44 The Clinical Laboratory Lesson 1: Lesson Objectives Upon completion of this lesson, students should be able to: Define and spell the terms to learn for this chapter. Explain the role of the clinical laboratory in patient care. Identify and explain three types of clinical laboratories and their roles. Lesson Objectives Upon completion of this lesson, students should be able to: Describe the role of the medical assistant in the physician's office laboratory. Summarize Occupational Safety and Health Administration laboratory safety regulations. Lesson Objectives Upon completion of this lesson, students should be able to: Explain the three Clinical Laboratory Improvement Amendments categories of testing. Define quality assurance and list at least five components of a quality assurance program. Perform quality control measures. Lesson Objectives Upon completion of this lesson, students should be able to: Identify several different types of laboratory equipment found in a physician's office laboratory. Identify and explain the parts of a microscope. Operate and properly care for a microscope. Lesson Objectives Upon completion of this lesson, students should be able to: Communicate effectively with patients regarding laboratory test preparation and specimen collection. List patient information necessary to complete a laboratory request form. Monitor and follow up on patient laboratory test results. The Role of the Clinical Laboratory in Patient Care
Screen for disease Confirm a condition suspected by the physician Rule out a condition Establish a baseline level before medication administration Monitor effectiveness of a medication or treatment Assess the progress of disease The Role of the Clinical Laboratory in Patient Care
Laboratory data should be used in conjunction with other clinical findings to provide quality care. It is unwise to rely on laboratory results alone to diagnosis or treat a patient. Laboratory tests fall into two general areas: qualitative quantitative The Role of the Clinical Laboratory in Patient Care
Qualitative Tests Typically positive or negative for the presence of a specific substance Example: pregnancy test shows if HCG is present Quantitative Tests Give a numerical value Example: glucose level in a blood sample The Role of the Clinical Laboratory in Patient Care
Quantitative Tests Values may vary at different facilities because different procedures, product manufacturers, techniques, and equipment may be used. Normal reference ranges may vary from book to book and lab to lab. Always determine normal ranges associated with specific laboratory and test before evaluation of results Types of Clinical Laboratories
Outside Laboratory Either hospital-based or independent Handles specimens collected from many types of facilities Performs tests ranging from simple to complex Types of Clinical Laboratories
Outside Laboratory Patient may go to outside laboratory to have blood drawn or a specimen taken with the test results then sent to referring physician Types of Clinical Laboratories
Outside Laboratory Typically provide supplies and forms for specimen collection and transport Most offer a directory with instructions for proper handling and transport of specimens Always consult instructions to determine how much of a specimen to collect, which container to use, and how to prepare the specimen for transport. Types of Clinical Laboratories
Outside Laboratories MA may be employed as a phlebotomist (one who performs a blood draw) or as an administrative assistant MA is responsible for requesting additional supplies to replenish the inventory on hand Types of Clinical Laboratories
Reference Laboratory May be associated with a teaching hospital or medical school, or be independently owned Handles more complex tests than an outside laboratory and those tests that are infrequently requested Types of Clinical Laboratories
Reference Laboratory Tests performed on a regular basis at a reference lab may provide more accurate results than tests performed a few times a year in an outside laboratory. Types of Clinical Laboratories
Physician's Office Laboratory (POL) Some of the tests the physician orders are performed in the office. In POL, doctor has the advantage of receiving the results more rapidly than if tests are done outside of the office Types of Clinical Laboratories
Physician's Office Laboratory (POL) Turnaround time 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 Disadvantages In-house testing may require more employees and the purchase of expensive equipment Types of Clinical Laboratories
Physician's Office Laboratory (POL) MAs are particularly suited to POL, although they are limited to performing only CLIA-waived tests. Usually housed in a separate room or work area that is well lighted and adequately ventilated Types of Clinical Laboratories
Physician's Office Laboratory (POL) Most have a refrigerator that is clearly labeled for storage of potentially infectious specimens only Supply of PEP, including gloves, masks, gowns, and protective eyewear is essential Types of Clinical Laboratories
