urinalysis Chapter 1

2. The best way to break the chain of infection is: A. Hand sanitizing B. Personal protective equipment C. Aerosol prevention D. Decontamination

A

OSHA

Occupational Safety and Health Administration

When mixing acid and water

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

Mouth/Nose/Eye

-Mask, eye protection, face shield (protect mucous membranes from potential body sprays) -N95 mask/respirator during patient care activitieies related to suspected mycobacterium exposure

accidental exposure to blood-borne pathogens... what do you do?

-must be immediately reported to a supervisor. -Evaluation of the incident must begin right away to ensure appropriate postexposure prophylaxis (PEP). -The CDC provides periodically updated guidelines for the management of exposures and recommended PEP.8,9

Means of Transmission of Infectious Disease Agents

1. Direct contact: the unprotected host touches the patient, specimen, or a contaminated object (reservoir) 2. Airborne: inhalation of dried aerosol particles circulating on air currents or attached to dust particles 3. 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) 4. Vehicle: ingestion of a contaminated substance (e.g., food, water, specimen) 5. Vector: from an animal or insect bite

Standard Precautions (How many are there, briefly list)

1. Hand Hygiene 2. Wear Gloves 3. Mouth, Nose, eye protection 4. Gown 5. Patient Care equipment 6. Environmental control 7. Linen 8. Occupational Health and blood-borne pathogens (sharps) 9. Patient Placement 10. Respiratory hygiene/cough etiquette

most susceptible hosts are those with the following things going on

1. Immunocompromised patients, including newborns, infants and the elderly 2. Stress, fatigue, lack of nutrition 3. Health care workers

MSCS list what kind of information

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

The Occupational Exposure to Blood-Borne Pathogens Standard requires the following engineering controls:

1. Providing sharps disposal containers and needles with safety devices. 2. Requiring discarding of needles with the safety device activated and the holder attached. 3. Labeling all biohazardous materials and containers.Work Practice Controls 4. Requiring all employees to practice Standard Precautions and documenting training on an annual basis. 5. Prohibiting eating, drinking, smoking, and applying cosmetics in the work area. 6. Establishing a daily work surface disinfection protocol.Personal Protective Equipment 7. Providing laboratory coats, gowns, face shields, and gloves to employees and laundry facilities for nondisposable protective clothing.Medical 8. Providing immunization for the hepatitis B virus free of charge. 9. Providing medical follow-up to employees who have been accidentally exposed to blood-borne pathogens.Documentation 10. Documenting annual training of employees in safety standards. 11. Documenting evaluations and implementation of safer needle devices. 12. Involving employees in the selection and evaluation of new devices and maintaining a list of those employees and the evaluations. 13. Maintaining a sharps injury log including the type and brand of safety device, location and description of the incident, and confidential employee follow-up.

Seven steps to proper hand-washing

1. Wet hands with warm water. Do not allow parts of body to touch the sink. 2. Apply soap, preferably antimicrobial. 3. Rub to form a lather, create friction, and loosen debris. Thoroughly clean between the fingers and under the fingernails for at least 40 seconds; include thumbs and wrists in the cleaning. 4. Rinse hands in a downward position to prevent recontamination of hands and wrists. 5. Obtain paper towel from the dispenser. 6. Dry hands with paper towel. 7. Turn off faucets with a clean paper towel to prevent contamination.

All urine specimens should be examined within...

2 hours. If this is not possible, written instructions for preserving the specimen must be available.

Label the following as (1)Pre-examination, (2)examination or (3)post-examination -Reagent expiration date -Rejecting a contaminated specimen -Constructing a Levy Jennings chart -Telephoning a positive clinitest result on a newborn -Calibrating the centrifuge -Collecting a timed urine specimen

2,1,2,3,2,1

Standard Precautions, Occupational Health and blood-borne pathogens

8. Occupational health and blood-borne pathogens: Take care to prevent injuries when using needles, scalpels, and other sharp instruments or devices; when handling sharp instruments after procedures; when cleaning used instruments; and when disposing of used needles. Never recap used needles or otherwise manipulate them using both hands or use any other technique that involves directing the point of a needle toward any part of the body; rather, use self-sheathing needles or a mechanical device to conceal the needle. Do not remove used unsheathed needles from disposable syringes by hand, and do not bend, break, or otherwise manipulate used needles by hand. Place used disposable syringes and needles, scalpel blades, and other sharp items in appropriate puncture-resistant containers, which are located as close as practical to the area in which the items were used, and place reusable syringes and needles in a puncture-resistant container for transport to the reprocessing area. Use mouthpieces, resuscitation bags, or other ventilation devices as an alternative to mouth- to-mouth resuscitation methods in areas where the need for resuscitation is predictable.

