Few important Lab skills for Medical Laboratory Technologists

List of Selected Participants

One Day workshop on ‘’Laboratory Safety, Personal Safety & Safety of Equipments “

For Lab Orderlies on 26.08.2014

At National Institute of Health Sciences

1.             Mr.Ginadasa Hatharasinghe,National Hospital of Sri Lanka,Colombo

2.             Mr.P.A.Nimal Nandasiri,Medical Research Institute,Colombo 08

3.             Mr.C.Dassanayake, Medical Research Institute,Colombo 08

4.             Ms.M.P.N.S.Marasinghe,Base Hospital,Avissawella

5.             Mr.B.A.Wijerathna, Base Hospital,Avissawella

6.             Mr.K.N.L.Samarajeewa,Central Laboratory,Welisara

7.             Ms.U.N.Madhubhashini,Government Hospital,Aluthgama

8.             Ms.M.Pushpa Kalyani Perera,Base Hospital,Homagama

9.             Mr.Withanage Welikala, Base Hospital,Homagama

10.          Mr.K.R.M.Senewirathna,Chest Hospital,Welisara

11.          Mr.M.D.Kulasiri Amarasinghe,Base Hospital,Horana

12.          Ms.W.K.Nadeera Niroshani,Base Hospital,Wathupitiwala

13.          Mr.G.D.Siripala,De Zoysa Maternity Hospital,Colombo 08

14.          Mr.T.A.Manoj Prasanna Almedha, De Zoysa Maternity Hospital,Colombo 08

15.          Ms.H.D.G.Malani,Service Laboratory,NIHS

16.          Ms.K.P.Padma Sriyalatha Peiris, Service Laboratory,NIHS

17.          Ms.B.V.Chitra Irangani,Food Chemistry Laboratory, NIHS

18.          Ms.A.A.Chitra Kumuduni Malkanthi,Food Microbiology,NIHS

19.          Ms.R.Nalani Rathnayaka,National Tuberculosis Programme,Welisara

20.          Ms.Chandima Dilani Ariyasinghe,District General Hospital,Gampaha

21.          Ms.K.K.S.K.Ranathunga, District General Hospital,Gampaha

22.          Ms.W.G.Nanda Piyaseeli,Central Chest Clinic,Borella

23.          Ms.H.M.U.P.Sandamali Herath,Base Hospital,Panadura

24.           Ms.Samanthi Priyadarshika Hettiarachchi,Base Hospital,Panadura

25.          Ms.G.S.Perera,General Hospital,Kalutara

26.          Ms.R.K.K.Y.Shashiprabha Ranasinghe, General Hospital,Kalutara

27.          Ms.D.Veronika Kanthi Kariyapperuma,School of Pharmacy,NIHS

28.          Mr.M.V.Patrick Jayarathna Perera,National Hospital of Sri Lanka,Colombo

29.          Ms.H.Dilikshiya Fernando,District General Hospital,Negombo

30.          Ms.S.Sriyani Senevirathna, District General Hospital,Negombo

31.          Mr.H.A.K.S.Premachandra,Base Hospital,Angoda

32.          Ms.R.P.A.I.Jayalath,Castle street Hospital for women, Colombo 08

33.          Ms.E.P.J.S.Edirisinghe, Castle street Hospital for women, Colombo 08

34.          Mr.D.Sunil Perera,Lady Ridgeway Hospital, Colombo 08

35.          Ms.W.A.D.S.Hindika, Lady Ridgeway Hospital, Colombo 08

36.          Ms.W.A.D.Thanoja Dilrukshi,Colombo South Teaching Hospital,Kolubovila

37.          Ms W.H.Chandra Malani, Colombo South Teaching Hospital,Kolubovila

38.          Mr.S.D.Gamini Subasinghe,National Cancer Institute,Maharagama

     39     Mr.Somadasa Dissanayaka, National Cancer Institute,Maharagama


www.nihs.gov.lk

Clinical Pathology Laboratories Use Quality Management Systems (QMS) to Deliver Added Value to Physicians 

Dhanapala D M R D (Bsc, PGDE, DMLT)

Using Quality Management to Deliver Added-Value Lab Testing Services

These are clinical laboratory and pathology organizations that have achieved a market-leading position in the communities that they serve because of their “close to the customer” mindset.

This clinical laboratory describes itself as the ‘Lexus of medical laboratories. It rigorously surveys the satisfaction of its patients and physicians and uses lots of quality management methods and tools to continuously add more value.

