1. OSHA defines workplace safety standards and ensures health and safety of employees through enforcing regulations, training, inspections, and fines for deficiencies. A key responsibility of medical offices is following proper procedures for hazardous materials, waste disposal, and incident reporting.
2. Proper use of personal protective equipment, biohazard disposal, spill clean-up, and housekeeping are important for maintaining a safe work environment and complying with OSHA guidelines. Any accidents or unusual occurrences require immediately notifying supervisors and completing a written incident report.
3. Medical assistants play an important role in ensuring laboratory safety through following procedures for specimen collection and handling, record management, use of personal protective equipment, and communicating testing instructions to patients
Aseptic Garbing, Hand Washing, and Gloving Kdurant36
The document provides an overview of aseptic garbing, hand washing, and gloving procedures according to USP Chapter <797> guidelines. It discusses learning objectives, topics that will be covered, and the importance of maintaining asepsis when preparing sterile compounded products. Specific procedures covered include self-assessment, use of personal protective equipment like gowns and gloves, essential supplies, and designated areas for aseptic hand washing. The goal is to avoid introducing pathogens while protecting both patients and healthcare workers.
The document discusses health and safety best practices for school laboratories, including identifying hazards, implementing engineering and administrative controls like proper ventilation and training, using personal protective equipment, complying with OSHA regulations, and properly handling chemical storage, waste disposal, and emergency situations. Maintaining a safe lab requires assessing hazards, having appropriate safety equipment and training procedures, and properly managing chemical inventory, storage, and disposal.
Wayne State University Laboratory Safety TrainingElena Fracassa
This training addresses basic laboratory safety issues for WSU labs and is required annually for all laboratory faculty, staff, and students working with hazardous chemicals.
Topics covered:
Contents of the OSHA Lab Standard (29 CFR 1910.1450)
WSU Chemical Hygiene Plan
Physical and health hazards of chemicals
Safety equipment in the laboratory
Safe handling and storage of chemicals
Hazard Communication & Global Harmonization System of Classifying & Labeling Chemicals
Safety Data Sheets
Personal Protective Equipment
Explanation of EPA, MDEQ, and DOT regulations
Explanation of the WSU Emergency Contingency Plan
Lab responsibilities as a hazardous waste generators
Definitions of hazardous waste
Procedures for collection, labeling, storage and removal of waste
Responding to injuries, spills, fires, and other emergencies in the lab
Flash sterilization is a last resort sterilization method used when there is insufficient time to sterilize an item through standard methods. It is not recommended for implantable devices due to risk of infection, but may be unavoidable in some cases. Proper recordkeeping is essential when flash sterilizing implantable devices.
Various low-temperature sterilization technologies have been explored as alternatives to ethylene oxide (EO) due to environmental regulations and health concerns. Acceptable alternative technologies include 100% EO, EO with different stabilizing gases, hydrogen peroxide gas plasma, and peracetic acid. No technology is ideal for all devices and understanding limitations is important for proper application.
EO
The document discusses proper care and maintenance of medical equipment used for patient care. It emphasizes that all equipment must be thoroughly cleaned and disinfected or sterilized between each use to prevent transmission of infections. General principles include cleaning equipment to remove organic matter, keeping items clean and in working order, following manufacturer's instructions for appropriate disinfectants, and storing equipment in a clean, dry location. Proper maintenance such as periodic calibration and repairs is important to ensure safe and effective use of medical devices.
This document discusses various topics relating to facility safety management. It addresses the importance of providing appropriate safety gear for employees, clearly identifying dangerous areas, ensuring visibility in low-light areas, proper protective equipment for electrical work, availability of first aid kits, risks of cell phone use and confined spaces. Requirements are outlined for eye wash stations, emergency showers, and safely operating aerial work platforms. The overall message is the importance of identifying hazards and ensuring proper safety protocols, training and equipment are in place to prevent workplace injuries.
Lab safety and regulations by dr.brahmesh, PG BIOCHEMISTRY, AMC, VIZAG, AP, I...Guntamukkala Brahmayesu
This document discusses laboratory safety regulations and guidelines. It outlines the responsibilities of both employers and employees to maintain a safe work environment. Some of the main hazards identified in clinical laboratories include chemicals, biological specimens, fires, electricity, and compressed gases. The document recommends various safety practices and use of personal protective equipment. It also describes U.S. regulations regarding occupational safety, including OSHA, and guidelines from organizations like NIOSH, NFPA, and NCCLS. Biological safety practices for handling infectious specimens are emphasized.
Glycolic Acid causes severe skin burns and eye damage.It is also known as Hydroxyethanoic Acid . Use protective gloves, protective clothing , eye protection while working on it .For more information,Visit: http://www.silverfernchemical.com/
Aseptic Garbing, Hand Washing, and Gloving Kdurant36
The document provides an overview of aseptic garbing, hand washing, and gloving procedures according to USP Chapter <797> guidelines. It discusses learning objectives, topics that will be covered, and the importance of maintaining asepsis when preparing sterile compounded products. Specific procedures covered include self-assessment, use of personal protective equipment like gowns and gloves, essential supplies, and designated areas for aseptic hand washing. The goal is to avoid introducing pathogens while protecting both patients and healthcare workers.
The document discusses health and safety best practices for school laboratories, including identifying hazards, implementing engineering and administrative controls like proper ventilation and training, using personal protective equipment, complying with OSHA regulations, and properly handling chemical storage, waste disposal, and emergency situations. Maintaining a safe lab requires assessing hazards, having appropriate safety equipment and training procedures, and properly managing chemical inventory, storage, and disposal.
Wayne State University Laboratory Safety TrainingElena Fracassa
This training addresses basic laboratory safety issues for WSU labs and is required annually for all laboratory faculty, staff, and students working with hazardous chemicals.
Topics covered:
Contents of the OSHA Lab Standard (29 CFR 1910.1450)
WSU Chemical Hygiene Plan
Physical and health hazards of chemicals
Safety equipment in the laboratory
Safe handling and storage of chemicals
Hazard Communication & Global Harmonization System of Classifying & Labeling Chemicals
Safety Data Sheets
Personal Protective Equipment
Explanation of EPA, MDEQ, and DOT regulations
Explanation of the WSU Emergency Contingency Plan
Lab responsibilities as a hazardous waste generators
Definitions of hazardous waste
Procedures for collection, labeling, storage and removal of waste
Responding to injuries, spills, fires, and other emergencies in the lab
Flash sterilization is a last resort sterilization method used when there is insufficient time to sterilize an item through standard methods. It is not recommended for implantable devices due to risk of infection, but may be unavoidable in some cases. Proper recordkeeping is essential when flash sterilizing implantable devices.
Various low-temperature sterilization technologies have been explored as alternatives to ethylene oxide (EO) due to environmental regulations and health concerns. Acceptable alternative technologies include 100% EO, EO with different stabilizing gases, hydrogen peroxide gas plasma, and peracetic acid. No technology is ideal for all devices and understanding limitations is important for proper application.
EO
The document discusses proper care and maintenance of medical equipment used for patient care. It emphasizes that all equipment must be thoroughly cleaned and disinfected or sterilized between each use to prevent transmission of infections. General principles include cleaning equipment to remove organic matter, keeping items clean and in working order, following manufacturer's instructions for appropriate disinfectants, and storing equipment in a clean, dry location. Proper maintenance such as periodic calibration and repairs is important to ensure safe and effective use of medical devices.
This document discusses various topics relating to facility safety management. It addresses the importance of providing appropriate safety gear for employees, clearly identifying dangerous areas, ensuring visibility in low-light areas, proper protective equipment for electrical work, availability of first aid kits, risks of cell phone use and confined spaces. Requirements are outlined for eye wash stations, emergency showers, and safely operating aerial work platforms. The overall message is the importance of identifying hazards and ensuring proper safety protocols, training and equipment are in place to prevent workplace injuries.
Lab safety and regulations by dr.brahmesh, PG BIOCHEMISTRY, AMC, VIZAG, AP, I...Guntamukkala Brahmayesu
This document discusses laboratory safety regulations and guidelines. It outlines the responsibilities of both employers and employees to maintain a safe work environment. Some of the main hazards identified in clinical laboratories include chemicals, biological specimens, fires, electricity, and compressed gases. The document recommends various safety practices and use of personal protective equipment. It also describes U.S. regulations regarding occupational safety, including OSHA, and guidelines from organizations like NIOSH, NFPA, and NCCLS. Biological safety practices for handling infectious specimens are emphasized.
Glycolic Acid causes severe skin burns and eye damage.It is also known as Hydroxyethanoic Acid . Use protective gloves, protective clothing , eye protection while working on it .For more information,Visit: http://www.silverfernchemical.com/
The document provides guidelines for infection prevention and occupational health programs at the Faculty of Dentistry, October 6 University. It outlines policies for developing and maintaining infection prevention programs, including having training for staff on standard precautions, exposure risks, and proper use of personal protective equipment. It also details procedures for sterilizing dental instruments, cleaning the clinical environment, and managing exposures to infectious materials to minimize risk of disease transmission.
This document provides a safety manual for laboratory workers. It introduces potential hazards in laboratories including chemical, biological, physical and ergonomic risks. The manual aims to ensure all laboratory staff follow safety procedures to protect themselves, others in the laboratory, and the external environment from infectious materials. It applies to all personnel working in medical laboratories and provides policies on general safety practices, such as wearing protective equipment and properly handling specimens and hazardous materials. The responsibilities of safety officers and all laboratory staff are outlined.
This document provides training on bloodborne pathogens for officers at the Plant City Police Department. It defines bloodborne pathogens as disease-causing microorganisms that may be present in human blood and can be transmitted through exposure to blood or other potentially infectious materials. The two most significant pathogens discussed are Hepatitis B and HIV. The document outlines universal precautions officers should take to prevent exposure, such as wearing gloves and washing hands. Proper procedures are described for handling evidence, cleaning contaminated areas, and documenting any exposure incidents.
General Laboratory Safety Training covers important safety procedures for handling chemicals, reading labels and MSDS sheets, protective equipment, storage requirements, emergency responses, and more. Key points include reading all container labels, using correct PPE like gloves and goggles, following storage guidelines for incompatible chemicals, knowing emergency procedures, and consulting the chemical hygiene plan for specific safety protocols. Proper safety precautions are necessary for protecting yourself and others from potential hazards in the laboratory.
This document discusses infection control and asepsis procedures in a healthcare setting. It begins by describing the characteristics of pathogenic microorganisms and the chain of infection process. It then discusses the body's immune response mechanisms and types of infections. The document outlines OSHA standards for exposure control plans, potentially infectious materials, and protocols for disposal of biologic waste. It explains principles of asepsis including proper hand hygiene, and differentiates between sanitization, disinfection, and sterilization. The role of the medical assistant in maintaining asepsis to prevent transmission of infection is also summarized.
Infection Control Guidelines for Dental Clinics [compatibility mode]drnahla
Infection Control Guidelines for Dental Clinics
Infection Prevention in Dental Clinics
Dr. Nahla Abdel Kader.MD, PhD. Infection Control Consultant, MOH Infection Control Surveyor, CBAHI Infection Control Director,KKH.
