LABORATORY SAFETY AND WASTE MANAGEMENT, QUALITY ASSURANCE AND SPECIMEN COLLECTION Flashcards
(217 cards)
1
Q
A program that is important in order to protect the lives of students and teachers, to protect the laboratory equipment and facilities, and to protect the environment.
A
Laboratory safety
2
Q
A method of infection control in which all human blood and other body fluids containing visible blood are treated as if infectious.
A
Universal Precautions
3
Q
A set of comprehensive safety guidelines designed to protect patients and healthcare workers by requiring that all patients and all body fluids, body substances, organs, and unfixed tissues be regarded as potentially infectious.
A
Standard Precautions
4
Q
Established procedure to be followed for a given operation or in a given situation with the purpose of ensuring that a procedure is always carried out correctly and in the same manner.
A
Standard Operating Procedure (SOP)
5
Q
Is the removal of microorganisms to a certain level as not to be able to infect humans and cause disease.
10% of sodium hypochlorite solution (dilute household bleach by mixing 1-part bleach to 9 parts of distilled water) it must be prepared daily and labeled with agent name, concentration, and date of preparation.
A
Decontamination
6
Q
Is the absolute removal of all microorganisms.
A
Sterilization
7
Q
Is a technical bulletin providing detailed hazard and precautionary information.
A
Material Safety Data Sheet (MSDS)
8
Q
Businesses are required to provide to their costumers the MSDS for all chemicals they manufacture or distribute.
A
TRUE
9
Q
The MSDS provides:
A
a. products information
b. fire and explosion precautions
c. toxicology
d. health effects
e. recommended PPE
f. storage recommendations
g. leaks and spills
h. waste disposal recommendations; EQUIPMENT
i. first aid
10
Q
The most effective at reducing hazards yet often the most difficult to implement.
A
Elimination
11
Q
Used as control organism with less pathogenic.
A
Substitution
12
Q
Favored over administrative and personal protective equipment (PPE) for controlling existing worker exposures in the workplace because they are designed to remove the hazard at the source, before it comes contact with the worker.
A
Engineering controls
13
Q
Bench top acrylic splash shield to protect the worker from aerosols, fine mist of liquid, biohazard containers, disinfectants, hand antiseptics, puncture-resistant sharps containers, safety needles, biosafety cabinet, fume hood, laminar flow.
A
Engineering controls
14
Q
Include the protocols or changes to work practices, policies, or procedures. They can be relatively inexpensive to establish but, over the long term, can be very costly to sustain.
A
Administrative controls
15
Q
Authorization/approval written biosafety procedures required for the experimental procedures and equipment including inventory of biological agents or materials, laboratory personnel biosafety training, medical surveillance (BSL 2 and above), health history, medical screening, immunization, serum storage, post-exposure, prophylaxis.
A
Administrative control
16
Q
The use of special clothing and equipment to protect staff and patients who maybe exposed to known or suspected pathogens.
A
Personal Protective Equipment (PPE)
17
Q
These are compulsory in all instances in the physical containment level 2 laboratory.
Be aware of the composition of fabrics, as some might be highly flammable.
A disposable laboratory coat is compulsory in physical containment level 3 laboratories or in specific instances such as collection when highly dangerous pathogens can be involved, such as suspected cases of H5N1 avian influenza or SARS.
A
Laboratory coats
18
Q
Serve as a barrier when splashes or sprays occur during specimen collection or handling.
A
Masks
19
Q
Protection of eyes is strongly recommended as a routine procedure to prevent contact with these droplets.
A
Goggles
20
Q
Should be worn in all instances, and should be available to laboratory staff on a routine basis.
A
Gloves
21
Q
Hazards occur by physical agents like fire, electrical, noise, radiation, high voltage, machinery with moving parts, sharp material.
A
Physical Hazards
22
Q
R.A.C.E?
A
Rescue or remove: rescue or remove any persons from the immediate scene
Alert or activate: pull the nearest alarm
Confine: close all doors to the hazard or fire area
Extinguish/evacuate: extinguishing using the closest fire extinguisher if the fire impedes your evacuation. Evacuate to your designated meeting location.
23
Q
Ordinary combustibles such as woods, papers, and plastics.
Pressurized water-based extinguishers
A
Class A
24
Q
Flammable liquids (i.e., ethanol, xylene) and electrical fires.
Carbon dioxide extinguisher
A
Class B/C
25
Ordinary combustibles, flammable liquids, and electrical fires.
Multipurpose dry chemical agent extinguisher
Class ABC
26
Combustible metals (i.e., magnesium, powdered aluminum).
