MEDICAL

LABORATORY
SCIENCE
The CLS Profession,
Professionalism, and Safety
 Professionalism
• A professional is a person who
• Engages in one of the learned
professions or an occupation
requiring a high level of training and
proficiency

• Is governed by an organized body

that regulates continued practice in
the field by requiring:

• Adherence to a code of ethics

• Assessment of competency
Professionalism

• Characteristics
• Unique body of
knowledge
• Sense of duty to those
served
• Controls all matters
related to the
profession
• Has esteem, recognition
from others
 Code of Ethics of Associate Members of
ASCP
• Treat patients and colleagues with
respect, care and thoughtfulness

• Perform my duties in an accurate,

precise, timely and responsible
manner

• Safeguard patient information as

confidential, within the limits of the
law
Code of Ethics

• Prudently use laboratory resources

• Advocate the delivery of quality
laboratory services in a cost-effective
manner
• Work within the boundaries of the laws
and regulations and strive to disclose
illegal or improper behavior to the
appropriate authorities
• Student memberships
• Associate &
Professional
memberships
• See ASCP.org,
ASCLS.org,
NAACLS.org, &
TACLS.org
Behavior & Appearances: The Aura of
Professionalism

• Good work ethic

• Dependability
• Honesty
• Integrity
• Confidentiality
• Positive attitude
Behavior & Appearances: The Aura of
Professionalism

• Appearance & Proper Attire:

• Clean, well-groomed
• Properly dressed for safety & infection control
• Appear unhurried, considerate & gentle
when handling patients
• Speak with a confident, authoritative,
but quiet voice
Behavior & Appearances: The Aura of
Professionalism
• PROPER APPEARANCE AND APPROPRIATE
BEHAVIOR ENHANCE THE PATIENT’S
CONFIDENCE IN THE WORK BEING
PERFORMED, THE EMPLOYEE PERFORMING
THE PROCEDURES, AND THE FACILITY AT
WHICH THE PROCEDURES ARE BEING
PERFORMED.
Roles of Laboratory Medicine in Providing
Patient Care
• Laboratory medicine/ clinical pathology: the medical
discipline by which clinical laboratory science and
technology are applied to the care of patients
• Traditional disciplines:
• chemistry, hematology/ coagulation,
microbiology, urinalysis/ body fluids,
immunology/ serology & blood banking
(immunohematology)
• Subdisciplines:
• cytogenetics, toxicology, molecular diagnostics &
others
Personnel in the Clinical Laboratory

• Medical Laboratory Scientist (MLS)

• Baccalaureate Degree
• Certification
• Generalist
• Specialists
• Advanced Degrees
Personnel in the Clinical Laboratory

• Medical Laboratory Technician (MLT)

• Associate Degree
• MLT Certification
Personnel in the Clinical Laboratory

• Phlebotomist—Non-Degree, Certification
available
• Other
• Clinical Laboratory Assistants (CLA)—Non-degree
• Support Staff
• Computer Specialists—LIS, etc.
• Clerical
Personnel in the Clinical Laboratory

• Pathologist—Medical Doctor (MD)

• Pathology subdivisions
• Cytotechnologist (CT)—Baccalaureate
Degree
• Histologists (HTL)—Baccalaureate
Degree
• Histotechnician (HT)—Associate Degree
 Clinical Laboratory Science: The Work We
Do
• Approximately 50-60 laboratory tests account for ~
70% of the laboratory results generated in most
hospitals

• The most common diseases or pathologies are

investigated (diagnosed/monitored) by using these
common tests

• It is unusual that the results from a single laboratory

assay will make a diagnosis

• The laboratory tests & results—information—are the

services that medical technologists provide
Clinical Laboratory Science: The Work We
Do
• Consultants in education of medical
community when new tests introduced
• Relate information to nursing services on
new test protocol
• Relate information to patient when
necessary
Clinical Laboratory Science: The Work We
Do