Physician's Office Laboratory (POL) Sharps container and biohazardous waste receptacle should be within easy reach Hand washing facilities and eyewash station are also important The Medical Assistant's Role in the Clinical Laboratory
For MAs working in a laboratory, training in phlebotomy and basic knowledge of laboratory testing is essential. The Medical Assistant's Role in the Clinical Laboratory
Training in administrative duties helps MAs to perform the many administrative tasks required in a laboratory. MAs' patient-oriented training helps them to be empathetic caregivers. The Medical Assistant's Role in the Clinical Laboratory
An understanding of basic lab methods and techniques helps MA understand the nature and importance of specific tests: Why tests are done How to prepare a patient for a test Conditions that may render test inaccurate How to evaluate test results The Medical Assistant's Role in the Clinical Laboratory
MAs play any of several key roles in a clinical laboratory: Record management Teaching patients Specimen management Quality assurance The Medical Assistant's Role in the Clinical Laboratory
Record Management Methods vary, depending on where sample is collected and where it is tested First priority: ensure the physician's order is clearly recorded and the proper lab forms are completed The Medical Assistant's Role in the Clinical Laboratory
Record Management In-house collection and processing must be charted. Results should be evaluated and carefully documented. The Medical Assistant's Role in the Clinical Laboratory
Record Management Requisition form provides essential information about: The test that is ordered How results will be reported Information for billing and coding The Medical Assistant's Role in the Clinical Laboratory
Requisition form MA will need to complete the form if tests are not being performed right away Requisition will be transported with specimens that are collected at the physician's office and sent out for testing, or The Medical Assistant's Role in the Clinical Laboratory
Requisition form MA will need to complete the form if tests are not being performed right away The requisition will go with the patient who is required to travel to a laboratory for collection and testing. Requisition must be labeled STAT if physician wants results immediately Completing a Laboratory Requisition and Preparing a Specimen for Transport to an Outside Laboratory
Check the patient's record for orders for specific lab tests. Verify which lab will be doing the testing and locate their required requisition form. Complete the patient demographic section. Complete the section requiring the physician's name, address, phone number, and account number. Completing a Laboratory Requisition and Preparing a Specimen for Transport to an Outside Laboratory
Complete the patient's insurance and billing information. Mark each box to indicate each test ordered by the physician. If a test is ordered that is not listed on the requisition, write in the name of the test on the lines provided. Indicate the type and source of the specimen to be tested. Completing a Laboratory Requisition and Preparing a Specimen for Transport to an Outside Laboratory
Enter the patient's diagnosis on the requisition as needed. If no diagnosis has been made, then code the patient'ssymptoms. Complete the patient authorization to release and assign the benefits as needed. Assemble the equipment and supplies needed to obtain the specimen. Completing a Laboratory Requisition and Preparing a Specimen for Transport to an Outside Laboratory
Perform hand hygiene and apply gloves. Obtain the specimen required after explaining the procedure to the patient. Label the specimen with the patient's name, date, physician's name, time of collection, and other information required by the facility. Completing a Laboratory Requisition and Preparing a Specimen for Transport to an Outside Laboratory
Initial the laboratory requisition and complete the date and time the specimen was obtained. Process the specimens, and if they are not to be sent out until later in the day, store them according to laboratory policies and procedures manual requirements. Completing a Laboratory Requisition and Preparing a Specimen for Transport to an Outside Laboratory
Attach the laboratory requisition securely to the specimen before sending. Remove gloves; dispose of them in the biohazard waste container. Perform hand hygiene. Document the patient's record. Completing a Laboratory Requisition and Preparing a Specimen for Transport to an Outside Laboratory
Record the specimen in the laboratory logbook, indicating date, time of collection, type and source of the specimen, tests ordered, where samples were sent, and the date they were sent. The Medical Assistant's Role in the Clinical Laboratory
Data to be collected on requisition form includes: Physician's name, address, phone number, and account number Patient's full name, address, phone number Patient's age, sex, date of birth (DOB) The Medical Assistant's Role in the Clinical Laboratory
Data to be collected on requisition form includes: Patient's complete insurance information All relevant diagnostic codes Diagnosis, if possible Source of specimen The Medical Assistant's Role in the Clinical Laboratory
