INTRODUCTION TO THE CLINICAL LABORATORY

INTRODUCTION TO THE CLINICAL LABORATORY
CHAPTER 15 INTRODUCTION TO THE CLINICAL LABORATORY

PRETEST True or False When the body is in homeostasis, an imbalance exists in the body. A routine test is performed to assist in the early detection of disease. The laboratory request form provides the outside laboratory with information needed to test the specimen. The clinical diagnosis is indicated on a laboratory request to correlate laboratory data with the needs of the physician. The purpose of a laboratory report is to indicate the patient's diagnosis.

PRETEST, CONT. True or False
A patient who is fasting in preparation for a laboratory test is permitted to drink diet soda. A small sample taken from the body to represent the nature of the whole is known as a specimen. A laboratory report marked QNS means that the patient did not prepare properly. Fecal occult blood testing is an example of a CLIA-waived test. The purpose of quality control is to prevent accidents in the laboratory.

Content Outline Introduction to Clinical Laboratory Laboratory tests:
Used along with the health history and physical examination to diagnose patient's condition Laboratory tests: Provide objective and quantitative information regarding status of body conditions and functions

Introduction to Clinical Laboratory
2. Homeostasis: state in which body systems are functioning normally Internal environment of the body is in equilibrium Body is in a healthy state Normal or reference range: An established range within which laboratory test results of a normal person are expected to fall What conditions are associated with an abnormal value?

Introduction to Clinical Laboratory, cont.
4. Body in homeostasis: Physical and chemical characteristics of body substances fall within normal range Body substances include: Fluids Secretions Excretions What are examples of each of the body substances? 6

5. Pathologic condition: Alters the normal functioning of the body Results in imbalance in the body Causes patient to experience symptoms of that particular pathologic condition (e.g., iron-deficiency anemia) What are other pathologic conditions? 7

May cause alteration in body substances Chemical content of blood or urine Antibody level Cell counts Cellular morphology May result in abnormal values laboratory test results Certain pathologic conditions cause abnormal values for specific laboratory tests Define cellular morphology. 8

6. Abnormal value for a particular test: may be seen with more than one pathologic condition Example: Decrease in hemoglobin levels seen with: Iron-deficiency anemia Hyperthyroidism Cirrhosis of the liver Abnormal hematocrit also has a number of reasons. List some. (anemia, liver problems, dehydration) 9

Physician cannot rely solely on laboratory tests to make a final diagnosis Must use a combination of data from: Health history Physical examination Laboratory/diagnostic test results 10

Laboratory Tests Number of tests ordered: depends on physician's clinical findings (health history and physical examination) May only need to order one test (e.g., urine culture for a urinary tract infection) May need to order a series of tests to diagnose a condition Many diseases have more than one alteration in: Physical and chemical characteristics of body substances Name some symptoms a patient may have that could be looked at as more than one condition. 11

Laboratory Tests, cont. Not all pathologic conditions require use of laboratory tests to arrive at a final diagnosis Diagnosis can be made from patient's symptoms and physical examination (e.g., otitis media) MA should have knowledge of laboratory tests performed most often Purpose of tests Normal value or range Where could the MA find this information? 12

Laboratory Tests, cont. Advance patient preparation or special instructions Any substances that might interfere with accurate test results Food Medication Make sure physician is alerted to abnormal results on laboratory tests as soon as possible Why could food alter the test results? 13

Purpose of Laboratory Testing
Assist in diagnosis of pathologic conditions: most frequent use of laboratory tests Confirm clinical diagnosis Clinical diagnosis: A tentative diagnosis of a patient's condition obtained through evaluation of the: Health history Physical examination Patient's symptoms may provide strong clinical diagnosis (e.g., diabetes) Laboratory tests are used to confirm that diagnosis (glucose tolerance test) What other tests do you know that are run for certain conditions? 14

