INTRODUCTION TO MEDICAL TECHNOLOGY

WHAT IS MEDICAL TECHNOLOGY ?

• (Hainemann) - Application of the principles of natural, physical,

biological sciences to the performance of laboratory procedures
which aid in the diagnosis and treatment of diseases.
• (Fagelson) – ‘branch of medicine concerned with the performance of
laboratory determinations and analyses used in the diagnosis and
treatment of diseases and the maintenance of health.”
• Walters defined medical technology of clinical laboratory science” as
the health profession concerned with performing laboratory analyses
in view of obtaining information necessary in the diagnosis and
treatment of disease.
• RA 5527 – defined Medical Technology as an auxiliary branch of
laboratory medicine which deals with the examination of tissues,
secretion and excretion of the human body and body fluids by
various electronic, chemical, microscopic and other medical
laboratory procedures or techniques either manual or automated
which will aid the physician in the diagnosis study and treatment of
disease and in the promotion of health in general.

CLINICAL LABORATORIES:
• Facilities that perform chemical and microscopic examinations of
various body fluids like blood and tissues.
• Found in a variety of settings both in government and private
hospitals or free standing( non- hospital) laboratories such as found
in clinics, group practices, physician’s offices, veterinary offices,
government agencies and military institutions.
• Large in size, offering sophisticated services and employing many
medical technologist and technicians or it maybe a small facility
having only few employees.
• Type of clinical laboratory:
• Small size hospital (< 100 beds) – routine procedures, more
complicated or infrequently requested tests may be sent to reference
labs.
• Medium size hospital( 100-300 beds) routine procedures including
complicated procedures.
• Laboratories in large size hospitals ( over 300 beds) –large volumes
of work and perform complex tests.

PATHOLOGIST:

• The director of a clinical laboratory is a pathologist.

• A licensed physician with a specialty in Pathology as certified by the
Philippine Board of Pathology.
• Pathology- defined as the practice of medicine which contributes to
diagnosis, prognosis and treatment through knowledge gained by
laboratory application of the biologic, chemical or physical sciences
to man or material obtained from a man.
Pathology - 2 areas:
• Anatomical
• Clinical
• Anatomical pathology is the diagnosis or confirmation of diseases
through autopsy examination and cellular differentiation of autopsy
and surgical tissues.
• Clinical pathology specializes in chemical, microbiological
( study of bacteria),and hematology ( study of blood )
Procedures.

MEDICAL TECHNOLOGIST:

• Has a baccalaureate degree program from a college or university

recognized by a Commission on Higher Education (CHED), has
completed a specified clinical internship in a training laboratory
accredited by the Bureau of Health Facilities and Service of the
Department of health and has passed the licensure examination
administered by the board of medical Technology of the Professional
regulation Commission.
• Work as a medical detectives.
• Use microscopes to observe details of cells, ova and cysts of parasitic
organisms.
• Test whether blood of donor is compatible with the blood pf patient –
recipient. Utilize special stains to identify organism and to analyze
various cells. Measure substances in blood and other fluids such as
glucose and cholesterol. Discover and identify microorganism
causing infection and disease. Operate complex apparatus,
instruments and machines. Use standards and c ontrol to improve
the reliability of laboratory results.
• Work under pressure with speed, accuracy and precision. Adhere to
high ethical standards of performance.
• Their work includes collecting blood specimen, inoculating
cultures needed to identify bacteria, monitoring the quality
control of tests and procedures, and reporting abnormal results
to pathologists or higher level medical technologists.

• Medical technologists may also perform complex and

sophisticated laboratory analysis, evaluate the effects that a
patient’s physiological conditions have on the results of the test
performed, confirm test results and provide the physician with
the necessary data to determine the presence, extent, cause, and
 Treatment of disease.

• A medical technologist analyzes human fluid samples using

techniques available to the clinical laboratory, such as
manual white blood cell differentials, bone marrow counts,
analysis via microscopy and advanced analytical
equipment. Medical technologists
assist doctors and nurses in choosing the correct lab tests
and collection methods; labeling and handling specimens;
and interpreting the resulting analysis.

• The technologist must recognize abnormalities and know how to

correct them. They monitor, screen, and troubleshoot analytical
devices including calibration, quality control, "on the fly" or run-by-
run assessment, statistical control of observed data, and recording
normal operations. To maintain the integrity of the laboratory
process, the medical technologist recognizes factors that could
introduce error and rejects contaminated or sub-standard specimens

EMPLOYMENT OPPORTUNITIES FOR MEDICAL

TECHNOLOGY GRADUATES

• Employed in government and private hospitals, in clinical

laboratories and in blood banks as medical technology generalists,
medical technology specialist ( in microbiology, hematology, blood
 banking, clinical chemistry), clinical laboratory supervisors, chief
medical technologist and laboratory owners.
• Sales and industry- sales representative, public relations
representatives or educational representatives for their company.
• Research-Industrial research- new products and necessary testing
(bacteriological , animals.) prior to the distribution of products.
Medical center research may involve development or evaluation of
laboratory methods- new clinical treatment method and varying
types of investigation.; Veterinary medicine
• Employment abroad in US, Middle East countries.
• Medical career.

Personal Traits of Medical Technologist.

• To succeed in the medical technology profession- physical stamina,

good eyesight, normal color vision, manual dexterity, good intellect
and aptitude for biological sciences and caring attitude.
• Communication skills and ability to relate well to fellow workers.
• Must be observant, motivated, able to perform precise manipulations
and calculations and good organizational skills.
• Must be service oriented.
• Patience is a must.
• Honesty , accuracy and skills are important. Medical Technologist
deals with human life. Any error, dishonesty and negligence in the
work endanger the life of the patient.
• Dedication enables Medical Technologist to work devotedly and
conscientiously in fulfilling his duties and responsibilities.
• Emotional maturity. Helps medical technologist deal with the
colleague in medical and paramedical profession harmoniously.
• X- factor makes one likeable not only as medical technologist but as
a “total person”.
 THE DEVELOPMENT OF MEDICAL TECHNOLOGY