Data to be collected on requisition form includes: If fasting or non-fasting specimen Date and collection time Specific tests requested per physician's orders, including five-digit procedure code Patient's present medications If request is stat or regular The Medical Assistant's Role in the Clinical Laboratory
Record Management Use the requisition slip designed specifically for the laboratory that will receive it. Record accurate results as soon as possible to prevent confusion and inaccuracies. The Medical Assistant's Role in the Clinical Laboratory
Record Management Document specimen collection in narrative notes. Notes should include test ordered, method of collection, patient's response and either results or where specimen was sent. The Medical Assistant's Role in the Clinical Laboratory
Paper Documentation When paper forms are used for outside testing: Form is completed to send with patient or specimen going to outside lab Results may be faxed, couriered, mailed, or called in If result is flagged as high priority, it should be brought to practitioner's immediate attention. The Medical Assistant's Role in the Clinical Laboratory
Paper Documentation All documentation is either written in or added to patient's paper chart. The Medical Assistant's Role in the Clinical Laboratory
Electronic Documentation EHR allows offices to communicate with outside labs through the computer. Lab orders are submitted electronically or printed out and sent with patient or specimen Test results are immediately accessible. The Medical Assistant's Role in the Clinical Laboratory
Electronic Documentation Abnormal results highlighted or marked for easier identification Practitioner will review and sign electronically MA saves report to patient's EHR The Medical Assistant's Role in the Clinical Laboratory
Paper Versus Electronic Documentation MA's responsibility to ensure physician or practitioner evaluates and signs all results Many physicians prefer to use flow sheets Charts used to evaluate patient's progress and response to treatment over time The Medical Assistant's Role in the Clinical Laboratory
Paper Versus Electronic Documentation As new results are added to patient record, flow sheets should be added as well. Electronic documentation allows for generation of flow sheets to visualize changes. The Medical Assistant's Role in the Clinical Laboratory
Teaching the Patient Explain ordered tests, how they will be useful, how a specimen will be collected, and when results will be available. Explain special preparations. Explain dietary or medication restrictions, activity limitations, time requirements, and/or special directions. The Medical Assistant's Role in the Clinical Laboratory
Teaching the Patient Provide a written copy of instructions for the patient to take home. Ensure patient understanding of restrictions in order to comply. Explain that patient results may be inaccurate if directions are not properly followed. The Medical Assistant's Role in the Clinical Laboratory
Teaching the Patient Follow office protocol for reporting results to patients. Some offices do not notify patients unless there is a problem that needs to be addressed; others routinely call patients. The Medical Assistant's Role in the Clinical Laboratory
Teaching the Patient Many practitioners will speak with patients directly; MA will set up the appointment. Some practitioners expect MAs to contact patients to relay new orders or instructions. Monitoring and Following Up on Laboratory Test Results
Review incoming lab results and compare with the reference values provided by the analyzing laboratory. Many laboratories highlight or indicate abnormal results on the lab result sheets with H or L. Highlight any abnormal results per facility policy. Monitoring and Following Up on Laboratory Test Results
Obtain the patient's medical record, attach the new laboratory results, and submit the chart to the physician for review. Accuracy when documenting results is critical. Follow the physician's orders regarding scheduling appointments or repeat testing. Monitoring and Following Up on Laboratory Test Results
Document the patient's record accordingly. PROCEDURE Monitoring and Following Up on Laboratory Test Results FIGURE A Correctly documenting laboratory test results in medical records, in writing or electronically, is critical. Mustafa Arican/Getty Images The Medical Assistant's Role in the Clinical Laboratory
Specimen Management Specimen is a small sample taken from the body Urine Feces Sputum Blood Other bodily tissues or secretions The Medical Assistant's Role in the Clinical Laboratory
Specimen Management Blood and urine are most commonly obtained specimens forlaboratory testing It is vital to properly collect and preserve a specimen to ensure that it truly represents the patient's body functions. Inaccurate test results may alter patient's diagnosis and treatment The Medical Assistant's Role in the Clinical Laboratory
Specimen Management in POL Specimens generally processed for in-house testing according to office policy Some specimens may be prepared for transportation to outside lab MA should perform CLIA-waived tests precisely according to manufacturer's instructions after checking expiration dates The Medical Assistant's Role in the Clinical Laboratory