Sodium chloride or copper based dry powder
Class D
27
Kitchen fires, cooking oils, and fats.
Potassium bicarbonate or wet chemical fine mist
Class K
28
P.A.S.S.
Pull the pin
Aim the base of the fire.
Squeeze the handle.
Sweep from side to side.
29
Hazards occurred by biological agents like blood, body fluids, and experimental animals, allergens, infectious agents, experimental agents, microbes, viral vectors
Biological hazards
30
Hazards occurred by chemicals cleaning agents, disinfectants, solvents, and compressed gases.
Chemical hazards
31
This is the major route.
Inhalation
32
May produce systemic poisoning.
Absorption through skin
33
Generally due to poor hygiene practices, such as eating or smoking in the laboratory.
Ingestion
34
Health hazard?
Blue quadrant
35
Flammable Hazard
Red quadrant
36
Reactivity/Stability Hazard
Yellow quadrant
37
Other special information
White quadrant
38
100% non filtered air
Non volatile - yes
Volatile - yes
Chemical fume good
39
100% HEPA filtered supply air
Non-volatile - no
Volatile - no
Clean bench
40
Type of BSC that 100% of HEPA filtered exhaust air
Non-volatile - yes
Volatile - Yes, in minute quantities while canopy connected
Class I
41
60% HEPA filtered exhaust air, 40% recirculated HEPA filtered air
Non-volatile - yes
Volatile - yes, but in small amounts towards rear of cabinet
Class II Type B1
42
100% HEPA filtered exhaust air
Non-volatile - Yes
Volatile - Yes
Class II Type B2
43
HEPA filtered supply and exhaust air ( varies depending on configuration)
Non-volatile - yes
Volatile - yes, if connected to building exhaust. Concentrations vary.
Class II Type C1
44
100% HEPA filtered supply and exhaust air
Non-volatile - yes
Volatile - yes
Class III
45
Velocity at the face of the wood (with sash on normal operating position) should be
100 to 120 ft per minute and fairly uniform across the opening
46
It removes the particles that may be harmful to the employee who is working with potentially infectious biologic specimens.
Biosafety Cabinets (BSCs)
47
Is a type of mechanical air filter that works by forcing the air through a fine mesh that traps a harmful particles at 99.99%
High Efficiency Particulate Air (HEPA)
48
Modern American Convention HEPA:
99.99% at 0.3 microns
49
Modern American Convention ULPA:
99.99% at 0.12 microns
50
Major sources of health care wastes
Hospitals and other health facilities
Laboratories and research center
Mortuary and autopsy centers
Animal research and testing laboratories
Blood banks and collection services
Nursing homes for the elderly
51
Is a solid, liquid, or gaseous material that displays either a “hazardous characteristic” or specifically listed by name as hazardous waste.
Hazardous waste
52
True or False
Hazardous chemicals must never poured down the drain as a method of disposal
True
53
Applies to waste that are liquids with a flash point less than 140 degrees Fahrenheit.
Solid that are capable of spontaneous combustion under normal temperature and pressure.
ex: ethanol, sodium nitrate, hydrogen gas, xylene, acetone
Ignitability
54
Applies to waste that aqueous solutions with less than or equal to 2% or greater than or equal to 12.5
This does not apply to solid or non-aqueous materials
ex: hydrochloric acid, nitric acid, sodium hydroxide
Corrosive
55
Refers to the materials that react violently or generate toxic fumes when mixed with water
Materials that are normally unstable or explosive
Reactivity
56
Refers to the characteristics applies to the wastes that have potential to contaminate ground water if improperly disposed
Toxicity
57
Waste contaminated with blood and other body fluids, cultures, and stocks of infectious agents from laboratory work or waste from patients with infections.
Infectious waste
58
Human tissues, organs or fluids, body parts and contaminated animal carcasses.
Pathological waste
59
Types of waste that contains syringes, needles, disposable scalpels and blades.
Sharps waste
60
Waste that contains of solvent and reagents for laboratory preparations, disinfectants, sterilant and heavy metals contained medical devices and batteries.
Chemical waste
61
Expired, unused, contaminated drugs and vaccines.
Pharmaceutical waste
62
Waste containing substances with genotoxic properties highly hazardous substances that are mutagenic, teratogenic, carcinogenic such as cytotoxic drugs used in cancer treatment and their metabolites
Cytotoxic waste
63
Products contaminated by radionuclides including radioactive diagnostic material or radiotherapeutic materials
Radioactive waste
64
Waste that does not pose any particular biological, chemical, radioactive.