This document provides information on needlestick injuries, splashes, and spill management for healthcare workers. It discusses that needlestick injuries occur most often during activities like recapping needles, blood draws, and giving injections. Needlesticks can transmit infections like hepatitis B, hepatitis C, and HIV. The document recommends always reporting injuries and using safety devices to prevent needlesticks. It also provides guidelines for managing minor blood spills and major spills, including wearing PPE and containing and cleaning spills properly. Splashes to the eyes or skin should be washed thoroughly and reported.
This document provides an overview of ampule-based preparations for sterile compounding. It defines what ampules are and how they are designed to break open at the neck. It outlines the safety procedures that must be followed when opening ampules, such as using a filter needle to remove any glass fragments. The document discusses the types of medications found in ampules and how they are administered. It also reviews the risks associated with parenteral preparations and ampule-based preparations specifically. Finally, it provides guidance on following USP Chapter <797> guidelines and understanding the necessary resources and supplies for working with ampules.
Bio medical waste management and handling rules 1998ARUNAYESUDAS
The document provides guidelines for managing hospital waste according to the World Health Organization. It discusses proper handling, storage, treatment, transport, and disposal of hospital waste. It emphasizes the importance of staff training, proper personal protective equipment, immunization, and monitoring worker health and safety to prevent injury and exposure when handling hospital waste.
Safety measures in clinical laboratory powerpointSamita Shrestha
This document discusses safety measures and procedures for clinical laboratories. It outlines standard precautions like wearing gloves and proper hand washing. Microorganisms are classified into 4 risk groups based on their pathogenic potential and consequences if exposed. Different biosafety levels are required depending on the risk group, with level 4 being the highest security. Proper decontamination methods include autoclaving, boiling, incineration, and use of chemical disinfectants like phenolics and alcohols.
Guideline on dead body management of covid 19Jonils Macwan
1. The document provides guidelines for handling dead bodies of COVID-19 cases, including standard precautions, removal from isolation, transportation, handling in the mortuary, autopsies, and procedures at crematoriums/burial grounds.
2. Key recommendations include wearing proper PPE, placing bodies in leak-proof body bags, disinfecting surfaces, avoiding non-essential autopsies or embalming, and allowing limited viewing and religious rituals at crematoriums while avoiding large gatherings or direct contact with the body.
3. Health workers handling bodies should be trained in infection control and properly use and dispose of PPE, disinfect equipment, and clean and dis
This document discusses various supplies used for sterile compounding, including needles, syringes, IV bags, vials, and ampules. It describes the components and proper use of these supplies, emphasizing that critical sites must be touched only with sterile tools to avoid contamination. Most sterile compounding procedures use a regular needle that is 1 1/2 inches long and syringes to withdraw or inject solutions.
This document discusses healthcare associated infections (HAIs) and standard precautions to prevent their transmission at Sandhills Endoscopy Center. It outlines objectives to understand what HAIs are, how to stop their spread, and the importance of following standard precautions protocols. The document reviews guidelines from the CDC and ASGE for using standard precautions like hand hygiene, personal protective equipment, cleaning equipment and the environment to minimize infection risks during GI procedures and within the endoscopy unit.
This document provides an overview of safety protocols at Sandhills Endoscopy Center. It discusses environmental safety hazards from equipment, chemicals, and physical hazards and how to properly clean and dispose of infectious materials. Electrical safety precautions are outlined for various medical devices. Chemical safety procedures include handling, storage, and spill protocols. The document also details disaster plans, code systems and emergency contacts for the facility. Patient, staff, and environmental safety are the top priorities at Sandhills Endoscopy Center.
This standard operating procedure summarizes the safety protocols for operating the BD FACSARIA III cell sorter. Personal protective equipment like gloves and safety glasses are required. Potential hazards include exposure to cells and electricity from deflection plates. The document provides detailed instructions on starting up and shutting down the device, installing nozzles, running tests and cleaning procedures. Waste disposal and emergency response procedures are also outlined.
The document discusses the importance and functions of the Central Sterile Supply Department (CSSD) in hospitals. It outlines the history and objectives of CSSDs, which aim to provide sterilized medical supplies from a central location. The optimal design principles are described, including workflow zones and layout. Key areas like cleaning, sterilization, storage and distribution are explained. Finally, the document provides an inventory of recommended equipment for setting up an ideal CSSD.
This document provides an overview of key laboratory safety topics, including:
- The hierarchy of controls for hazards and types of engineering, administrative and personal protective controls.
- Chemical, biological and physical hazards like noise, radiation and ergonomics. It outlines exposure limits and safety measures.
- Requirements for chemical hygiene plans, exposure monitoring, medical exams, hazard communication, and more.
- Best practices for working with research animals, managing change, conducting safety training, and chemical inventory control.
- Examples of incidents involving water-reactive chemicals and lack of proper protective equipment emphasize importance of compliance.
This document discusses the sterile compounding environment, including the setup and characteristics of anterooms and clean rooms. It describes the ISO classification levels for particulate matter in these areas and different types of hoods used for sterile compounding. USP Chapter <797> guidelines for hoods and the four risk levels for sterile compounding are also summarized.
Blood-borne pathogens present a risk of disease transmission to workers through contact with infected blood or bodily fluids. The presentation defines blood-borne pathogens as infectious microorganisms in human blood and other potentially infectious materials that can cause diseases. It identifies the main blood-borne pathogens as HIV, Hepatitis B, and Hepatitis C and discusses how they are transmitted occupationally through contact with mucous membranes, non-intact skin, or sharps injuries. The presentation outlines the key elements of protection against blood-borne pathogens as awareness, engineering and work practice controls, and personal protective equipment. It also describes the essential components of a blood-borne pathogen program for workplaces.
This document outlines basic laboratory safety procedures for a medical technology laboratory course. It covers standard operating procedures for personal protective equipment, safe handling of biological and hazardous materials, chemical and gas safety, radiation safety, fire safety, and electrical safety. Key points emphasized include wearing proper PPE like lab coats and gloves, adding acids to water, safe sharps disposal, labeling hazardous materials, separating oxidizing and flammable gases, and knowing emergency procedures for fires, spills, and accidents.
The document provides guidelines for infection prevention and occupational health programs at the Faculty of Dentistry, October 6 University. It outlines policies for developing and maintaining infection prevention programs, including having training for staff on standard precautions, exposure risks, and proper use of personal protective equipment. It also details procedures for sterilizing dental instruments, cleaning the clinical environment, and managing exposures to infectious materials to minimize risk of disease transmission.
This document provides a safety manual for laboratory workers. It introduces potential hazards in laboratories including chemical, biological, physical and ergonomic risks. The manual aims to ensure all laboratory staff follow safety procedures to protect themselves, others in the laboratory, and the external environment from infectious materials. It applies to all personnel working in medical laboratories and provides policies on general safety practices, such as wearing protective equipment and properly handling specimens and hazardous materials. The responsibilities of safety officers and all laboratory staff are outlined.
This document provides training on bloodborne pathogens for officers at the Plant City Police Department. It defines bloodborne pathogens as disease-causing microorganisms that may be present in human blood and can be transmitted through exposure to blood or other potentially infectious materials. The two most significant pathogens discussed are Hepatitis B and HIV. The document outlines universal precautions officers should take to prevent exposure, such as wearing gloves and washing hands. Proper procedures are described for handling evidence, cleaning contaminated areas, and documenting any exposure incidents.
General Laboratory Safety Training covers important safety procedures for handling chemicals, reading labels and MSDS sheets, protective equipment, storage requirements, emergency responses, and more. Key points include reading all container labels, using correct PPE like gloves and goggles, following storage guidelines for incompatible chemicals, knowing emergency procedures, and consulting the chemical hygiene plan for specific safety protocols. Proper safety precautions are necessary for protecting yourself and others from potential hazards in the laboratory.
This document discusses infection control and asepsis procedures in a healthcare setting. It begins by describing the characteristics of pathogenic microorganisms and the chain of infection process. It then discusses the body's immune response mechanisms and types of infections. The document outlines OSHA standards for exposure control plans, potentially infectious materials, and protocols for disposal of biologic waste. It explains principles of asepsis including proper hand hygiene, and differentiates between sanitization, disinfection, and sterilization. The role of the medical assistant in maintaining asepsis to prevent transmission of infection is also summarized.
Infection Control Guidelines for Dental Clinics [compatibility mode]drnahla
Infection Control Guidelines for Dental Clinics
Infection Prevention in Dental Clinics
Dr. Nahla Abdel Kader.MD, PhD. Infection Control Consultant, MOH Infection Control Surveyor, CBAHI Infection Control Director,KKH.
This document provides information on needlestick injuries, splashes, and spill management for healthcare workers. It discusses that needlestick injuries occur most often during activities like recapping needles, blood draws, and giving injections. Needlesticks can transmit infections like hepatitis B, hepatitis C, and HIV. The document recommends always reporting injuries and using safety devices to prevent needlesticks. It also provides guidelines for managing minor blood spills and major spills, including wearing PPE and containing and cleaning spills properly. Splashes to the eyes or skin should be washed thoroughly and reported.
This document provides an overview of ampule-based preparations for sterile compounding. It defines what ampules are and how they are designed to break open at the neck. It outlines the safety procedures that must be followed when opening ampules, such as using a filter needle to remove any glass fragments. The document discusses the types of medications found in ampules and how they are administered. It also reviews the risks associated with parenteral preparations and ampule-based preparations specifically. Finally, it provides guidance on following USP Chapter <797> guidelines and understanding the necessary resources and supplies for working with ampules.
Bio medical waste management and handling rules 1998ARUNAYESUDAS
The document provides guidelines for managing hospital waste according to the World Health Organization. It discusses proper handling, storage, treatment, transport, and disposal of hospital waste. It emphasizes the importance of staff training, proper personal protective equipment, immunization, and monitoring worker health and safety to prevent injury and exposure when handling hospital waste.
Safety measures in clinical laboratory powerpointSamita Shrestha
This document discusses safety measures and procedures for clinical laboratories. It outlines standard precautions like wearing gloves and proper hand washing. Microorganisms are classified into 4 risk groups based on their pathogenic potential and consequences if exposed. Different biosafety levels are required depending on the risk group, with level 4 being the highest security. Proper decontamination methods include autoclaving, boiling, incineration, and use of chemical disinfectants like phenolics and alcohols.
Guideline on dead body management of covid 19Jonils Macwan
1. The document provides guidelines for handling dead bodies of COVID-19 cases, including standard precautions, removal from isolation, transportation, handling in the mortuary, autopsies, and procedures at crematoriums/burial grounds.
2. Key recommendations include wearing proper PPE, placing bodies in leak-proof body bags, disinfecting surfaces, avoiding non-essential autopsies or embalming, and allowing limited viewing and religious rituals at crematoriums while avoiding large gatherings or direct contact with the body.