Specimen Management (Outside Lab) Determine specific requirements of the lab. Each lab has its own policies regarding which specimen containers to use/how much to collect. The Medical Assistant's Role in the Clinical Laboratory
Specimen Management (Outside Lab) 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. The Medical Assistant's Role in the Clinical Laboratory
Complications of a Specimen Collection 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. The Medical Assistant's Role in the Clinical Laboratory
Complications of a Specimen Collection Not enough specimen may be collected, resulting in QNS (quantity not sufficient) lab report Incomplete/incorrectly handled specimens may require retesting. The Medical Assistant's Role in the Clinical Laboratory
Specimen Management Proper identification of patient is important Check the chart to verify the order. Ask the patient to state his or her full name and date of birth to prevent miscommunication. The Medical Assistant's Role in the Clinical Laboratory
Specimen Management Proper identification of patient is important Compare the name and date of birth information the patient has given with the chart to verify that this is the right patient. The Medical Assistant's Role in the Clinical Laboratory
Labeling Specimens Use two identifiers (such as name and date of birth) Date and time collected The Medical Assistant's Role in the Clinical Laboratory
To prevent cross-contamination: A label should never be placed on a removable lid. A specimen should always be sealed and labeled before walking away from a sample. The Medical Assistant's Role in the Clinical Laboratory
Labeling Specimens If patient was not supposed to eat before the test and forgot, label the specimen as non-fasting and check with physician to determine if the test should still be run The Medical Assistant's Role in the Clinical Laboratory
Specimen Management In many activities in medical facility, no one but you knows whether you have followed proper procedure: Wash your hands each and every time you go to a new patient. Change gloves as required. Perform the test procedure correctly. Write down the correct test results. Actually perform controls as required The Medical Assistant's Role in the Clinical Laboratory
Specimen Management MA's integrity, honesty, and reliability are on the line every day Keep in mind Code of Ethics and Medical Assistant's Creed The Medical Assistant's Role in the Clinical Laboratory
Quality Assurance (QA) QA procedures Planned and systematic activities to ensure requirements are met and results are accurate The Medical Assistant's Role in the Clinical Laboratory
Quality Assurance (QA) QA program is a written program that includes mechanisms to: Evaluate laboratory procedures and policies Identify and correct problems Ensure reliable and prompt reporting of results and testing by competent individuals The Medical Assistant's Role in the Clinical Laboratory
Steps for Quality Assurance Most offices and labs have a policies and procedures manual with a set of routine checklists to follow. Keep lab and patient areas clean and provide clear patient instructions. The Medical Assistant's Role in the Clinical Laboratory
Steps for Quality Assurance Restock supplies to ensure correct materials are available. Check storage instructions and expiration dates for all reagents and test kits before storage and before use. The Medical Assistant's Role in the Clinical Laboratory
Quality Assurance (QA) Routinely review procedure manuals and follow the most recent manufacturer's instructions for correct test performance. The Medical Assistant's Role in the Clinical Laboratory
Quality Assurance (QA) Properly document scheduling or performance of routine maintenance, including calibrations. Properly label laboratory refrigerators for restricted use; check and record thermometer daily. The Medical Assistant's Role in the Clinical Laboratory
Quality Assurance (QA) Date and initial the container when opening a new stock container or multiuse reagents, chemicals, or test strips. Identify assigned lab values and compare them to the specimen result. The Medical Assistant's Role in the Clinical Laboratory
Maintenance All laboratory equipment must be maintained on a regular basis according to manufacturers' instructions. Written record of the maintenance performed must be readily available Keep a record of each piece of equipment with model and serial numbers, date of purchase and manufacturers' inserts. The Medical Assistant's Role in the Clinical Laboratory
Documentation Written record of test result, control result, maintenance performed, or temperature recorded is proof of activity If it is not written down in the appropriate place, you did not do it. The Medical Assistant's Role in the Clinical Laboratory
Quality Control (QC) Accomplished by routinely performing mock tests using calibration or control solutions The Medical Assistant's Role in the Clinical Laboratory
Quality Control (QC) Calibration Some machines require evaluation by calibration devices. Calibration devices specially prepared test strips or cartridges that are designed to produce a predetermined result The Medical Assistant's Role in the Clinical Laboratory