• Quality Assurance Programs must be in

place in all laboratories
Testing Sites

• Centralized CORE Labs

• Stat Lab & other Satellite Labs
• Point-of-Care Testing
• Physician Office Laboratories (POL)
• Reference Laboratories
 Governing/ Regulatory Agencies &
Legislation
• CLIA • NAACLS
• HCFA • TACLS
• CAP • HIPAA
• Joint Commission • ASCP
• OSHA • FDA
• CDC
Certifying Agencies

• Board of Registry of the American Society of

Clinical Pathologists (ASCP)
• State Agencies
• Program Accrediting Agencies
• University Accrediting Agencies
The Patient’s Bill of Rights
 Summary of basic patient rights as
endorsed by the Joint Commission on
Accreditation of Healthcare
Organizations (JCAHO), from Linne &
Ringsrud Clinical Laboratory Science—
The Basics and Routine Techniques, 4th
ed.)
Safety in the Clinical Laboratory

• Rules, standards and Regulations set by

federal, state, local & professional
organizations demand safe & healthful
working conditions in the clinical laboratory.
• OSHA
• CAP
• Joint Commission
• CLIA ’67, ‘88
OSHA Standards
 Purpose is to ensure safe and healthy working
conditions for every American worker
 Provisions and warnings (labels etc) to alert
workers to potential hazards
 Defines appropriate protective equipment
 Outlines exposure control procedures
 Implements training and education programs
OSHA Mandated Plans
 All clinical labs must implement a chemical hygiene plan
and an exposure control plan
 Chemical hygiene plan
 Designation of chemical hygiene officer
 Inventory of chemicals in the lab
 Availability of MSDS sheets
 Labeling requirements
 Record-keeping requirements
 Engineering controls
 Protective equipment (list and maintenance of)
 Special precautions for working with hazardous substances
 Information on waste removal and disposal
 Requirements for employee medical exams
Exposure Control Plan
 OSHA-mandated program in 1992
 Occupational Exposure to Bloodborne Pathogens
 Labs are to develop a plan that ensures the
protective safety of lab staff to potential
infectious blood-borne pathogens
 Management and handling of medical waste in
a safe manner
There are three general methods for
controlling one's exposure to hazardous
substances:
– Engineering Controls
– Work Practices and Administrative Controls
– Personal Protective Equipment
Biohazard Safety

• Universal or Standard Precautions &

Transmission Based Precautions

• Universal/Standard Precautions are for use

on all patients and with all patient
specimens. Includes OSHA Blood-Borne
Pathogens Rules and CDC Universal
Precautions.
Biohazard/ Blood Borne Pathogen Safety

• HANDWASHING
• Wash hands after handling blood, body
fluids, secretions, excretions and
contaminated items
• Wash hands immediately after gloves are
removed, and between patients.
Biohazard/ Blood Borne Pathogen Safety

• Personal Protection Equipment (PPE):

• Use of Laboratory Coats
• Always wear inside laboratory
• Never wear outside laboratory
• Use of gloves
• Use of face shields
or goggles
Biohazard/ Blood Borne Pathogen Safety

Proper Safety Practice:

• NO eating, drinking, smoking or application
of cosmetics in the laboratory!
• Food is never stored in laboratory
refrigerators.
• Mouth pipetting of any substance is never
allowed
Biohazard/ Blood Borne Pathogen Safety

• Label all containers being used in any

procedure—test tubes, beakers, etc.

• Spills should be cleaned up immediately and

with proper technique; supervisor must be
notified immediately
 Biohazard/ Blood Borne Pathogen Safety

Disposal of Waste & Biohazard Materials:

• Regular trash—clear liners for paper, boxes and other
non-contaminated materials
• Small white biohazard waste containers (orange/red
liners) for contaminated materials such as gloves and
unwanted specimens
• Sharps Containers—Red; various sizes; all needles and
disposable glass containing contaminated material
should be carefully placed in sharps containers only
• All biohazard containers are packaged and placed for
medical waste disposal
Chemical Safety