4. An employee who is accidentally exposed to a possible blood-borne pathogen should immediately: A. Report to a supervisor B. Flush the area with water C. Clean the area with disinfectant D. Receive HIV prophylaxis

A

Telephoneing/transmitting results

According to Joint Commission 1. must document the person receiving the information 2. The test result must be repeated by the person receiving the information

Labelling

All reagents and reagent strips must be properly labeled with the date of preparation or opening, purchase and received date, expiration date, and appropriate safety information.

Quality Control (QC)

An assessment of quality based on internal standards, processes, and procedures established to control and monitor quality. External (perform on standartds if reagents are changed or if an instument malfunctions, or if test results are questioned by the health-care provider or if they look questionable)- analyze two levels of control, document properly. Internal Quality Control- internal monitoring systems built into the test system. -they monitor sufficient addition of specimen/reagent -instrument/reagent interaction -whether the sample migrated through the test strip properly

Fomite

Any inanimate object to which infectious material adheres and can be transmitted- equipment or soiled object- especially if they contain blood, urine or other body fluids

22. The NPFA classification symbol contains information on all of the following except: A. Fire hazards B. Biohazards C. Reactivity D. Health hazards

B

26. Quality assessment refers to: A. Analysis of testing controls B. Increased productivity C. Precise control results D. Quality of specimens and patient care

B

28. As supervisor of the urinalysis laboratory, you have just adopted a new procedure. You should: A. Put the package insert in the procedure manual B. Put a complete, referenced procedure in the manual C. Notify the microbiology department D. Put a cost analysis study in the procedure manual

B

Types of Safety Hazards

Biological, Physical, Sharps, Chemical, Radioactive, Electrical, Fire or explosive, Latex sensitivity

1. In the urinalysis laboratory the primary source in the chain of infection would be: A. Patients B. Needlesticks C. Specimens D. Biohazardous waste

C

33. When a new bottle of QC material is opened, what information is placed on the label? A. The supervisor's initials B. The lot number C. The date and the laboratory worker's initials D. The time the bottle was opened

C

CLIA- what is it and what does it require for lab accreditation

Clinical Laboratory Improvement Amendments - Mandates comparison testing for lab accreditation

CLSI

Clinical Laboratory Standards Institute; and organization that sets standards for laboratories

Delta Test

Comparison between current results of lab test and previous test results for same patient

Universal Precautions (UP)

Concern over exposure to blood-borne pathogens, such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), resulted in the drafting of guidelines and regulations by the CDC and OSHA to prevent exposure. In 1987 the CDC instituted Universal Precautions (UP). Under UP all patients are considered to be possible carriers of blood-borne pathogens. The guideline recommends wearing gloves when collecting or 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 all needles and sharp objects they are placed in puncture-resistant containers. Limitation: 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.

30. The testing of sample from an outside agency and the comparison of results with participating laboratories is called: A. External QC B. Electronic QC C. Internal QC D. Proficiency testing

D

32. What steps are taken when the results of reagent strip QC are outside of the stated confidence limits? A. Check the expiration date of the reagent strip B. Run a new control C. Open a new reagent strips container D. All of the above

D

Policy for Handling Mislabeled Specimens

Do NOT assume any information about the specimen or patient. Do NOT relabel an incorrectly labeled specimen. Do NOT discard the specimen until investigation is complete. Leave specimen EXACTLY as you receive it; put in the refrigerator for preservation until errors can be resolved. Notify floor, nursing station, doctor's office, etc. of problem and why it must be corrected for analysis to continue. Identify problem on specimen requisition with date, time, and your initials. Make person responsible for specimen collection participate in solution of problem(s). Any action taken should be documented on the requisition slip. Report all mislabeled specimens to the appropriate supervisor.

Electronic Control is a type of ____ QC and what is it? What is a limitation?

External Quality control- can also be internal- uses a mechanical or electrical device in place of a liquid QC specimen -limitation- verifies the functional ability of the testing device, but does not verify the integrity of the testing supplies

Standard precautions, gloves use

Gloves: Wear gloves (clean, nonsterile gloves are adequate) when touching blood, body fluids, secretions, excretions, and contaminated items. Put on gloves just before touching mucous membranes and nonintact skin. Change gloves between tasks and procedures on the same patient after contact with material that may contain a high concentration of microorganisms. Remove gloves promptly after use, before touching noncontaminated items and environmental surfaces, and between patients. Always sanitize your hands immediately after glove removal to avoid transferring microorganisms to other patients or environments.