Non hazardous or General waste
65
Non infectious dry waste
Black
66
Sharps and pressurized
Red
67
Infectious and pathologic wet waste
Yellow
68
Non-infectious wet waste
Green
69
Chemical wastes
Yellow with black band
70
Systemic actions necessary to provide adequate confidence that laboratory services will satisfy given medical needs for patient care.
Quality assurance
71
What is the primary goal of quality assurance?
To deliver quality service and products to costumer
72
Refers to the planned and systemic activities implemented in a quality system so that the quality requirements for a product or service will be fulfilled
Quality assurance
73
What are the two principles involved in QA?
Fit for purpose
Right first time
74
Mistakes should be eliminated
Right first time
75
Product should be suitable for the intended purpose
Fit for purpose
76
Test ordering
Specimen collection, transport, and processing
Preservatives used
Entering patient information
Pre analytical phase
77
Test processing and analysis
QC data
Record keeping
Analytical phase
78
Reporting out of specimen results
Physician contact
Reference range
Post Analytical phase
79
True or False?
QA monitors quality performance starting from the ordering of a laboratory determination to its reporting, the interpretation of the results, and then application to patient care.
True
80
A system used to monitor the analytical process to detect and prevent errors that would impact on the accuracy and precision of laboratory results.
Quality control
81
What is the goal of QC?
To detect the errors and correct them before patient’s results are reported
82
It is concerned with the analytic phase of QA
Quality control
83
Objectives of Quality Control?
To check the stability of the machine
To check the quality reagents
To check the technical errors
84
Also known as Intralaboratory QC
Performed by laboratory personnel using control materials of know values and comparing the control values to established acceptable ranges
Internal QC
85
Also known as Interlaboratory QC, Proficiency testing
Performed by labor personnel when analyzing specimens sent to the laboratory by an external agency and the results generated are submitted to the agency for assessment.
External QC
86
It detects both random and systematic errors
Internal QC
87
The purpose is to maintain the accuracy of the analytical methods
External QC
88
NRL
Hematology
National Kidney and Transplant Institute (NKTI)
89
Clinical Chemistry
Lung Center of the Philippines
90
Bacteriology, Clinical Microscopy, Blood banking, Mycology, Parasitology
Research Institute for Tropical Medicine (RITM)
91
HIV/AIDS and other Sexually Transmitted Infections
San Lazaro Hospital - STD AIDS Cooperative Central Laboratory (SLH/SACCL
92
The nearness or closeness of the assayed value to the target or true value.
Accuracy
93
The ability of an analytical method to give repeated results on the same sample that agree with one another.
Precision
94
The degree by which the method is easily repeated.
Practicability
95
The ability of an analytical method to maintain the accuracy and precision over an extended period of time during the equipment, reagents, and personnel may change.
Reliability
96
The ability of an analytical method to measure the smallest concentration of the analyte of the interest.
Sensitivity
97
Ability of the test to detect the proportion of individuals with that disease who test positively with the test
Diagnostic sensitivity
98
Indicates the ability of the test to generate more true-positives and few false-negative.
Diagnostic sensitivity
99
True or False
Screening tests require high sensitivity so that no case is missed.
True
100
Ability of an analytical method to measure only the analyte of interest (no interfering substance)
Specificity
101
Ability of the test to detect the proportion of individuals without the disease who test negatively for the disease.
Diagnostic of Specificity
102
It reflects the ability of the method to detect true-negatives with very few false-positives.
Diagnostic of the Specificity
103
True or False
Confirmatory tests require high specificity to be certain in diagnosis.
True
104
A quality management technique and symbols logic flow charts used by management information system to chart specific process of information flow.
It serves as a disruption to the exact sequence of work task and ways.
Flow Chart
105
Also known as trend charts.
They are designed to show patterns of performance.
A unique graph used to display over a period of time.
Run Charts
106
Used to plot control measurements against standards.
It is used to identify whether the process is in or out of control.
Control Charts
107
It is a term assigned to a bar chart that is designed to illustrate the classical Pareto principle, which states that 80% of all the problems can be attributed to 20% of the possible causes.
Pareto charts
108
Also known as Ishikawa diagrams and Fishbone diagrams.
This method identifies possible causes or contributing factors on quality defects.
The problem is placed in the head of the diagram, with possible causes branching out of the backbone, in the work flow direction.
Cause and Effect Diagrams
109
This method used to show relationship between one variable and another.
A big advantage of this diagram is that all data points, not just the summary statistical indexes are plotted on the graph.
Scatter Diagram
110
A technique of using a practical sequence on a flip chart or other visual aid to “tell the story”
Story Boards
111
Extent which the test value is close to the true value.
Refers to the correctness of the value obtained to the actual value of analyte.