3. Health workers handling bodies should be trained in infection control and properly use and dispose of PPE, disinfect equipment, and clean and dis
This document discusses various supplies used for sterile compounding, including needles, syringes, IV bags, vials, and ampules. It describes the components and proper use of these supplies, emphasizing that critical sites must be touched only with sterile tools to avoid contamination. Most sterile compounding procedures use a regular needle that is 1 1/2 inches long and syringes to withdraw or inject solutions.
This document discusses healthcare associated infections (HAIs) and standard precautions to prevent their transmission at Sandhills Endoscopy Center. It outlines objectives to understand what HAIs are, how to stop their spread, and the importance of following standard precautions protocols. The document reviews guidelines from the CDC and ASGE for using standard precautions like hand hygiene, personal protective equipment, cleaning equipment and the environment to minimize infection risks during GI procedures and within the endoscopy unit.
This document provides an overview of safety protocols at Sandhills Endoscopy Center. It discusses environmental safety hazards from equipment, chemicals, and physical hazards and how to properly clean and dispose of infectious materials. Electrical safety precautions are outlined for various medical devices. Chemical safety procedures include handling, storage, and spill protocols. The document also details disaster plans, code systems and emergency contacts for the facility. Patient, staff, and environmental safety are the top priorities at Sandhills Endoscopy Center.
This standard operating procedure summarizes the safety protocols for operating the BD FACSARIA III cell sorter. Personal protective equipment like gloves and safety glasses are required. Potential hazards include exposure to cells and electricity from deflection plates. The document provides detailed instructions on starting up and shutting down the device, installing nozzles, running tests and cleaning procedures. Waste disposal and emergency response procedures are also outlined.
The document discusses the importance and functions of the Central Sterile Supply Department (CSSD) in hospitals. It outlines the history and objectives of CSSDs, which aim to provide sterilized medical supplies from a central location. The optimal design principles are described, including workflow zones and layout. Key areas like cleaning, sterilization, storage and distribution are explained. Finally, the document provides an inventory of recommended equipment for setting up an ideal CSSD.
This document provides an overview of key laboratory safety topics, including:
- The hierarchy of controls for hazards and types of engineering, administrative and personal protective controls.
- Chemical, biological and physical hazards like noise, radiation and ergonomics. It outlines exposure limits and safety measures.
- Requirements for chemical hygiene plans, exposure monitoring, medical exams, hazard communication, and more.
- Best practices for working with research animals, managing change, conducting safety training, and chemical inventory control.
- Examples of incidents involving water-reactive chemicals and lack of proper protective equipment emphasize importance of compliance.
This document discusses the sterile compounding environment, including the setup and characteristics of anterooms and clean rooms. It describes the ISO classification levels for particulate matter in these areas and different types of hoods used for sterile compounding. USP Chapter <797> guidelines for hoods and the four risk levels for sterile compounding are also summarized.
Blood-borne pathogens present a risk of disease transmission to workers through contact with infected blood or bodily fluids. The presentation defines blood-borne pathogens as infectious microorganisms in human blood and other potentially infectious materials that can cause diseases. It identifies the main blood-borne pathogens as HIV, Hepatitis B, and Hepatitis C and discusses how they are transmitted occupationally through contact with mucous membranes, non-intact skin, or sharps injuries. The presentation outlines the key elements of protection against blood-borne pathogens as awareness, engineering and work practice controls, and personal protective equipment. It also describes the essential components of a blood-borne pathogen program for workplaces.
This document outlines basic laboratory safety procedures for a medical technology laboratory course. It covers standard operating procedures for personal protective equipment, safe handling of biological and hazardous materials, chemical and gas safety, radiation safety, fire safety, and electrical safety. Key points emphasized include wearing proper PPE like lab coats and gloves, adding acids to water, safe sharps disposal, labeling hazardous materials, separating oxidizing and flammable gases, and knowing emergency procedures for fires, spills, and accidents.
This document discusses infection control guidelines for dentistry. It states that dental professionals are at risk of exposure to diseases through contact with blood or other infectious materials. By carefully following infection control and safety guidelines from the CDC, ADA, and OSHA, the dental team can minimize risks of disease transmission to themselves and patients. The document outlines various infection control procedures including hand hygiene, use of personal protective equipment, instrument sterilization, surface disinfection, and more.
Infection prevention and control Lecture 2.pptxmsalahabd
This document provides an overview of standard infection control precautions (SICPs) which are basic measures to reduce infection transmission. It discusses 10 key elements of SICPs including hand hygiene, personal protective equipment, safe patient placement, respiratory hygiene, and safe management of equipment, linen and the care environment. Proper use of SICPs is important for all staff, in all care areas, at all times, and for all patients to ensure safety. SICPs help prevent transmission from both recognized and unrecognized infection sources.
The document outlines the key components of an exposure control plan, which includes determining exposures, evaluating procedures, and annually reviewing the plan. It identifies employees at risk of exposure through daily tasks or incidental contact and notes that hepatitis B vaccine and awareness of workplace hazards is important. Records of all elements of the plan must be kept for at least 3 years.
We can can minimize the risks of disease transmission to our self and to the patients in the dental office through carefully following the infection control and safety guidelines,
Dr. Hesham Dameer
The document discusses evaluating and controlling workplace hazards and risks. It explains that evaluating hazards involves determining the level of risk and likelihood of harm. Control measures should aim to eliminate hazards, substitute less hazardous options, isolate hazards, introduce safe work procedures, and use personal protective equipment (PPE) as a last resort. Common workplace hazards like electrical, chemical, slips/trips/falls, fire, and ergonomic risks are described along with appropriate control methods. The advantages of wearing PPE to prevent skin issues and inhalation of harmful substances are also summarized.
Created by Attuluri Vamsi Kumar, Assistant Professor, Department of MLT, UIAHS, Chandigarh University.
Description:
This in-depth laboratory manual, "Comprehensive Laboratory Manual for Hematological Investigations," provides detailed step-by-step procedures for 10 pivotal hematological experiments. Ideal for students, researchers, and laboratory professionals, the manual comprehensively covers essential techniques including blood sample collection, plasma separation, and various blood cell counts.
The manual begins with a straightforward guide on the preparation of EDTA Vials, a critical component in most hematological investigations. It then advances to hands-on protocols for blood sample collection and plasma separation, vital for a plethora of diagnostic procedures.
Subsequent experiments offer in-depth methodologies on the estimation of ESR, an essential marker in understanding inflammation and disease progression. There's also an instructive procedure on ABO Blood Grouping, crucial in transfusion medicine.
Further along, readers are guided through precise techniques for assessing both Bleeding and Clotting Times, providing essential knowledge in hemostasis. The manual also meticulously explains procedures for determining Total White Blood Cell Count, Total Red Blood Cell Count, and Platelet Count, valuable in diagnosing and monitoring various hematological disorders.
The Hemoglobin estimation using the Shali's method chapter ensures an understanding of this critical blood component's measurement. The final experiment on Differential Leukocyte Count (DLC) provides an in-depth analysis of the various white blood cells, instrumental in the diagnosis and monitoring of numerous medical conditions.
Created by: Mr. Attuluri Vamsi Kumar, Assistant Professor, Department of MLT, UIAHS, Chandigarh University, Mohali, Punjab. For more details website: https://www.mltmaster.com
Welcome to the Hematology Laboratory Practical Manual, an essential tool in your journey as a Medical Laboratory Technology student. This manual has been meticulously curated to provide an effective foundation for your practical skills in hematology and enhance your understanding of the human blood system's dynamics.
Hematology, a branch of medicine, focuses on the study of blood, blood-forming organs, and blood diseases. It includes the study of etiology, diagnosis, treatment, prognosis, and prevention of blood diseases. The manual bridges the gap between theoretical knowledge and practical application, intending to prepare you to perform and interpret various laboratory tests related to blood.
The manual introduces you to laboratory practices, standard operating procedures, and safety protocols. It explores a wide range of topics from the basic blood collection techniques, preparation of blood smears, and staining techniques to complex tests like complete blood count (CBC), coagulation tests, bone marrow examination, hemoglobinopathies, and blood group typing, to name a few.
Understanding the principles and methods used in hematology laboratory tests is crucial for any Medical Laboratory Technologist (MLT). You will find this manual to be instrumental in developing the necessary skillset and cultivating the meticulous approach required in laboratory practice. Each practical in this manual is supplemented with objectives, materials required, procedures, observations, precautions, and viva questions to enrich your learning experience.
The laboratory is a place where the theories you learn in the classroom come alive. Here, you will understand the importance of accuracy, precision, and repeatability. You will learn to calibrate equipment, handle samples, observe reactions, record data, analyze results, and generate reports. You will become acquainted with the microscope, centrifuge, pipettes, hemocytometers, reagents, and other laboratory tools.
To further enhance your learning experience, case studies and clinical correlation sections are incorporated, connecting the dots between laboratory findings and clinical symptoms. You will be challenged to interpret results and provide a plausible explanation for various hematological conditions.
This manual is designed to stimulate your curiosity, encourage critical thinking, and prepare you for your future role as a Medical Laboratory Technologist. It is not merely a collection of laboratory procedures but a practical guide to understanding the human blood system and its associated disorders.
The path to becoming a competent MLT involves understanding and respecting the significance of laboratory practices. It's about knowing that each sample represents a person awaiting diagnosis, treatment, or confirmation of health stat
Group three of the Department of Biology at the College of Science and Technology submitted an assignment on principles and practice of biosafety in microbiology laboratories and waste management. The 10-member group studied under Dr. Noël Gahamanyi and submitted the assignment on January 16, 2023. The report covered standard microbiological practices, laboratory facilities, special practices, types of laboratory waste, waste separation, and labeling. It concluded by emphasizing the responsibility of all laboratory personnel to properly manage and dispose of wastes.
Successful infection prevention program
A successful infection prevention program depends on:
1-Developing standard operating procedures.
2- Evaluating practices and providing feedback to dental health care personnel (DHCP).
3- Routinely documenting adverse outcomes (e.g., occupational exposures to blood) and work-related illnesses in DHCP.
4- Monitoring health care associated infections in patients.
Standard Precautions
Standard Precautions: are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. These practices are designed to both protect DHCP and prevent DHCP from spreading infections among patients.
Standard Precautions include:
1- Hand hygiene.
2- Use of personal protective equipment (e.g., gloves, masks, eyewear).
3- Respiratory hygiene / cough etiquette.
4- Sharps safety.
5- Safe injection practices (i.e., aseptic technique for parenteral medications).
6- Sterile instruments and devices.
7- Clean and disinfected environmental surfaces.
Each element of Standard Precautions is described in the following sections. Education and training are critical elements of Standard Precautions, because they help DHCP make appropriate decisions and comply with recommended practices.
1- HAND HYGIENE:
1- Perform hand hygiene.
a. When hands are visibly soiled.
b. After bare hand touching of instruments, equipment, materials, and other objects likely to be contaminated by blood, saliva, or respiratory secretions.
C. Before and after treating each patient.
d. Before putting on gloves and again immediately after removing gloves.