Handling of Chemicals:
• Color Codes

• All chemicals, flammables, corrosives (acids/alkalis)

should be handled carefully and stored properly

• Keep chemicals away from heat and flames

• Use fume hood when appropriate

• Spills should be cleaned quickly and properly

Chemical Safety
Material Safety Data Sheets (MSDS)
• Manufacturers required to furnish MSDS for each
chemical
• Must be available at each facility
• Provide information on hazardous ingredients, physical
data, fire and explosion data, health hazards, reactivity
data, spill or leak procedures, special protection and
special precaution
• Should be consulted when a spill or contamination of
chemicals occur
Chemical Hazards
 Proper storage and use of chemicals is essential
to avoid a potential fire or health hazard
 Store flammables in OSHA approved metal storage
cabinet
 Organic solvents are to be kept in a fume hood
 Carcinogens
 Substances that cause development of cancerous
growth in living tissue
 Hazard warnings
 NFPA labeling
Decontamination/Spill cleanup
 Sodium hypochlorite
 Bleach
 10% solution
 1 part bleach to 9 parts water
 Spills
 Wear gloves and lab coat
 Absorb spill with disposable towels or spill pillow
 Use 10% bleach solution to clean the site, allow to
bleach to sit on spill site (10 minutes) before wiping
dry
 Wipe the spill with towels soaked in bleach
 Place all disposable materials from decontamination in
a biohazard container
 More Safety . . .
 Sharps
 NEVER recap a needle!!!
 Dispose of all sharps (needles, scalpels, glass, etc) in a special
sharps container
 Red, puncture resistant
 Do not overfill the sharps container

 Specimen processing
 Transport in leakproof bags
 Wear protective gloves when handling any specimen
 Uncap blood/fluids behind a splash shield
 Always keep caps on tubes when centrifuged
 Centrifuge buckets may also have covers which should be used
 Allow the centrifuge to stop on its own
More Hazards . . .
 Electrical
 NFPA requirements for grounding electrical equipment must
be met
 Glass
 Broken or cracked glass must be discarded in proper sharps
container
 Fire
 National Fire Codes (NFPA published) must be met
 Fire classes
 Class A – Ordinary combustibles
 Class B – Flammable liquids and gases
 Class C – Electrical equipment
 Class D – Powdered metal (combustible) material
 Class E – Cannot be extinguished
Safety Equipment

• Fire Extinguishers—located throughout building, at least 2

in each lab, and in halls
• Proper use of fire extinguisher is to pull out the pin, and point the
hose near the bottom and periphery of the fire, and sweep across the
fire.

• Fire Blanket—located in south lab

Fire Extinguishers
 Class A, B, or C
 Also available Class AB, BC, ABC
 The designated class of extinguisher
determines what type of fire it can be used to
control
 PASS
 Pull
 Aim
 Squeeze
 Sweep
Fire Safety continued
 RACE
 Rescue
 Alert/Alarm
 Contain/Close doors
 Extinguish (PASS)
 Pull pin
 Aim at base of fire
 Squeeze trigger
 Sweep back and forth
Safety Equipment
• Eye Wash Stations—one on west side of each lab
• Proper use is to hold eyes open and over station , allowing
water to flush out the contamination or chemical

• Emergency shower—one on west side of each lab (with eye wash

station)
• Use immediately when chemical spills have occurred over a
large part of the body. Stand under and pull handle
Safety Equipment

• First Aid Kit:

• Located in south lab
• Used for minor emergencies only

• ALWAYS INFORM TEACHER OR SUPERVISOR WHEN

AN ACCIDENT OF ANY KIND HAS OCCURRED.
MUST BE REPORTED!!!
Safety
• Walk through
• Safety Manual
• MSDS
• Warning Signs
• PPE
• Volatiles, Corrosives
• Fire Extinguishers, Fire Blankets
• Showers, Eye Wash Stations
• Blood Borne Pathogen Disposal
• First Aid Kit
Additional Observation & Classwork

• Videos
• Computer Safety Program
• Exams
BLOOD SAFETY
UNDERSTANDING THE LAW
TRAINING AND COMPLIANCE
 HISTORY OF THE LAW

• 1970 - OCCUPATIONAL SAFETY &

HEALTH ACT
• 1986 – Healthcare Employees first
considered under OSHA
• 1988 & 1990 - Enforcement
manual for exposure to HBV & HIV
• 1991 – Occupational exposure to
blood borne pathogens
• 1999 – Directive to adopt latest
technology to prevent needle stick
injuries
• 2000 – Needle stick Safety &
Prevention Act
COST OF NON-COMPLIANCE