Purpose of Laboratory Testing, cont.
Assist in differential diagnosis Two or more diseases may have similar symptoms Laboratory tests ordered to determine which disease is present Name some symptoms that would require a lab test to confirm diagnosis. 15

Obtain information regarding patient's condition May not be enough evidence to support a clinical diagnosis Patient may be exhibiting vague symptoms Example: Nonspecific abdominal pain Series of laboratory and diagnostic tests ordered to pinpoint cause of patient's problems What are some lab and diagnostic tests that may be ordered for abdominal pain? 16

Evaluate patient's progress and to regulate treatment: after making the final diagnosis Based on laboratory results: therapy may need to be adjusted or further treatment prescribed Examples: Complete blood count on patient with iron-deficiency anemia to assess response to iron therapy Adjusting Coumadin therapy based on results on physical therapy (PT) test Obtain a lab manual. What test is run for hypothyroidism therapy? 17

Establish patient's baseline Age, gender, race, geographic location: cause individuals to have different normal levels within established normal range Laboratory tests establish each patient's baseline against which future results can be compared 18

Prevent or reduce the severity of disease by early detection of abnormal findings (e.g., hyperlipidemia, anemia, diabetes) Known as a routine test: a test performed on a routine basis on apparently healthy patients to assist in the early detection of disease Easy to perform Usually part of general physical examination Why is it important to test for hyperlipidemia? 19

Common routine tests Urinalysis Complete blood count (CBC) Cholesterol Routine blood chemistries What test is being performed on this slide? 20

Requirement by state law Example: Statutes of most states require gonorrhea and syphilis tests be performed on pregnant women Purpose: to protect mother and fetus from harm The MA must be familiar with state mandates. 21

Types of Clinical Laboratories
Medical office may use outside laboratory or have its own laboratory (physician's office laboratory) Most offices use a combination of both Physician's Office Laboratory (POL) For tests that are convenient to perform and commonly required (e.g., glucose, urinalysis) Time-consuming and expensive to perform complex tests in the office What are some other tests that may be performed in a POL? 22

Outside Laboratories MA works closely with outside laboratory
Outside laboratories include: Hospital laboratories Privately owned commercial laboratories Laboratory provides office with supplies and forms to collect and prepare specimens for transport MA responsible for checking and reordering supplies How are the specimens transported? 23

Laboratory Directory Reference source for proper collection and handling of specimens Provided to office by outside laboratory Where would the MA keep a lab directory in the medical office? 24

Laboratory Directory, cont.
Information included: Names of tests performed by laboratory Normal range for each test Instructions on completion of forms (e.g., laboratory request) Patient preparation required for each test Obtain a lab directory. How would you look up a test? 25

Laboratory Directory, cont.
Supplies required for collection of each specimen Amount and type of specimen required for each test Techniques for collection of specimen Proper handling and storage of specimen Instructions for transporting specimen If MA has any questions: Call laboratory Not all lab directories are the same. Use the directory of the lab that you are sending the specimen to. 26

Laboratory Directory

Collection and Testing Categories
Specimen collected and tested at office Specimen collected at office and transferred to outside laboratory Patient given laboratory request to have specimen collected and tested at outside laboratory Responsibilities of MA depend on which method is used If a test is done at an outside laboratory, the MA is responsible for filling out the request and explains to the patient any instructions such as fasting or withholding medications, etc.. 28

Laboratory Requests Purpose
Laboratory request: Printed form containing a list of most frequently ordered laboratory tests a. Can be completed manually MA writes in all required information b. Can be completed on a computer screen MA enters information on a keyboard All lab tests are ordered by the physician. 29

Laboratory Requests, cont.
2. Required when a specimen is: Collected at office and sent to outside laboratory for testing Collected and tested at an outside laboratory Request given to patient at office to take to laboratory The lab request can also be faxed to the facility.