Henry Ford Production System Used by Department of Pathology

The process of engaging physicians and patients to learn about how the laboratory could better meet their expectations was a key step in guiding the performance improvement efforts of the department. The main approach to reduce lab errors was to create a process that would capture defects each day. Other than that cross-functional teams look to identify the sources of defects and rapidly institute fixes to the system. Examples of errors can be wrong patient identification and ‘not enough specimen’ (QNS) for lab testing.

The next interesting element in this quality management story is how staff as a team engaged the laboratory testing sites and other hospitals and clinics. Many Health Systems adopt and use Lean and similar methods. The benefits here are increased standardization of testing activities in ways that support added value to physicians throughout the health system

ISO 15189 At chemical Pathology Laboratory

Most chemical pathologists suggest and adopt the ISO 15189 QMS, to their laboratories, because it was recognized that QMS would provide the entire laboratory staff with a framework to improve the quality of the laboratory’s testing services in ways that would make a difference for physicians, patients, payers, and even the lab staff.

The short overview of this letter presentation shared and demonstrates why ever-growing numbers of clinical laboratories and pathology groups are choosing to implement a quality management philosophy and operating culture within their organization. During this phase it emphasized that quality management is now the essential cornerstone that allows them to achieve competitive advantage and deliver more value to referring physicians and their patients.

The researches observed that the experience of most successful laboratory organizations provides a useful insight into their ongoing evolution of the laboratory testing profession. So Pathologists and clinical laboratory managers will want to stay abreast of the pace of adoption of this quality management philosophy and its associated management techniques. 

Lipoproteins
Good cholesterol (HDL), Bad cholesterol (LDL)

Cholesterol is an essential structural component of cell membranes and of the myelin sheaths that insulate the axons of nerve cells. Cholesterol is also a precursor of steroid hormones and of the bile acids necessary for digestion. The liver produces approximately 70% of the cholesterol used by the body, and the other 30% comes from the diet.Lipoproteins are small spherules that transport fats in the body and consist of protein, cholesterol, triglycerides, and phospholipids. The terms "good" and "bad" cholesterol refer to High Density Lipoproteins (HDL) and Low Density Lipoproteins (LDL), respectively. High levels of LDL are associated with coronary atherosclerosis, whereas high levels of HDL appear to protect against cardiovascular diseases.

Classification of Lipoproteins
There are five main classes of lipoproteins:

·        Chylomicrons

·        Very Low Density Lipoproteins (VLDL)

·        Intermediate Density Lipoproteins (IDL)

·        Low Density Lipoproteins (LDL)

·        High Density Lipoproteins (HDL)

Lipoprotein particles range in size from 10 to 1000 nanometers. The largest lipoproteins are about one tenth the size of a red blood cell. The density of lipoproteins increases in proportion to their ratio of proteins to lipids. In general, as the density of a lipoproteins increases, the size of the particles decreases. The outer layer of a lipoprotein consists of a water-soluble (hydrophilic) layer of apolipoproteins, phospholipids and cholesterol. The center of a lipoprotein is composed of cholesteryl esters, triglycerides, fatty acids and fat-soluble vitamins like Vitamin E.

apolipoprotein	a protein that binds to lipids
cholesteryl ester	a compound of cholesterol and a fatty acid
triglyceride	a compound of glycerol and three fatty acids, an ordinary fat molecule
phospholipid	a compound of glycerol, two fatty acids, and choline phospate, an emulsifier like lecithin

Structure of Lipoproteins

Lipoprotein Glossary

Chylomicrons
Chylomicrons are the largest and least dense of the lipoproteins. These 1000-nanometer particles originate in the intestinal mucosa. Their function is to transport dietary triglycerides and cholesterol absorbed by the intestinal epithelial cells. Chylomicrons contain about 1-2% protein, 85-88% triglycerides, ~8% phospholipids, ~3% cholesteryl esters and ~1% cholesterol. The high triglyceride content of chylomicrons gives them a density of less than 0.95. The lymphatic system transports chylomicrons to the plasma where they acquire additional apolipoproteins from HDL. Triglycerides contained in chylomicrons are hydrolyzed in the tissues and the particle remnants are processed by the liver.

Relative Sizes of Lipoproteins

Very Low Density Lipoproteins (VLDL)
Very low density lipoproteins are approximately 25-90 nanometers in size, and have a density of ~0.98. VLDL contains 5-12% protein, 50-55% triglycerides, 18-20% phospholipids, 12-15% cholesteryl esters and 8-10% cholesterol. VLDL also acquires several apolipoproteins from plasma HDL and is a source of triglycerides for the cells.