• 460 B.C. Greek, Physician Hippocrates – known as the father of

medicine formulated the most famous Hippocratic Oath , the code of
ethics for practicing physician.
• Hippocrates described 4 humors or body fluids in man- blood,
phlegm, yellow bile and black bile.- source of a person’s disposition
and disease in ancient times.
• Urine was regarded as composite of these humors.
• Urinalysis or the study of urine- oldest laboratory procedures today.
Polyuria-noted ancient times- 600 B.C. Hindu physician recorded the
sweet taste of diabetic urine.
• Year 1500 B.C. Vivian Herrick ( Med. Technologist)- traces the
beginning of medical technology when Intestinal parasites such as
Taenia and Ascaris were first identified.
• Ebers Papyrus believe that medical technology began when a book
for the treatment of diseased published,- description of three stages
of hookworm, infection and disease.
• Ruth Williams believe that medical technology began from medieval
period (1096-1436)
• Hindu doctors mad scientific observation that urine of certain
individuals attracted ants, and that urine has a sweetish taste.
• 14 th century, Anne Fagelson medical technology started when a
prominent Italian doctor at University of Bologna employed
Alessandra Giliani to perform different task in the lab, but die due to
laboratory acquired infection.
• 1632-anton Van Leeuwenhoek invented and improves the compound
microscope. First to describe red blood cells, to see protozoa and
classify bacteria according to shape .Invention lead to rapid progress
of microbiology and pathology.
• Melphigi (1628-1694) Greatest of early microscopist.
“Founder of Pathology”
- Pathology was practiced in the time of Rudolph Virchow
 (1847) One of the youngest of medical specialist.
Founder of the Archives of pathology in Berlin.
• In 1848, Herman Fehling- perform the first quantitative test for urine
sugar.
• Discovery of the different dyes as aniline dyes used in staining
microorganisms – Middle of 15th century. Led to the development
and advancement of microbiology.
• New science became known in Germany and spread in Greece,
Japan, Turkey, England and Unites States, where medical technology
practice was developed to a high level because of its financial
capability, manpower and interest.

HISTORY OF MEDICAL TECHNOLOGY IN THE

UNITED STATES

* 1878- Dr. William Welch

- established laboratory at the Bellevue Hospital Medical College.
- gave the first laboratory course in Pathology ever offered in
American Medical School.
• 1885, He became the first professor of Pathology at John Hopkins
University.
• 1896 – the first clinical laboratory at the John Hopkins Hospital by
Dr. William Osler.
• routine examination; special search for malarial parasites in blood.
• Clinical lab was opened at University of Pennsylvania at 1896
• 1908 - Dr. James C. Todd wrote “ A Manual of clinical diagnosis’.
The book was entitled “ Clinical Diagnosis by laboratory Methods-
19th edition- became the standard reference for laboratories.
• 1915, the state legislature of Pennsylvania enacted a law requiring
all hospitals institutions to have an adequate laboratory and employ
full time lab technician.
• First schools for training workers was established at university of
Minnesota- Course bulletin entitled “ Courses in Medical
Technology for clinical and Laboratory technicians’ –issued in 1922.
• 1921, The Denver Society of Clinical Pathologists was organized.
More scientist were developed.
• 1936- American Board of Pathology was established.
• World War II marked effect on laboratory medicine.The use of blood
increased and closed system of blood collection was widely adopted.

HISTORY OF MEDICAL TEHCNOLOGY IN THE

PHILIPPINES

• 1944, US bases were built in Leyte, US bring in members of health

care team to the Philippines to resolve the health problem of soldiers
and Filipinos.

• 9th day of January, 1945, 850 US ships of US army began around

about to Lingayen gulf . Real medical facilities were made available
to the Philippines which includes the” 26th Medical Laboratory of the
6 th US army”-Quiricada, Sta. Cruz Manila- now known as Public
Health Laboratory- division of Manila Health Department

• 1945, the laboratory was formerly reorganized by Dr. Pio de Roda

and assisted by Dr. Mariano Icasiano-Manila City Health Officer-
Laboratory later name Manila Public health Laboratory.
• Training program for laboratory workers was offered in 1947 was
offered by Dr. Pio de Roda.- Ineffective- no program and no
certificates were issued to trainees.

• Dr. Pio de Roda instructed Dr. Sta. Ana to prepare a formal syllabus
of training program.

• 1954, the training began using a syllabus for 6 months. Formal

education of medical technology in the Philippines began.

FORMAL MEDICAL TECHNOLOGY EDUCATION IN

THE PHILIPPINES

• First 4 year B.S Medical Technology course was offered in 1954 by

Philippine Union College of Baesa, Caloocal, Rizal( now located in
Silang Cavite), after 2 years(1956), PUC graduated its first graduate-
Dr. Jesse Umali- OB- gynecologist and owner of Omega Lab, Vito
cruz, Manila.

• 1957-1958, Dr.Antonio Gabriel and Dr. Gustavo Reyes of the faculty

of Pharmacy, UST offered Medical Technology as an elective to t4th
and 5th year in BS Pharmacy students, and because of the popularity
of Medical Technology among pharmacy students, Rev. Fr, Lorenzo
Rodriguez decided to offer it as a course.

• June 17,1957- temporary permit was issued by the Department of

Education for first to third year students.

• June 1960, the permit for the internship program was issued.
• June 14,1961- full recognition of the 4th year BS Medical
Technology course was given.

• CEU, Mrs. Purificacion Sunico- Suaco undertook feasibility study

for the offering of the BS Med Tech Course, proposal was granted
permission by the University President, Carmen de Luna, the first
batch graduated in 1962.

• Dr. Horacio Ylagan and Dr. Serafin Juliano thru the authority of Dr.
Lauro H. Panganiban(Dean IM) and Dr, Jesus Nolasco(sec.IM)
applied for the offering the BS Med tech course. The Bureau of
Education approved the program in July 5, 1962, the first batch
graduated in 1963.

• Many schools followed to offer the BS Medical Technology Course.

According to DECS, approx. 50 colleges and universities offering the
course. UP offer dimilar course but the degree conferred in B.S.
Public health.

• Postgraduate studies are offered to BS medical Technology courses.

UST graduate school and Philippine Women;s University are
offering MS Medical Technology; UP is offering a one0year, non –
thesis degree in master in Public Health.

The Philippine Association of Schools of Medical

Technology and Public Health.(PASMETH)

• National organization of about 50 recognized schools of medical

technology in the Philippines.
• 1970, formed by some representatives of school of medical
technology/Public health in the Phils.- to maintain the highest
standard of medical technology/Public health education.
• May 13,1970.Dr. Narciso Albaracin appointed Dr.Sarafin Juliano for
the Health and Hygiene.
• First organizational meeting –UST-June 22,1970.
• First officers are:

President: Dr.Gustavo Reyes

Vice President: Dr.Sarafin Juliano
Secretary/ treasurer: Dr.Velia Trinidad
Press Relation officer: Dr. Faustino Sunico

First annual meeting – UST- May 7,1971

School year 1972 -1973 elected officers are:

President: Dr. Gustavo Reyes

Vice President: Dr. Claro Cabrera
Secretary; Dr. Elvira silva
PRO: Dr.Faustino Sunico

• It was formally registered with Securities and Exchange

Commission – October 6,1989 – atty. Dexter Bihis who acted as
PASMETH Local Counsel.
• Pasmeth accomplishment include;
• continuing professional organization program for medical technology
faculty
• preparation of standard curriculum for BS Medical Technology
• Preparation of standard course syllabi for professional subjects in
Medtech.
• Scholarship grants for Med.Tech. students
• community outreach projects
• Recognition to graduates of B.S Medical technology Course
(PASMETH Gold Medal for Excellence Award) accreditation as
CPE provider for medical technologists/

THE PHILIPPINE ASSOCIATION OF MEDICAL

TECHNOLOGISTS

• Is the national organization of registered medical technologists in the

Philippines.
• Organized by mr. Crisanto Almano( Father of PAMET) – standardize
and give dignity to the profession-Sept.15,1963- Manila Public
Health Laboratory in Sta. Cruz Manila.
• First national convention of PAMET – Far Eastern University- Sept.
20,1964.