Quality Control (QC) Control solutions Some tests are evaluated by using regular testing materials; instead of adding a patient sample, a provided control solution is added in its place. Chemicals that produce an expected result; they are usually purchased from or provided by the manufacturer of the testing equipment. The Medical Assistant's Role in the Clinical Laboratory
Quality Control (QC) Regardless of method, result should fall within acceptable range provided by manufacturer The Medical Assistant's Role in the Clinical Laboratory
Quality Control Abnormal Results Always investigate abnormal quality control results. Causes may include: User error Impaired quality Outdated materials Malfunction Machine The Medical Assistant's Role in the Clinical Laboratory
Quality Control Abnormal Results Try retesting with newly opened materials or ask coworker to perform quality control test The Medical Assistant's Role in the Clinical Laboratory
Quality Control Abnormal Results If results remain abnormal, machine is not considered accurate and should be serviced or repaired and retested before using on patients The Medical Assistant's Role in the Clinical Laboratory
Quality Control Tests are performed according to manufacturer's requirements and lab policy, often daily. Results recorded in a quality control log, which is evaluated after each use. CLIA 1992 standards mandate that written policies and procedures must be in place for a comprehensive quality control program. The Medical Assistant's Role in the Clinical Laboratory
Quality Control Laboratory is required to: Evaluate the effectiveness of its policies and procedures Identify and correct problems Ensure reliable and prompt test results The Medical Assistant's Role in the Clinical Laboratory
Quality Control Laboratory is required to: Ensure the competence and adequacy of staff Take corrective action if errors are found Integrate corrective procedures into future policies and procedures The Medical Assistant's Role in the Clinical Laboratory
Quality Control Laboratory requirements Document employee training, and assess competency yearly after the first year Maintain the identity and integrity of patient samples during the entire testing process The Medical Assistant's Role in the Clinical Laboratory
Quality Control Laboratory requirements Be subject to inspection every two years if performing moderate- or high-complexity tests BOX 44-2 Using Controls to Monitor Results Evaluating a Contour TS Glucometer Using Control Solutions
Assemble the equipment and supplies. Check the expiration and discard dates for the control solutions and test strips. Make sure the test strip is dry, clean, and intact. Hold the test strip with the gray end facing up and insert into the orange port at the front of the meter. Evaluating a Contour TS Glucometer Using Control Solutions
The machine will automatically turn on. Once the test strip and the drop of blood appear on the screen, wait for the blood drop to flash. Before opening, gently rock the control bottle, to mix the solution evenly. Evaluating a Contour TS Glucometer Using Control Solutions
Squeeze a small drop of the control solution onto a piece of wax paper and recap the solution. Do not apply the solution directly onto the test strip. Immediately touch the tip of the test strip to the drop of control solution. Hold it in place until the machine beeps. Evaluating a Contour TS Glucometer Using Control Solutions
Compare the test result with the control range printed on the bottom of the test strip bottle label. If the result falls outside the specified range, consult themanufacturer's instructions for the error codes and symbols chart. Compare the code or symbol that appears on thescreen. Repeat the test, if necessary. Evaluating a Contour TS Glucometer Using Control Solutions
Record the results in the Quality Control Log. Remove the test strip and dispose. Repeat the above steps with a different control solution, as required. Glucometer Calibration and Quality Control Log Critical Thinking Question
Why is having safety regulations in the laboratory so critical? Laboratory Safety Regulations
Occupational Safety and Health Administration (OSHA) Established within the Department of Labor in 1970 by Congress Creates safeguards covering nearly every employee in U.S. Laboratory Safety Regulations
Occupational Safety and Health Administration (OSHA) Develops specific guidelines governing particular fields and requires adherence General duty clause must be followed if no specific guideline exists Laboratory Safety Regulations
OSHA In 1996, CDC developed and published new guidelines for isolation precautions in hospitals called standard precautions Standard precautions combine major features of universal precautions and body substance isolation precautions into one set of recommendations. Laboratory Safety Regulations
OSHA CDC precautions enforced by OSHA Copies of general guidelines: Laboratory Safety Regulations