2. Use soap and water when hands are visibly soiled (e.g., blood, body fluids); otherwise, an alcohol-based hand rub may be used.
2- PERSONAL PROTECTIVE EQUIPMENT (PPE):
1- Provide sufficient and appropriate PPE and ensure it is accessible to DHCP.
2- Educate all DHCP on proper selection and use of PPE.
3- Wear gloves whenever there is potential for contact with blood, body fluids, mucous membranes, non-intact skin or contaminated equipment.
a- Do not wear the same pair of gloves for the care of more than one patient.
b- Do not wash gloves. Gloves cannot be reused.
c- Perform hand hygiene immediately after removing gloves.
4- Wear protective clothing that covers skin and personal clothing during procedures or activities where contact with blood, saliva, or OPIM (other potential infectious materials) is anticipated.
5- Wear mouth, nose, and eye protection during procedures that are likely to generate splashes or spattering of blood or other body fluids.
6- Remove PPE before leaving the work area.
3- RESPIRATORY HYGIENE / COUGH ETIQUETTE:
1- Implement measures to contain respiratory secretions in patients and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at point of entry to the facility and conti
The way to infection control in dental clinics
Introduction:
The unique nature of dental procedures, instrumentation and patient care settings require specific strategies directed to the prevention of transmission of diseases among dental health care workers and their patients.
Disease: impairment of normal functioning, manifested by signs and symptoms.
Infection: state produced by an infected agent in or on a suitable host, host may be or may not have signs or symptoms.
Carrier: individual harbors the agent but does not have symptoms (person can infect others).
Factors that allow or aid infection:
= The presence of pathogenic micro-organisms.
= There must be a portal of entry via which the organisms invade and colonize the susceptible host.
Medical history
A thorough medical history should be taken and up-dated at subsequent examinations. Medical history screening is essential in alerting the clinician to medical problems that could, in conjunction with dental treatment, adversely affect the patient.
Protective measures
Protection can be achieved by a combination of immunization procedures, use of barrier techniques and strict adherence to routine infection control procedures.
(a) Immunization:
All dental health care workers are advised to be immunized against HBV unless immunity from natural infection or previous immunization had been documented
(b) Protective coverings:
=Uniforms:
Uniforms should be changed regularly and whenever soiled. Gowns or aprons should be worn during procedures that are likely to cause spattering or splashing of blood.
=Hand protection:
Gloves must be worn for procedures involving contact with blood, saliva or mucous membrane. A new pair of gloves should be used for each patient.
If a gloves damaged, it must be replaced immediately. Hands should be washed thoroughly with a proprietary disinfectant liquid soap prior to and immediately after the use of gloves.
Disposable paper towels are recommended for drying of hands.
Any cuts o abrasions on the hands or wrists should be covered with adhesive waterproof dressings at all times.
=Protective glasses, masks or face shields Protective:
Glasses, masks or face shields should be worn by operators and close-support dental surgery assistants to protect the eyes against the spatter and aerosols which may occur during cavity preparation, scaling and the cleaning of instruments.
(c) Sharp instruments and needles:
Sharp instruments and needle should be handled with great care to prevent unintentional injury. Needles should never be recapped by using both hands indirect contact or by any other technique that involves moving the point of a used needle towards any part of the body. The needle can be recapped by laying the cap on the tray, placing the cap in a re-sheathing device or holding the cap with forceps before guiding the needle into the cap.
(d) First aid and inoculation injuries:
Ic guidelines for burn unit [compatibility mode]drnahla
Infection Control Guidelines for burn unit
Dr. Nahla Abdel Kader.MD, PhD. Infection Control Consultant, MOH Infection Control Surveyor, CBAHI Infection Control Director,KKH.
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Structure function ch4_pg79-81_ch21_pg499_cma_bookrupalmahesh
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This document discusses infection control and microorganisms. It defines infection control as reducing exposure to pathogens to prevent disease spread. Pathogens are disease-causing organisms. The chain of infection is described as requiring a reservoir host, means of exit and transmission for the pathogen, a means of entrance, and a susceptible host. Proper infection control practices like hand hygiene and disinfection are important to break the chain. Common multidrug-resistant organisms like MRSA and VRE are also discussed.
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Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTblessyjannu21
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Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
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Lecture notes test 5 ch 6 44-45
1. Mod 1 Clinic Lecture notes- CMA book – Ch. 6, 44, 45
1
A. Occupational Safety and Hazard Administration
1. OSHA:
a. is a governmental agency
b. is responsible for the safety of all employees of companies operating in the United Sates
c. ensures the safety and health of America’s workers by setting and enforcing standards
d. provides training, outreach, and education related to workplace safety
e. encourages continual improvement in workplace safety and health
f. has the authority to inspect a workplace without notification
g. can fine workplaces where deficiencies in health and safety of employees exist
h. is concerned with workplace hazards that might impact the safety of employees
See pg. 118 Professionalism box
Discuss fire safety in a medical office
1. Each employee should be instructed on the proper use of fire equipment. Review the PASS acronym:
Pull, Aim, Squeeze, Sweep.
2. Define the acronym “RACE.” To help employees remember what to do in case of a fire, offices have
adopted the acronym “RACE—Rescue, Alert, Confine, and Extinguish.
3. 1. Rescue employees and patients from the fire area.
4. 2. Alert by calling 911.
5. 3. Confine by closing doors and windows.
6. 4. Extinguish the fire.
Identify the chemicals in a medical office that are hazardous to the human body.
1. Biohazards such as medical waste and samples of a virus or bacterium pose a threat to human beings and
are potentially infectious.
2. Corrosive materials cause burns, and flammable materials can burst into flames.
3. Toxic materials can cause serious illness or death by exposure through skin contact, ingestion, or
inhalation.
Discuss the purpose and contents of an MSDS.
1. Any workplace where employees handle a hazardous product is required to provide the employees with
a Material Safety Data Sheet (MSDS).
2. An MSDS contains printed material concerning a hazardous chemical.
3. Each MSDS offers basic information needed to ensure the safety and health of the user at all stages of
manufacture, storage, use, and disposal of a hazardous chemical product.
4. An MSDS provides information regarding the hazards of using the product, how to protect oneself from
injury by using the appropriate personal protection equipment (PPE), and what actions to take if an
2. Mod 1 Clinic Lecture notes- CMA book – Ch. 6, 44, 45
2
accidental splash or exposure occurs. PPE consists of protective gloves, fluid-resistant lab coats, safety
glasses, and a surgical mask, shield, or respirator.
5. Each office must have an accessible HAZCOM binder where all MSDS information is filed, and all
employees must know where the binder is kept.
6. Each office should have a designated OSHA compliance officer, an employee who is aware of and
trained in the required controls for use and storage of hazardous materials.
7. Discuss how, through the use of personal protective equipment (PPE), employees can be protected from
exposure to bloodborne pathogens. All PPE must be provided by the employer and readily available for
use.
8. Explain how safety is the responsibility of every member of the medical office staff. While it is
imperative that the medical office staff provide a safe working environment, the staff must also be
constantly aware of their surroundings and any possible hazards. Employees must be willing to
implement all safeguards to keep themselves and patients safe.
Describe the four major types of medical waste:
1. Solid
a. Generated in many areas of medicine, including patient rooms and surgery suites
b. Not always hazardous, but can cause pollution of the environment
c. Mandatory recycling can reduce the amount of solid waste produced
2. Chemical
a. Includes substances such as germicides, cleaning solvents, and pharmaceuticals
b. Can be a causative factor in a fire or an explosion
c. The safe manner with which to handle and dispose of chemicals is included in the MSDS.
3. Radioactive
a. Any waste that contains or is contaminated with liquid or solid radioactive material, such as iodine-
123, iodine-131, and thallium-201
b. Must be clearly labeled as “radioactive”
c. Must be removed by a licensed disposal agency.
4. Infectious
a. Any waste material that has the potential to carry disease
b. Includes laboratory cultures, blood, and blood products from blood banks, operating rooms,
emergency rooms, medical and dental offices, autopsy suites, and patient rooms.
c. Must be separated from other solid and chemical waste at the point of origin
d. A licensed medical waste removal agency must dispose of these materials
1. OSHA defines body fluids as:
a. Blood
b. Semen
c. Amniotic fluid
3. Mod 1 Clinic Lecture notes- CMA book – Ch. 6, 44, 45
3
d. Cerebrospinal fluid
e. Synovial fluid
f. Vaginal secretions
g. Pleural fluid
h. Pericardial fluid
Identify the elements of a written Exposure Control Plan that must be provided to assist in minimizing
employee exposure to infectious materials. This plan must be reviewed by all office staff and updated
annually. An Exposure Control Plan must include:
1. Exposure determination—listing of job classifications within the office to determine at-risk employees
(those with potential exposure to infectious materials)
2. Method of compliance—specific measures to reduce the risk of exposure.
3. Post-exposure—evaluation and follow-up, which specify the steps to follow when an exposure incident
occurs.
1. OSHA guidelines for using PPE and clothing are listed in Guidelines 6-2 in the textbook.
a. The employer must supply the protective clothing and provide cleaning or disposal of it.
b. The clothing or other equipment must be strong enough to act as a barrier to infectious materials
that might reach the employee’s street clothing, work clothing, eyes, mouth, or skin.
c. Disposable gloves may not be reused.
d. Protective eye equipment must have solid sides to prevent infectious material from entering the
eye area from the side.
e. All equipment and clothing must be removed and placed in a designated container before leaving
the medical office.
Discuss the purpose and use of an eyewash station.
1. An eyewash station should be available to use in the event that infectious materials enter the eyes. It
should be located close to any area where chemicals that may contaminate the eyes or skin are used.
2. The eyewash station should be checked monthly to ensure that it is working properly.
3. Each station is accompanied by a set of instructions; manufacturer’s requirements for use and
maintenance should be followed. Procedure 6-2 in the textbook explains proper use of the eyewash
station attached to a sink faucet.
Review the procedure for using OSHA housekeeping guidelines.
1. Prior to performing any housekeeping procedures, the employee should ensure that the appropriate PPE
has been applied.
2. For any wet spills, use the prepared spill kit according to package directions.
3. Immediately clean and disinfect contaminated surfaces with a 1:10 bleach/water solution after exposure
to infectious materials. All surfaces must be decontaminated on a regular schedule. This schedule must
be posted, signed by the person who performs the decontamination, and kept with OSHA records.
4. Properly bag contaminated clothing and laundry in leakproof, labeled biohazard bags. Contaminated
laundry should not be handled or washed at the medical office or with other uncontaminated clothing.
4. Mod 1 Clinic Lecture notes- CMA book – Ch. 6, 44, 45
4
5. Replace a damaged biohazard bag by placing a second bag around the first. Do not remove infectious
material from the damaged bag.
6. Biohazardous waste must be removed by a licensed waste disposal service and incinerated or autoclaved
before placing in a designated landfill area.
7. Use puncture-proof, sealable, biohazard sharps containers for all needles and sharps, such as razors and
glass pipettes.
