SAFETY AND QUALITY

SAFETY PRACTICES
ASSESSMENT 1. Proper handwashing
SAFETY 2. Correct disposal of contaminated materials
 To work safely in this environment, 3. Wearing personal protective equipment
laboratory personnel must learn what (PPE)
hazards exist, the basic safety precautions UNIVERSAL PRECAUTIONS
associated with them, and how to apply the
 All patients are possible carriers of
basic rules of common sense required for
bloodborne pathogens.
everyday safety for patients, co-workers,
 Wearing gloves when collecting or
and themselves
handling blood and body fluids
 Safety procedure manuals must be readily
contaminated with blood and wearing face
available in the laboratory
shields when there is danger of blood
 Manual must be updated and reviewed splashing on mucous membranes and
annually by the laboratory director when disposing of all needles and sharp
objects in puncture-resistant containers
 The CDC excluded urine and body fluids
not visibly contaminated by blood from UP,
although many specimens can contain a
considerable amount of blood before it
becomes visible.

BODY SUBSTANCE ISOLATION

 They consider all body fluids and moist
body substances to be potentially
infectious
 Personnel should always wear gloves
when encountering moist body substances
BIOHAZARD  A major disadvantage of BSI guidelines is
 These microorganisms are frequently that they do not recommend handwashing
present in the specimens received in the after removing gloves unless visual
clinical laboratory. contamination is present.

STANDARD PRECAUTIONS
1. Hand hygiene
2. Gloves
3. Mouth, nose, and eye protection
4. Gown
5. Patient care equipment
6. Environmental control
7. Linen
MEANS OF TRANSMISSION 8. Occupational health and blood-borne
1. Direct contact pathogens
2. Airborne 9. Patient placement
3. Droplet 10. Respiratory hygiene/cough etiquette
4. Vehicle
5. Vector
 SPECIFIC REQUIREMENTS OF OSHA BIOLOGICAL WASTE DISPOSAL
STANDARD  All biologic waste, except urine, must be
 Engineering Controls placed in appropriate containers labeled
 Work Practice Controls with the biohazard symbol
 Personal Protective Equipment  Urine may be discarded by pouring it into a
 Medical laboratory sink
 Documentation  Disinfection of the sink using a 1:5 or 1:10
dilution of sodium hypochlorite should be
 Any accidental exposure to a possible blood- performed daily
borne pathogen must be immediately reported SHARP HAZARDS
to a supervisor. Evaluation of the incident must
 Needles
begin right away to ensure appropriate
 Lancets
postexposure prophylaxis (PEP).
 Broken glasswares
 All sharp objects must be disposed in
puncture-resistant, leak-proof container
with the biohazard symbol
 Puncture-resistant containers should be
conveniently located within the work area
 Biohazard sharp containers should not be
overfilled and must always be replaced
when the safe capacity mark is reached

CHEMICAL HAZARDS
 To avoid getting these materials in or on
bodies, clothes, or work area
 Every chemical in the workplace should be
presumed hazardous

HAND HYGIENE
 Includes both hand washing and using alcohol
based antiseptic cleansers
 Hand contact is the primary method of
infection transmission
 Alcohol-based cleansers can be used when CHEMICAL SPILLS AND EXPOSURE
hands are not visibly contaminated; not  When skin contact occurs, the best first aid
recommended after contact with spore-forming is to flush the area with large amounts of
bacteria, including Clostridium difficile and water for at least 15 minutes, then seek
Bacillus sp. medical attention
 Contaminated clothing should be removed
WHEN USING ALCOHOL-BASED as soon as possible
CLEANERS  NO attempt should be made to neutralize
1. Apply the cleanser to the palm of one hand chemicals
2. Rub your hands together and over the
entire cleansing area, including between
the fingers and thumbs
3. Continue rubbing until the alcohol dries.
 CHEMICAL HANDLING
 Chemicals should NEVER be mixed
together
 Acid should always be added to water to
avoid the possibility of sudden splashing
 Chemicals should be used from containers
ELECTRIC HAZARDS
that are of an easily manageable size
 Pipetting by mouth is unacceptable in the  Equipment should not be operated with
laboratory wet hands
 Equipment that has become wet should be
unplugged and allowed to dry completely
before reusing
 Equipment also should be unplugged
before cleaning
 All electrical equipment must be grounded
with three-pronged plugs
 When an accident involving electrical
shock occurs, the electrical source must be
removed immediately

