M1 - Office Lab

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Occupational Safety and Health Administration

(OSHA)

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Government agency responsible for safety of all employees of companies operating around the US

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Possible office disasters

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--Fire / Flood / Tornado / Earthquake

--Hurricane / Explosion

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Fire Safety

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--Floor plans showing all exits, fire extinguisher locations and stairwell locations large enough to read from a distance

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Types of Fire Extinguishers

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--Type ABC - multi-use dry chemical extinguisher that is safe for most fires.

--Type A - Cloth, wood, rubber, paper, Plastic

--Type B - grease, gasoline, or oil-based fires

--Type C - electrical fires caused by appliances and tools plugged into electrical outlets

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*When using Fire Extinguisher Acronym:

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PASS

--PULL safety pin

--AIM nozzle at base of fire

--SQUEEZE handle & discharge contents

--SWEEP from side to side 6" over fire until out

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*RACE in case of Fire

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--Employees should RESCUE other employees and Patients

--ALERT by calling 911

--CONFINE fire by closing doors and windows

--EXTINGUISH the fire

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Electrical Safety

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All equipment should be grounded according to manufacturer's instructions to avoid electrical shock, don't use extension cords, surge protectors should be used at all electrical equipment, don't use "frayed" cords.

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*Ground Fault Circuit Interrupter (GFCI)

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outlet designed to protect people from severe or fatal electrical shocks in wet areas.

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Biohazards

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Biological substances that pose a threat to human beings & are potentially infectious Eg: medical waste, virus or bacteria

OSHA has established a Hazard Communication Standard (HCS) that require employees to disclose toxic and hazardous substances in workplace.

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*Material Safety Data Sheet (MSDS)

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Product data sheet or Safety Data Sheet offering basic information needed to ensure safety and health of user at all stages of manufacture, storage, use and disposal of hazardous products.

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Types of Medical Waste

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--Solids

--Chemical

--Radioactive

--Infectious

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Solid Medical Waste

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Solid trash in exam rooms and surgery suites that are not always hazardous.

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Chemical Medical Waste

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Germicides, cleaning solvents and pharmaceuticals

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Radioactive Medical Waste

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Any waste that contains or is contaminated with liquid or solid radioactive material.

Eg: Iodine 123 or Thallium 201

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Infectious Medical Waste

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Any waste material that has the potential to carry disease

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Occupational Exposure

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Reasonable anticipation that employee's duties may result in skin, mucous membrane, eye or parenteral contact with infectious material.

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*Types of Body Fluids

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--Blood / Semen / Amniotic Fluid

--Cerebrospinal Fluid / Synovial Fluid

--Vaginal Secretions / Pleural Fluid

--Pericardial Fluid

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Exposure Determination

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Listing jobs within the office to determine at risk employees

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Method of Compliance

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Specific measures to reduce risk of exposure

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Post-Exposure

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Evaluation and Follow-up

Steps to follow when exposure incident occurs

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*Universal Precautions

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CDC issued recommendations for protection of health care workers which states all blood and bloody fluids should be treated as if they are contaminated with any bloodborne pathogen

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Spill Clean-ups

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Proper procedures must be followed in clean up. A spill kit should be used. Simple kit can be assembled using plain clay cat litter, small dust pan and a biohazard bag.

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Office Security

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--Medical offices make attractive targets for thief / addict looking for drugs. Ensure doors & windows are secure.

--systems activated by leaving /entering office

--procedures should be implemented to secure staff, patients, medical records, computer stations, medical supplies, prescription pads

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*Incident Report

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Written report in BLACK ink stating accident, injury or unusual occurrence.