Laboratory Requests, cont.
Provides laboratory with information for: Accurate testing Reporting of results Billing Format of laboratory requests varies depending on laboratory Laboratories have their own request forms. The MA is responsible for filling out the correct form. 31

Laboratory Request Form

Parts of a Laboratory Request Form
Physician's name and address Facilitates reporting of results to physician May be preprinted on form 33

Parts of a Laboratory Request Form, cont.
Patient's name and address Needed for: Identifying report Billing purposes 34

Patient's age and gender Normal ranges for some tests vary based on age and gender Example: Hemoglobin Female: 12 to 16 g/dL Male: 14 to 18 g/dL 35

Date and time of collection of specimen Date: Indicates number of days that have passed since specimen was collected Provides information regarding freshness of specimen Too long of a time lapse can result in inaccurate results Why is it important to send the specimen the same day it was obtained? 36

Time: Normal range for some tests vary based on whether test is an AM or a PM specimen A urinalysis may need to be a first morning voided specimen. 37

Laboratory tests desired Usually indicated by marking a box adjacent to tests Mark box clearly Space designated for additional tests is provided Use to specify a test not listed on request form The test will also have an identification number that needs to be recorded on the request form. Where would you find this information? 38

Profile: contains many laboratory tests Profiles performed by laboratory and tests included in each: listed in laboratory directory Specific profile: all tests relate to specific organ Used when physician has a good idea of what organ is involved in patient's condition Example: Hepatic profile tests assist in diagnosis of liver conditions Have students look in lab directory for other profiles. 39

General profile: contains routine laboratory tests Used for routine health screens or when patient's symptoms are vague Example: comprehensive metabolic profile 40

Laboratory Profiles

Source of specimen (e.g., throat, wound, ear, eye, urine, vagina) Tells laboratory where specimen came from May not be possible to determine by looking at specimen Method laboratory uses to test specimen: based on source of specimen What are some other sources of specimens? 43

Physician's clinical diagnosis Assists the laboratory in correlating clinical laboratory data with the needs of physician Further testing may be needed if one test method proves inconclusive Alerts laboratory to possibility of presence of a dangerous pathogen (e.g., hepatitis) Required for billing 44

Medications Certain medications may interfere with accuracy and validity of test results Must be indicated on request to inform laboratory List some medications that may interfere with test results. 45

STAT Performed as soon as possible Results telephoned or faxed to office Place completed request form with specimen for transport to laboratory Without request: laboratory does not have info to carry out orders Results in delay in completing tests and reporting results Where would the MA record the results if they were phoned to the office? 46

Laboratory Reports Purpose May be: a. Preprinted form:
Relay laboratory test results to physician May be: a. Preprinted form: Results are printed on form by computer b. Computer report Entire report (tests and results) are printed by the computer 47

Laboratory Report

Laboratory Reports, cont.
Includes: Name, address, and telephone number of laboratory Physician's name and address Patient's name, age, and gender Patient's accession number Provides positive identification of each specimen and access to patient's laboratory records 49

Date specimen received by laboratory Date results reported by laboratory Names of tests performed Results of tests 50

Normal range for each test performed A single value cannot be used because of individual differences among general population (age, gender, race, geographic location) Normal range varies slightly from one laboratory to another depending on: Test method used Equipment used Reagents used Important to compare test results with normal range supplied by laboratory performing the test If the test result is out of range, the lab will indicate this on the report. 51

Reports are relayed to office: Hand-delivered Sent electronically (by computer) Faxed Mailed to office Who hand-delivers the reports? 52

Abnormal results posing a threat to patient's health or STAT reports: Telephoned as soon as possible Written results will follow MA responsible for reviewing reports as they are received Notify physician of abnormal results Most reports flag abnormal results If not: MA should circle abnormal results with red pen How are reports given to the physician? (e.g., attached to patient’s chart) 53

Reports reviewed by physician: correlates with info from health history and physical examination Physician initials laboratory report after reviewing it MA files report in patient's chart Where would the MA file the report in the patient’s chart? 54

What Would You Do? What Would You Not Do?

