminated following institutional
policy.
o (Example. incineration, autoclaving etc…)
Urine may be discarded by pouring it into a laboratory sink.
Disinfection of the sink using sodium hypochlorite should be MATERIAL SAFETY DATA SHEETS
performed daily. The OSHA Federal Hazard Communication Standard
requires that all employees have a right to know about all
SHARP HAZARDS chemical hazards present in their workplace.
All sharp objects must be disposed in puncture resistant Information contained in an MSDS includes the following:
containers. o 1. Physical and chemical characteristics
Puncture-resistant containers should be conveniently o 2. Fire and explosion potential
located within the work area o 3. Reactivity potential
o 4. Health hazards and emergency first aid procedures
CHEMICAL HAZARDS o 5. Methods for safe handling and disposal
Every chemical in the workplace should be presumed
hazardous. RADIOACTIVE HAZARDS
Radioactivity is encountered when procedures using
CHEMICAL SPILLS radioisotopes are performed.
flush the area with large amounts of water for at least 15 The amount of radiation exposure is related to a
minutes and seek medical attention combination of time, distance, and shielding.
Contaminated clothing should be removed as soon as Exposure to radiation during pregnancy presents a danger
possible. to the fetus
Chemical spill kits should be always available for cleaning
up spills. PRECAUTIONS:
Equipment should not be operated with wet hands.
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Equipment that has become wet should be unplugged and
allowed to dry completely before reusing.
Equipment also should be unplugged before cleaning.
What to do when electrical shock occurs?
o electrical source must be removed immediately
o Turning of the circuit breaker
o Unplugging the equipment
o Use of nonconductive material to move the equipment.
FIRE/EXPLOSIVE HAZARDS
JCAHO requires that all health-care institutions post
evacuation routes and detailed plans to follow in the event
of a fire.
o Rescue
o Alarm
o Contain
o Extinguish
PRECAUTIONS:
Flammable chemicals should be stored in safety cabinets
Explosion-proof refrigerators and cylinders of compressed
gas should be located away from heat and securely
fastened to prevent accidental capsizing.
Fire blankets should be present in the laboratory.
The NFPA classifies fires with regard to the type of burning
material.
FIRE EXTINGUISHING TYPE OF EXTINGUISHER
TYPE MATERIAL FIRE/COMPOSITION
OF FIRE
CLASS A Wood, paper, Class A Water
clothing
CLASS B Flammable Class B Dry chemicals,
organic carbon
chemicals dioxide, foam,
or halon
CLASS C Electrical Class C Dry chemicals,
carbon
dioxide, or
halon
CLASS D Combustible None Sand or dry
metals powder
Class ABC Dry chemicals
It is important to be able to operate the fire extinguishers.
REMEMBER PASS
o Pull
o Aim
o Squeeze
o Sweep
GENERAL PRECAUTIONS:
Avoid running in rooms and hallways
Watch for wet floors
Bend the knees when lifting heavy objects
Keep long hair pulled back
Avoid dangling jewelry
Maintain a clean and organized work area.
Wear closed-toe shoes