Should immediately notify employer, police or liability insurance carrier

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*Information included in an Incident Report Form

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--Names of all persons involved/ Date & time

--Exact location / name of person reporting

--Time of report / Brief description

--Witness Names / Action Taken at incident

--Name/description of equipment involved

--Action taken to prevent recurrence

--Signature & title of person completing report

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Quality Medical Care

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Expectation of all Patients and requires health care team use procedures and techniques that result in best possible outcome for the patient

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*Quality Assurance

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process of gathering & evaluating info about services provided & comparing to an accepted standard referred to as a "benchmark" which may apply to local, state or national standards

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*Quality Improvement Programs (QIP)

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Use data gathered by quality assurance and assessment to make quality improvements in health care

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*Quality Assurance Programs (QAP)

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Required in order for facility to receive funding by Public Health Service Act (defines requirements) as well as to achieve and maintain accreditation.

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*Basic Components of QAP

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--Establish QA committee w/ Rep each area such as DR, nurse, MA

--Review all clinical/administrative services and procedures

--Set up structure to review items w/ particular attention to issues

--Limit # of issues by setting a # to review

--Maintain careful records

--Quantify issues: Avg waiting time, # of errors /claims/failed venipuntures

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*MA Role in QAP

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--pay attention to quality of care given to pt

--May be 1st and last person to respond to pt's complaint. Have opportunity to present pt's complaints to a QA meeting so corrective measures can be taken.

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Role of Clinical Laboratory in Patient Care

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Clinical lab test results provide clues to assist with proper diagnosis, treatment & evaluation.

--Essential part of pt care and helpful in:

Screen for disease/ confirm conditions /

Rule out condition/ establish baseline /

Monitor effectiveness of meds or treatment

/ Assess progress of disease

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*Qualitative Test

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POS / NEG result of specific substance

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*Quantitative Test

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Gives numerical value to a test

Eg: glucose test

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Types of Clinical Laboratories

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--Outside Laboratories

--Reference Laboratories

--Physician's Office Laboratory (POL)

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Outside Laboratories

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handles specimens collected from MANY types of facilities and performs tests ranging from simple to very complex.

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Reference Laboratories

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May be associated with a teaching hospital or medical school or independently owned.

-Tests on a regular basis may provide more accurate results than tests only a few times a year at an outside lab.

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*Physician's Office Laboratory (POL)

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Laboratory in which some of the tests that a DR orders are performed right in the office.

--Advantages: Low turn-around time

--Disadvantages: In-house testing may require more employees and purchase of expensive equipment.

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Requisition

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Form that provides essential info about test ordered, how results will be reported and info for billing and coding.

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Records management info

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--Methods of lab test record management vary depending on where it's collected and where it's tested.

--First priority is to make sure DR's office is clearly recorded and proper lab forms are completed.

--In-house collection/processing must be charted & results should be evaluated and charted.

--if flagged as high priority, bring it to attention of DR immediately

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Postprandial (PP)

Post Cibum (PC)

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After meal

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Specimen

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Small sample taken from body such as urine, feces, sputum, and blood

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*Quantity Not Sufficient (QNS)

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Less than the required amount.

Incomplete or incorrectly handled specimens may require re-testing.

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Specimen Management Notes

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--To prevent cross contamination and mislabeling specimens, a label should always be sealed and labeled before walking away from a sample.

--If Pt ate for a fasting test, write "non-fasting" and check with DR to determine if testing should still be run.

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*Quality Assurance

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ENSURING that requirements are met and results are accurate

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Maintenance

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All lab equipment must be maintained on a regular basis to the manufacturer's instructions. A written record of maintenance performed must be readily available for OSHA.

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*Quality Control

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Physical PROOF that results are accurate using calibration devices and control solutions.

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Calibration Devices

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Specially prepared test strips or cartridges that are designed to produce a predetermined result

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Control Solutions

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chemicals that produce an expected result; usually purchased from or provided by manufacturer of the testing equipment

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*Clinical Laboratory Improvement Amendments (CLIA)

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Developed by Centers for Medicare and Medicaid Services (CMS) in response to widespread concern over accuracy of lab tests.

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*CLIA divisions of lab tests

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--Waived

--Moderate Complexity

--High Complexity

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*CLIA Waived Tests

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--Tests that are simple enough for patient to perform at home with basic instructions.

--In POL, they come in boxed test kit which contains several tests and materials

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CLIA Waived Autoanalyzers

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--waived due to technology advancement

--processes specimen w/single use reagent test strips / cassettes.