• $7,000 MAXIMUM PENALTY FOR EACH VIOLATION

• UP TO $70,000 FOR WILLFUL OR REPEATED
VIOLATIONS
• PENALTY FACTORS INCLUDE THE SEVERITY AND
PROBABILITY THAT AN INJURY OR ILLNESS COULD
OCCUR AS A RESULT
• 1999 DATA - $1,191,849.75 IN PENALTIES UNDER
THE BLOODBORNE PATHOGEN STANDARD
 EVALUATE RISK

• TASK ASSESSEMENT

• PPE – USE OF PERSONAL

PROTECTIVE EQUIPMENT

• USE OF ENGINEERING
SAFETY EQUIPMENT

• USE OF SAFE WORK

PRACTICES
 BLOOD BORNE PATHOGENS
• DISEASE – CAUSING GERMS
(micro-organisms)
in human blood and
other body fluids

• OSHA REGULATIONS ATTEMPT TO

LIMIT OCCUPATIONAL EXPOSURE TO
BLOOD AND OTHER POTENTIALLY
INFECTIOUS MATERIALS
UNIVERSAL PRECAUTIONS

ASSUME THAT ALL

BLOOD AND ANY
OTHER BODILY
FLUID IS
POTENTIALLY
INFECTIOUS
 HBV - HEPATITIS B

• Occupational hazard for Symptoms include:

health care workers • Flu-like illness
• Nausea & vomiting
• Loss of appetite
• Spread by contact with • Abdominal pain
infected blood and other body • Skin rashes
fluids • Jaundice & Liver cirrhosis

• Incubation is 45-160 days

• Virus can survive on dirty

work surfaces for up to one
week at room temperature
HEPATITIS VACCINATION

• OFFERED WITHIN 10 DAYS OF

EMPLOYMENT

• EMPLOYEE MAY DECLINE BUT

CAN LATER REQUEST TO
RECEIVE THE SERIES OF THE
VACCINATION AT ANY TIME

• 3 DOSES (initial, 1 month & 6

months)
 HIV – AIDS
• ACQUIRED IMMUNODEFICIENCY
SYNDROME (AIDS) HIV FOUND IN:
• BLOOD
• VIRUS ATTACKS YOUR IMMUNE • SEMEN
SYSTEM • VAGINAL SECRETIONS
• BREAST MILK
• NO CLEAR SYMPTOMS • SPINAL FLUID
• FRAGILE VIRUS – DOES NOT CANNOT BE AQUIRED BY
SURVIVE OUTSIDE THE BODY CASUAL CONTACT
• INCUBATION IS ONE TO THREE
MONTHS
 HCV - HEPATITIS C

• Most common chronic SYMPTOMS

• 60-70% HAVE NO APPARENT
blood borne infection SYMPTOMS
• Incubation period is • 20-30% HAVE JAUNDICE
from 2 weeks to 6
months (most often 6-8 • 10-20% SIMILIAR TO HBV
weeks) • 10-20% DEVELOP CIRRHOSIS
OF THE LIVER
• Less infectious than HBV
& HIV • INCREASES RISK OF LIVER
CANCER
 RISK OF EXPOSURE

RISK HEPATITIS B HIV - AIDS

Chances of
infection from 20-33% 0.5%
needle stick
Viral particles 500,000,000 5-10 particles
in 1 teaspoon particles
of blood
 WHAT YOU CAN DO

• USE APPROPRIATE PPE

• USE APPROPRIATE
ENGINEERING DEVICES
AND WORK PRACTICES
• USE COMMON SENSE
• BE AWARE OF THE
HAZARDS
AND……..
 HAND WASHING
• MOST IMPORTANT FOR PREVENTING THE SPREAD OF
INFECTIONS

• MUST WASH HANDS AFTER ALL GLOVE REMOVALS

Proper Glove Removal
Safety Symbols
 Ergonomics
“Study of Work”