MATERIAL SAFETY DATA SHEETS

(MSDS)
 OSHA Federal Hazard Communication
Standard requires that all employees have
a right to know about all chemical hazards FIRE/EXPLOSIVE HAZARDS
present in their workplace  All health-care institutions post evacuation
 Contains the following information routes and detailed plans to follow in the
1. Physical and chemical characteristics event of a fire
2. Fire and explosion potential  Laboratory workers often use potentially
3. Reactivity potential volatile or explosive chemicals that require
4. Health hazards and emergency first aid special procedures for handling and
procedures storage
5. Methods for safe handling and disposal
6. Primary routes of entry
7. Exposure limits and carcinogenic
potential

RADIOACTIVE HAZARDS
 Radioisotopes
 Persons working in a radioactive
environment are required to wear
measuring devices to determine the
amount of radiation they are accumulating
 Exposure to radiation during pregnancy
presents a danger to the fetus; personnel
who are pregnant or think they may be
should avoid areas with this symbol
  Bend the knees when lifting heavy objects
 Keep long hair pulled back
 Avoid dangling jewelry
 Maintain a clean, organized work area

QUALITY ASSESSMENT
 Refers to the overall process of
guaranteeing quality patient care is
regulated throughout the total testing
system
 This is a continual monitoring of the entire
process from test ordering, specimen
collection, processing, reporting and
interpretation

QUALITY SYSTEM
 Refers to all the laboratory’s policies,
processes, procedures, and resources
needed to achieve quality testing

URINALYSIS PROCEDURE MANUAL

 Principle or purpose of the test
 Clinical significance
 Patient preparation
 Specimen type and method of collection
 Specimen acceptability and criteria for
rejection
 Reagents, standards and controls,
instrument calibration and maintenance
protocols
 Schedules, step by-step procedure,
calculations, frequency and tolerance limits
for controls
 Corrective actions, reference values and
 It provides a simple, readily recognized, critical values, interpretation of results,
easily understood system for identifying specific procedure notes, limitations of the
the specific hazards of a material and the method, method validation, confirmatory
severity of the hazard that would occur testing, recording of results, references,
during an emergency response effective date, author, and review schedule
PHYSICAL HAZARDS PRE-EXAMINATION VARIABLES
 Avoid running in rooms and hallways  Occur before the actual testing of the
 Watch for wet floors specimen and include test requests,
 patient preparation, timing, specimen testing patient samples, and it must always
collection, handling, and storage be performed if reagents are changed, an
instrument malfunction has occurred, or if
TURNAROUND TIME (TAT)
test results are questioned by the health-
 Defined as the amount of time required care provider
from the point at which a test is ordered by
the health-care provider until the results
are reported to the health-care provider

SPECIMEN COLLECTING AND INTERNAL QUALITY CONTROL

HANDLING
 monitor the sufficient addition of a patient
 All urine specimens should be examined specimen or reagent, the
within 2 hours instruments/reagents interaction, and, for
 Criteria for specimen rejection for both lateral flow test methods, whether the
physical characteristics and labeling errors sample migrated through the test strip
must be present properly
1. The actual date and time of specimen
collection EXTERNAL QUALITY CONTROL
2. Whether the specimen was refrigerated  Used to verify the accuracy (ability to
before transporting, obtain the expected result) and precision
3. The time the specimen was received in the (ability to obtain the same result on the
laboratory and the time the test was same specimen) of a test and are exposed
performed to the same conditions as the patient
4. Tests requested samples
5. An area for specific instructions that might  Reliability is the ability to maintain both
affect the results of the analysis, and; precision and accuracy
6. Patient identification information
POST EXAMINATION VARIABLES
EXAMINATION OF VARIABLES  Processes that affect the reporting of
 Processes that directly affect the testing of results and correct interpretation of data
specimens
 Reagents, instrumentation and equipment REPORTING RESULTS
 Testing procedure  Forms for reporting results should provide
 QC adequate space for writing and should
present the information in a logical
 Preventive maintenance (PM)
sequence
 Access to procedure manuals
 A written procedure for reporting,
 Competency of personnel performing the
reviewing, and correcting errors must be
tests
present
QUALITY CONTROL
 Refers to the materials, procedures, and
techniques that monitor the accuracy,
precision, and reliability of a laboratory test
 Performed to ensure that acceptable
standards are met during the process of
patient testing
 Performed at scheduled times, such as at
the beginning of each shift or before