--facility required to have Certificate of Waiver from CMS so employees can legally perform tests.

--To maintain status, facilities must permit on-site inspections as requested.

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Autoclave

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Used to sterilize equipment and instruments that are used on patients or in certain test procedures

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Centrifuge

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Instrument used to separate specimens into component layers by spinning samples at high speed allowing lighter components to float to top and heavier to sink to bottom

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Microscope

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Instrument used to see objects that are too small to be seen by eye by implementing sets of lenses.

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*Microscope Objectives

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--10x - lowest objective to view epithelial cells

--40x - high dry setting to view RBCs / WBCs

--100x - Oil immersion setting for different blood smears or bacteria slides

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*Parts of a Microscope

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--Eyepieces / body tube / Arm / Nosepiece

--Objectives / Stage / Mechanical Stage

--Stage adjustments / condenser / light source

--coarse & fine adjustment knobs / Base

--Iris Diaphragm Lever

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**Information on Lab Requisition Form

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--DR's name, Address, phone, Acct #

--PT's full name, address, phone #, Date & time

--Pt's age, sex, DOB, Insurance info, diagnosis

--Relevant diagnostic codes, specimen source

--fasting/non-fasting specimen

--Specific test requested / Pt's current meds

--If Request is STAT or routine

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*CLIA-Waived Tests

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--Dipstick urine Testing / fecal occult blood

--Ovulation / urine pregnancy / Blood glucose

--Hemoglobin / Spun hematocrit

--Rapid Streptococcus testing

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CLIA Moderate-Complexity Tests / Level 1

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--75% of tests performed w/ autoanalyzers for chemistry and hematology

--Microscopic analysis of urine sediment

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CLIA High-complexity Tests / Level 2

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All test in field of cytogenetics, cytology, histopathology and histocompatibility

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*Microbiology

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Study of microorganisms

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*Microorganisms

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Living organisms that are too small to be seen by the naked eye

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*Normal Flora

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Beneficial bacteria that help resist pathogens

--Not all bacteria are bad and help to decompose & recycle waste. Bacterium may be harmless in one area but pathogenic in another. It is important to understand differences between which can be harmful to effectively help pt's recovery from illness.

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Role of MA in Microbiology

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***Safety must always come above all else!

--MA's frequently come into contact with blood & body fluids. Standard Precautions is a significant priority to prevent contamination & spread of infection.

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*Naming Microorganisms

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Has two names: Genus (capitalized) & the species (lowercase)

--Most microbes are non-pathogenic (98-99%), only 1-2% are pathogenic.

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*Retention of Dyes

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Bacteria are characterized by reactions to stains used to make microorganisms visible under a microscope.

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*Gram Stain

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Most common method of staining bacteria, named after Dr. Hans CJ Gram, a Danish DR

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*Gram Positive

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Colors violet

--Staphylococcus aureus / Streptococcus pneumoniae

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*Gram Negative

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Colors Pink

--Escherichia Coli / Neisseria gonorrheoeae / Salmonella typhimurium

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*Acid-Fast Stain

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Some organisms do not stain well with Gram stain and require a special stain

Eg: Tuberculosis

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Oxygen and Bacteria

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Bacteria can be characterized whether they can survive in oxygen-rich environment or not

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*Aerobes

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survive in oxygen-rich environment

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*Anaerobes

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Die in presence of oxygen

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*Facultative Anaerobes

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Anaerobes that are flexible and can live with some oxygen

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*Agar

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A medium for growing bacterial cultures that contain whole blood

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Bacteria

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Small, unicellular microorganisms that are capable of rapid reproduction in warm, dark and moist environments. Overgrowth can cause an imbalance and lead to disease.

--Escherichia coli organism reproduces in about 30 mins. By 24 hours, there will be an enormous amt of cells creating an infection.

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*Morphology

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Shape of an organism

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Bacteria Types

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--Cocci - spherical in shape in grapelike clusters, chain clusters and pair clusters

--Bacilli - rod shaped

--Spirilla - spiral or corkscrew shaped

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***Staphylococci

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Grapelike cluster that is gram positive found in normal flora in nose, on skin and many body orifices.