PRESIDENTS of PAMET were:

• Mr. Charlemagne Tamondong- ( 1963-1967)

• Mr.Nardito Moraleta (1967-1970)
• Mr.Felix Asprer ( 1970-71,1973-77)
• Mr.Bernardo Tabaosares ( 1971-1973)
• Ms.Angelina Jose (Jan-Sept.1973)
• Ms.Venerable C.V. Oca (1977-feb.1982)
• Ms.carmencita Acedera ( 1982-1992)
• Mrs.Marilyn Atienza (1992-1996)
• Dean Norma N.Chang (1996-2000)
• Ms.Agnes Medenilla ( 2000-2002)
• Ms.Shirley Cruzada- (2002-2008)

PAMET Accomplishments include;

• Its recognition as a profession

• Approved of house Bill no.7082 on may 10,1967
• Approval of RA 5527, otherwise known as Philippine Medical
Technology Act of 1969.
• Registration of PAMET with International association of Medical
Technology Technologist on May 26,1970
• Organization of the council of Medical Technology in 1969 in
compliance with RA 5527
• Accreditation of PAMET as bona fide professional organization for
medical technologist with the PRC.
• Amendment of Teves Law ( about salaries of medical professionals)
• Proclamation of 3 rd week of sept. as the Philippine medical
Technology week.
• Upgrading of the Medical Technology profession by raising its
professional code numbers from 20-3.
• Continuing professional education of medical technologist
• Medical mission which offer free lab services to the poor and the less
fortunate Filipinos
• National interschool medical Technology Quiz contest
• Classification of PAMET members into different categories
• Closer coordination with other professional organization in the health
care delivery system
• Scholarship program for medtech students and faculty members.
• Wider affiliation with international association of clinical laboratory
technologists
• Acquisition of its official secretariat/ headquarter – cityland 10 tower
2 condominium unit 1720, 6817 Ayala North, Makati City
 HEALTH CARE ORGANIZATION:

ORGANIZATIONAL STRUCTURE:
• Chief executive officer and board of trustees (CEO)
• Chief Operating Officer ( COO)
• Chief Financial Officer ( CFO)
• Chief Information Officer (CIO)
• Chief Technology Officer (CTO)

Hospital Organizational Chart

PRESIDENT / CEO

Vice President
Human Resources
Vice President
Central Services
Vice president
Finance
Vice president
Clinical Services
Vice president
Nursing

Inpatient pathology; Accounting Physical Plant Recruiter

Services Clinical
Laboratories Purchasing food services personnel
Anatomical
administrator

Nursing Radiology Patient Safety Pension

Supervisors accounts
Administrator

Social Service Pharmacy other financial Communications Other

Services service

Staff development Outpatient Management

Services Information
services

Organization of Clinical Laboratory

Department Chairman
(Laboratory Director)

Department Manager
Support Services
Laboratory Medicine
Directors
Anatomical Pathology

Point of
Care testing

Molecular
diagnostics
Histology
Supervisor -----Central
processing

-----phlebotomy
Autopsy
Service Chemistry -----Clerical
Coagulation Services

Hematology -----Laboratory
Immunology Information
Services
 Microbiology

Toxicology

LABORATORY MEDICINE ( CLINICAL PATHOLOGY )

• Medical discipline in which clinical laboratory science and technology are
applied to the care of patients.
• Disciplines:
• Clinical Chemistry and Urinalysis
• Hematology
• Clinical microbiology
• Immunology
• Blood banking

• Leaders and managers of the clinical laboratory must be certain that all legal
operating regulations have been met and all persons working in the laboratory
setting are fully aware of the importance of compliance with these regulations.

USE OF THE CLINICAL LABORATORY:

• Laboratory serve to educate the physicians and other health care providers so
that the information available through the reported results can be used
appropriately.
• Continuing education is a part of laboratory’s program for ensuring high
quality service as well as for maintaining the morale of laboratory staff.

LABORATORY DEPARTMENTS OR DIVISIONS:

• Organization of clinical laboratory depends on its size, number of test done and
facilities available.
• Larger laboratories- departmentalized; designated area for each of various
divisions.
• Open design or a core lab- personnel can work in any of several areas or
divisions.
• Laboratory divisions:
• hematology
• hemostasis and coagulation
• urinalysis
• clinical chemistry
• blood bank(immunohematology)
• transfusion services
• Immunology and serology
• Microbiology

HEMATOLOGY:
• Study of blood
• Formed elements of blood –blood cells- erythrocytes (red blood cells, RBC),
leucocytes ( white blood cells, WBC) and thrombocytes ( platelets)
• CBC –complete blood count- includes- RBC count, WBC count, platelet count,
hemoglobin concentration, hematocrit and percentage differential of WBC’s
present.
• useful in diagnosis of anemia- too few RBC-too little hemoglobin
• leukemia- too many WBC or abnormal WBC/ infectious process.
• Test – hematology lab- automated instrument
• Automated cell counter- WBC differential analysis, separation of the types of
WBC.
• Cell counts- body fluids.
• Microscopic assessment – stained blood film-CBC
• Reticulocyte count and Eryhtrocyte sedimentation rate (ESR)
• Bone marrow examination

HEMOSTASIS AND COAGULATION:

• Assess bleeding and clotting problems
• Coagulation laboratory – prothrombin time (PT)and activated partial
thromboplastin time (aPTT)
• used to identify potential bleeding disorders and to monitor anticoagulant
therapy.
• Patients who have had heart attack/ stroke – ( formation of blood clots ) are
given medications that anti-coagulate their blood / slow the clotting process.

URINALYSIS:
• For the detection of disease related to the kidney and urinary tract.
• 3 components:
• physical characteristics of urine specimen( color, clarity, specific gravity)
• screening for chemical constituents (pH, glucose, ketone bodies, protein, blood
bilirubin, urobilinogen, nitrites, leucocyte esterase)
• microscopic examination of urinary sediment (metabolic diseases – diabetes
mellitus, kidney disease and infectious diseases of urinary bladder or kidney.