Intermediate Density Lipoproteins (IDL)
Intermediate density lipoproteins are smaller than VLDL, approximately 40 nanometers, and have a density of ~1.0. IDLs are composed of 10-12% protein, 24-30% triglycerides, 25-27% phospholipids, 32-35% cholesteryl esters and 8-10% cholesterol. IDLs are derived from VLDL by triglyceride depletion and therefore contain the same apolipoproteins as VLDL. IDL becomes LDL as its triglycerides are transferred to the cells.

Low Density Lipoproteins (LDL) - "Bad" Cholesterol
Low density lipoproteins are smaller than IDL, approximately 26 nanometers, and have a density of ~1.04. LDL contains 20-22% protein, 10-15% triglycerides, 20-28% phospholipids, 37-48% cholesteryl esters, and 8-10% cholesterol. One of the protein components of LDL is apolipoprotein B100 which serves to bind the lipoprotein particles to LDL-specific receptors on the surface of many cells. LDL particles bound to the surface of a cell are engulfed and the cholesterol in the LDL particles is used as a structural component of cell membranes or converted to steroid hormones. Apoprotein B is the major protein in all lipoproteins, except high density lipoprotein (HDL). LDL and HDL transport both dietary and endogenous cholesterol in the plasma, but LDL is the main transporter of cholesterol and cholesteryl esters and makes up more than half of the total lipoprotein in plasma.

High Density Lipoproteins (HDL) - "Good" Cholesterol
High density lipoproteins are the smallest of the lipoproteins. HDL particles have a size of 6-12.5 nanometers and a density of ~1.12. HDL contains approximately 55% protein, 3-15% triglycerides, 26-46% phospholipids, 15-30% cholesteryl esters, and 2-10% cholesterol. HDL contains a large number of different proteins including apolipoproteins such as apo-AI (apolipoprotein A1), apo-CI, apo-CII, apo-D, and apo-E. The HDL proteins serve in lipid metabolism, complement regulation, and participate as proteinase inhibitors and acute phase response to support the immune system against inflammation and parasitic diseases.

HDL is produced in the liver and intestine and acts like a scavenger of cholesterol. HDL can bind to cholesterol in cell membranes by using the apo-AI protein to mediate the formation of cholesteryl esters. The apo-D protein in HDL then activates the transfer of cholesteryl esters to VLDL and LDL. HDL also transfers apo-CII and apo-E proteins to chylomicrons and other low density lipoproteins. In the liver, the apo-E protein is used to recognize and absorb the remants of lipoproteins so that excess cholesterol can be removed and converted to bile acids that are excreted into the duodenum (small intestine) through the bile duct. 

Importance of Positive attitutes as Medical Laboratory technologists

Attitudes

Mrs. Thamara Dayani, Tutor –Microbiology, National Institute of Health Sciences, Kalutara

What is an attitude?

Attitude is a little thing that makes a big difference. Attitude is the way you look at things mentally. For an example, a health care worker may not have bothered to check whether vaccine has been kept at right temperature. In this case, it is assumed that health care worker knows what should be done and has the necessary skill to do it, but he has not used his knowledge and skills. This is seen as an evidence of an unsatisfactory attitude. This example shows the link between attitude and behavior. In fact attitudes are perhaps best thought of as the driving forces which determine how people tend to behave or perform. So attitude can be defined as, feeling that motivate a person to perform a task.

What are the factors effecting development of attitudes?

There are some factors that influence the attitudes,

·        Hereditary

·        Environments

·        Culture

·        Religion 

·        Biasness of supervisor

·       Interpersonal skills and knowledge

What are the types of attitudes?

Attitudes are divided in to three categories; positive, negative and neutral. Positive attitudes help to cope more easily with the daily affairs of life. Positive thinking extends and expands to positive attitudes which include positive thoughts, positive words and positive actions. If you are mainly negative, you will be mainly focus on bad things, sad thought and finally it will lead to unsuccessful out comes.

Benefits of having positive attitudes

• Better for your mental health because you are better able to cope with stressful situations at work
• Ability to inspire and motivate self and others.
• Ability to turn every challenge into an opportunity, or make less than ideal situations into better ones.
• Seen as role models and garner more respect.
• Other employees around you will also adopt a positive work attitude making it easier for everyone to get along in the workplace.
• Help achieving goals and attaining success
• Fewer difficulties encountered along the way   
• You expect positive outcomes and results, and you usually get them, resulting in more success at work.
• Ability to stick to activities and see them through.
• Stronger immune system

How to cultivate positive attitudes?