Patient Preparation and Instructions
Factors may affect results of certain laboratory tests: Food consumption Medication Activity Time of day Why would these factors affect the results? Discuss your answers. 57

Patient Preparation and Instructions, cont.
Advance patient preparation may be required to obtain a quality specimen Inaccurate results may occur if patient does not prepare properly MA responsible for instructing patient in advance preparation Explain reason for preparation: patient will be more likely to comply To ensure accurate test results To avoid having to collect specimen again Written instructions as well as verbal instructions should be given to the patient. 58

Check to make sure patient completely understands instructions Written instruction sheet may be provided Patient can refer to it at home

Some tests may require patient to remain at site for specified period of time (e.g., glucose tolerance test) Patient should be told in advance of time requirement Ask the patient if there is a time that is better for him or her. Some tests may be scheduled at any time of the day. 60

Patient may collect specimen at home (e.g., first-voided urine specimen) MA should: Explain instructions on proper technique for collection Provide appropriate specimen container Instruct patient on proper handling and storage of specimen What other specimen may be obtained at home? 61

Type of preparation: depends on test ordered and method used to run test Outside laboratory testing: preparation required listed in laboratory directory POL testing: preparation listed in manufacturer's instructions Advance preparation usually in form of: Fasting Medication restriction Diet modification What does fasting mean? 62

Fasting Required for some venous blood specimens
Composition of blood is altered by consumption of food Example: Food intake results in falsely high results for: Fasting blood sugar (FBS) Glucose tolerance test (GTT) Triglycerides Must also fast for any profile including a test that requires fasting (e.g., lipid profile) What is a lipid profile? 63

Fasting, cont. Fasting: abstaining from food and fluids (except water) for a specified amount of time (usually 12 to 14 hours) Specimen collected in the morning Food from evening meal completely digested and absorbed Least amount of inconvenience to patient Can a person have coffee in the morning? 64

Fasting, cont. MA responsible for relaying instructions to patient
Make sure patient understands to abstain from both food and fluid (except water) Advisable to drink water: To prevent dehydration: can alter certain test results In case a urine specimen is required as part of the test Are there some tests that require a person to take his or her medications? 65

Fasting, cont. When to start fasting
Indicate the specific time to start fasting (e.g., 6 PM) What time to report for collection of specimen The MA should answer all questions the patient has about the test. 66

Medication Restrictions
Many medications affect physical and chemical characteristics of body substances May lead to inaccurate test results Example: antibiotic therapy before collection of throat specimen for strep testing may cause falsely negative results What are some other medications that may interfere with test results? 67

Medication Restrictions, cont.
Patient told not to take medications before collection (if does not cause health threat or serious discomfort to patient) Medications discontinued: 48 to 72 hours: before urine collection 4 to 24 hours: before blood collection Medications more likely to interfere with urine results than blood test results What type of medications would cause a health threat if the patient was to refrain from taking it? Example: insulin should not be stopped because it could cause serious complications for the patient. 68

If patient cannot be taken off medications: Medications being taken should be recorded on laboratory request Laboratory may be able to use alternate method of testing 69

If test performed in medical office: MA should consult manufacturer's instructions for medications that interfere with test Physician determines what medications to discontinue MA ensure patient understands medication restrictions Written instructions may be best if a patient is taking a lot of medications. 70

Collecting, Handling, and Transporting Specimens
Specimen: small sample or part taken from the body to represent the nature of the whole Majority of laboratory tests performed on specimens that are easily obtained: Blood Urine Feces Sputum Cervical and vaginal scraping of cells How is a sputum test performed? For what could we test the sputum? 73

Collecting a Blood Specimen

Collecting, Handling, and Transporting Specimens, cont.
Sample of secretion or discharge for microbiologic analysis: Nose Throat Wound Ear and eye Vagina Urethra 75

Other specimens not as easy to obtain Gastric juices Cerebrospinal fluid Pleural fluid Peritoneal fluid Synovial fluid Tissue specimens for biopsy Describe how these tests are obtained. 76