_______is the primary method of infection transmission.

Hand contact

Standard Precautions, Hand washing

Hand hygiene: Hand hygiene includes both hand washing and the use of alcohol-based antiseptic cleansers. Sanitize hands after touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn. Sanitize hands immediately after gloves are removed, between patient contacts, and when otherwise indicated to avoid transferring microorganisms to other patients or environments. Sanitizing hands may be necessary between tasks and procedures on the same patient to prevent cross-contamination of different body sites.

HICPAC

Healthcare Infection Control Practices Advisory Committee

Chain of infection is...

How microorganisms/disease is transmitted from one being to another 1. Causative Agent 2. Reservoir 3. Portal of Exit 4. Mode of Transmission 5. Portal of Entry 6. Susceptible Host

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

Joint Commission (JC)

Possible Errors that are often made in reporting results

Patient Identification, Specimen labeling, result transcription

PEP- what is it, and what can it do?

Post-exposure prophylaxis: can reduce the risk of HIV infection immediately AFTER exposure

Preexamination, Examination and post examination variables

Pre Specimen handling and collection Patient preperation test requests Examination Processes that directly affect the testing of specimens Reagents Instrument and equipment (temps of refrigerators, etc) Testing Procedure Quality control- all types Personnel and Facilities Post Reporting Results Interpreting results

PT ir EQA

Proficiency Testing or External Quality Assessment. Testing is done on unknown samples received from an outside agency. Done periodically to provide validation of the quality of test results from the lab

When a fire is discovered, all employees are expected to take the actions in the acronym

RACE: Rescue—rescue anyone in immediate danger Alarm—activate the institutional fire alarm system Contain—close all doors to potentially affected areas Extinguish/Evacuate—attempt to extinguish the fire, if possible or evacuate, closing the door

How often are reagent strips tested?

Reagent strips should be checked against known negative and positive control solutions on each shift or at a minimum once a day, and whenever a new bottle is opened.

Quality Assessment errors

SUMMARY 1-1 Quality Assessment Errors Preexamination Patient misidentification Wrong test ordered Incorrect urine specimen type collected Insufficient urine volume Delayed transport of urine to the laboratory Incorrect storage or preservation of urine Examination Sample misidentification Erroneous instrument calibration Reagent deterioration Poor testing technique Instrument malfunction Interfering substances present Misinterpretation of quality control data Postexamination Patient misidentification Poor handwriting Transcription error Poor quality of instrument printer Failure to send report Failure to call critical values Inability to identify interfering substances

NFPA is what? What does it require for chemicals?

The National Fire Protection Association (NFPA) has developed the Standard System for the Identification of the Fire Hazards of Materials, NFPA 704.14 This symbol system is used to inform firefighters of the hazards they may encounter with fires in a particular area. The diamond-shaped, color-coded symbol contains information relating to health, flammability, reactivity, and personal protection/special precautions. Each category is graded on a scale of 0 to 4,

To Protect workers from blood-borne pathogens, what law is used, and who enforces it

The Occupational Exposure to Blood-Borne Pathogens Standard is a law monitored and enforced by OSHA.

Operating a fire extinguisher - acronym

The acronym PASS can be used to remember the steps in the operation: 1. Pull pin 2. Aim at the base of the fire 3. Squeeze handles 4. Sweep nozzle side to side

If a mistake is made in the clinical record, what procedure should be followed to make the correction?

The patient's records must be corrected ASAP, but you cannot erase original results, everything must be documented properly.

Types of water must be specified. What is CLRW?

The type of water used for preparing reagents and controls must be specified. Distilled or deionized water or clinical laboratory reagent water (CLRW) must be available

Table 1-4 Criteria for Urine Specimen Rejection

Unlabeled containers Nonmatching labels and requisition forms Contaminated specimens with feces or toilet paper Containers with contaminated exteriors Insufficient volume of urine Improperly transported or preserved specimens Delay between time of collection and receipt in the laboratory

Disposal of urine

Urine may be discarded by pouring it into a laboratory sink under a Plexiglas countertop shield. -Care must be taken to avoid splashing -and the sink should be flushed with water after specimens are discarded -Disinfection of the sink using a 1:5 or 1:10 dilution of sodium hypochlorite should be performed daily. Sodium hypochlorite dilutions stored in plastic bottles are effective for 1 month if protected from light after preparation

Centrifuges are disinfected how often?