Accuracy
112
True or False
The accuracy of the method is reflected by its ability to reproduce the value of reference samples of known concentration.
True
113
True or False
To achieve accuracy, we also use blank.
True
114
Used to set the absorbance (OD) to zero.
Blank
115
Used when reagent is colorless
Water blank
116
Used when reagent is colored
Reagent blank
117
Also the Reference Material or Calibrator
It is used as a basis or reference for the calculation of the value of the unknown.
Standard
118
It has highest purity
Can be measured directly.
Primary standard
119
It has lowest purity.
Concentration is determined by comparison to a primary standard and this is less expensive.
Secondary standard
120
Refers to the average of values.
Measure the central tendency.
Mean
121
Refer to the most common value.
Mode
122
The middle value and the 50th centile
Median
123
Refers to the nearness of the obtained value to each other.
It is the “reproducibility” of a laboratory determination when it is run repeatedly under identical conditions.
Precision
124
Substance having a known or determined range of values.
Control
125
Values stated by the manufacturer
More expensive but can be used as external checks for accuracy.
Assayed commercial control
126
Values not given, determined by the user.
Unassayed commercial control
127
Shortcomings include increased for exposure to pathogens, deterioration, contamination and loss of potency.
Pooled control sera
128
True or False
Bovine-based QC material is not the choice for immunochemistry, dye binding, and certain bilirubin assays.
True
129
This refers to the control range
Range of values within which control result must fall.
Confidence interval
130
Most common unit of precision
Measure of dispersion of the values around the mean
Standard Deviation
131
Percentile express of the mean
Coefficient of Variation
132
A measure of variability.
Variance
133
Bell shaped curve
It is obtained by plotting the values from multiple analyses of sample.
Gaussian Distribution Curve
134
It is occurs when data elements are centered around the mean with most elements close to the mean.
It focuses on the distribution of errors from the analytical method rather than the values from a healthy or patient population
Gaussian Distribution Curve
135
Refers to the degree of flatness or sharpness in the peak of a set values having a Gaussian distribution.
Kurtosis
136
It calculates the difference between QC results and the target means.
This plot will give the earliest indication of systemic errors (trend) and can be with the 13s rule.
Cumulative Sum Graph (CUSUM)
137
True or False?
When a systemic error is present the CUSUM values steadily increase.
True
138
Used to compare results obtained on a high and low control serum from different laboratories.
Youden/Twin plot
139
Compares most recent patient result with previous results.
Most commonly used patient based-QC technique
Delta Check
140
Most common and most widely used in QC chart in the laboratory.
Shewhart Levey-Jennings Chart
141
Is a graph wherein quality control data is plotted on to give a visual indication whether a laboratory test is working well.
Shewhart Levey-Jennings Chart
142
It is formed by control values that either increase or decrease for 6 consecutive days.
Trend
143
What is the main cause of trend?
Deterioration of Reagents
144
It is formed by control values that distribute themselves on one side or either side of the mean for 6 consecutive days.
Shift
145
What is the main cause of shift?
Improper calibration of the instrument
146
Refers to the sample values that are widely scattered in an unusual and unexplained pattern around the mean.
Dispersion
147
Causes of dispersion
Operators inattention
Clerical errors
Interfering substances in the reagent
Electronic or optical variation in instrument
148
Are control values that are far from the main set of values.
Are highly deviating values caused by random or systemic errors.
Outliers
149
It is recognized that the use of simple upper and lower control limits is not enough to identify analytical problems.
Used to accept or reject a “run” of samples.
Westward Multi-rules
150
What are random errors?
1:3S and R:4S
151
What are systematic errors?
2:2S
4:1S
10:x
152
Is due to chance
Basis for varying differences between repeated measurements
Random error
153
Unable to predict because they are no pattern
Random error
154
Random errors are caused by:
Pipetting errors (incorrect volume)
Mislabeling of the specimen
Voltage/Temperature fluctuation
Improper mixing of the sample and reagent
Analytical result is assigned to a wrong specimen
Sample error (lipemia, drug interference, hemolysis)
155
Is an error that influences observations consistently in one direction (constant difference)
Predictable
Usually analytical errors
Systematic error
156
Systematic error are often related to:
Calibration problems
Deterioration of reagents and control materials
Contaminated solutions
Unstable and inadequate reagent blanks
Dirty photometer
Leaky ion selective electrode (ISE)
Failing instrumentation
Poorly written procedures
157
Highest frequency of clerical errors with the use of handwritten labels and request forms.
Online computer input is the most error-feee means of requesting laboratory tests.