Clinical Laboratory Improvement Amendments (CLIA) Enacted in 1988 by Congress in response to widespread concern over the accuracy of laboratory tests Mandates that all laboratories that test human specimens must be regulated to help ensure accurate patient test results Laboratory Safety Regulations
Clinical Laboratory Improvement Amendments (CLIA) Since 1988, CLIA have been kept current through periodic amendments and updates Laboratory Safety Regulations
CLIA Divides laboratories into three categories: waived, moderate complexity, and high complexity MAs are qualified to perform only waived testing. Many CLIA-waived tests are simple enough for patient to perform at home with basic instructions Laboratory Safety Regulations
CLIA In POL, waived-tests frequently come in boxed test kit set, which contains several tests and the materials needed to properly use them Many automated analyzers are now CLIA-waived as a result of the advancements of technology. Laboratory Safety Regulations
CLIA Automated analyzer Typically a small or handheld machine that processes a specimen with single-use reagent test strips or cassettes Results are displayed quickly, proving an advantage for a patient who may need to be treated right away. Laboratory Safety Regulations
CLIA Information regarding state laboratory regulations may be obtained from state health departments. Facility is required to have a Certificate of Waiver from the Centers for Medicare & Medicaid Services (CMS) so that its employees can legally perform simple tests Laboratory Safety Regulations
Certificate of Waiver Tests Least complex tests; present the least risk if performed incorrectly See Box 44-3 for examples. Many of these tests have been approved by the FDA for home use. BOX 44-3 Categories of CLIA Tests Laboratory Safety Regulations
Certificate of Waiver Tests Only tests an MA may perform without further training. May only be performed in a laboratory that has been granted a Certificate of Waiver Laboratory Safety Regulations
Maintaining CLIA-waived status During an inspection, evaluators will determine if necessary standards are being met. A significant issue of discovery is when manufacturer's instructions are either missing, outdated, or are not followed to the letter. Laboratory Safety Regulations
CLIA-waived tests If modified even the slightest bit, tests are no longer considered waived tests and become subject to the more stringent CLIA requirements. A POL must apply to perform WTs and then may not perform the more complex tests from Level I or Level II. Laboratory Safety Regulations
CLIA-waived tests Approved tests are considered exempt from complying with CLIA 1988 standards; termed CLIA-waived or waived tests (WT) QA and quality control methods must still be observed. Laboratory Safety Regulations
CLIA-waived tests Laboratories may be subject to random inspections and investigation if test results questioned or complaints made against lab Laboratory Safety Regulations
CLIA-waived tests A POL qualified to perform moderate-complexity and waived tests receives a Certificate of Provider-Performed Microscopy (PPM) MA employed in a facility with PPM certificate can perform moderate-complexity tests with further training and under supervision of a laboratory professional or physician Laboratory Safety Regulations
Categories of CLIA Tests Waived Tests Dipstick urine testing or table testing Fecal occult blood testing Ovulation testing Urine pregnancy testing Erythrocyte sedimentation rate (non-automated) Laboratory Safety Regulations
Categories of CLIA Tests Waived Tests Hemoglobin testing with CLIA-waived analyzer Spun hematocrit Blood glucose using FDA-approved glucose analyzer Rapid Streptococcus testing Laboratory Safety Regulations
Categories of CLIA Tests Moderate-Complexity Tests/Level I Tests 75 percent of tests performed daily using automated analyzers for chemistry and hematology Microscopic analysis of urine sediment Laboratory Safety Regulations
Categories of CLIA Tests High-Complexity Tests/Level II Tests All tests in the field of cytogenetics, cytology, histopathology, and histocompatibility Laboratory Safety Regulations
Critical Steps in CLIA Testing Follow the instructions in the most current manufacturer's product insert EXACTLY. Report results using proper documentation and recordkeeping. Laboratory Safety Regulations
Critical Steps in CLIA Testing Adhere to expiration dates. Perform quality control testing regularly. Use only recommended storage requirements. Laboratory Safety Regulations
Critical Steps in CLIA Testing Keep manufacturer's instructions in an easily accessible area. Replace manufacturer's instructions every time a new product is received. Be aware of federal, state, and local regulations. Laboratory Hazards MAs must be familiar with the following regulations: Hazard Communication Standard Universal Precautions and Bloodborne Pathogen Standards Hazardous Waste Operations Needlestick Safety and Prevention Act Laboratory Hazards Chemical Hazards
Material Safety Data Sheets (MSDS) 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 FIGURE MSDS labels provide an abridged version of substance hazards information and must be permanently attached to their containers. Laboratory Hazards Chemical Hazards
