Urinalysis Chapter 1

What agency provides guidelines for writing lab procedures and policies?

The Clinical and Laboratory Standards Institute (CLSI)

What agency(ies) mandate lab safety policies?

• Center for Disease Control (CDC)

• Occupational Safety and Health Administration (OSHA)

What is the chain of infection?

How microorganisms are transmitted

What is infection control?

Procedures put in place to control and monitor infections occurring within a facility

What is an infectious agent?

• bacteria

• fungi

• parasites

• viruses

What are the six elements of the chain of infection?

• infectious agent

• reservoir

• portal of exit

• means of transmission

• portal of entry

• susceptible host

What is a reservoir?

The location of potentially harmful microorganisms

What are some examples of a reservoir?

• contaminated clinical specimens

• infected patients

• fomites

• spores

What is the portal of exit?

The method in which an infectious agent exits the reservoir

What are some methods an infectious agent uses as a portal of exit?

• through the mucus membranes of a reservoir’s mouth, nose and eyes

• through blood and other body fluids

What is the means of transmission?

The way an infectious agent reaches a susceptible host after leaving the reservoir

What are some possible means of transmission?

• direct contact: between the unprotect host and a patient, specimen or other contaminated object

• airborne: inhaling aerosol particles circulating in the air or attached to dust particles

• Droplets: inhaling aerosol droplets from the reservoir

• Vehicle: Host ingests contaminated substance

• Vector: from an animal or insect bite

What is the portal of Entry?

The means with which an infectious agent enters a new reservoir

What are some portals of entry?

• sometimes the same as the port of exit ie through the mucus membranes of the mouth, nose and eyes

• open wounds or breaks in the skin

What is a susceptible host?

Can be another patient during invasive procedures, visitors and healthcare professionals. Immunocompromised patients, infants and the elder are at increased risk

What is the most direct source of infection in the clinical laboratory?

Contact with patient specimens

What is PPE?

Personal protective equipment

• gloves

• lab coats

• goggles

• masks

What are some examples of practices used to break the chain of infection?

• Proper hand hygiene

• proper disposal of contaminated material

• wearing PPE

• Regular disinfection of work area

What does the Universal Precautions (UP) state and recommend?

That all patients are considered carriers of bloodborne pathogens. That gloves should be worn when handling and collecting blood and blood contaminated body fluids, wearing face shields when there is a possibility of samples splashing and that all sharps need to be disposed of in a puncture resistant container

What was originally excluded from UP?

Urine and body fluids not visibly contaminated with blood

What is the body substance isolation (BSI)?

Modification to UP to include all body fluids and moist body substances

What was a disadvantage of BSI?

It did not recommend hand sanitizing after removing gloves

What replaced both UP and BSI?

Standard Precautions

What are the SP guidelines?

1. Hand hygiene

2. Gloves

3. Mouth, eye and nose protection

4. Gown

5. Patient care equipment

6. Environmental control

7. Linen

8. Occupational Health and bloodborne pathogens: take care to prevent injuries when handling sharps

9. Patient placement

10. Respiratory hygiene/cough etiquette

What are engineering controls?

• providing container sharps disposal and needles with safety devices

• discarding needles with safety device activated and holder attached

• labeling all biohazardous material and containers

What is the occupational exposure to bloodborne pathogens standard?

A law enforced by OSHA that requires control to be proved or mandated by the employer for all employees

What are work practice controls?

• requiring all employees to practice SP and documenting training annually

• prohibitng eating, drinking, smoking and applying cosmetics in work area

• establishing a daily work surface disinfection protocol

Work places are required to prove what according to the Occupational Exposure to bloodborne pathogens standard law?

PPE

• lab coats, gowns, face shields, and gloves

• laundry facilities for non disposable protective clothing

Medical

• Free HBV immunization

• Follow up medical care to employees who have been accidentally exposed to blood borne pathogens

What Documentation is required according to the OEBPS law?

• annual training in safety standards

• evaluation and implantation of safer needle devices

• Involving employees in selection and evaluation of new devices and maintaining that list and evaluations

• sharp injury log and employee follow-up

If an accidental exposure occurs who must be notified first?

A supervisor

What is PEP?

Postexposure prophylaxis

What must occur within 24 hours of exposure?

A confidential evaluation to insure the proper PEP is initiated. If significant then HIV, HBV and HCV must be performed on employee and patient source alone with treatment and counseling.

Is wearing gloves a substitute for hand hygiene?

No

What are the symptoms associated with a latex allergy?

• irritant contact dermatitis

• delayed hypersensitivity reaction within 24-48 hours

• immediate hypersensitive reaction

What are the requirements for lab coats in the clinical lab?

• full length

• fluid resistant

• wrist cuffs

How should gloves be worn with lab coats?

Over cuffs

When must employees sanitize their hands?

• before patient contact

• after gloves are removed

• before leaving work area

• when hands have knowingly been contaminated

• before going to break area

• before and after using the bathroom

What does hand hygiene include?

Hand washing and alcohol based antiseptic cleansers

When are alcohol based cleanser recommend and when are they not?

When hands are not visibly contaminated. They are not recommended after contact with spore forming bacteria like Bacillus and C. diff

What biological waste does not have to be disposed of in a leakproof container labeled with a biohazard symbol/color?

Urine

How may urine be disposed?

In a sink with a Plexiglas countertop shield with care taken to avoid splashing. Then disinfected with 1:5 or 1:10 dilution of bleach.

When should lab countertops be disinfected?

After every shift and spill with a 1:10 dilution of bleach. Other products may be used as long as their effectiveness and contact time is known.

Should spills be moped or wiped?

No, absorbent powder or paper towels should be put on top to absorb as much as possible before disinfecting.

