1 SAFETY AND QUALITY ASSESSMENT

SAFETY PROCEDURE MANUALS

Must be readily available in the laboratory that
describes the safety policies

Centers for Disease Control and Prevention
(CDC) and the Occupational Safety and Health Administration
(OSHA)

Safety procedure manuals must be readily
available in the laboratory that describe the safety policies mandated by?

laboratory personnel

strict adherence to these guidelines by
( ) is essential.

annually
laboratory director

The manual must be updated and reviewed ( ) by the ( )

Clinical
and Laboratory Standards Institute (CLSI)

provides the
guidelines for writing these procedures and policies.

chain of infection

how microorganisms
are transmitted

infection control

procedures to control and monitor infections occurring within
their facilities

infectious agent
reservoir
portal of exit
means of transmission
portal of entry
susceptible host

The
chain of infection requires a continuous link between an

bacteria
fungi
parasites
viruses

Infectious
agents consist of ( )

reservoir

the location of potentially harmful microorganisms,
such as a contaminated clinical specimen or an infected
patient.

Fomites

inanimate object that can be reservoir

spores

Some microorganisms form
( ) or become inactive when conditions are not ideal and
wait until a suitable reservoir is available.

mucous membranes of nose, mouth, and eyes, and blood or other body fluids

The infectious agent
must have a way to exit the reservoir to continue the chain
of infection. This can be through the

Direct contact
Airborne
Droplet
Vehicle
Vector

Means of transmission include

Direct contact

the unprotected host touches the patient,
specimen, or a contaminated object (reservoir)

Airborne

inhalation of dried aerosol particles circulating
on air currents or attached to dust particles

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)

Vehicle

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

Vector

from an animal or insect bite

portal of exit
breaks in the skin
open wounds

The portal
of entry can be the same as the ( ), which includes
the mucous membranes of the nose, mouth, and eyes, ( ), and ( ).

patient specimens

In the clinical laboratory, the most direct contact with a source of infection is through contact with ( )

biologic safety.

Preventing completion of the chain of infection is a primary objective of ( )

hepatitis B virus (HBV)
hepatitis C virus (HCV)
human immunodeficiency virus (HIV)

Different blood borne pathogen

Universal Precautions

Regulation in BBP draft by CDC nd OSHA

1987

When does UP created

all patients are considered to be possible carriers of bloodborne pathogens

Universal Precaution states that

gloves
face shield
puncture-resistant containers

The UP guideline recommends wearing ( )
when collecting or handling blood and body fluids contaminated with blood and wearing ( ) when there is danger of blood splashing on mucous membranes and when disposing of all needles and sharp objects in ( ).

urine and body fluids not visibly contaminated by blood

Ano ang hindi kasali sa UP?

body substance isolation

The modification of UP

Consider all specimen as infectious

Ano ang meron sa BSI na wala sa UP?

Not performing handwashing after removing gloves except if it is visually contaminated

A major disadvantage of BSI

Standard precaution

Combination of UP and BSI

CDC
Healthcare Infection Control Practices Advisory Committee (HICPAC)

Created SP

1996

When does SP created?

The Occupational Exposure to Blood-Borne Pathogens Standard

These
controls are required by OSHA to be provided by or mandated
by the employer for all employees.

PERSONAL PROTECTIVE EQUIPMENT (PPE)

Providing laboratory coats, gowns, face shields

and gloves to employees and laundry facilities for non-
disposable protective clothing.

hepatitis B virus

Providing immunization for ( ) free of
charge.

medical check up

Providing ( ) follow-up to employees who
have been accidentally exposed to blood-borne pathogens.

annual training

Documenting ( ) of employees in
safety standards.

safer needle devices

Documenting evaluations and implementation of
( )

new devices

Involving employees in the selection and
evaluation of ( ) and maintaining a list of those
employees and the evaluations.

sharp injury log

Maintaining a ( ) including the type
and brand of safety device, location and description of the
incident and confidential employee follow-up.

biohazard symbol

All biologic waste, except urine, must be placed in appropriate
containers labeled with the ( )

incineration
autoclaving
pickup by a certified hazardous waste company

The waste is then decontaminated
following institutional policy

laboratory sink
water

Urine may be discarded by pouring it into a ( ) under a Plexiglas countertop shield and must be flushed with ( )

sodium hypochlorite

Disinfection of the sink using a
1:5 or 1:10 dilution of sodium hypochlorite should be performed daily

1 month

Sodium hypochlorite dilutions stored in plastic
bottles are effective for ( ) if protected from light after preparation

puncture-resistant, leak-proof container

All sharp objects must be
disposed in ( ) with the
biohazard symbol.

Sharp objects

Can caused the transfer of BBP

needles
lancets
broken glassware

Sharp objects in the lab

overfilled
safe capacity mark

The biohazard sharp containers should not be ( ) and must always be
replaced when the ( ) is reached.

presumed hazardous

Every chemical in the workplace should be ( )

15 minutes

When skin contact occurs, the best first aid is to flush the area with large amounts of water for at least ( ), then seek
medical attention

Chemical spill kits

( ) containing protective apparel, nonreactive
absorbent material, and bags for disposing of contaminated
materials should be available for cleaning up spills.