Source of specimen: may not be indicative of pathologic condition Example: Thyroid tests are performed on blood serum MA responsible for collection of majority of specimens Most common specimens collected by MA: blood and urine What are ways to collect blood specimens? What PPE would you need when collecting blood? 77

Certain specimens must be collected by the physician Examples: Vaginal discharge Urethral discharge Tissue specimen MA assists with collection How would an MA assist with the procedures listed on the slide? 78

Collecting a Tissue Specimen

Handle specimen properly: to maintain in vivo characteristics In vivo: Occurring in the living body If handled improperly: may cause inaccurate test results May interfere with accurate diagnosis and treatment Do not contaminate the specimen or container. 80

Guidelines for Specimen Collection
Review and follow OSHA Bloodborne Pathogens Standard Review requirements for collection and handling of the specimen Collection materials required Type of specimen required (e.g., serum, plasma, whole blood, urine) Amount of specimen required Procedure for collecting specimen Proper handling and storage of specimen 81

Guidelines for Specimen Collection, cont.
Assemble equipment and supplies Use only appropriate specimen containers Substituting containers may affect test results Container should be sterile: To prevent contamination of specimen: may affect accuracy of test results How would you know which specimen container to use? 82

MA should check each container before using: to make sure it is not broken, chipped, cracked, or otherwise damaged Discard damaged containers 83

Label each tube and container: Patient's name Date MA initials Any other information required by laboratory What would you use to label the tube or container? Should you include the time the specimen was obtained? 84

Identify the patient by full name and date of birth Avoids collecting from wrong patient Could lead to invalid test results May affect patient's diagnosis and treatment Explaining procedure helps relax and reassure patient Gains patient's confidence and cooperation Answer any questions the patient may have about the procedure. 85

Identify the Patient

Determine if pt has prepared properly Improper preparation may lead to inaccurate test results Example: FBS: If patient does not fast, results will be falsely high Inform physician if patient failed to prepare Physician may want patient to prepare properly and return Physician may have MA collect specimen anyway Alert laboratory to situation on request form Example: Nonfasting specimen 87

Explain the procedure a. Helps relax and reassure patient b. Gains patient’s confidence and cooperation

7. Collection of the specimen Involves medical and surgical asepsis Collect specimen using proper technique What is the difference between medical and surgical asepsis?

Collect proper type of specimen Collect proper amount of specimen Refer to appropriate reference material If specimen transported to outside laboratory: refer to laboratory directory If specimen tested in office: refer to manufacturer's instructions What would happen if the proper amount of the specimen is not collected? 90

If proper amount not collected: laboratory unable to perform test Laboratory request will be returned marked QNS (quantity not sufficient) Patient must be called back for another collection 91

Once collected, MA records in chart: Date and time of collection Laboratory tests ordered Type of specimen Source of specimen If transferred to outside laboratory: date specimen was collected should be recorded (if different from date of collection) Record where the specimen was taken from if applicable. (left arm) 92

Recording Specimen Collection

8. Properly handle and store the specimen: to preserve in vivo qualities Best to perform laboratory tests on fresh specimens (within 1 hour after collection) Yield most reliable test results Where should urine be stored? 94

If specimen awaiting laboratory pick-up: properly preserve specimen to maintain in vivo physical and chemical characteristics

Clinical Laboratory Improvement Amendments (CLIA)
Purpose of CLIA 1988 To improve the quality of laboratory testing in the United States Consists of federal regulations governing all facilities that perform laboratory tests for means of: Health assessment Diagnosis, prevention, or treatment of disease Health Care Financing Administration (HCF) (division of Department of Health and Human Services): responsible for monitoring compliance with CLIA regulations 98

Categories of Laboratory Testing
Categories of laboratory testing based on complexity of testing methods Waived tests Simple procedures including procedures that are easy to perform Include procedures that patients can perform at home b. Laboratories must apply for certificate of waiver from HCFA Exempts laboratory from many CLIA requirements Must still adhere to good laboratory practices Includes: following manufacturer's instructions for each product or testing kit A list of waived tests the office performs should be documented in the office. 99