--Causes infection when resistance is lowered by a break in skin or in mucous membrane such as MRSA and Food Poisoning

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**Methicillin-Resistant Staphylococcus aureus (MRSA)

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Common cause of nosocomial infection that are acquired in hospital setting or community based.

--Vancomycin-Resistant enterococci (VRE) and Carbapenem-Resistant enterobacteriaceae (CRE) are becoming more prevalent.

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Streptococci

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Round chain cluster that is gram positive found in normal flora of upper respiratory tract, throat and skin.

--Group A beta-hemolytic S. pyogenes causes a wide variety of diseases from simple strep to life threatening like necrotizing fasciitis.

--S. pneumonia - frequent cause of bacterial pneumonia, middle ear infections and meningitis

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Necrotizing Fasciitis

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Severe infection as a result of destruction of subcutaneous tissue and fascia with 30% mortality rate.

--Causes other infections: pneumonia, tonsillitis, bacterial endocarditis, abscesses, wound infections and bacteremia

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Diplococci

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Pair Clusters that are gram positive typically causing bacterial pneumonia which gram

negative causing gonorrhea, bacterial meningitis and septicemia.

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**Meningococcal meningitis

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has a high mortality rate and requires

IMMEDIATE treatment!

--A vaccine is available that is recommended for students entering high school or college, those joining the military service and others who may be at high risk.

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Bacilli - Gram Negative

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Rod shaped found mainly in intestinal tract, but many will cause other infections in other body locations such as E-Coli is frequently associated with UTI's.

--Some illnesses are Salmonella, Typhoid fever, Helicobacter pylori, Dysentery, Gastroenteritis, UTIs, whooping cough, tetanus, botulism, tuberculosis, and pneumonia

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Salmonella organisms

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Major cause of foodborne illnesses worldwide with symptoms of rapid onset, abdominal pain, nausea, diarrhea, and in some children even death.

--Contaminated Food such as raw eggs, chicken or beef is usual route of transmission.

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**Typhoid Fever

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Caused by the S. typhimurium & is found in 3rd world countries & natural disasters area where proper sanitation is lacking.

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**Bacillary Dysentery

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characterized by frequent blood, puss or mucous-containing stools resulting from inadequate sanitary conditions.

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**Helicobacter Pylori

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Causative agent of peptic ulcers and a risk factor in gastric malignancy in some infected persons

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Bacilli - Gram Positive

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--Found in chains or singly & with or without spores.

--Notable illnesses in this group is Tetanus and Botulism

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Spores

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thick walled reproductive cell produced by some organisms that is capable of withstanding unfavorable environmental conditions.

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Tetanus

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Disease resulting from a cut or injury associated with contaminated soil such as from a rusty nail or farm implement

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Botulism

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--Severe, possibly fatal form of food poisoning caused by powerful neurotoxin produce by the Clostridium botulinum.

--It is associated with improper canning process and it's potential use as a bioterrorism agent

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Vibrios

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Comma shaped Bacilli whose enterotoxin causes cholera by ingesting drinking water or eating shellfish from water contaminated with infected urine, feces or vomiting which is common in Asiatic Countries.

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Spirilla

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Spiral or corkscrew Shaped rods in various shapes.

--Most notable illnesses are Syphilis and Lyme's Disease

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Viruses

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smallest known infectious organism and requires use of an electron microscope to see

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Fungi

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unable to make their own food so they depend upon other life forms such as yeast and molds

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Mycology

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Study of fungi

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Fungus

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--Singular version - ONE

Plural version (Fungi)

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Parasites

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Receives nourishment from another organism

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**Worm Types

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--Flatworms / roundworms

--tapeworms / pinworms

--has to ingest egg or immature form of the worm, or in some cases can penetrate through the skin.

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Tapeworm

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May grow to be feet in length. Stool of pt can be inspected for presence of ova and mature forms of the worm.