“ergo” = work
“nomics” = laws of

“The science of fitting the job

to the worker”
What Is Ergonomics?
 Modify jobs to fit
capabilities of people
 Reduce MSDs
 Repetitive reaching,
forceful exertions,
bending and lifting,
or working with
vibrating equipment
 Engineering controls
 Safe work practices
 PPE
Job Risk Factors
 Working in awkward postures / positions
 Prolonged sitting and standing
 Bending, reaching, stretching
 Driving for extended periods of time
 Heavy lifting
 Awkward lifting
 Lifting in combination with twisting
 Pushing, pulling, carrying
 Accidents, slips, trips, falls
 Vibration
Goals of Ergonomics Program…
Reduce work-related musculoskeletal disorders
developed by workers when their jobs involve...

 Awkward postures  Repetition

 Static positions  Contact stress
 Reaching  Vibration
 Bending & Lifting  Repetition
 Force
U.S. Department of Labor Occupational Safety & Health Administration
What are MusculoSkeletal Disorders?
MSDs are injuries and illnesses
that affect muscles, nerves,
tendons, ligaments, joints or
spinal discs.

U.S. Department of Labor Occupational Safety & Health Administration

 Common Body Parts Prone To
Workplace MSDs

 Back - Lower
 Neck and Upper Back
 Upper Extremities - Arms and Hands
 Lower Extremities - Legs and Feet
Examples of MSDs

 Carpal tunnel
 Rotator cuff syndrome
 Lateral epicondylitis
- tennis elbow
 Low back pain
 Chronic MSD-Type Injuries
Repetitive Placing,
Grasping, or
Moving Objects
20%
Repetitive
Use of Tools 8%
Repetitive Motion
9% 63%
Typing or
Key Entry
MSD Symptoms
 Back and neck—
shooting pain, stiffness
 Shoulders—pain,
stiffness, loss of mobility
 Arms and legs—
shooting pains,
numbness
 Elbow and knee
joints— pain, swelling,
stiffness, soreness
MSD Symptoms (cont.)
– Hands and wrists
— swelling,
numbness, loss of
strength
– Fingers—jerking
movements, or loss
of strength, mobility,
and feeling
– Thumbs—pain at
the base
– Feet and toes—
numbness, tingling,
stiffness, burning
sensation
Musculoskeletal Disorders: How &
Why?

 Related to intensity of work

 Have biomechanical and physiological factors
 Can occur after weeks, months, years on job
 Can take weeks, months, years to resolve
 Have occupational and non occupational causes

French & Zecha, 2005

Musculoskeletal Disorders: How & Why?
listening to our body…
 Disruption in balance between breakdown
and recovery
 1st sx….fatigue (of body part)
 2nd sx…ache
 3rd sx…pain
 Leading to loss of function

French & Zecha, 2005

Ergonomic Instruments
Is my “ergonomic” screwdriver really
ergonomic?

 To be ergonomic a design
must…
• Fit the user
• Be easy to use
• Improve comfort
• Improve performance
• Improve health and safety
• Not just bells and whistles!
 At risk procedures
 Pipetting
 Microscopy
 Operating microtomes
 Fume hoods
 Keyboarding
 Static positions
 Repetitive Pipetting
 Use pipettes with newer trigger mechanisms
requiring less force to activate, and use the pointer
finger to aspirate and the thumb to dispense

 Use pipettes that fit comfortably in the user's hand.

 For tasks such as mixing or aliquotting, use an

electronic pipettor with mixing functions.
 Microscopy
 Edge of the work surface
 Elevation
 Spine neutrality
 Ergonomically designed chair
 Armrests

Ergonomics Under The Microscope, Warner, ADVANCE, 2010.

 Micro-Manipulation & Fine Motor
Skills
 Alternate holding styles
Ergonomics Management
 Job assessment
 MSD reporting and response system
 Designated coordinator
 Training
 Encourage employee participation and
reporting of MSDs
 Control Methods
 Install engineering controls including workstation
layout and proper tools
 Institute work practice controls including neutral
postures for performing tasks
 Administrative controls including rescheduling to
reduce frequency or duration of exposure to MSDs
 Personal protective equipment (PPE) to provide
a protective barrier between worker and MSD