CLINMIC LEC LAB SAFETY, INTRO TO URINALYSIS, RENAL FUNCTION

Universal precautions

• All patients are considered to be possible carriers of blood-borne pathogens

• Recommends wearing gloves when collecting and handling blood and body fluids contaminated with blood and wearing face shields when there is danger of blood splashing on mucous membranes and when disposing of all needles and sharp objects in puncture-resistant containers

• Exclude urine and body fluids not visibly contaminated by blood from UP

Body substance isolation

• Considered all body fluids and moist body substances to be potentially infectious

• Personnel should wear gloves at all times when encountering moist body substances

• Do not recommend handwashing following removal of gloves unless visual contamination is present

Standard precautions

• Combined the major features of UP and BSI

• Placed emphasis on patient contact. These are the principles most certainly can also be applied to handling patient specimens

Universal precautions

Handling and storage of specimen should follow what?

Biologic hazard

Source: infectious agents

Possible injury: Bacterial, fungal, viral or parasitic infections

Sharps hazard

Source: needles, lancets, broken glass

Possible injury: Cuts, punctures, blood-borne pathogen exposure

Chemical hazards

Source: Preservatives and reagents

Possible injury: Exposure to toxic, carcinogenic or caustic agents

Radioactive hazard

Source: Equipment and radioisotopes

Possible injury: Radiation exposure

This hazard cannot cause immediate harm

Electrical hazard

Source: Ungrounded or wet equipment, worn cords

Possible injury: Burns or shock

Fire/Explosive

Source: Open flames, organic chemical

Possible injury: Burns or dismemberment

Physical hazards

Source: Wet floors, heavy boxes, patients

Possible injury: Falls, sprains or strains

Ergonomic hazards

Hazards regarding posture

Reactivity

Yellow quadrant of the NFPA hazardous materials classification

Fire hazard

Red quadrant of the NFPA hazardous materials classification

Flammables

< 37.8 degrees C

Combustibles

>37.8 degrees C

Health hazard

Blue quadrant of the NFPA hazardous materials classification

Specific hazard

White quadrant of the NFPA hazardous materials classification

• Flush the area with large amount of water for 15 minutes, then seek medical attention.

• Remove contaminated clothing as soon as possible.

• No attempt should be made to neutralize chemicals that come in contact with the skin.

What to do in case of a chemical spill? (3) (FRN)

Acid to water

What is proper procedure when mixing acid and water?

30-50 gallons of water per minute

20-50 psi

Safety showers should be able to release how much gallons of water per minute and at what pressure?

100 feet per 10 seconds travel time

Eye wash stations should accessible at an area within?

Explosion proof refrigerators

Where are flammables stored in?

1. Physical and chemical characteristics

2. Fire and explosion potential

3. Reactivity potential

4. Health hazards and emergency aid procedures

5. Methods for safe handling and disposal

What does the MSDS contain? (5)

1. Appropriate work practices

2. Standard operating procedures

3. PPE

4. Engineering controls (fume hoods, fire safety cabinets)

5. Employee training requirements

6. Medical consultation guidelines

What does the chemical hygiene plan entail? (6)

Pathogen

Reservoir

Portal of exit

Mode of transmission

Portal of entry

Susceptible host

6 parts of a chain of infection

1. Wet hands with warm water

2. Apply antimicrobial soap

3. Rub to form a lather, create friction and loosen debris

4. Thoroughly clean between fingers, including thumbs, under fingernails and rings, and up to the wrist for at least 15-20 seconds (MOST CRUCIAL PART)

5. Rinse hands in a downward position

6. Dry with a paper towel

7. Turn off faucets with a clean paper towel to prevent recontamination

Proper hand hygiene (7 steps)

Disposable towels

Best way of drying the hands is thru using?

Thoroughly clean between fingers, including thumbs, under fingernails and rings, and up to the wrist for at least 15-20 seconds

What is the most crucial part in handwashing?