Weekly

reservoir

a contaminated clinical specimen or an infected patient

Chemical spills

alert all others; flush skins in contact- 15 minutes- and wash all clothing

Quality system refers to

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

portal of entry

any body opening on an uninfected person that allows pathogens to enter, mucous membranes (mouth, nose, eyes), breaks in the skin, needlestick/sharps injury

infectious agents

bacteria, viruses, parasites, fungi, prions too (not in manual)

Absorbent materials used for cleaning countertops and removing spills must be discarded in ______.

biohazard containers

BSI is _____. The concept says that..... One major limitation...

body substance isolation, -says all body fluids may be potentially infectious, so gloves should be worn -Does not require hands to be washed when gloves are removed

Deionized water used for reagent preparation is quality controlled by...

checking pH and purity meter resistance on a weekly basis and the bacterial count on a monthly schedule.

For chemicals, you must have a....

chemical hygiene plan (CHP) available to employees.13 The purpose of the plan is to detail the following: 1. Appropriate work practices 2. Standard operating procedures 3. PPE 4. Engineering controls, such as fume hoods and flammables safety cabinets 5. Employee training requirements 6. Medical consultation guidelines

Hand Sanitizers are not recommended after _____

contact with spore-forming bacteria, including Clostridium difficile and Bacillus sp.

the effects of radiation are _______and related to the amount of exposure

cumulative

parenteral route

dispensation via a needle into the skin layers

an internal laboratory quality improvement form is used as a tool to...

document a problem at the point of discovery, describing what happened and the immediate corrective action taken

Calibration of centrifuges is customarily performed how often?

every 3 months

How is biohazardous waste processed?

following institutional policy: incineration, autoclaving, or pickup by a certified hazardous waste company.

How long does sodium hypochlorite (NaClO) remain effective?

for one month if protected from light

When must hands be washed/sanitized?

must always sanitize hands: -before patient contact -after gloves are removed -before leaving the work area -at any time when hands have been knowingly contaminated -before going to designated break areas -before and after using bathroom facilities. Hand hygiene includes both hand washing and using alcohol-based antiseptic cleansers. Alcohol-based cleansers can be used when hands are not visibly contaminated. They are not recommended after contact with spore-forming bacteria, including Clostridium difficile and Bacillus sp.

empty urine containters go to

nonbiologically hazardous waste.

gloves should be pulled ____. They are worn at all times when working with patient specimens and are removed prior to ____. They are changed when they become ______. Disposable coats are placed in ______, and nondisposable coats are placed in designated laundry receptacles.

over the cuffs leaving the work area visibly soiled containers for biohazardous waste

symptoms of latex allergy

range from mild contact dermatitis to moderately severe sx of rhinitis, conjunctivitis, urticaria, and bronchospasm; possible anaphylaxis; Reactions to latex include irritant contact dermatitis, which produces patches of dry, itchy irritation on the hands; delayed hypersensitivity reactions resembling poison ivy that appear 24 to 48 hours after exposure; and true, immediate hypersensitivity reactions often characterized by facial flushing and breathing difficulties.

Standard Precautions, year, developed by, developed for

recommendations that must be followed to prevent transmission of pathogenic organisms by way of blood and body fluids 1996, CDC, HICPAC (Healthcare Infection Control Practices Advisory committee); developed for Patient Contact, but the principles can be applied to handling patient specimens as well

Microscopes should be cleaned how often?

should be kept clean at all times and have an annual professional cleaning

Temperatures of refrigerators and water baths should be

taken daily and recorded.

Documentation of QA procedures is required by all laboratory accreditation agencies, including

the Joint Commission (JC), College of American Pathologists (CAP), American Association of Blood Banks (AABB), American Osteopathic Association (AOA), American Society of Histocompatibility and Immunogenetics (ASHI), and the Commission on Laboratory Assessment (COLA); it is also required for Medicare reimbursement.

When an accident involving electrical shock occurs....

the electrical source must be removed immediately. This must be done without touching the person or the equipment involved to avoid transferring the current. Turning off the circuit breaker, unplugging the equipment, or moving the equipment using a nonconductive glass or wood object are safe procedures to follow. The victim should receive immediate medical assistance following discontinuation of the electricity. Cardiopulmonary resuscitation (CPR) may be necessary.

When specimens are received in containers with contaminated exteriors

the exterior of the container must be disinfected or, if necessary, a new specimen may be requested.

Any symptoms of latex allergy should be reported to a supervisor because

true latex allergy can be life-threatening.

Specimens must never be centrifuged in ____

uncapped tubes or in uncovered centrifuges.