8. Place the sharps container close to the work area and ensure that the container remains upright.
9. Replace the sharps containers when they are 2/3 full.
10. Seal and label the sharps containers before placing with the biohazard waste for removal by the disposal
service.
11. In the event of broken glass, use a dustpan or other mechanical device such as hemostats or another type
of forceps to pick it up. Never pick up broken glass with hands.
12. Properly dispose of PPE used during housekeeping. Failure to do so may result in an OSHA citation.
13. Perform hand hygiene both before and after using gloves.
Explain the purpose of incident reports.
1. Any unusual occurrence or accident is referred to as an incident in the medical setting. Examples of
incidents include:
a. A patient falls on a wet floor
b. A housekeeping employee is stuck by a needle while emptying the trash
c. A prescription pad is missing
d. A patient receives the wrong medication
e. A patient misplaces or loses personal property, such as a hearing aid or glasses, while in the office
f. Syringes or needles are found to be missing from the supply cupboard
g. A medical assistant receives a needlestick from a contaminated needle
h. An employee’s purse is missing
i. A patient is abusive and uses vulgar language
2. Whenever any accident, injury, or unusual occurrence takes place, the employee should immediately
notify the supervisor. This is especially important if a needlestick accident is involved because time is of
the essence when drawing appropriate baseline blood specimens.
3. The supervisor will require the employee to complete a written report immediately.
4. The incident report should be completed in black ink.
5. An incident report can protect both the employer and the medical assistant against possible lawsuits.
6. Some incidents should also be reported to either the police or the liability insurance carrier. For
example, stolen property should be reported to the police, and a slip and fall should be reported to the
insurance carrier.
7. The incident should be described as simply as possible, stating only facts and not opinions.
8. The incident report may be used as a legal document; thus only objective information should be
5. Mod 1 Clinic Lecture notes- CMA book – Ch. 6, 44, 45
5
included, such as “Patient fell while getting onto exam table.” Do not include subjective comments, such
as “Patient was not paying attention to what he was doing.”
9. Medical offices should have their own customized forms. However, most incident reports include the
following information:
a. Names of all persons involved
b. Date and time of the incident
c. Exact location of the incident (including the address of the medical facility and the location of the
incident within the facility)
d. Name of the person to whom the incident is reported and the time of the report
e. Brief description of what happened
f. Names of all witnesses
g. Name and description of any equipment involved in the incident
h. Action taken at the time of the incident
i. Action taken to prevent a recurrence
j. Signature and title of the person completing the report
10. The incident report, like all other information relating to the patient, is subject to subpoena in litigation
(lawsuits).
11. A copy of the incident report should be placed in a master incident report file, the patient’s file, and the
employee’s record.
See Pg. 128. Image on pg. 129
See Professionalism box pg. 131
Explain the purpose of the Clinical Laboratory Improvement Amendment (CLIA). The federal government now
requires that all clinical laboratories that test human specimens must be controlled. The Clinical Laboratories
Improvement Amendment of 1988 (CLIA88) divides laboratories into three categories:
A. Waived--Simple Testing (Level I) – Incorrect test results pose little risk for the patient. Laboratory is
subject to random inspectors only. Some physicians’ laboratories fall in this category.
B. Moderately Complex--Intermediate-Level Testing (Level II) – Poses risk to patient if there is an
incorrect test result. Must be certified by approved accrediting agency. Must be staffed by credentialed
personnel. Must meet quality assurance standards.
C. Highly Complex--Complex Testing (Level III) – Poses high risk to patient if there is an incorrect test
result. Must be certified by approved accrediting agency. Must be staffed by credentialed personnel.
Must meet quality assurance standards.
K. Discuss the function of the Joint Commission
1. The Joint Commission is a private, nongovernmental agency that establishes guidelines for
hospitals and health care agencies regarding quality care.
2. Supported by representatives of the American Hospital Association, American College of
Physicians, American College of Surgeons, and American Dental Association
6. Mod 1 Clinic Lecture notes- CMA book – Ch. 6, 44, 45
6
3. Forms guidelines for hospitals, ambulatory care facilities, and long-term care institutions and
conducts surveys and accreditation programs
4. Indicators for accreditation include:
a. Mortality rate
b. Frequency of medical complications
c. Nosocomial infection rate
d. Autopsy rate
5. Does not have authority to take punitive action for poor treatment, but its survey results can be
used by other agencies to impose sanctions or penalties.
Explain the three types of clinical laboratories that perform tests of varying levels of complexity.
1. Outside laboratory
a. Either a hospital-based or independent laboratory.
b. Handles specimens collected from many types of facilities.
c. Performs tests ranging from simple to very complex.
d. A patient may go to the outside laboratory to have blood drawn or a specimen taken with the test
results to be sent to the referring physician.
e. A medical assistant may be employed in one of these laboratories as a phlebotomist (one who
performs a blood draw) or as an administrative assistant.
f. Outside laboratories typically provide supplies and forms for specimen collection and transport.
g. Most offer a directory with instructions for proper handling and transport of specimens.
h. When these instructions are available, always consult them to determine how much of a specimen
to collect, which container to use, and how to prepare the specimen for transport.
i. The MA is also responsible for requesting additional supplies to replenish the inventory on hand.
3. Physician’s office laboratory (POL)
a. Some of the tests the physician orders are performed in the office.
b. In the POL, the doctor has the advantage of receiving the results more rapidly than if tests
are done outside of the office.
c. Turnaround time is how long it takes for the test to be performed and the results
generated, sent back for physician review, and added to the patient’s chart.
d. Disadvantages to the POL: In-house testing may require more employees and the
purchase of expensive equipment.
e. This is the laboratory environment that MAs are particularly suited to, although they are
limited to performing only CLIA-waived tests.
f. The POL is usually housed in a separate room or work area that is well lighted and
adequately ventilated.
7. Mod 1 Clinic Lecture notes- CMA book – Ch. 6, 44, 45
7
Most have a refrigerator that is clearly labeled for storage of (potentially infectious)
specimens only.
A supply of PPE, including gloves, masks, gowns, and protective eyewear is essential.
A sharps container and a biohazardous waste receptacle should be within easy reach.
Hand-washing facilities and an eyewash station are also important.
Discuss the medical assistant’s role in the clinical laboratory.
1. Medical assistants are particularly suited to working in POLs and clinical laboratories because of their
cross-training in administrative and clinical areas.
a. For MAs working in a laboratory, training in phlebotomy and basic knowledge of laboratory
testing are essential.
b. In addition, training in administrative duties helps medical assistants to perform the many
administrative tasks required in a laboratory.
c. MAs’ patient-oriented training helps them to be empathetic caregivers.
d. Whether you work as a medical assistant in a laboratory or in other areas of a medical practice, a
fundamental understanding of basic lab methods and techniques helps you understand the nature
and importance of specific tests. This includes an understanding of why specific tests are done,
how to prepare a patient for a test, conditions that may render a test inaccurate, and how to
evaluate the results.
2. Medical assistants may play any of several key roles in a clinical laboratory.
3. Depending on their level of involvement in the laboratory, these roles may include record management,
teaching patients, specimen management, and quality assurance.
a. Discuss record management in the clinical laboratory.
b. Methods of lab test record management vary, depending on where a sample is collected and
where it is tested.
c. The first priority is to make sure that the physician’s order is clearly recorded and the proper lab
forms are completed.
d. In-house collection and processing must be charted.
e. Results should be evaluated and carefully documented.
f. A requisition is a form that provides essential information about
the test that is ordered
how results will be reported
information for billing and coding
4. The MA will need to complete a requisition if not performing the tests right away.
a. The requisition will be transported with specimens that are collected at the physician’s office and
sent out for testing.
b. Alternatively, the requisition will go with the patient, who is required to travel to a laboratory for
collection and testing.
8. Mod 1 Clinic Lecture notes- CMA book – Ch. 6, 44, 45
8
c. If the physician wants the results immediately for a medical intervention, then the requisition
must be labeled STAT (immediately) and processed accordingly.
5. Refer to Procedure 44-1: Completing a Laboratory Requisition and Preparing a Specimen for Transport
to an Outside Laboratory in the text for detailed instructions on this process.
1. Specimen Management
a. A specimen is a small sample taken from the body, such as:
Urine
Feces
Sputum
Blood
Other body tissues or secretions.
b. Urine and blood are the most commonly obtained specimens for laboratory testing.
It is vital to properly collect and preserve a specimen to ensure that it truly represents the
patient’s body functions.
Otherwise, inaccurate test results are likely, which may alter the patient’s diagnosis and
treatment.
c. In a POL:
Specimens are generally processed for in-house testing according to office policy
Some may be prepared for transportation to an outside lab.
The MA should perform CLIA-waived tests precisely according to manufacturer’s instructions
after checking expiration dates.
If specimens are sent to an outside lab:
Determine the specific requirements of the lab being used.
Each lab has its own policies regarding which specimen containers to use and how much to
collect.
Some specimens will need to be refrigerated, spun, or have chemicals added to them.
Some labs schedule routine pickups, but others may require specific contact to pick up a
specimen.
d. Refer again to Procedure 44-1 to review the steps to correctly complete a laboratory requisition and
prepare a specimen for transportation to an outside laboratory.
e. Complications of specimen collection may occur.
If there is difficulty drawing blood, the cells may hemolyze, or burst.
Accidental contamination or collection in the wrong container can be a problem.
Exposure to heat or direct sunlight may cause damage.
9. Mod 1 Clinic Lecture notes- CMA book – Ch. 6, 44, 45
9
If less than the required amount of a specimen is collected, testing may not be possible; in this
case, a lab report will read QNS (quantity not sufficient).
Incomplete or incorrectly handled specimens may require retesting.
f. To avoid collecting a specimen from the wrong patient, proper identification is important. Use this
three-step process:
Check the chart to verify the order.
During introductions, ask the patient to state his or her full name and date of birth. The patient
must state, rather than verify, this information to prevent miscommunication, especially if there
is a language barrier or the patient has difficulty hearing.
Compare the information the patient has given with the chart to verify that this is the right
patient. Always compare both the name and the date of birth in case more than one person with
that name has a file in the same office.
g. Properly labeling specimens is essential.
Use two identifiers (such as name and date of birth),
Indicate the date and time collected.
h. To prevent cross contamination and mislabeling specimens:
A label should never be placed on a removable lid
A specimen should always be sealed and labeled before walking away from a sample.
i. If the patient was not supposed to eat before the test and forgot, label the specimen as non-fasting
and check with the physician to determine if the test should still be run.
A. Discuss the role of the medical assistant in carrying out quality assurance (QA) procedures.
1. Planned and systematic activities to ensure that requirements are met and results are accurate.
2. A QA program is a written program that includes mechanisms to evaluate laboratory procedures and
policies, identify and correct problems, and ensure reliable and prompt reporting of results and
testing by competent individuals.
3. Steps for quality assurance in the laboratory:
a. Most offices and laboratories have a policies and procedures manual with a set of routine
checklists to follow.
A basic QA checklist generally begins with keeping the lab and patient areas clean and
providing clear patient instructions.
It includes restocking supplies to ensure that the correct materials are available.