60 seconds

Entire duration of handwashing?

Gown

Mask or respirator

Goggles or face shield

Gloves

Donning steps (GowMaGogGlo)

Inner gloves

In double gloving technique, what is the first step in donning?

Gloves

Goggles or face shield

Gown

Doffing steps (3) (GloGogGow)

Rescue

Activate alarm

Contain

Extinguish/Evacuate

What to do in case of fire? RACE

Evacuate

What does “E” stand for in RACE when it comes to arsenal fires/detonating agent?

Pull the pin

Aim at the base of the fire

Squeeze the nozzle

Sweep side to side

How to use the fire extinguisher? (PASS)

Urine

All biological wastes except _________ must be placed in an appropriate container labeled as biohazard

Pouring it into the sink

Urine may be discarded by ________________ avoiding splashing and flushing it with water.

1:5 (20%)

1:10 (10%)

2 dilutions of sodium hypochlorite that can be used in daily disinfection of the sink

1 month

Sodium hypochlorite solutions are stable for how many months if protected from light after preparation?

Class A

What fire type? (a ASH, when these materials are burned they turn to ash)

Wood, paper, clothing

Water

Extinguisher for Class A fires?

Class B

What fire type?

Flammable organic materials

Dry chemical

CO2

Foam

Halon

Extinguishers for Class B fires (DCFH)

Class C

What fire type?

Electrical

Dry chemical

Carbon dioxide

Halon

Extinguishers for Class C (DCH)

Class D

What fire type?

Combustible materials (Mg, Na, K)

Dry chemicals

Most commonly used fire extinguisher?

Class K

What fire type?

Grease, oil, fats

Liquid designed to prevent splashing and cool the fire

Extinguisher for class K?

Monthly

When should fire extinguishers be inspected?

Frederik Dekkers

discovered albuminuria in 1694 by boiling urine

Thomas Bryant

wrote about a book about “pisse prophets”; inspired the passing of the first medical licensure laws in England

Thomas Addis

developed the first method of quantitative urine microscopic examination

Henry Bence-Jones

father of CC

95% Water and 5% solutes

Urine is how many percent water and how many percent solutes?

Urea

Creatinine

Uric acid

Hippuric acid

Organic components of the urine (UCUH) (4)

Urea

Primary organic component

Creatinine

product of creatine metabolism

Uric acid

product of nucleic acid breakdown

Hippuric acid

excretion form of benzoic acid

Ammonium

Chloride

Calcium

Sodium

Potassium

Phosphate

6 inorganic components of the urine (ACCSPP)

Chloride

Primary inorganic component

SODIUM

Primarily from salt intake

POTASSIUM

Combined with chloride and other salts

PHOSPHATE

Combines with sodium; buffers the blood

AMMONIUM

Regulates blood and tissue fluid acidity

CALCIUM

Combines with chloride, sulfate, phosphate

Clean, dry, leak-proof, wide-mouthed, flat bottom, must be made from clear material

50mL

Characteristics of urine containers

Labels

Must include patient’s name and identification number, date and time of collection

– Additional information such as patient’s age and location, physician’s name

– Must be attached not on the lid

– Should not be detached when specimen is refrigerated or frozen

Requisition form

– Must accompany the specimen when delivered to the laboratory

– The information on this form must match the specimen label

– Additional information can include method of collection, type of specimen, medications, clinical information

– The time the specimen is received should be recorded on the form

1. Specimens in unlabeled containers

2. Nonmatching labels and requisition forms

3. Specimens contaminated with feces or toilet paper

4. Containers with contaminated exteriors

5. Specimens of insufficient quantity

6. Specimens that have been improperly transported

   NOTE: Never discard any specimen without consulting with the chief.

6 instances where in specimen is rejected

2 hours

Following collection specimens should be delivered in the laboratory promptly and tested within how many hours?

2-8 degrees Celcius

The most routinely used method of preservation or refrigeration is at what temperature?