CLINICAL CHEMISTRY:
• Quantitative analytical procedures on body fluids- serum and plasma-.
• Common test:
• Glucose- to diagnose and monitor diabetes mellitus
• Cholesterol- lipid status
• Electrolytes- affect many metabolic process of the body- osmotic pressure and
water distribution in body compartments, maintenance of pH, regulation of
function of the heart, oxidation- reduction process.
• Drug therapy and drug levels – toxicology

BLOOD BANK ( IMMUNOHEMATOLOGY) AND

TRANSFUSION SERVICES
• Proper sample identification is crucial in blood banking procedures –
MISLABELLED SPECIMEN could result in severe transfusion reaction or
even death for recipient.
• Testing is based on antigen- antibody reaction.
• Specific test performed in blood bank, the antigens are specific proteins that
are attached to the red and white blood cells-nature of these antigens
determined the blood group – Group A, B, O,AB. Rh typing.
• Donated blood-is screened for antibodies ( infectious and unusual) –hepatitis
virus ,and HIV.
• Blood transfusion-Only properly matched blood be transfused.
• Transfusion medicine using component of blood or blood products.

IMMUNOLOGY AND SEROLOGY

• Normal immune system functions to protect the body from foreign
microorganisms that may invade it.
• Foreign material is being eliminated by the immune system.
• Body’s defensive action is carried out by lymphocytes, monocytes (WBC).
• Foreign material (antigen) is introduced into the body , body reacts by means
of its immune system to make antibodies to the foreign antigen. Antibodies
formed can be measured in the laboratory.
• In evaluation of certain infectious diseases, detection of antibodies in the serum
of patient is important in making and confirming a diagnosis and in the
management of illness.

MICROBIOLOGY
• Microorganisms that can cause disease are identified.(Pathogens)
• Specimen in micro lab for culture include swabs from throat and wounds,
sputum, vaginal excretions, urine and blood.
• Differential testing- inoculation and incubation of classic culture plate to
observation of microorganism’s growth characteristics; Gram staining
techniques to separate gram positive and gram negative organisms.
• Rapid testing method- immunologic tests –monoclonal antibodies to identify
streptococcal organism causing pharyngitis or “ strep “ throat.
• Identify appropriate antibiotic for treatment of offending pathogen
Pathogen is tested by using a panel of antibiotics of various types and dosages to
determine the susceptibility of the organism to various antibiotics

EXTERNAL ACCREDITATION AND REGULATION:

3 primary accrediting organizations:

• Commission on Office Laboratory Accreditation (COLA) accredits 6179

facilities or 40% of laboratories.
• College of American pathologist (CAP)- 34 % lab.
• Joint commission on accreditation of Health care Organization
(JCAHO)accredits 3467 or 23 % laboratories.
• American association of blood banks (AABB), American Society of
histocompatibility and Immnogenetics (ASHI) -381 facilities / 3% lab.

• Regulations and standards are designed to protect staff working in the lab,
health care personnel, patients treated in health care facilities and society.-
Federal regulations.
• Regulatory mandates have been issued externally- Clinical Laboratory
Improvement Amendments of 1988 (CLIA).
• regulate chemical waste disposal, use of hazardous chemicals, issues of
laboratory safety personnel, handling of biohazard.
• Laboratory that wants to receive payment for its services from Medicare or
Medicaid must be Licensed under the Public Health Service Act.
• Any facility performing quantitative , qualitative or screening test procedures
or examination on materials derived from the human body is regulated by
CLIA ’88-
Hospital lab; physician office lab,; nursing home facilities; clinics; industrial
lab, pharmacies, fitness centers; independent laboratories.

• The Clinical and Laboratory Standards Institute( CLSI), formerly National

Committee for Clinical Laboratory Standards (NCCLS)- a nonprofit,
educational organization created for the development, promotion and use of
national and international lab standards.
• CLSI employs voluntary consensus standards to maintain the performance of
clinical lab at high level necessary for quality patient care.
• Occupational Safety and health Administration ( OSHA).- assessment given to
workers that they are in safe atmosphere.

ALTERNATE SITES OF TESTING

Central Laboratory Testing vs. Point - of- care Testing (Decentralization of

Laboratory Testing)

• traditional setting for performance of diagnostic lab testing has been a

centralized location in a health care facility (hospital) where specimens from
patients are sent to be tested.
• Point-of –care testing-comes to bedside of the patient. Any changes to
implement the use of POCT should show significant improvement in patients
outcome and total financial benefit to the patient and institution.

POCT ( Point of-Care Testing)

• Decentralization of testing away form traditional lab setting can greatly

increase the interaction of laboratory personnel with patients and with other
members of the health care team.
• Not always performed by lab staff. Other health care personnel – nurses,
respiratory therapist, anesthesiologist, operating technologist.
• CLIA’88 regulation associated with clinical lab testing must be followed for
POCT.

Reference Laboratories:
• Can perform complex tests for many customers, giving good turn around times.
• Should be managed by professionals who recognize the importance of
providing quality results and information about the utilization of results when
needed.

Physician Office Laboratories (POL)

• is a laboratory where the test performed are limited to those done for the
physician’s own patients coming to the practice, group or clinic
• test: reagent strip urinalysis, blood glucose, occult fecal blood, rapid
streptococcus A in throats, hemoglobin, urine pregnancy, cholesterol and
hematocrit.
• POL must submit an application to the Department of Health and Human
services.
Include details about number of test done, methodologies for each
measurement, qualifications of each of testing personnel employed to perform
the tests.
* Certificate are issued – 2 years.

PERSONNEL IN CLINICAL LABORATORY

• Clinical lab staff members are an essential component of medical team.
• Medical doctor (pathologist) medical technologist/ clinical laboratory scientist,
clinical laboratory technicians, laboratory assistants, phlebotomists and
specialist in various laboratory disciplines- chemists, hematologists and
microbiologists.

CLIA requirements for Personnel

• CLIA regulations defines the responsibilities of working in each testing where
tests of moderate or high complexity , educational requirements , training and
experience.

PATHOLOGIST
• anatomic pathologist- licensed physician trained- 4-5 years after graduating
from medical school to examine ( grossly and microscopically) all the
surgically removed specimens from patients- frozen sections, tissue samples
and autopsy specimen; examination of pap smears and other cytologic and
histologic test.
• Clinical pathologist- licensed physician , additional training in clinical
pathology or laboratory medicine.
• Services – examination of surgical specimen- done by anatomic pathologist.

CLINICAL LABORATORY PERSONNEL

• Depending on the size of laboratory, number and types of lab test performed,
various levels of trained personnel are needed.
• Laboratory supervisor or manager- responsible for the technical aspects of
management of laboratory- Medical technologist/ clinical laboratory scientists
with additional education and experience in administration.
• Technical manager – supervise technical aspects of facility- quality control
programs, off-site-testing and maintenance of lab equipment
• Major concern of administrative technologists is ensuring that all federal, state
and local regulatory mandates are being followed by the laboratory.
• Supervisory position be able to communicate in a clear, concise manner to
persons working In the laboratory settings and to the physician and other health
care workers.