All personnel have the right to know about hazards pertaining to materials in use. All personnel must receive appropriate training. Each hazardous material must have hazardous material label attached to container with shortened MSDS information Laboratory Hazards Bloodborne Pathogens and Precautions
Biohazards have potential to infect others OSHA's Occupational Exposure to Bloodborne Pathogen Program must be in place at all working laboratories. Laboratory Hazards Bloodborne Pathogens and Precautions
Standard precautions must be employed when dealing with any infectious materials. All potentially biohazardous material must be labeled with the biohazard label. FIGURE An orange-red biohazard symbol indicates that bloodborne pathogens may be present, and items should be treated accordingly. Laboratory Hazards Needlestick Hazards
Healthcare workers must follow safety protocols per Needlestick Safety and Prevention Act of 2000. Review all new safety devices to lessen the needlestick risks of employees. Ask for safety input from employees on an annual basis. Keep a detailed report of all contaminated needlestick incidents. Laboratory Hazards Fire and Safety Hazards
Reduce chances of fire and electrical accidents by having an awareness of floor plan and exits. Know the location of safety devices such as eye washes, showers, and safety blankets. Laboratory Hazards Hazardous Waste Removal Blood Blood products
Body fluids and tissues Cultures Vaccines Laboratory Hazards Hazardous Waste Removal Sharps Gloves
Inoculation loops Paper contaminated with body fluids Laboratory Hazards Hazardous Waste Removal
Dispose of all in proper containers identified with biohazard labels Place sharps in puncture-proof, leak-proof containers. Laboratory Equipment Autoclave
Used to sterilize equipment or instruments used on patients or in certain test procedures Provides high-pressure, saturated steam that is capable of sterilizing metal objects Laboratory Equipment Centrifuge
Instrument used to separate specimens into component layers Laboratory Equipment Centrifuge
Spins samples at high speed, which allows lighter components to float to the top and heavier components to sink to the bottom Used to separate urine so urine sediment can be examined under microscope Used to separate whole blood from plasma for chemical testing Laboratory Equipment Centrifuge Photometer
Microcentrifuge separates whole blood samples into layers to measure patient hematocrit Photometer Instrument that measures light intensity Glucometer is a type of handheld photometer used to test glucose levels in patients Laboratory Equipment Incubator
Used to maintain a specific temperature to achieve a specific result Laboratory Equipment Microscope
Used to examine urine sediment, vaginal and bacteriological smears, and differential smears Magnifies structures unseen by the naked eye for the purpose of counting, naming, or differentiating Laboratory Equipment Microscope
Compound microscope achieves maximum magnification by using two sets of lenses: oculars and objectives Resolution refers to the ability to distinguish clearly between two adjacent but distinct objects. Better microscopes have better resolution. Laboratory Equipment 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) Laboratory Equipment Parts of the microscope
Objectives (magnification imprinted on each objective): 10, low-power setting; 40, high dry setting; and 100, oil immersion setting Stage Laboratory Equipment Parts of the microscope
Mechanical stage (movable device that holds slide) Mechanical stage adjustments (two knobs that control vertical/horizontal movement of slide) Laboratory Equipment Parts of the microscope
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) Laboratory Equipment Parts of the microscope Condenser adjustment knob
Light source (illuminator set in base) Iris diaphragm lever Base Laboratory Equipment Using the Microscope
Magnification of 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 Ensure use of the correct lens for type of microscopic work to be done Laboratory Equipment Using the Microscope
Microscopic work on the high dry setting is done with a cover glass on the specimen. FIGURE 44-6 A compound microscope. Using and Cleaning the Microscope
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. Using and Cleaning the Microscope
Turn on the light and rotate the nosepiece until 10objective 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. Using and Cleaning the Microscope
Look through the eyepiece and adjust the coarse focus knob until the microscope field is seen (a round circle of bright light). Use the fine adjustment knob for a clearer image. Open the diaphragm and, if necessary, adjust the rheostat to focus. Using and Cleaning the Microscope
Raise or lower the condenser to alter light refraction. The condenser is usually lowered when using 10 power. Observe the slide. Using and Cleaning the Microscope
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. Using and Cleaning the Microscope
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. Laboratory Equipment Care of the 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. Laboratory Equipment Care of the Microscope
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. Questions? 160