Checking storage instructions and expiration dates for all reagents and test kits is
important before storage and before use.
b. QA involves routinely reviewing procedure manuals and following the most recent
manufacturer’s instructions for correct test performance.
c. Scheduling or performing routine equipment maintenance, including calibrations, should
always be properly documented.
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d. Laboratory refrigerators should be properly labeled for restricted use and should have a
thermometer that is both checked and recorded daily.
e. When opening a new stock container of multiuse reagents, chemicals, or test strips, you
should date and initial the container.
f. You should also be able to identify assigned lab values and compare them to the specimen
result.
4. Maintenance
a. All laboratory equipment must be maintained on a regular basis according to manufacturers’
instructions.
b. A written record of the maintenance performed must be readily available.
c. A record of each piece of equipment with model and serial numbers, date of purchase, and
manufacturers’ inserts should be available when repair is necessary or the laboratory is being
inspected.
5. Documentation
a. Documentation is important for QA. Without a written record of a test result, control result,
maintenance performed, or temperature recorded, you have no proof of activity.
b. The end result is the same as if you did not perform the procedure.
c. If it is not written down in the appropriate place, you did not do it.
E. Discuss quality control (QC), which is focused on physical proof that results are accurate.
1. QC is accomplished by routinely performing mock tests, using one of two predetermined methods:
a. Calibration
Some machines require evaluation by calibration devices, which are specially prepared test
strips or cartridges that are designed to produce a predetermined result.
b. Control solutions
Other tests are evaluated by using regular testing materials but, instead of adding a patient
sample, a provided control solution is added in its place.
Control solutions are chemicals that produce an expected result; they are usually purchased
from or provided by the manufacturer of the testing equipment.
c. In either case, the result should fall within the acceptable range listed on the calibration device or
control solution bottle.
2. Abnormal quality control results should always be investigated.
a. Things that may cause abnormal results include
User error
Impaired quality
Outdated materials
A malfunctioning machine
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b. In this case, try retesting with newly opened materials or asking a coworker to perform a quality
control test.
c. If results remain abnormal, the machine is not considered accurate and should be serviced or
repaired and retested before using on patients.
3. QC tests are performed according to manufacturer’s requirements and lab policy, often daily.
a. Results are recorded in a quality control log, which is evaluated after each use.
b. The CLIA 1992 standards mandate that written policies and procedures must be in place for a
comprehensive quality control program that will “evaluate the ongoing and overall quality of the
testing process.”
c. To this end, the laboratory is required to do the following:
Evaluate the effectiveness of its policies and procedures.
Identify and correct problems.
Ensure reliable and prompt test results.
Ensure the competence and adequacy of staff.
Take corrective action if errors are found.
Integrate corrective procedures into future policies and procedures.
Document employee training and assess competency yearly after the first year.
• Maintain the identity and integrity of patient samples during the entire testing process.
d. • Be subject to inspection every two years if performing moderate- or high-complexity tests.
4. Refer to Box 44-2: Using Controls to Monitor Results for more information on this topic.
a. As a professional in health care, it is important that you comprehend the importance of
patient test results and control samples. What would you do if the control sample results
were correct according to the manufacturer’s value sheet, but the patient test results were
very abnormal compared with the reference values of your facility? For example, imagine a
patient’s fasting glucose level is 47 mg/dL when tested.
b. The reference range in your facility is 70 to 100 mg/dL.
c. The control tests were 55 mg/dL and 132 mg/dL, which were in range according to the
manufacturer.
If a result seems incongruous to you, it should not be reported without retesting.
The test and controls should be repeated.
The original specimen should be examined to ascertain that the specimen was not hemolyzed
(red cells burst, causing serum to be a cherry-red color) or icteric (bilious yellow-green
color). If either problem exists, a new specimen may be required and the test should be
repeated.
The results from previous tests on this patient should be examined. Is there a pattern among
previous test results?
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The patient’s results should be flagged and brought to the attention of the supervisor or
physician if test and control results were the same as the first test results.
A protocol should be in place in your POL that establishes the appropriate steps to follow
when a result is flagged.
A small portion of the original specimen may be sent to an outside laboratory for testing to
compare results.
5. Refer to Procedure 44-3: Evaluating a Contour TS Glucometer Using Control Solutions for detailed
instructions for carrying out one such control solution test.
Explain the Clinical Laboratory Improvement Amendments (CLIA).
1. In 1988 Congress enacted CLIA as developed by the Centers for Medicare and Medicaid Services
(CMS) in response to widespread concern over the accuracy of laboratory tests.
2. Mandates that all laboratories that test human specimens must be regulated to help ensure accurate
patient test results.
3. Since their enactment in 1988, the CLIA have been kept current through periodic amendments and
updates. CLIA divide laboratories into three categories: waived, moderate complexity, and high
complexity.
4. Medical assistants are qualified to perform only waived testing.
5. Many CLIA-waived tests are simple enough for a patient to perform at home with basic instructions.
a. In the POL, they frequently come in a boxed test kit set, which contains several tests and the
materials needed to properly use them.
b. Many automated analyzers are now CLIA-waived, too, as a result of the advancements of
technology.
c. An automated analyzer is typically a small or handheld machine that processes a specimen with
single-use reagent test strips or cassettes.
d. Results are displayed quickly, proving an advantage for a patient who may need to be treated
right away.
6. Information regarding state laboratory regulations may be obtained from state health departments.
7. A facility is required to have a Certificate of Waiver from the Centers for Medicare and Medicaid
Services (CMS) so that its employees can legally perform simple tests used to prevent, diagnose, or
treat a disorder or disease.
a. These tests are referred to as Certificate of Waiver Tests (WTs) or CLIA-Waived Tests.
b. They are the least complex and present the least risk if performed incorrectly.
c. Some examples of these tests are indicated in Box 44-3.
d. Many of these tests have been approved by the FDA for home use.
e. These are the only laboratory tests that a medical assistant may perform without further training;
they may only be performed in a laboratory that has been granted a Certificate of Waiver.
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8. Although other types of testing are discussed in the textbook, anything that is not CLIA-waived is for
demonstration purposes only and does not qualify the medical assistant to perform that test in the
laboratory.
9. To maintain CLIA-waived status, facilities must permit on-site inspections, as requested.
a. During an inspection, evaluators will determine if necessary standards are being met.
b. A significant issue of discovery is when manufacturer’s instructions are either missing, outdated,
or not followed to the letter.
c. This is a concern, because the only CLIA requirement for performing waived testing is to follow
the manufacturer’s instructions.
10. Improper testing can lead to inaccurate results, which may result in incorrect diagnosis or treatment.
Therefore, if modified even the slightest bit, tests are no longer considered waived tests and become
subject to the more stringent CLIA requirements.
11. A POL must apply to perform WTs and then may not perform the more complex tests from Level I or
Level II.
12. Approved tests are considered exempt from complying with CLIA 1988 standards and are thus termed
CLIA-waived or waived tests (WTs).
a. However, quality assurance and quality control methods should still be observed.
13. The laboratories that perform WTs may be subject to random inspections and investigation if test
results are questioned or complaints are made against the laboratory.
14. A Certificate of waiver is given to laboratories that perform only low-complexity tests.
a. A POL qualified to perform moderate-complexity and waived tests receives a Certificate of
Provider-Performed Microscopy (PPM).
b. A medical assistant employed in a facility with a PPM certificate can perform moderate-
complexity tests with further training and under the supervision of a laboratory professional or
physician.
15. Refer to Box 44-3: Categories of CLIA Tests for tests in the different categories:
a. Waived Tests—Simple procedures approved for home use and POL or POC testing. Common
examples include:
Dipstick urine testing or table testing
Fecal occult blood testing
Ovulation testing
Urine pregnancy testing
Erythrocyte sedimentation rate (non-automated)
Hemoglobin testing with CLIA-waived analyzer
Spun hematocrit
Blood glucose using FDA-approved glucose analyzer
Rapid Streptococcus testing
b. Moderate-Complexity Tests/Level I Tests
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75 percent of tests performed daily using automated analyzers for chemistry and
hematology; microscopic analysis of urine sediment
c. High-Complexity Tests/Level II Tests
All tests in the field of cytogenetics, cytology, histopathology, and histocompatibility
16. Refer to Box 44-4: Critical Steps in CLIA Testing for required procedures.
a. Follow the instructions in the most current manufacturer’s product insert EXACTLY.
b. Report results using proper documentation and recordkeeping.
c. Adhere to expiration dates.
d. Perform quality control testing regularly.
e. Use only recommended storage requirements.
f. Keep manufacturer’s instructions in an easily accessible area.
g. Replace manufacturer’s instructions every time a new product is received.
h. Be aware of federal, state, and local regulations.
Explain that the laboratory includes biohazards, chemical hazards, and physical hazards and that most accidents
are preventable.
1. Laboratory safety must be the concern of all who are employed in the laboratory field.
2. Medical assistants must be familiar with the following regulations:
a. Hazard Communication Standard
b. Universal Precautions and Bloodborne Pathogen Standards
c. Hazardous Waste Operations
d. Needlestick Safety and Prevention Act
3. Chemical hazards
a. Material Safety Data Sheets (MSDSs) provide safety information for all in the laboratory
environment including:
Product identification
Safety information about proper storage and disposal
Potential health hazards
Handling precautions
Fire and explosion information
b. All laboratory personnel have the right to know about hazards pertaining to materials they are using
and must receive training appropriate to the materials in use.
c. Each hazardous substance must have a hazardous material label attached to the container that
provides a shortened version of the MSDS information.
4. Bloodborne pathogens
a. Biohazards are hazards that have the potential to infect others.
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b. Since 1992, OSHA’s Occupational Exposure to Bloodborne Pathogen Program must be in place at
all working laboratories.
c. The CDC specimen-handling precautions known as standard precautions (formerly universal
precautions) must be employed when dealing with any infectious materials.
d. All potentially biohazardous material must be labeled with the biohazard label.
5. Needlestick hazards
a. Since OSHA revised the bloodborne standards to include the Needlestick Safety and Prevention
Act of 2000, health care employers must follow certain safety protocols:
Review all new safety devices to lessen the needlestick risks of their employees.
Ask for safety input from their employees on an annual basis.
Keep a detailed report of all contaminated needlestick incidents.
6. Fire and safety hazards
a. Staff must take care to reduce the chances of fire and electrical accidents by having an awareness of
the floor plan and exits.
b. They must be familiar with the floor plan, exits, and location of safety devices such as eye washes,
showers, and safety blankets.
7. Hazardous waste removal
a. Hazardous waste includes:
Blood
Blood products
Body fluids and tissues
Cultures
Vaccines
Sharps
Gloves
Inoculation loops
Paper contaminated with body fluids
All must be disposed of in proper containers identified with biohazard labels. Sharps must be placed in
punctureproof, leakproof containers.
1. Microscope
a. Frequently used in the medical office to examine urine sediment, vaginal and bacteriological
smears, and differential smears, which categorize types of white cells in a sample.
This optical instrument magnifies structures unseen by the naked eye for the purpose of
counting, naming, or differentiating.