CLINICAL LABORATORY SCIENTIST:

• Medical technologist (MT) also known as clinical laboratory scientist (CLS)-
earned a bachelor of science degree I medical technology/ clinical laboratory
science .
• MT – perform lab assays, supervise other staff or teach, research.
• Training- to understand the science behind the test being performed.

MEDICAL LABORATORY TECHNICIAN/ CLINICAL

LABORATORY TECHNICIAN, CLINICLA
LABORATORY ASSISTANT AND CERTIFIED
PHLEBOTOMIST
• have less formal education or training than the MT/CLS. –formal training;
• completed associate degrees, certificate of completion from a technical school
or vocational course.
• General or routine testing is supervised by MTs but performed by individuals
with a lower level of certification.
• CLT/ MLT or phlebotomists collects, processes and tests specimen for the
many routine, high volum, repetitive test done in clinical lab.
PATIENT SPECIMEN:
• Clinical laboratory provide the information regarding the assay results for the
specimen analyzed it is more important that the specimen be properly
collected.
• In testing process, analytes or constituents are measured by using only very
small amounts of specimen collected.
• In interpreting the results, results obtained represent the actual concentration of
the analytes in the patient
• Appropriate quality assessment programs must be in pace in the laboratory to
make certain that each patient is given the best analysis.

ANALYTICAL FACTORS in quality Assessment:

Term used in clinical Quality assessment:

• Accuracy- describes how close a test result is to the true value. Reference
samples and standards with known values are needed to check accuracy.
• calibration – comparison of an instrument measurement or reading to a known
physical constant.
• Control – represent a specimen that is similar in composition to the patient
whole blood or plasma. Value of control specimen is known. Control specimen
are tested exactly the same way as the patient specimen and are tested or in
conjunction with the unknown specimen.
• Precision- describes how close the test results are to one another when repeated
analyses of same material are performed.
• refers to the reproducibility of test results.
• Standards- are highly purified substance of a known composition, a standard
may differ from a control in its overall composition and the way it is handled in
the test.
• best way to measure accuracy, used to establish reference points in the
construction of graph or to calculate a result

6.Quality control – process that monitors the accuracy and reproducibility of

results
though the use of control specimens.
Functions of quantitative quality control program
• Assaying control specimen and standards along with patient specimen serves
several major functions:

• Provides a guide to the functioning of equipment, reagents and individual

technique.
• Confirms the accuracy of testing when compared with reference values
• Detects an increase in the frequency of both high and low minimally
acceptable values ( dispersion)
• Detects any progressive drift of values to one side of the average value for at
least 3 days( trend0\)
• Demonstrates an abrupt shift or change form the established average value for
3 days in row( shift).

PROFICIENCY TESTING:
• Acdg to CLIA’88- laboratory must establish and follow written quality control
procedures for monitoring and evaluating the quality of analytical process of
each method, to ensure the accuracy and reliability of patient test results and
reports.
• Proficiency testing- is a means by which quality control between laboratories is
maintained.
• Provisions of CLIA’88 require enrollment in an external PT program for
laboratories performing moderately complex or highly complex test.

MEDICAL LEGAL –ISSUES:

Informed consent- means that the patient is aware of, understands, and agrees to
the nature of the testing to be done and what will be done with the results reported
• Patient- implied consent to routine procedures.
• Specific consent form for more complex procedures- bone marrow aspiration,
lumbar puncture for collection of CSF and fine needle biopsy, non-urgent
transfusion of blood or its component.

CONFIDENTIALITY:
• Any results obtained for specimens from patients must be kept strictly
confidential.
• The Health Insurance Portability and Accountability act enacted in 1996
requires the privacy of patient information.
• Only authorized persons should have access to the information about a patient.
And any release of the information to non- health care persons such as
insurance personnel, lawyers or friends of the patient can be done only when
authorized by the patient.

CHAIN OF CUSTODY
• Laboratory results that could potentially be used in a court of law, such as a
trial or judicial hearing must be handled in a specific manner.
• For evidence to be admissible, each step of the analysis, beginning with the
moment the specimen is collected and transported to the laboratory, to the
analysis itself and reporting of results, must be documented, this process is
known as maintaining the Chain of custody.
• Specimens that provide alcohol levels, specimens collected from rape victims,
specimen for paternity testing and specimen submitted from medical
examiner’s cases are usual types requiring chain of custody documentation.

OTHER LEGAL CONSIDERATIONS:

• Health care organization and their employees are obliged to provide an
acceptable” standard of care”- degree of care that a reasonable person would
take to prevent an injury to another.
• When hospital, other health care provider, physician or medical professional
does not treat patient with the proper quality of care resulting in serious injury
or death, the provider has committed medical negligence.-perceived negligence
may result in legal action or a lawsuit or tort. Torts are called “ civil wrongs”.
FUTURE DIRECTIONS FOR LABORATORY
MEDICINE:
- Biotechnology is a fast growing discipline of diagnostic laboratory.
Molecular biology or molecular diagnostics.
• Molecular pathology applies the principles of basic molecular biology to the
study of human diseases. New approaches to human disease assessment are
being developed by clinical laboratories because of the new information about
the molecular basis of disease process in general.
• Molecular biology introduces a predictive component : findings from these test
can be used to anticipate events that may occur in the future, when patient
maybe at risk for a particular disease or condition.

SAFETY STANDARDS AND GOVERNING AGENCIES:

• U.S Department of Labor’s Occupational Safety and Health Administration
(OSHA)
• Clinical and Laboratory Standards Institute (CLSI) formerly the National
Committee for Clinical Laboratory Standards( NCCLS).
• Centers for Disease Control and Prevention ( CDC)
• Department of Health and Human Services (DHHS), Public Health Service
• College of American Pathologist (CAP)
• Joint Commission on Accreditation of Health Care Organization (JCAHO).

Occupational Safety and Health Administration Acts and

Standards.
• Occupational Safety and Health Act of 1970 and 1988-The Hazard
communication Standard.
* Programs deal with many aspects of safety and health protection, including
compliance arrangement, inspection procedures, penalties for non- compliance,
complaint procedures, duties and responsibilities for administration and operating
system and how the many standards are set.

OSHA standards- provisions for warning labels or other appropriate forms of

warning to alert workers to potential hazards, suitable protective equipment,
exposure control procedures and implementation of training and programs.
• primary purpose: to ensure safe and healthful working conditions for every
worker.

OSHA and CDC published safety standards and

regulations for clinical laboratory:
• A formal safety program
• Specifically mandated plans ( chemical hygiene, blood borne pathogens)
• Identification of various hazards ( Fire, electrical, chemical and biological)

OSHA mandated plans:

• 1991, OSHA mandated all clinical laboratories to implement a chemical
hygiene plan and exposure control plan.
• Copy of material safety data- file accessible and available to all employees at
all times.

