Urinalysis and Body Fluids (Chapter 1)

Infection Control

What do you call the procedures to control and monitor infections occurring within their facilities.

FUN FACT

Chain of Infection

Infectious Agent

Reservoir

Portal of Exit

Means of transmission

Portal of Entry

Susceptible Host

FUN FACT

Means of transmission include:

1. Direct contact: the unprotected host touches the patient, specimen, or a contaminated object (reservoir)

2. Airborne: inhalation of dried aerosol particles circulating on air currents or attached to dust particles

3. Droplet: the host inhales material from the reservoir (e.g., aerosol droplets from a patient or an uncapped centrifuge tube, or when specimens are aliquoted or spilled)

4. Vehicle: ingestion of a contaminated substance (e.g., food, water, specimen)

5. Vector: from an animal or insect bite

True

Acid should always be added to water to avoid the

possibility of sudden splashing caused by the rapid generation of heat in some chemical reactions. (TRUE OR FALSE)

Rescue—rescue anyone in immediate danger

Alarm—activate the institutional fire alarm system

Contain—close all doors to potentially affected areas

Extinguish/Evacuate—attempt to extinguish the fire, if possible or evacuate, closing the door

What does RACE stands for?

Quality Assessment

Refers to the overall process of guaranteeing quality patient care and is regulated throughout the total testing system.

Quality Control

Refers to all of the laboratory's policies, processes, procedures, and resources needed to achieve quality testing.

>Preexamination Variables

occur before the actual testing of the specimen and include test requests, patient preparation, timing, specimen collection, handling, and storage

>Preexamination Variables

>Examination Variables

>Postexamination Variables

FUN FACTS

Criteria for Urine Specimen Rejection

Unlabeled containers

Non-matching labels and requisition forms

Contaminated specimens with feces or toilet paper

Containers with contaminated exteriors

Insufficient volume of urine

Improperly transported or preserved specimens

Delay between time of collection and receipt in the laboratory

FUN FACTS

Policy for Handling Mislabeled Specimens:

Do NOT assume any information about the specimen or patient.

Do NOT relabel an incorrectly labeled specimen.

Do NOT discard the specimen until investigation is complete.

Leave specimen EXACTLY as you receive it; put in the refrigerator for preservation until errors can be resolved.

Notify floor, nursing station, doctor's office, etc. of problem and why it must be corrected for analysis to continue.

Identify problem on specimen requisition with date, time, and your initials.

Make person responsible for specimen collection participate in solution of problem(s). Any action taken should be documented on the requisition slip.

Report all mislabeled specimens to the appropriate supervisor.

FUN FACTS

Postexamination

Patient misidentification

Poor handwriting

Transcription error

Poor quality of instrument printer

Failure to send report

Failure to call critical values

Inability to identify interfering substances

FUN FACTS

Quality Assessment Errors

Preexamination

Patient misidentification

Wrong test ordered

Incorrect urine specimen type collected

Insufficient urine volume

Delayed transport of urine to the laboratory

Incorrect storage or preservation of urine

Examination

Sample misidentification

Erroneous instrument calibration

Reagent deterioration

Poor testing technique

Instrument malfunction

Interfering substances present

Misinterpretation of quality control data

C. Specimens

In the urinalysis laboratory the primary source in the

chain of infection would be:

A. Patients

B. Needlesticks

C. Specimens

D. Biohazardous waste

A. Hand sanitizing

The best way to break the chain of infection is:

A. Hand sanitizing

B. Personal protective equipment

C. Aerosol prevention

D. Decontamination

D. Standard Precautions

The current routine infection control policy developed

by CDC and followed in all health-care settings is:

A. Universal Precautions

B. Isolation Precautions

C. Blood and Body Fluid Precautions

D. Standard Precautions

A. Report to a supervisor

An employee who is accidentally exposed to a possible

blood-borne pathogen should immediately:

A. Report to a supervisor

B. Flush the area with water

C. Clean the area with disinfectant

D. Receive HIV prophylaxis

B. Are fluid-resistant

Personnel in the urinalysis laboratory should wear lab

coats that:

A. Do not have buttons

B. Are fluid-resistant

C. Have short sleeves

D. Have full-length zippers

A. Urine specimen containers

All of the following should be discarded in biohazardous

waste containers except:

A. Urine specimen containers

B. Towels used for decontamination

C. Disposable lab coats

D. Blood collection tubes

C. OSHA

An employer who fails to provide sufficient gloves for

the employees may be fined by the:

A. CDC

B. NFPA

C. OSHA

D. FDA

D. Sodium hypochlorite

An acceptable disinfectant for blood and body fluid

decontamination is:

A. Sodium hydroxide

B. Antimicrobial soap

C. Hydrogen peroxide

D. Sodium hypochlorite

D. Turning on the water with a paper towel

Proper handwashing includes all of the following

except:

A. Using warm water

B. Rubbing to create a lather

C. Rinsing hands in a downward position

D. Turning on the water with a paper towel

C. Aerosols

Centrifuging an uncapped specimen may produce a

biologic hazard in the form of:

A. Vectors

B. Sharps contamination

C. Aerosols

D. Specimen contamination

B. Hold the arm under running water for 15 minutes

An employee who accidentally spills acid on his arm

should immediately:

A. Neutralize the acid with a base

B. Hold the arm under running water for 15 minutes

C. Consult the MSDSs

D. Wrap the arm in gauze and go to the emergency

department

A. Acid is added to water

When combining acid and water, ensure that:

A. Acid is added to water

B. Water is added to acid

C. They are added simultaneously

D. Water is slowly added to acid

B. Material safety data sheets

An employee can learn the carcinogenic potential of

potassium chloride by consulting the:

A. Chemical hygiene plan

B. Material safety data sheets

C. OSHA standards

D. Urinalysis procedure manual

D. Pregnant

Employees should not work with radioisotopes if

they are:

A. Wearing contact lenses

B. Allergic to iodine

C. Sensitive to latex

D. Pregnant

A. Pulling the person away from the instrument

All of the following are safe to do when removing the

source of an electric shock except:

A. Pulling the person away from the instrument

B. Turning off the circuit breaker

C. Using a glass container to move the instrument

D. Unplugging the instrument

B. Operation of a fire extinguisher

The acronym PASS refers to:

A. Presence of vital chemicals

B. Operation of a fire extinguisher

C. Labeling of hazardous material

D. Presence of radioactive substances

C. NFPA

The system used by firefighters when a fire occurs in the

laboratory is:

A. MSDS

B. RACE

C. NFPA

D. PASS

C. Dry chemicals

A class ABC fire extinguisher contains:

A. Sand

B. Water

C. Dry chemicals

D. Acid

A. Rescue persons in danger

The first thing to do when a fire is discovered is to:

A. Rescue persons in danger

B. Activate the alarm system

C. Close doors to other areas

D. Extinguish the fire if possible

B. May have developed a latex allergy

If a red rash is observed after removing gloves, the

employee:

A. May be washing her hands too often

B. May have developed a latex allergy

C. Should apply cortisone cream

D. Should not rub the hands so vigorously

D. Not acceptable in the laboratory

Pipetting by mouth is:

A. Acceptable for urine but not serum

B. Not acceptable without proper training

C. Acceptable for reagents but not specimens

D. Not acceptable in the laboratory

B. Biohazards

The NPFA classification symbol contains information on

all of the following except:

A. Fire hazards

B. Biohazards

C. Reactivity

D. Health hazards

A. Class A

The classification of a fire that can be extinguished with

water is:

A. Class A

B. Class B

C. Class C

D. Class D

C. HBV

Employers are required to provide free immunization for:

A. HIV

B. HTLV-1

C. HBV

D. HCV

D. Running to answer the telephone

A possible physical hazard in the hospital is:

A. Wearing closed-toed shoes

B. Not wearing jewelry

C. Having short hair

D. Running to answer the telephone

D. Quality of specimens and patient care

Quality assessment refers to:

A. Analysis of testing controls

B. Increased productivity

C. Precise control results

D. Quality of specimens and patient care

D. All of the above

During laboratory accreditation inspections, procedure

manuals are examined for the presence of:

A. Critical values

B. Procedure references

C. Procedures for specimen preservation

D. All of the above

B. Put a complete, referenced procedure in the manual

As supervisor of the urinalysis laboratory, you have just

adopted a new procedure. You should:

A. Put the package insert in the procedure manual

B. Put a complete, referenced procedure in the manual

C. Notify the microbiology department

D. Put a cost analysis study in the procedure manual

2, 1, 2, 3, 2, 1

Indicate whether each of the following would be consid

ered a 1) preexamination, 2) examination, or 3) postex

amination factor by placing the appropriate number in

the blank:

_____ Reagent expiration date

_____ Rejecting a contaminated specimen

_____ Constructing a Levy-Jennings chart

_____ Telephoning a positive Clinitest result on a

newborn

_____ Calibrating the centrifuge

_____ Collecting a timed urine specimen

D. Proficiency testing

The testing of sample from an outside agency and the comparison of results with participating laboratories is called:

A. External QC

B. Electronic QC

C. Internal QC

D. Proficiency testing

C. Internal QC

A color change that indicates that a sufficient amount of

patient's specimen or reagent is added correctly to the

test system would be an example of:

A. External QC

B. Equivalent QC

C. Internal QC

D. Proficiency testing

D. All of the above

What steps are taken when the results of reagent strip

QC are outside of the stated confidence limits?

A. Check the expiration date of the reagent strip

B. Run a new control

C. Open a new reagent strips container

D. All of the above

C. The date and the laboratory worker's initials

When a new bottle of QC material is opened, what

information is placed on the label?

A. The supervisor's initials

B. The lot number

C. The date and the laboratory worker's initials

D. The time the bottle was opened

D. All of the above

When a control is run, what information is

documented?

A. The lot number

B. Expiration date of the control

C. The test results

D. All of the above

a. Review of the procedure by a designated authority

has not been documented.

b. Instructions and training are not being provided to

personnel performing collections.

c. A safety statement about the heat produced by the

reaction is not in the procedure manual.

d. The bottles have not been dated and initialled.

State a possible reason for an accreditation team to

report a deficiency in the following situations:

a. The urine microscopic reporting procedure has

been recently revised.

b. An unusually high number of urine specimens are

being rejected because of improper collection.

c. A key statement is missing from the Clinitest

procedure.

d. Open control bottles in the refrigerator are examined.

a. Correct; proficiency survey tests should be rotated among personnel performing the tests.

b. Accept; QC on the Clinitest tablets must only be

performed when they are used to perform a test.

c. Correct; documentation of technical competency should be performed on all personnel working in the section and educational qualifications assessed.

As the new supervisor of the urinalysis section, you

encounter the following situations. Explain whether

you would accept them or take corrective action.

a. You are told that the supervisor always performs

the CAP proficiency survey.

b. QC is not performed daily on the reagent strips.

c. The urinalysis section is primarily staffed by

personnel assigned to other departments for whom

you have no personnel data.

a. The procedure was being performed incorrectly. The correct timing of the glucose reaction was not being done.

b. The technologist performing the test. QC ensures

that the reagents and instrument are working properly and that the technologist is performing the test correctly.

c. At the beginning of each shift, when a new bottle of reagent is opened or as stated in the procedure manual.

The medical technologist was assigned to test 10 urine specimens chemically. She removed 10 strips from the container and proceeded with testing. Several patients' urine indicated a trace positive glucose in the urine. She then opened a new bottle of reagent dipsticks and proceeded to perform the QC. The negative control also tested as a trace positive for glucose. The medical technologist consulted the supervisor. The supervisor

an the QC and the results were in the correct range. After observing the medical technologist's technique, the supervisor realized that the medical technologist was waiting too long to read the glucose results and therefore reporting erroneous results.

a. What is wrong with this scenario?

b. Who should run the QC for each test? Why?

c. When should controls be run?

d. What do you do when the QC is out of range?

e. When can you report patient results?