A compound microscope achieves maximum magnification by using two sets of lenses:
oculars (eyepiece lenses) and objectives (lenses at the bottom near the sample).
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The resolution of a microscope refers to the ability to distinguish clearly between two
adjacent but distinct objects.
Better microscopes have better resolution.
b. Parts of the microscope:
One or multiple eyepieces (monocular or binocular) with magnification imprinted on them
Body tube (directional light source)
Arm (used in carrying the microscope)
Revolving nosepiece (holds objectives and rotates for selection)
Objectives (magnification imprinted on each objective: 10, low-power setting; 40, high dry
setting; and 100, oil immersion setting
Stage
Mechanical stage (movable device that holds slide)
Mechanical stage adjustments (two knobs that control vertical/horizontal movement of slide)
Coarse and fine adjustment knobs (small knob atop larger knob that adjusts stage up and
down for focusing)
Condenser (lens system used to increase light for sharper focus)
Condenser adjustment knob
Light source (illuminator set in base)
Iris diaphragm lever
Base (holds illuminator, rheostat, and microscope upright and is used while carrying
microscope)
c. Using the microscope:
Magnification of an object is calculated by multiplying the objective magnification by the
eyepiece magnification.
On low power, magnification would be 10 (the objective) times 10 (the eyepiece) equaling
magnification of 100 times the size of the sample.
It is important to use the correct lens for the type of microscopic work to be done. For
example, the low-power objective, 10×, is used to view epithelial cells, such as skin
scrapings; the high dry setting, 40×, is used for urine RBCs (red blood cells), WBCs (white
blood cells), or blood RBCs; the oil immersion setting, 100×, is for differential blood smears
(stained with Wright’s stain) or bacteria slides (stained with Gram stain).
Microscopic work on the high dry setting is done with a cover glass on the specimen.
d. Refer to Procedure 44-4: Using and Cleaning the Microscope for instructions on these techniques.
Equipment and Supplies: Binocular compound microscope; specimen slide; lens paper; lens cleaner; dust
cover for microscope
Method
Always carry the microscope with one hand on the arm and one hand under the base.
Make sure the stage is in the down position before starting.
Clean objectives with lens paper starting with 10× and ending with oil immersion.
Turn on the light and rotate the nosepiece until the 10× objective is directly over the slide. Place
the prepared slide on the stage.
Use the coarse adjustment knob to raise the stage until the objective is close to the slide on the
stage.
Look through the eyepiece and adjust the coarse focus knob until the microscope field is seen (a
round circle of bright light).
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Use the fine adjustment knob for a clearer image.
Open the diaphragm and, if necessary, adjust the rheostat to focus. Clean the objective lens.
Raise or lower the condenser to alter light refraction. The condenser is usually lowered when
using 10× power.
Observe the slide.
Change the objective to 40× and readjust as needed. Move the objective and place a drop of oil
on the slide before completing the turn to oil immersion lens.
When focusing and examination are complete, lower the stage before removing the slide.
Turn off the light.
Clean the eyepieces and objectives with lens paper. Clean the oil immersion lens with lens
cleaner.
Unplug the electrical cord and wrap it around the base.
Cover the microscope with a dust cover.
Clean the slide and store.
e. Care of the microscope:
Microscopes are delicate instruments that will last for many years if maintained properly.
Refer to Guidelines 44-1 for the rules for the proper care and maintenance of a microscope:
Care and maintenance of a microscope
Follow cleaning requirements during mandatory daily maintenance.
Always use two hands to carry a microscope: one hand to hold the arm of the microscope and one to
support the base.
Clean oculars, objectives, and stage using only lens paper and lens cleaner.
Keep extra light bulbs on hand.
Document inspections and repairs in logbook.
Store with electrical cord wrapped loosely around base.
Cover the microscope with a dust cover when it is not in use.
Begin the lesson by defining microbiology and explaining microorganisms.
1. The field of microbiology is the study of living organisms too small to be seen with the naked eye
(microorganisms).
2. Antonie Van Leeuwenhoek’s invention of the microscope in 1674 allowed people to observe microbes
for the first time.
3. Louis Pasteur, the father of microbiology, developed methods for culturing and identifying microbes in
the laboratory.
4. The study of microorganisms has greatly advanced the field of medicine and currently allows
individuals to live longer, healthier lives.
a. To successfully treat a patient, it is important to first discover the exact cause of the problem.
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b. By evaluating body fluid samples, an offending microorganism may be identified so that the
most effective medication or treatment can be prescribed.
5. We are surrounded by microorganisms. Yet not all bacteria are bad.
a. Bacteria in the environment help us to decompose and recycle waste.
b. Normal flora on our bodies consist of beneficial bacteria that help us resist pathogens.
6. However, a bacterium that is harmless in one area may be pathogenic in another, especially in large
amounts or in an area that is normally sterile.
7. It is important to understand differences between microorganisms and learn which can be harmful to
effectively help patients to recover from illness.
1. Bacteria can be characterized by their reactions to certain stains.
a. A stain is a dye used in coloring microorganisms to allow for visibility under a microscope.
b. The Gram stain, named for Dr. Hans C. J. Gram, a Danish physician, is a commonly used
method of staining bacteria.
A gram-positive bacterium retains the violet color of the stain used in the staining of the
microorganism.
Some of the more common gram-positive bacteria are Staphylococcus aureus and
Streptococcus pneumoniae.
A gram-negative bacterium has the pink color of the counterstain used in Gram’s method of
staining microorganisms.
A few of the most common gram-negative bacteria are Escherichia coli, Neisseria
gonorrhoeae, and Salmonella typhimurium.
c. Some organisms do not stain well with Gram stain and require a special stain, such as the acid-
fast stain used for the organism that causes tuberculosis.
4. Bacteria can be categorized by their use of oxygen:
a. Aerobes can survive in an oxygen-rich environment.
b. Anaerobes die in the presence of oxygen.
c. Facultative anaerobes are flexible and can live with some oxygen.
d. Successful culturing requires an understanding of the oxygen requirements of bacteria.
e. If the ultimate goal is to grow and identify a sample of the organism that is causing disease in a
patient, then we must provide proper oxygen, moisture, nutrition, and temperature in the
laboratory setting.
5. Bacteria have other identifying characteristics:
a. Differences such as cell structure and the presence or absence of organelles (small structures in
the cytoplasm of a cell) are used to classify organisms.
If they are capable of movement, their means of motility is unique to specific categories of
microorganisms.
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They may possess flagella (long whiplike extensions of the cytoplasm) or cilia (fine hairlike
extensions).
For example, Trichomonas vaginalis, the protozoan that is responsible for one type of
vaginitis, has four flagella at one end that produce the characteristic circular whiplike
movement seen in wet preparations and microscopic examinations of infected individuals’
urine.
b. Bacteria can also be categorized by their ability to hemolyze (burst) red blood cells in the blood
agar (a medium for growing bacterial cultures that contains whole blood).
c. Biochemical analysis, often done on semiautomated analyzers, provides the microbiologist with
information that assists in identification of certain pathogens, such as enteric organisms (those
that live in the intestines).
C. Point out how microbes can be divided into groups based on special characteristics.
1. Bacteria (singular: bacterium)
a. Small, unicellular microorganisms that are capable of rapid reproduction.
b. Although their mere presence is not necessarily harmful, the overgrowth of bacteria can cause an
imbalance and lead to disease or pathology.
c. Most bacteria thrive in a warm, dark, moist environment. Because the human body is capable of
providing this atmosphere upon entry, bacteria can easily thrive and grow.
d. Their reproductive ability explains how some infections become overwhelming in a short period of
time and can be dangerous.
For example, one Escherichia coli organism, the most common cause of urinary tract infections
(UTIs), reproduces in about 30 minutes.
By the end of a 24-hour period, this one Escherichia coli (E. coli) cell will have produced an
enormous number of cells capable of creating an infection if they have been introduced into the
bladder.
e. Bacteria may be named for their morphology (shape):
Cocci (spherical)
Bacilli (rod-shaped)
Spirilla (spiral shape)
Discuss coccus/cocci, round bacteria that are arranged in various configurations.
1. Staphylococci are gram-positive, grape-like clusters of cocci, some of which are pathogenic.
a. Nonpathogenic staphylococci are found on our skin and in many of our body orifices, or openings.
b. Staphylococcus aureus (S. aureus), or staph, is the major pathogen of this genus and may be found
as normal flora in the nose and on the skin.
It causes infection, especially when resistance is lowered by a break in the skin or in the
mucous membranes.
The skin is the most common site of infection by S. aureus.
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It produces infections such as impetigo in children and is associated with infection of wound
sites and surgical incisions.
It causes pus-producing abscesses such as boils, carbuncles, and folliculitis.
S. aureus is a common cause of nosocomial infections and may also cause pneumonia,
meningitis, and septicemia in individuals with reduced resistance.
Toxic shock syndrome is also caused by this virulent organism.
S. aureus produces one type of enteritis (food poisoning) that occurs within in a few hours of
eating improperly refrigerated food contaminated with the toxin produced by the bacteria.
This toxin causes nausea, vomiting, diarrhea, and abdominal cramping.
S. aureus is coagulase positive, meaning it produces an enzyme that can be used to help
differentiate S. aureus from other species of this organism.
2. Today, because of increased reliance on treatment with antibiotics to treat low-level infections,
superbugs are becoming common.
a. This term refers to various microorganisms that are mutating to produce antibiotic-resistant forms.
b. Of particular interest is methicillin-resistant Staphylococcus aureus (MRSA).
This form of S. aureus produces an enzyme the makes the organism resistant to penicillins and
cephalosporins normally used for treatment and renders these antibiotics ineffective.
Similarly, vancomycin-resistant enterococci (VRE) and carbapenem-resistant enterobacteriaceae
(CRE) are becoming more prevalent.
Tests are available to indicate the presence or absence of this enzyme and help determine the
most favorable treatment.
c. The problem of antibiotic resistance is a major concern for health care providers and is being
experienced worldwide.
Describe the infectious organisms known as viruses.
1. Although potent, a virus is the smallest known infectious organism and requires the use of an electron
microscope for visualization.
2. A virus, a simpler form of life than a cell, is parasitic, depending on living cells of other organisms for
growth.
3. When a virus enters a cell, it may immediately cause a disease, such as influenza, or it may remain
dormant for days or even years.
a. Herpes zoster can cause an outbreak of chickenpox within 7 to 14 days of exposure, where HIV
can lie dormant for years before symptoms are note.
4. Viruses cause many common diseases such as colds, chickenpox, mumps, infectious mononucleosis, and
warts.
5. Other illnesses caused by viruses are hepatitis, measles, encephalitis, and herpes.
6. Fortunately, vaccines are available to protect people from viral diseases such as polio, German measles,
measles, hepatitis B, mumps, and chickenpox.
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Define fungi and the classifications used for this group of microorganisms.