Chemical Hygiene Plan (CHP)

• is the core of OSHA safety standard. Existing safety and health plans may meet
the CHP requirements.
• Written CHP Is to be developed by each employer and specify the following:
• Training and information requirements of OSHA standard
• Designation of a chemical hygiene officer and committee
• Appropriate work practices
• List of chemicals inventory
• Availability of material safety data sheets
• Labeling requirements
• Record keeping requirements
• Standard operating procedure and house keeping requirements
• Methods of required engineering controls( eyewashes., safety showers)
• Measures for appropriate maintenance and list of protective equipment
• Requirements for employee medical examinations
• Special precautions for working with particularly hazardous substances
• Information on waste removal and disposal

MATERIAL SAFETY DATA SHEETS:

• 1991 CHP is designed to ensure that laboratory workers are fully aware of the
hazards associated with chemicals in their workplaces.
• Information is provided in material safety data sheet( MSDS)- describes
hazard, safe handling ,storage, and disposal of hazardous chemicals.
• Each MSDS contains basic information about the specific chemical or product-
trade name, chemical name / synonyms, chemical family, manufacturer’s name
and address, emergency telephone number for further info about the chemical,
hazardous ingredients, physical data ,fire and explosion data, health hazard and
protection information.
• Describes the effect of overexposure and exceeding the threshold limit value
of allowable exposure for an individual employee in an 8 hour a day.
• Also describes protective personal clothing, equipment requirements, first –aid
practices, spill information and disposal procedures.

“RIGHT TO KNOW” LAWS

• Legislation on chemical hazard precautions, “right to know law” and OSHA –
set the chemical hazard communication ( HAZCOM) and determine the type of
documents that must be on file in a laboratory.
• Example; yearly inventory of all hazardous chemicals must be performed and
MSS should be made available in each department for use.

LABELLING
• OSHA recommends that all chemically hazardous contents and severity of the
material, as well as bear a hazard symbol.
• Substance can be classified as hazardous by the Department of Transportation
(DOT), Environmental Protection Agency ( EPA), or National Fire Protection
program(NFPA). Labels of chemicals in the original containers must not be
removed or altered.
• For chemicals not in original container, the labeling for all substances with a
rating of 2 or greater( scale 0-4, 4= greater risk) acdg to hazard identification
developed by NFPA, must include the following:
• Identity of hazardous chemical, Route of body entry, health hazard, physical
hazard, target affected organ.
Hazard identification system / Diamond Shaped Symbols
Red- Flammability

Blue /Health Yellow

Hazards Reactivity
warning

White /Other special

Hazard information

* Within each section: rank degree of hazard:

4: Extreme hazard / 3: Serious Hazard / 2: moderate hazard/1 slight hazard/ 0;
no or
minimal hazard.

• White section- water reactivity; strong oxidizer; corrosivity; radioactivity

Threshold Limits: Permissible Exposure limits (PEL)

• Threshold Limit Values (TLV)- are maximum safe exposure limits as set down
by the federal government
• OSHA sets PELs to protect workers against the health effects exposure to
hazardous substance. Based on an 8 hour time weighed average.
• PELs are regulatory limits on the amount or concentration of a substance in the
air.

EXPOSURE CONTROL PLAN:

OSHA mandated program Occupational Exposure to Bloodborne Pathogen –law
in March 1992.

• laboratories develop, implement and comply with a plan that ensures the
protective safety of laboratory staff to potential infectious blood borne
pathogens.
• Manage and handle medical waste in a safe and effective manner.
• Government regulations require that all employees who handle hazardous
material must be trained to use and handle these materials.
• CDC also recommends safety precautions concerning the handling of all
patients specimens, known as Standard Precautions formerly “Universal
Precautions”
• CLSI issued guidelines for the laboratory worker in regard to protection from
blood borne diseases spread through contact with patient specimen.

BIOHAZARD:
• Potential risk – direct infection or though the environment. Infection can occur
during the process of specimen collection or from handling , transporting or
testing the specimen.

• Infections are frequently caused by:

• accidental aspiration of infectious materials, accidental inoculation with
contaminated needles or syringes, animal bites, sprays form syringes, aerosols
from the uncapping of specimen tubes, centrifuge accidents.
• Laboratory infections- cuts and scratches from contaminated glasswares, cuts
from instruments used during animal surgery or autopsy, spilling or spattering
of pathogenic samples on work desk or floors.

AVOIDING TRANSMISSION OF INFECTIOUS

DISEASES:
• Purpose of the standards for blood-borne pathogen and occupational exposure
is to provide a safe work environment. OSHA mandates that an employer must:
• Educate and train health care workers in standard precautions and in preventing
blood borne infections
•
• Provide proper equipment and supplies ( gloves)
• Monitor compliance with the protective bio safety policies.
• HIV has been isolated from blood , semen, vaginal secretions, saliva ,tears,
breast milk, CSF, amniotic fluid and urine but only blood, semen, vaginal
secretions and breast milk have been implicated in transmission of HIV to date.
• Risk of occupational transmission of HIV vary with the type and severity of
exposure.
• Average risk 0.3% after a percutaneous exposure to HIV infected blood and
0.09% after a mucus membrane exposure, increased risk- exposure to larger
quantity of blood and from a source person with higher titer of HIV in the
blood in terminal AIDS.
• HBV –Hepatitis virus maybe stable in dried blood and blood products at 25
degrees C for up to 7 days- HIV retains infectivity for more than 3 days in
dried specimens at room temp and for more than 1 week in an aqueous
environment at room temperature.
• HIV and HBV can be indirectly transmitted, viral transmission can result from
contact with inanimate objects- work surface or equipment contaminated with
infected blood or body fluids.
• Modes of transmission for HIV and HBV are similar but the potential for
transmission In the occupational setting is greater for HBV than HIV.
• OSHA estimates –occupational exposures account for 5,900 to 7,400 cases of
HBV infection annually. It decline since hap B vaccine became available in
1982.

UNIVERSAL PRECAUTIONS :
* Method of controlling infection in which all blood and body fluids are treated
as infected with Hepatitis B, HIV, tissue producing blood borne pathogen.

1. Treat all laboratory specimens as infectious. Make no exceptions, and do not

rely on warning labels to designate contaminated specimens.

1. Use a PROTECTIVE BARRIER, gloves, when handling blood and body fluids.
Wear a gown or laboratory coat and change when contaminated. Cover all
cuts and abrasions with adhesive tape or bandage.

1. Avoid handling of hypodermic needles. Disposed of used needles in a rigid

container.During phlebotomy, used needles should not be recapped,bent, or
broken by the technologist.The unsheated needle should be placed directly into
an appropriate labeled puncture- resistant biohazard container for disposal.