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Insects

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Insects may bite, burrow under skin or attach to the skin such as ticks, scabies, and lice

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Lyme's Disease

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With early detection and treatment w/ antibiotics, many pt have complete recovery. Arthritis may be a sequel (long lasting effect). Cardiac conduction abnormalities, aseptic meningitis and Bell's palsy may also be associated conditions.

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**Culturette System

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--Composed on disposable, clear plastic tube; a sterile cotton-tipped applicator swab inside tube; and a sealed plastic vial of medium (broth containing nourishment for bacteria and a preservative)

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*Viable

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capable of living

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*Smear

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thin layer of microorganisms spread on glass slide for identification

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*Exudates

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wound drainage material made of serum, white blood cells and fibrin

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**Types of specimens

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--blood / feces / cerebrospinal fluid / mucous

--urine / sputum / wounds / tissue / exudates

--Specimens must be transported immediately to lab so the organisms remain viable

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***Laboratory Requisition Information

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Specimen will be rejected if info on label, the requisition or both is incomplete or if specimen is insufficient in quantity or improperly packaged.

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***Information you need on Requisition form

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--Patient's Name / Address / ID number / Age

--Gender / Insurance info / Test required

--Specimen type and source / Diagnosis

--Medication being taken / DR info

--Special information or orders

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Throat Cultures Specimen

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--Typically done for upper respiratory infections, sore throat, sinus infection

--DONOT touch inside of mouth or tongue with swab to avoid contaminating

--For nasal swabs, label "right" or "left" to identify which nostril specimen was taken from

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Sputum Specimen

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Mucous substance expelled by coughing deeply or clearing bronchi and spitting into sterile container without saliva from mouth. Try to collect in morning if possible.

--Purpose of sputum culture is to diagnose diseases such as streptococcal pneumonia, influenza and tuberculosis

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Urine Specimen

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Must be either catheterized specimen or clean catch midstream sample (CCMS) to provide sterile samples. Any other sample would be contaminated by organisms in container or on hands or genitals of patient.

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Stool Specimen

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Waste from bowel which are free from urine, water from toilet and toilet tissue.

--Discussing stool sample collection is often embarrassing to both PT and MA, but correct collection is critical to accurate results.

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Stool Culture

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Small amt of feces required and must be collected with aseptic technique and sent to lab ASAP. Sterile tongue depressors can be used to transfer to sterile container. If sample cannot be sent immediately, store in fridge.

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Occult Blood Testing

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Test for occult (hidden) blood that may indicate bleeding in gastrointestinal tract. Directions are provided on each test unit, but you should review w/ patient. Instruct patient to refrain from consuming vit C and red meat for 3 days before testing to avoid false positives.

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Stool For Ova and Parasites

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Hand to mouth transmission

--presence of microbial microorganisms such as ova and parasites (O&P) in fresh stool specimens obtained early in the morning and two additional vials for preserved specimens: one containing formalin and other containing polyvinyl alcohol.

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**Cerebrospinal Fluid (CSF) specimen

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Collecting cerebrospinal fluid from spinal column is STAT specimen and uncomfortable procedure. Collect 3 tubes while test is ran on 2nd tube, since there is chance of contamination on 1st and 3rd due to entry and exit process of collection.

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Culture Media

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Media will either inhibit or encourage growth of certain microorganisms or pathogens

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*Types of Common Culture Media

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Broth and Agar

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Colony

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Group of living organisms

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**Purpose of a colony

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Microbiologists will observe the culture for presence and appearance of a colony, then examine sample under a microscope for morphology and staining properties to determine which microorganism it is.

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*Media Culture Classifications

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--Supportive - grows wide variety of organisms

--Selective - encourages some &restricts others

--Differential - includes dyes or chemicals that give organisms different appearance.

--Enrichment - encourages growth of fastidious (fussy) organisms such as gonorrhea organisms

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*Serology Testing

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Study of antigen and antibody reactions of the body's immune system.

Testing Eg: Pregnancy, rheumatoid arthritis, mononucleosis, HIV and Strep