1. The study of fungi (singular is fungus) is known as mycology.
2. Fungi are present in soil, water, and air.
3. Fungi are unable to make their own food, so they depend on other life forms.
4. Included in this classification are yeasts and molds.
5. In our environment we encounter fungi in the form of mushrooms and penicillin molds on stale bread.
6. Penicillium mold was discovered by Alexander Fleming, and its antibiotic properties changed modern
medical treatment.
7. Penicillin is now synthetically produced.
8. Yeasts are single-celled fungi that reproduce by budding.
9. Molds are those fungi that produce spores.
10. Most fungi are not pathogenic and cause few diseases in humans. Of the ones that do, most will produce
only superficial infections, such as athlete’s foot (Tinea pedis) or ringworm.
11. A few do produce life-threatening illnesses when they invade the internal organs of the body.
12. Candida albicans is the causative agent of moniliasis or candidiasis, a yeast infection, and thrush.
13. Individuals with compromised immune systems or those who have been on long-term antibiotic therapy
may develop severe infections.
a. In these cases, the normal flora that protect the openings of the body cavities are killed by the
antibiotic therapy and allow harmful fungi a fertile environment in which to reproduce.
b. This type of infection is referred to as a superinfection.
14. It takes a long time and persistence to get rid of a fungal infection. Fungal infections are resistant to
antibiotics and must be treated with antifungal agents.
1. Collection Devices:
a. Sterile swabs are frequently used in collection of specimens.
The shafts and the tips of swabs vary in terms of the type of material used.
They are wrapped in a sterile wrapper or container to preserve sterility.
Cotton swabs are used less frequently today because certain microbes are inhibited by the natural
ingredients in cotton.
Polyester and rayon are used for the tips and wood, plastic, or wire for the shaft.
Swabs also vary in size of tip and flexibility of the shaft to permit collection in difficult-to-reach
areas.
After a swab is collected, it is placed in a sterile container that may or may not contain culture
media.
C. Note that pathogens can be observed in specimens of blood, feces, cerebrospinal fluids, mucus, urine,
sputum, wounds, tissue, and exudates of other body specimens. Review the types of specimens and
information for obtaining them.
1. Throat
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a. One of the most frequently requested specimens in a POL is a throat swab or culture.
b. Based on signs and symptoms the patient presents with, such as upper respiratory infection, sore
throat, or sinus infection, the physician will order a throat culture to identify the pathogen involved
and begin treatment.
c. Confirmation of Streptococcus pyogenes is important because of its virulence and possible
complications.
d. When performing a throat culture, it is important not to touch the insides of the mouth or the tongue
with the swab to avoid contaminating it.
e. If the culture is to be done in house, it is streaked.
A bacitracin antibiotic disk will be placed on the culture plate in the area with the heaviest
inoculation.
A zone of no growth around the disk is presumptive evidence that the pathogen is group A beta-
hemolytic strep.
Other strep organisms are not sensitive to bacitracin.
Bacitracin is not used to treat strep throat, only as a differentiating antibiotic.
Broad-spectrum antibiotics such as penicillin, ampicillin, and erythromycin are used to treat
strep.
If strep is suspected, an antigen–antibody test for strep may be ordered.
f. Nasal swabs are sometimes requested, and care should be taken to label the swabs “Right” and “Left”
to identify from which nostril the specimen was taken.
g. Smaller sterile swabs with thinner more flexible shafts are generally used for obtaining nasal
specimen.
h. Refer to Procedure 45-1: Obtaining a Throat Culture for instructions in this procedure:
2. Sputum
a.To obtain a sputum (mucous substance expelled by coughing or clearing the bronchi) specimen, the
patient must be carefully instructed to cough deeply and spit up the coughed up material into a sterile
container.
b. Explain to the patient that this should not be saliva from the mouth.
c.Often it is possible to obtain a good sputum specimen if the patient is reminded to try on rising in the
morning, using a sterile container provided by the POL.
d. The purpose for obtaining a sputum specimen is to isolate and diagnose diseases such as
streptococcal pneumonia, influenza, and tuberculosis.
e. Refer to Procedure 45-2: Obtaining a Sputum Specimen for Culture for instructions on this
procedure.
3. Urine
a. A urine specimen for culture must be either a catheterized specimen or a clean-catch midstream
sample (CCMS).
Both methods provide sterile samples.
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Any other type of urine specimen (one for routine analysis, for example) would be contaminated
by organisms in the container or on the hands or genitals of the patient.
b. Refer to Procedure 46-1 in Chapter 46, Urinalysis, for collection of a clean-catch midstream urine
specimen from both male and female patients.
4. Stool
a. Stool or feces (waste product from bowel) may be tested for bacterial, parasitic, or protozoal
infections; for the presence of occult blood; and for excessive amounts of fat (steatorrhea).
b. The collection of stool specimens varies with the type of test ordered.
c. Discussing stool sample collection is often embarrassing to both patient and medical assistant;
however, correct collection is critical to an accurate result.
d. Fecal specimens must be free of urine, water from the toilet, and toilet tissue.
e. Stool culture
To detect bacteria or viruses a small amount of feces is needed.
The collection containers must be sterile, and aseptic technique must be used in the collection
process.
Once collected, the stool must be sent immediately to the testing facility.
Sterile collection devices are available.
Sheets of special paper, coverings for the toilet, and bedpans can be used to collect specimens.
Sterile tongue depressors or applicator sticks can be used to transfer a small of amount of stool
to a sterile container for transportation to the laboratory or office.
In the office a sterile bedpan may be used or sterile pan placed over the bowl of the toilet.
f. Occult blood
A stool specimen is required to test for occult or hidden blood that may indicate bleeding in the
gastrointestinal tract.
Often the patient is given the test units to take home and collect the specimen.
Directions are provided on each test unit; however, instructions should be reviewed each time
they are given to a patient.
Patients are instructed to write their name, date, and doctor’s name on label of the collection
unit.
Using one of the wooden spatulas provided, they are to collect a small amount of stool and place
it in one of the circles on the back of the booklet, obtain another sample from a different area of
the stool, and placed on the other circle.
Patients should close the unit and take it or mail it to the doctor’s office or the laboratory as
requested.
For more accurate results patients should be instructed to refrain from consuming vitamin C and
red meat for three days prior to testing because they may cause false positives.
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It is important to check the expiration date of any test kit before giving it to the patient.
Refer to the procedure on testing for occult blood in Chapter 37, Assisting with Medical
Specialties.
g. Stool for ova and parasites
The presence of microbial organisms, such as ova and parasites (O&P), may be determined by
testing feces or stool.
The presence of ova or eggs or other forms of a parasite indicates parasitic infestation.
Identification of the parasite aids in selecting the correct treatment.
Commercial kits are available that provide containers for fresh stool specimen and two additional
vials for preserved specimens, one containing formalin and the other containing polyvinyl
alcohol.
The patient should be instructed to mix portions of stool in each vial and seal.
If O&P are suspected, three specimen collections will be requested.
The specimen is usually obtained in the early morning.
The patient should be instructed to defecate into a stool specimen container or by using a
bedpan, if available, placed over the toilet.
The stool specimen samples should be taken from several different parts of the stool since
ova and parasites may be in one portion of the stool and not another.
Refer to Procedure 45-3: Obtaining a Stool Specimen for Ova and Parasites for instructions in this
technique.
1. Explain sensitivity testing. Refer to Box 45-1: Sensitivity Testing.
a. Once the physician or laboratory specialist identifies the pathogenic organism on the culture, it is
necessary to determine which antibiotics will be effective in killing these bacteria.
b. This method of detection is called sensitivity testing.
A petri dish with Mueller-Hinton agar and antibiotic disks are used.
A new petri dish with Mueller-Hinton agar is prepared with the pure culture specimen, using
overlapping strokes in a technique called the lawn technique or colony count.
Several disks, each soaked in a different antibiotic, are placed on top of the inoculated agar.
The lid of the petri dish is replaced, inverted, and placed in the incubator for 24 hours.
After 24 hours, the organism will have grown all over except around those disks that inhibit its
growth.
These zones around the disks are measured to determine the susceptibility of the organism to
each particular antibiotic disk.
The disk with the largest, clearest area around it has the most effective medication.
After the most effective antibiotic is identified, the patient is given that medication.
Define serology and discuss serology specimen testing.
1. Serology is the study of the antigen and antibody reactions of the body’s immune system.
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2. The body’s ability to recognize a foreign substance (antigen) and produce an antibody against it is called
the immune response.
3. Antibodies are specific for a particular antigen. For instance, polio antibody is specific for polio only.
4. Antigen-antibody reaction is a frequently used testing tool for pregnancy, rheumatoid arthritis,
mononucleosis, and strep, among other conditions.
5. Test is serological because it studies or tests the serum component of the blood.
6. Test kits contain all of the equipment and supplies necessary and assist the MA in ensuring that reagents
are fresh and quality control is maintained.
7. Kits standardize testing, thus ensuring accuracy, precision, and quality control.
8. It is absolutely essential to follow exactly the manufacturer’s directions.
N. Review the why and the how of performing a strep test.
1. Group A Strep Screen is a test that is done frequently in POLs.
2. Especially efficient in the pediatric office because it is self-contained and can be done while the patient
waits.
3. Screen is an antigen detection test for group A beta-hemolytic streptococci and follows the general
procedure for antigen–antibody agglutination (clumping together) tests, which produce a clumping of
cells.
4. There are many CLIA-waived group A strep kits available that test for the extracted group A beta-
hemolytic streptococcus antigen.
a. These self-contained kits are commercially prepared diagnostic testing kits that include detailed
instructions and contain reagents, controls, and quality control suggestions.
5. A variety of other serological test kits are available for infectious mononucleosis, rheumatoid arthritis,
and HIV, to name a few.
6. The specialty of the physician will determine which tests will be used.
7. Refer to Procedure 45-8: Perform Rapid Group A Strep Testing for detailed instructions in this
technique.
2. Remember that microbiological specimens are living organisms and must have proper conditions to
survive, but not to multiply. Refer to Guidelines 45-1 in the text.
Specimen Collection
The basic rules for specimen collection are:
Confirm the identity of the patient by asking the patient to state his or her name and spell it, if
necessary.
Screen the patient to determine if pretest preparation was followed.
Collect specimen before beginning antibiotic treatment.
Collect sufficient quantity of material for testing.
Use only appropriate collection technique by observing proper cleaning and aseptic procedures
to control contamination.
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Use only sterile containers.
Select the proper containers for collection that comply with the reference laboratory’s or outside
laboratory’s requirements.
Ensure that the collection container is tightly closed and appropriately sealed to avoid leakage
and contamination of the specimen and any surface with which the container may come in
contact.
Label the specimen accurately at the time of collection with the following information:
Patient’s full name
Date
Time of collection
Type of specimen
Antibiotic treatment in use, if any
Your initials
Fill out the requisition form for the reference lab and double-check that the information matches
the label.
Deliver specimen promptly to laboratory and document it. Otherwise, maintain proper storage
until specimen can be picked up or transported appropriately.
Note: Cerebrospinal fluid always requires immediate delivery.
Diversity
What might be some cultural issues with collection of specimens?