Categories of Laboratory Testing, cont.
Examples of Waived Tests: Dipstick or tablet reagent urinalysis Fecal occult blood testing Ovulation testing Urine pregnancy testing Erythrocyte sedimentation rate (nonautomated) 100

Hemoglobin using a CLIA-waived analyzer Spun microhematocrit Blood glucose determination (using an FDA-approved blood glucose monitor) Rapid strep testing 101

Moderate-complexity tests Account for 75% of estimated 10,000 laboratory tests performed in United States Examples: Hematology and blood chemistry tests performed on automated blood analyzer (that are not CLIA-waived) Microscopic analysis of urine sediment CLIA guidelines must be followed on tests performed in the medical office. 102

High-complexity tests Include: Cytogenetics Histopathology Histocompatibility Cytology (e.g., Pap test) 103

Requirements for Moderate- and High-Complexity Testing
Must meet CLIA regulations Subject to unannounced inspections every 2 years by HCFA Patient test management System to maintain optimal integrity and identification of specimens System to ensure accurate reporting of results What does HCFA stand for? 104

Requirements for Moderate- and High-Complexity Testing, cont.
Quality control: to ensure accurate and reliable test results Each laboratory must establish and follow written procedures That monitor and evaluate quality of each testing process Where should the quality control manual be kept? 105

Includes: Developing laboratory procedure manual Following manufacturer's instructions Performing calibration procedure every 6 months and documenting results Performing two levels of controls daily and documenting results Performing and documenting actions taken when problems or errors occur Documenting all quality control activities Describe how to record a quality control. 106

Quality assurance Must establish and follow written policies and procedures: To monitor and evaluate the overall quality of the total testing process Who needs to be trained in quality assurance? Who establishes the quality assurance written policies? 107

Proficiency testing (PT) Form of external quality control Laboratory specimens prepared by an approved PT agency Unknown specimens shipped to POL POL tests specimens and reports results to PT agency for evaluation Done 3 times per year Who in the office performs the PT? 108

Personnel requirements CLIA specifies education and training qualifications and responsibilities for: Laboratory directors Technical consultants Clinical consultants Testing personnel Where would the documentation be kept on the personnel requirements? 109

The Physician's Office Laboratory
MA may be responsible for performing laboratory tests and recording results Laboratory tests can be classified into categories: Hematology: Examination of blood for the detection of abnormalities Includes: Blood cell counts Cellular morphology Clotting ability of blood Identification of cell types How would we identify the cell types? 110

The Physician's Office Laboratory, cont.
Clinical chemistry: Determining the amount of chemical substances present in body fluids, excreta, and tissues Largest area in clinical chemistry: blood chemistry Serology and blood banking: Studying antigen-antibody reactions to assess the presence of a substance and/or to determine the presence of disease Urinalysis: Physical, chemical, and microscopic analysis of urine 111

Microbiology: Identification of pathogens present in specimens taken from the body Examples of specimens: -Urine - Wound -Blood -Urethra -Throat -Vagina -Sputum -Cerebrospinal fluid What other specimen may contain pathogens? 112

Parasitology: Detection of the presence of disease-producing human parasites or eggs present in specimens taken from the body Examples of specimens: Stool Vaginal Blood What other specimen can be obtained? (hair) 113

Cytology: Detection of the presence of abnormal cells Histology: Detection of diseased tissue 114

Categories of Laboratory Tests

Categories of Laboratory Tests, cont.

Specimens can be analyzed by either manual or automated method Steps for testing specimen Specific amount of specimen required: measured from specimen sample Chemical reagents are combined with specimen 117

Specimen/reagents may require further processing (e.g., centrifuging, incubation) Substance is manually or automatically measured or identified Results obtained from direct readout or by mathematic calculation The picture shows the MA centrifuging a urine specimen. What type of test is incubated?