1. Avoid an aerosol or droplets when opening a vacuum tube container blood.

Point tube away from yourself and open slowly, preferably in hood.

1. Use Pasteur pipette or other devices for transferring fluid samples. Do not
pour from one tube to another, because a drop or two may contaminate the
outer surface of the tube.

1. Never pipette by mouth.

1. Minimize spills and spatters. If they should occur, absorb the liquid with
disposable, absorbent material, clean with detergent and disinfect with a
hypochlorite solution.

1. All specimens for centrifugation must be centrifuged in a closed tube(a top

must be on every tube).
1. Wash hands after contamination, after removing gloves and always before
eating.

1. Dispose of samples properly when no longer needed for possible reanalysis.

Samples should be autoclaved before discarding.

1. Place warning signs on all known biohazards.

1. Blood and most other body fluids including semen, vaginal secretions,
pericardial fluid, peritoneal fluid, synovial fluid ,pleural fluid, amniotic fluid,
saliva, tears, (CSF) cerebrous spinal fluid, and breast milk of all patients
maybe considered potentially infectious for HIV, HBV.Unfixed tissues, organs
or blood slides may also be considered potentially infectious.

1. Wash hands after removal of gloves, after any contact with blood or body
fluids and between patients. Practice of washing and reusing gloves between
patients is discouraged.

1. Eating, drinking, smoking, applying cosmetics or touching contact lens is

PROHIBITED in working laboratory areas.

1. Instrumentation must be decontaminated prior to servicing, If this is not

possible, a warning should be placed on the equipment.

1. Vaccination against HBV.

17.No precaution labels are used on any patient specimens because of the
fact that all specimen are considered infectious and handled
accordingly.
Techniques common to all phlebotomy procedures.
1.Correct patient identification is critical.

2.Correct specimen identification.

3.Blood specimen obtained should be labeled with patient’s first and last name,
hospital identification number, patient location, time and date and Phlebotomist
initials.
To be consistent with Laboratory guidelines and Universal precaution, Gloves
must be worn at all times while performing phlebotomy techniques to protect the
technologist from acquiring blood-borne infection.

4.Puncture site should be cleaned by rubbing vigorously with a pad thoroughly

moistened with 80 % isopropanol. The area is then dried using sterile gauze.
Phlebotomy site once it has been cleaned the decontaminated area should not be
touched.

5. All sharp objects such as lancets and needles must be disposed of in special
puncture- resistant disposable needle containers labeled as biohazardous. Needles
should not be ebent, broken or resheated before disposal.

LABORATORY SAFETY, PRECAUTIONS AND PROPER

WASTE DISPOSAL

Incidence of Laboratory Associated Infection (LAI)

82 % Unknown
working with agent
being in the laboratory
handling infected animal

18% Carelessness and Human Error

Spills and Sprays
Broken Glass or sharp object injury
Aspiration through Pipette
Animals Bites and scratches

Persons at Risk for LAI

82% Scientific personnel

Trained Investigators
Technical assistant
Animal caretaker
Graduate students

13.7% Maintenance

Janitors
Dishwashers

4.0 % Clerical Personnel

BIOHAZARD
- are infectious agents or biological materials that present a risk to the health of
humans or animals .The risk can be direct through infection or indirect through
damage to the environment.
Infectious agents have the ability to replicate and to give rise to large numbers of
organisms when small numbers are released from a controlled situation.

COMMON LABORATORY HAZARDS

Microbiological
Chemical (radioactive and non- radioactive)
Physical, e.g. (fire, electrical hazard)
MAIN CAUSE OF EXPOSURE TO LABORATORY
HAZARDS
Handles the agent - handles animals
Performs experiments - clean up spills
Operates equipment

BIOSAFETY LEVELS:
BSL 1: Involves agents of no known or minimal potential hazard to lab personnel
or environment work is usually done on open bench top.

BSL 2: Suitable for work involving agents of moderate potential hazard to

personnel and the environment. Primary health services, public health and most
clinical labs.

BSL 3: Applicable to clinical diagnosis, teaching, research or production facilities

where work is done with indigenous or exotic agents that may cause serious or
potential lethal diseases as a result of exposure or inhalation, also done on special
diagnostic.

Steps to perform a biological risk assessment.

Identify biohazardous materials to be used in the lab.
Identify the procedure’s specific risk factors for exposure to the identified hazards.
Review available resources for health hazards, laboratory hazards, handling
procedures.
And recommended precautions.
BIOSAFETY LEVELS: SAFETY AND PRECAUTIONS:
Work surfaces are decontaminated once a day.
All contaminated liquid or solid wastes are decontaminated before disposal.
No mouth pipetting, no food and drinks, laboratory protection devices should be
worn.
Access to the lab is restricted when testing is in progress.
Personnel wear appropriate clothing.
Laboratory has special engineering and design features.
Laboratory gowns are decontaminated before laundered.
Baseline serum samples are collected from specimen.
Biological materials from BSL4 should be in an air tight container and remove
from the room thru an disinfectant tank, fumigation chamber.
No material to be removed from BSL 4 unless autoclaved.

Spills of BIOSAFETY LEVEL

Wear disposable gloves
soak paper towels in disinfectant &place over spill area.

Carefully pour freshly prepared 1:10 dilution of household bleach around the
edges of the spill and into the spill.

Clean spill area with fresh towels soaked in disinfectant.

Attend to injured / contaminated persons & remove them from exposure.

Remove contaminated clothing

Vigorously wash exposed area with soap and water/ at least 1 minute
Obtain medical attention

Basic Good Laboratory Practices for Clinical Laboratories:

Wearing of protective gloves

Disinfection of hands after handling of infectious materials.
Disinfection of instrument immediately after use.
Mandatory report of accidents, exposure to infectious materials.

UNIVERSAL PRECAUTIONS:
Pathological waste- stored with disinfectants- must be autoclaved or incinerated.
Infectious agents- ( from cultures, surgery, disposable towels, gowns and
gloves.)metal bin storage is required. Autoclaved and incinerated.

Commonly errors in Chemical waste handling:

Improper labeling of waste
Improper segregation of waste
Improper storage
Needles, scalpels, syringes, blades, broken glasses should be placed in a
punctured-proof container.

Color coding of waste:

Black – non-infectious dry waste
Green- for non-infectious wet waste
Yellow- For infectious and pathological
Yellow w/ black band –chemical waste
Orange- radioactive waste
Red- for infectious and pathological waste.

SAFE WORK PRACTICES FOR INFECTION CONTROL

• Personal protective Equipment( PPE) program:
• Selection and use of gloves:
• Gloves for phlebotomy and laboratory work are made up of vinyl or latex
• Care must be taken to avoid indirect contamination of work surfaces or objects
in the work area
• Gloves should be properly removed or covered with an uncontaminated glove
or paper towel before answering the phone, handling laboratory equipment .
• Guidelines for use of gloves:
• Gloves must be worn when performing fingersticks or heelsticks on infants and
children
• gloves must be worn when receiving phlebotomy training
• gloves should be changed between each patient contact.