Acid
water

( ) should always be added to ( ) to avoid the
possibility of sudden splashing caused by the rapid generation of heat in some chemical reactions.

goggles
fume hood

Wearing( ) and preparing reagents under a ( ) are recommended safety
precautions.

chemical hygiene plan (CHP)

OSHA also requires all facilities that use hazardous chemicals to have a written ( ) available to employees

Chemical Hygiene Officer

responsible for implementing and documenting compliance with the CHP

emergency shower
eye wash station

Chemical safety aids

Standard System for the Identification of the Fire Hazards of Materials

This symbol system is used to inform
firefighters of the hazards they may encounter with fires in
a particular area

NFPA 704

The diamond-shaped, color-coded symbol
contains information relating to health, flammability, reactivity,
and personal protection/special precautions.

National Fire Protection Association (NFPA)

Created Standard System for the Identification of the Fire Hazards of
Materials,

Material Safety Data Sheets

Collection of information all about the chemicals in the laboratory

radioisotopes

Radioactivity may be encountered in the clinical laboratory
when procedures using ( ) are
performed

cumulative

effects of radiation are ( )
related to the amount of exposure

time
distance
shielding

The amount of radiation
exposure is related to a combination of ( ), ( ), and
( )

measuring devices

Persons working in a radioactive environment are
required to wear ( ) to determine the amount
of radiation they are accumulating.

unplugged
dry

Equipment that has become wet should be ( ) and
allowed to ( )completely before reusing.

cleaning
three-pronged plugs

Equipment also should be unplugged before ( ). All electrical equipment
must be grounded with ( ).

nonconductive glass or wood object

Turning off the circuit breaker, unplugging
the equipment, or moving the equipment using a ( ) are safe procedures to follow

Joint Commission (JC)

The ( ) requires that all health-care
institutions post evacuation routes and detailed plans
to follow in the event of a fire.

Rescue
Alarm
Contain
Extinguish or Evacuate

acronym RACE

safety cabinets
explosion-proof refrigerators
heat

Flammable chemicals
should be stored in ( ) and ( ),
and cylinders of compressed gas should be located
away from ( ) and securely fastened to a stationary device to
prevent accidental capsizing.

burning material
fire extinguisher

The NFPA classifies fires with regard to the type of ( ). It also classifies the type of ( ) that is used to control them

multipurpose ABC fire extinguishers

The ( ) are the most common, but the label should always be checked before using

Pull pin
Aim at the base of the fire
Squeeze handles
Sweep nozzle side to side

The acronym
PASS can be used to remember the steps in the operation

quality assessment

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

Quality system

refers to all of the laboratory’s
policies, processes, procedures, and resources needed to
achieve quality testing

Quality control

Testing controls

preexamination
examination
postexamination

The original terms preanalytical,
analytical, and post-analytical have been replaced with

International Organization for Standardization (ISO) standard

What org replace the terms preanalytical,
analytical, and post-analytical

specimen collection
handling
storage

preexamination variables

reagent and test performance
instrument calibration and maintenance
personnel requirements
technical competence

examination variables

reporting of results and interpretation

postexamination variables

Preexamination variables

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

Turn around time

is defined as the amount of time required from the point
at which a test is ordered by the health-care provider until the
results are reported to the health-care provider.

improvement

The laboratory can then monitor the TATs to
determine areas in the process that need ( )

beginning

Specific information on specimen collection and handling
should be stated at the ( ) of each procedure listed in
the manual

2 hours
preserving the specimen

All urine specimens should be examined within ( ).
If this is not possible, written instructions
for ( ) must be available

EXAMINATION VARIABLES

Are the processes that directly affect the testing of
specimens

Distilled or deionized water
clinical laboratory reagent water

The type of water used for preparing
reagents and controls must be specified.

negative and positive control
once a day

Reagent strips should be checked against known ( ) solutions on each shift or at a minimum ( ), and whenever a new bottle is opened.

refractometers
osmometers
automated reagent strip readers
automated microscopy instruments

The most frequently encountered instruments in the urinalysis laboratory are

refrigerators
centrifuges
microscopes
water baths

Equipment found in the urinalysis laboratory commonly
includes

daily

Temperatures of refrigerators and water baths should be taken ( ) and recorded.

3 months
relative centrifugal force
weekly

Calibration of centrifuges is customarily
performed every ( ), and the appropriate ( ) for each setting is recorded. Centrifuges are
routinely disinfected on a ( ) basis.

annual professional cleaning.

Microscopes should be kept clean at all times and have an ( )

PM

A routine ( ) schedule for instruments and equipment should be prepared as mandated by the JC or CAP guidelines, and records kept of all routine and nonroutine maintenance
performed.

pH
purity meter
monthly schedule

Deionized water used for reagent preparation is quality controlled by checking ( ) and ( ) resistance on a weekly basis and the bacterial count on a ( )

quality control

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