Room temperature

Specimens must be returned to what temperature before chemical testing by reagent strips because the enzyme reactions on the strips perform best at room temperature?

24 hours

Specimens for culture should be refrigerated on transport and kept refrigerated until culture for up to how many hours?

pH

Bacteria

Odor

Nitrite

Color

What analytes will increase if urine is unpreserved? (pBaON)

Glucose

Most affected analyte in unpreserved urine?

Protein

Least affected analyte in unpreserved urine?

Refrigeration

• Most routinely used method of preservation; does not interfere with chemical tests

• Disadvantage: precipitates amorphous phosphates and urates

• Prevents bacterial growth for 24 hours

Boric acid

URINE PRESERVATIVES

• Prevents bacterial growth and metabolism

• Disadvantage: Interferes with drug and hormone analysis

• Keeps pH at about 6.0: can be used for urine culture transport

Formalin

URINE PRESERVATIVES

• Excellent sediment preservative

• Disadvantage: Acts as a reducing agent interfering with chemical tests for glucose, blood, leukocyte esterase and copper reduction

• Rinse specimen container with formalin to preserve cells and casts

Sodium fluoride

URINE PRESERVATIVES

• A good preservative for drug analysis

• Inhibits reagent strip glucose, blood, and leukocytes

Phenol

URINE PRESERVATIVES

• Advantage: Does not interfere with routine tests

• causes an odor change

• ● Use 1 drop per ounce of specimen

Thymol

URINE PRESERVATIVES

• Preserves glucose and sediments well

  • Interferes with acid precipitation test for protein

Toluene

URINE PRESERVATIVES

• Floats on the surface of the specimen and clings to pipettes and testing materials

Saccomano’s fixative

URINE PRESERVATIVES

• 50% ethanol + 2% carbowax

• Preserves cellular elements; used for cytological studies

Formalin

What is the 2nd best choice used in cytological studies next to Saccomano’s fixative? (If Saccomano’s fixative isn’t in the choices)

Concentrated HCl

URINE PRESERVATIVES

• 10 mL of 6N HCl + 3-4 L container

  • Catecholamines (epinephrine, VMA, 5 HIAA)

Hydrochloric acid

Glacial acetic acid

Boric acid

URINE PRESERVATIVES

• Quantitative analysis of steroids, hormones (HGB)

Boric acid at 1g/dL

URINE PRESERVATIVES

• Estriol and estrogen for up to 7 days

Random specimen

TYPES OF URINE SPECIMEN

• Most commonly received specimen

• Useful for routine screening tests to detect obvious abnormalities

First morning specimen

TYPES OF URINE SPECIMEN

• Ideal morning specimen; most concentrated

• 'Prevention of false-negative pregnancy test and evaluation of orthostatic proteinuria

Timed specimen

TYPES OF URINE SPECIMEN

• Quantitative chemical tests

• Measurement of analytes exhibiting diurnal variations

50mL

Volume of aliquot used in urinalysis

Catheterized specimen

TYPES OF URINE SPECIMEN

• Collected under sterile conditions by passing a hollow tube through the urethra into the bladder

Midstream clean-catch

TYPES OF URINE SPECIMEN

• Provides a safer and less traumatic method of obtaining urine for culture

• Alternative to catheterized specimen

Suprapubic aspirate

TYPES OF URINE SPECIMEN

• Preferred sample for bacterial culture and cytological examination

Pediatric specimen

TYPES OF URINE SPECIMEN

• Done using soft, clear, plastic bags with hypoallergenic skin adhesive to attach to the genital areas

• Bag is checked every 15 minutes until the needed amount of sample has been collected

Drug testing specimen

TYPES OF URINE SPECIMEN

• Collection and handling of specimen must follow the chain of custody

• Urine volume: 30-45 mL

• Container volume: 60 mL

• Urine temperature: 32.5 to 37.7 degree Celsius tested within 4 minutes after collection