There are 12 words to inspire you to develop your positive attitudes. They are act, appreciate, begin, believe, connect, forgive, learn, read, review, trust, give, and hope.  Some measures to be taken to cultivate positive attitudes are listed below

• Take responsibility for your own life.
• Prepare for the day’s activity at a reasonable pace.
• Think about all the positive things you expect to accomplish during the day and always expect the best.
• Smile and laugh often – it’s powerful and relaxes the whole body.
• Develop a habit of using only positive language.
• Surround yourself with positive people.
• Perform your work with passion and enthusiasm.
• Always give thanks, acknowledge a job well done, and celebrate successes, even the small ones.
• Look for the good in every bad/challenging situation.

Can you teach attitudes to your staff members?

There are no guaranteed methods of teaching attitudes. There are five general methods suggested   to teach attitudes. They are providing information, providing examples or models, providing experience, providing discussion.

Providing information is not always enough to change people’s attitudes but it may help. For an example, the relationship between smoking and the risk of cancers and heart disease is well known by many people. For some people, this information has been enough to persuade them to change their attitudes.

Providing models is a very effective method to shape others attitude. As senior personals in the laboratory, you may help others to shape their attitudes. Easy way of doing this is that you always set a good example for your staff. Therefore your staff also may behave in the same manner.

Providing experiences is also an effective method. As senior personals you can share your experiences and inspire your staff to cultivate positive attitudes.

 

As senior medical Laboratory Technologists, do you wish to measure your attitude your selves?

If so, read the statements cycle the number where you feel you belong.

                                                                                                Agree                          Disagree

I seek responsibility                                                               5          4          3          2          1

Becoming a respected supervisor is important to me                       5          4          3          2            1

I enjoy helping others do a good job                                      5          4          3          2          1

I want to know about human behavior                                   5          4          3          2          1

I want to climb the management ladder                                5          4          3          2          1

I am anxious to learn and master supervisory skills             5          4          3          2          1

I like leadership situations                                                     5          4          3          2          1

Problems in working station would be an interesting                       5          4          3          2            1         

challenge

I intend to devote time to learn motivational skill                5          4          3          2          1           

I am excited about the opportunity to become a supervisor 5          4          3          2          1

If you scored above 40, you have an excellent attitude toward becoming a supervisor. If you rated yourself between 25- 40, it would appear you have a few reservation. A rating under 25 indicates you probably should not pursue becoming a supervisor. 

                                                                       

Good Laboratory Documentation Practices

D. M. R. D. Dhanapala, Act. Principal , School of MLT,NIHS,  Kalutara

Documentation should permit the complete reconstruction of a study/process.

–       Record data directly, promptly and legibly in indelible ink (never pencil)

–       Initial and date all observations and any resulting changes, but do not obscure original data

–       Initial and date only work you’ve performed

–       Do not document selectively or in advance of performing the activity

–       Do not use white-out correction fluid or tape

–       Do not use  marks

–       Copy all heat sensitive paper and stamp “exact copy”

–       Verify critical calculations using a second person and document that

–       Notebook pages requiring a second signature shall be completed with that signature

–       Properly head all pages, tables, columns; identify units

–       Describe Statistical & Calculation Procedures used

–       Sign, Date, and File automated printouts (e.g., QC forms)

–       Retain all Raw Data (original records) in the Study File

–       Do not document by exception.  Use positive documentation, even if only a check marks.

–       Documentation must allow another person to be able to accurately reconstruct what you have done

–       Keep all original observations including those observations recorded directly into a computer

–       Sign and date all computer printouts

–       Never back-date anything

–       Follow SOPs and Protocol

–       Document all deviations with accompanying explanations

–       Indicate in the record all applicable units and equipment used

Raw Data Correction

•        All changes to raw data must be made without obscuring the original entry

•        All changes must be initialed and dated by the person making the change, accompanied by an explanation for the change

Abbreviations for Reasons-

Notation	Meaning	Definition
EE	Erroneous Entry	Entry of a wrong number or incorrect word
SP	Spelling Error	Entered word is misspelled
RD	Repeated Data	Data are already correctly entered elsewhere
MC	Miscalculation	Number shown is the result of a miscalculation
NL	Not Legible	Entry is illegible or has been overwritten
OE-OK	Original Entry OK	Ignore single line cross-off
STET	Original Entry OK	Ignore single line cross-off

Reference : ISO 17050 Guidelines for laboratory Documentation

A  Quality Laboratory Documentation system includes followings

I- Testing strategies / protocols

    - Specimen identification

    - Confidentiality

II – Standard Operation Procedures

    - Sample processing

    - Test performance and result interpretation

Deming Cycle(Plan Do, Check & Act)

,    - Inspection of incoming goods

    - Validation

    - Equipment maintenance and calibration

    - Safety

III-Records

    - Test results

    - Equipment maintenance

    - Equipment calibration

    - Control charts

    - Validation

    - Training