Should an attempt be made to neutralize chemicals when they come in contact with skin?

No

Should water be added to acid?

No acid should always be added to water in order to avoid splashing by the rapid generation of heat by some reactions.

What does OSHA require of facilities that used hazardous chemicals?

A chemical hygiene plan (CHP)

What is included in a CHP?

1. Appropriate work practices

2. Standard operating procedures

3. PPE

4. Engineering controls like fume hoods and flammables safety cabinets

5. Employee training requirements

6. Medical consultation guidelines

   -all labs must appoint a chemical hygiene officer responsible for the implementation of the CHP

What should hazardous chemicals have?

A label with a description of their particular hazard

What does the diamond shaped NFPA label contain?

Health (Blue), Flammability (Red), Reactivity (Yellow) and specific hazards (white).

What are chemicals and regents that contain a hazardous ingredient in a concentration greater than 1% required to have?

A Safety Data Sheet (SDS)

What does a SDS contain?

1. physical and chemical characteristics

2. fire and explosion potential

3. reactivity potential

4. Health hazards and emergency first aid procedures

5. Methods for safe handling and disposal

6. Primary routes of entry

7. Exposure limits and carcinogenic potential

What is the globally Harmonized system (GHS)?

An international effort to standardize the classification of hazardous chemical and the symbols used to communicate that hazard and in the SDS.

What does a GHS label include?

GHS hazard pictograms, signal words and a GHS hazard statement.

What does RACE stand for?

Rescue : rescue anyone in immediate danger

Alarm: Activate the fire alarm

Contain: Close all doors to potentially affected area

Extinguish/evacuate: attempt to extinguish fire if possible or evacuate

What does PASS stand for?

Pull pin

Aim at base of fire

Squeeze handles

Sweep nozzle side to side

What does quality management (QM) refer to?

To the overall process of guaranteeing quality patient care.

What does quality management system (QMS) refer to?

To all of the lab’s polices. processes, procedures and resources needed to achieve quality testing.

In the clinical laboratory, QMS also includes?

• quality controls

• preexamination variables

• examination variables

• postexamination variables

• documentation

What is a class A fire type and how is it extinguished?

Wood, paper or clothing fires, extinguished with water

What is a class B fire type and how is it extinguished?

Flammable organic chemicals and it is extinguished with dry chemicals, carbon dioxide, foam or halon

What is a class C type and how is it extinguished?

Electrical. Extinguished with dry chemicals, carbon dioxide or halon

What is a class D fire type and how is it extinguished?

Combustible metals. Extinguished with sand or dry powder. If fire created is type ABC, with dry chemicals

What is class K fire type and how is it extinguished?

Grease, oils and fats. Extinguished with liquid designed to prevent splashing and cool the fire

What is included in a QMS?

• procedure manuals

• internal quality control

• external quality control

• electronic quality control

• calibration verification

• standardization

• proficiency testing

• record keeping

• equipment maintenance

• safety programs

• training

• education and competency assessment of personnel

• review of processes documentation

What is required by all accreditation agencies?

Documentation of QM procedures

What are preexamination variables?

Variables that occur before the actual testing of the specimen

What are some examples of preexamination variables?

• test requests

• patient preparation

• timing

• specimen collection

• handling

• storage

What should requisition forms include?

• date and time of specimen collection

• whether specimen was refrigerated

• time specimen was received in lab and when testing was performed

• tests requested

• Area for specific instructions that might affect results

• patient identification info

What time should all urine specimens be examined in and what should be done if this is not possible?

Within two hours and if not possible urine must be preserved.

When is a root cause analysis done?

When there is a problem with testing

What are examination variables?

Processes that directly affect the testing of samples

What are some examples of examination variables?

• reagents

• instrumentation and equipment

• testing procedure

• QC

• preventive maintenance

• access to procedure manuals

• competency of testing personnel

All reagents must be labeled with?

• date of preparation/opening

• purchase/receive date

• appropriate safety information

When should reagent strips be checked against a known positive and negative?

• once a day at the minimum

• each shift

• when a new bottle is open

When should reagents be checked?

daily or when testing is performed

What does quality control (QC) refer to?

The materials, procedures, and techniques that monitor the accuracy, precision and reliability of a laboratory test

What are external quality controls?

Controls that are exposed to the same conditions as patients specimens.

What should a external control contain?

Concentrations at medically significant levels and be as much like human specimens as possible

How are external controls evaluated?

By establishing a mean and standard deviation through repeat measurements then seeing if result is within the established control range based on the established confidence interval

What are internal controls?

Internal monitoring systems built into the test system.

What are electronic controls?

Mechanical or electrical devices used in place of liquid QC specimens.

Do electronic controls verify the integrity of testing supplies?

No, they only verify the functional ability of a testing device

What is proficiency testing?

The testing of unknown samples received from an outside agency. They prove unbiases validation of the quality of patient test results.

What agency mandates comparison testing for laboratory accreduation?

Clinical Laboratory Improvement Amendments (CLIA)

What is an alternative CLIA QC option?

A individualized quality control plan (IQPC)

What does a IQCP consider?

The entire testing process and not just the frequency of QC and number of QC material

What does an IQCP require?

• risk assessment

• quality control plan

• quality assessment

What are postexamiantion variables?

Processes that affect the reporting of results and correct interpretation of data

Reports may be?

Hand written or electronic

What must be present on a laboratory report?

• patient first and last name

• patient’s unique identification number

• specimen collection date and time

• specimen source

• condition of unsatisfactory specimen

• tests performed, results and reference range

• date and time of final results

• facility where test was performed

What is a delta check?

A QM procedure that compares patient’s test results with a previous result

What is specificity?

The likelihood of measuring the analyte desired

What is the sensitivity?

The lowest level of an analyte that a test can detect