• Facial Barrier protection and Occlusive bandages

• for potential splashing or spraying of blood or body fluids
• Mask and facial protection should be worn if mucous membrane contact with
blood or certain body fluid is anticipated.

• Laboratory Coats or gowns as barrier protection

• color coded, two-lab coat should be used whenver lab personnel are working
with potentially infectious specimen.
• Coat should be changed immediately if grossly contaminated with blood or
body fluids to prevent seepage through street clothes to skin.

Handwashing:
• be performed after contact with patient and laboratory specimens.
• Should be used as an adjunct to, not a substitute for hand washing.
• Hands should be washed with soap and water or by hand antisepsis with an
alcohol based hand rub:
• after completing lab work and before leaving the laboratory
• After removing gloves. Association for Professionals in Infection control and
Epidemiology reports extreme variability in quality of gloves, with leakage 4%
to 63% of vinyl gloves and 3% to 52% of latex gloves.
• Before eating , drinking , applying makeup and changing contact lens and
before and after using the bathroom
• Before all activities that involve hand contact with mucous membranes or
breaks in skin.
• Immediately after accidental skin contact with blood, body fluids or tissues.

DECONTAMINATION of work surfaces, Equipment and

Spills:
• Sodium hypochlorite solutions are inexpensive and effective broad spectrum
germicidal solutions.
• Household chlorine bleach
• 1:10 1:100 free chlorine are effective depending on the amount of organic
material present.

Specimen –Processing Protection

• Specimen should be transported to the laboratory in plastic leakproof bags.
• Protective gloves should always be worn for handling any type of biological
specimen.
• Substances can become airborne when the stopper is popped off of a blood-
collecting container, a serum sample is poured from one tube to another or
serum tube is centrifuged. When the cap is being removed from a specimen
tube or a blood collection tube, the top should be covered with a disposable
gauze pad or a special protective pad.
• Specially constructed plastic splash shields are used in many laboratories for
the processing of blood specimens. The tube caps are removed behind or under
the shield, which acts as barrier between the person and the specimen tube.
This is design to prevent aerosols from entering nose, eyes, or mouth.

Specimen –Handling and shipping requirements.

• If a blood specimen is to be transported , the shipping container must meet
OSHA requirements for shipping clinical specimens. Shipping container must
meet the packaging requirements of major couriers and department of
Transportation hazardous materials regulations.
• Approved reclosable plastic bags have bright orange and black graphics- as
holding hazardous materials.
• Products such as Insul –Tote (Palco Labs) are convenient for specimen
transport from the field to the clinical laboratory.
• Errors in specimen collection and handling ( preanalytical errors ) are
asignificant cause of incorrect patient results.

PREVENTION OF DISEASE TRANSMISSION:

• Immunization
• a well planned and properly implemented immunization program is an
important component of a health care organization’s infection prevention and
control program.
• Valuable resources are available from the Advisory Committee on
Immunization Practices (ACIP ) and the Hospital Infection Control Practices
advisory Committee. (HICPAC).
• ACIP and HICPAC recommendations are divided in 3 categories:
• immunizing agents strongly recommended for health care workers.
• Other immunologics that are or maybe indicated for health care workers.
• Other vaccine- preventable diseases.
• Some vaccines may or may not be routinely administered but maybe
considered after an injury or exposure incident or for immunocompromised or
older health care workers.
• Vaccine –preventable diseases:
• Hepatitis B
• Influenza
• Measles
• Mumps
• Rubella
• Varicella
• Hepatitis B
• leading occupationally acquired infection in health care workers. OSHA issued
a federal standard in 1991 mandating employers to provide Hepatitis B
vaccine to all employees who have or may have occupational exposure to
blood or potentially infective materials.
• Influenza
• has been shown to be transmitted to health care facilities during community
outbreaks.
• Programs that immunize both the health care worker and the individuals serve
have been extremely effective in reducing morbidity and mortality.
• Measles
• 1985-1989, 3.5 % of all reported measles cases occurred in medical settings.
• Mumps
• transmission has been reported in medical settings.
• Rubella
• Vaccination programs significantly decreased the overall risk for rubella
transmission in all age groups.
• Trivalent MMR ( Measles, Mumps and Rubella)
• Varicella
• post exposure to address varicella- zoster virus are usually ostly and disruptive
to a health care organization.
Optional immunizations:
• Hepatitis A
• Also been recommended fro preexposure prophylaxis for the following groups
who maybe included in a health care worker population.
• Those who traveled to an endemic country
• Household and sexual contacts of HAV infected people
• Lab workers who handle live HAV ; workers and attendees at day care
centers,; food handlers, staff and residents for mentally handicapped patients;
chronic carriers of hepatitis B and chronic liver disease.
• Meningococcal disease
• Outbreak of serogroup C meningococcal disease is identified, use of
meningococcal vaccine maybe warranted.
• Pertussis
• No vaccine against pertussis is licensed for use in an adult population. If one
becomes available in the future,booster doses of adult formulations may be
recommended because pertussis is highly contagious.
• Typhoid
• Should be administered to workers in microbiology laboratories who frrquently
worked with Salmonella typhi.
• Vaccinia
• administered who work orthpoxviruses, lab workers, who handle cultures or
animals contaminated or infected with vaccinia.

CHEMICAL HAZARDS:
• Proper storage and use of chemicals are essential to avoid a potential fire
hazard and other health hazards resulting from inhalation of toxic vapors or
from skin contact.
• Fire and explosions are a concern when flammable solvents are used.
• These materials should always be stored in special OSHA- approved metal
storage cabinets that are properly ventilated
• Organic solvents should be used in fume hood.

Specific hazardous Chemicals

• Sulfuric acid- 65 % cause blindness; may produce burn on the skin; if taken
orally may cause severe burns, depends on concentration.
• Nitric acid-yellow fumes- extremely toxic and damaging to tissues;
overexposure to vapor can cause death, loss of eyesight, extreme irritation,
itching, yellow discoloration of skin; if taken orally, can cause extreme burns,
may perforate the stomach wall or cause death.
• Acetic acid- Severely caustic; continuous exposure can lead to chronic
bronchitis
• Hydrochloric acid- Inhalation of vapors should be avoided; any acid on the
skin should be washed away immediately to prevent a burn.
• Sodium hydroxide- Extremely hazardous in contact with the skin, eyes or
mucous membrane, causing caustic burn, dangerous even at low
concentrations; any contact necessitates immediate care.
• Carbon tetrachloride: Damaging to the liver even at exposure level w/ no
discernible odor.
• Trichloracetic acid-Severely caustic; respiratory tract irritant
• Ethers- cause depression of central nervous system.