Results are recorded on laboratory report form or in patient's chart: Patient's name (not needed if recording in chart) Date Time Name of laboratory test(s) Results of laboratory test(s) Name of individual performing test(s) Why must the individual who performed the test sign his or her name? 119

Recording Laboratory Test Results

Manual Method Involves performing a series of steps by hand
Testing kits available to speed up process a. Examples of testing kits: -Urinalysis -Strep testing -Mono testing -Urine pregnancy testing What is mono testing? 121

Manual Method, cont. Requires a thorough knowledge of testing procedure Must be careful to avoid errors

Automated Analyzers Automated analyzers designed for use in medical office Permit processing of specimens in a short period of time Provide greater precision than manual method Training is required to use automated analyzers.

Automated Analyzers, cont.
Tests results by direct readout (digital or printed) Must be able to recognize signs that indicate analyzer is malfunctioning May lead to inaccurate test results The MA is thoroughly trained by a representative from the manufacturer. 124

Numerous automated systems available Operating manual with each that includes information needed to: Collect specimen Handle specimen Perform quality control procedures Test specimen The MA must be familiar with each operating manual. 125

Personnel available for on-site training and service Examples of automated analyzers: QBC hematology analyzer Reflotron blood chemistry analyzer Clinitek urine analyzer If there was a malfunction with the analyzer and a part needed to be ordered, what would you do with the specimens that needed to be run? 126

Quality Control Must make sure laboratory test is accurately measuring what it is supposed to measure Encompasses every aspect of: Patient preparation Specimen collection Handling Transport Testing 127

Quality Control, cont. Quality control: the application of methods and means to ensure that test results are reliable and valid and that errors that may interfere with obtaining accurate test results are detected and eliminated Quality control methods Use standards and controls: To check the precision and accuracy of laboratory equipment To detect errors in technique 128

Quality Control, cont. Discard outdated reagents
Follow the procedure exactly to test specimen Perform tests in duplicate Periodically check the accuracy of test results with reference laboratory Maintain equipment by having it checked periodically Why can’t outdated reagent strips be used? Where would you discard outdated reagent strips? 129

Laboratory Safety Carefully handle and store glassware:
Arrange in storage cabinets to prevent breakage Carefully remove from storage cabinets If breakage occurs: dispose in puncture-resistant container Describe a puncture resistant container. How would you clean up glass that has a specimen in it? 130

Laboratory Safety, cont.
Handle chemical reagents carefully Reagent container should be clearly labeled If label becomes loose, reattach Recap container immediately after using Why would you recap container immediately after use? 131

Laboratory specimens should be handled carefully: Follow OSHA Bloodborne Pathogens Standard Wash hands immediately if accidentally touch specimen c. Avoid hand-to-mouth contact d. Immediately clean up any spill What would be the first step you would take if a specimen came in contact with your skin? 132

Properly dispose of all contaminated materials Cover any break in the skin Make sure specimen containers are tightly capped Handle all laboratory equipment and supplies properly Where would we dispose of contaminated materials? Why would we cover any break in the skin? 133

POSTTEST True or False Laboratory tests are most frequently ordered by the physician to assist in the diagnosis of pathologic conditions. A laboratory directory indicates the patient preparation required for laboratory tests. Laboratory tests termed profiles contain a number of different tests. A lipid profile includes a test for glucose. The purpose of patient preparation for a laboratory test is to ensure the test results fall within normal range.

POSTTEST, CONT. True or False
A comprehensive metabolic profile requires that the patient fast. Antibiotics taken by the patient prior to the collection of a throat specimen for culture may result in a false-positive result. The purpose of CLIA is to prevent exposure of employees to bloodborne pathogens. If a POL is performing moderate-complexity tests, CLIA requires that two levels of controls be run daily. The study of blood and blood-forming tissues is known as serology.

INTRODUCTION TO THE CLINICAL LABORATORY

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