Clerical errors
158
Also the reference limit/interval/value or normal value
Range in which a certain percentage of the population is expected to fall
Reference Range
159
Factors to be considered when establishing reference intervals
Composition of the reference population
Criteria used for excluding and including the individuals from the reference population
Physiologic and environmental conditions
Specimen collection, including preparation for testing
Analytical method used
160
FBS
8-10 hours
161
Lipid profile
10-14 hours
162
BMP (Na, K, Cl, CO2, Glu, BUN, CRT, Ca:
10-12 hours
163
A process by which blood is obtained from a patient vein
Venipuncture
164
Is the deoxygenated blood with a dark red color.
Venous blood
165
What are the advantages of the venipuncture?
Collect large amount of blood
Repeated and additional blood tests can be made
Can be stored for future use
Ideal for blood chemistry determination
166
Outpatient/Ambulatory patient:
Verbally ask the name
DOB
Ask for an ID card conscious
167
In patient/Hospitalized patients
Verbally ask the full name
Verify the name using ID/bracelet
168
Sleeping patients
Must be awakened before blood collection
Verbally ask full name
Verify the name using ID/bracelet
169
Unconscious, mentally incompetent patients
Ask the attending nurse or the relative verify using ID/bracelet
170
Infants/children
A nurse or relative may identify the patient verify using ID bracelet
171
What is the proper patient positioning in venipuncture
The patient is lying supine or sitting in a phlebotomy chair
Position patient’s arm using the phlebotomy wedge or patient’s fist
172
Torniquet application
Should not be pinched
Should be flat around the arm and not rolled or twisted
Should be applied 3 to 4 inches or 3 fingers above the venipuncture site
Remain in place for 1 minute
Should be released for 2 minutes before being reapplied
173
Blood pressure cuff
Inflated 40 mm/hg
174
Site selection
Select a vein that is large and does not roll
Exam in antecubital area first
Ask the patient to hold arm still and make a fist
Palpate the vein using the tip of your index finger not the thumb
Use a warm, moist compress for 3 to 5 minutes to increase vein sized if needed
175
Cleansing the site
Circular motion, starting inside of the venipuncture site and working outward in widening concentric circles about 2 to 3 inches
Cleaning the site with an antiseptic (70% isopropyl alcohol) helps prevents contamination
Be sure to allow the alcohol to dry before attempting the venipuncture procedure
Never blow on the site/never wipe it dry
176
Performing the venipuncture
Reapply the tourniquet
Visually confirm the venipuncture site
Anchor the below the venipuncture site, place the thumb of the non dominant hand 1-2 inches below the puncture site and pulling the skin taut.
Insert the needle at a 15 degrees to 30 degrees angle.
Insert the evacuate tube and allow it to fill.
177
Calcium A
5x
178
Na Citrate
3-4x
179
Heparin
8x
180
EDTA
8x
181
NaF
8x
182
Bruising or skin discoloration
Ecchymosis
183
Collection of blood into the surrounding tissue and skin layer
Hematoma
184
Following information that needs to be fill up in collecting specimen
Patient’s name
Identification number
Date and Time of collection
Phlebotomist initial
Test maybe included
185
Do NOT draw blood in the following areas
Edematous or has a lesion
IV site
Arm on the side of a mastectomy
Underside wrist
Lower extremities
Feet
Ankle
186
True or False
The gauge of the needle is inversely related to the size of the needle
True
187
21 gauge
Standard for venipuncture
188
23 gauge
Children
189
23 or 25 gauge
Winged infusion set
190
23 gauge butterfly
For small and difficult veins
191
25 gauge
Collection from scalp or other tiny veins of infants
192
Sites to be avoided for venipuncture
Burned areas
Areas with hematoma
Thrombosed veins
Edematous arms
Mastectomy on one or both arms
Arms with AV shunt
Casts
IV therapy lines in both arms
193
Procedures in collecting below the IV
Turn off the IV at least 5 minutes before venipuncture
Apply the torniquet below the IV site
Select a vein other than the one with the IV
Draw 5 ml of blood and discard before drawing the specimen tubes for testing
194
Common causes of hematoma
Vein is fragile or too small for the needle size
Needle penetrates all the way through the vein
Needle is partly inserted in to the vein
Needle is removed while the torniquet is still on
Pressure is not adequately applied after venipuncture
195
Liquid that remains when clotting is prevented with the addition of an anticoagulant
Plasma
196
Density is 1.025 g/ml
Plasma
197
Liquid that remains after the blood has clotted.
Serum
198
Obtain after the centrifuging whole blood containing anticoagulant
Plasma
199
Contain clotting factors
Plasma
200
Obtain after centrifuging clotted blood
Serum
201
Does not contain clotting factors
Serum
202
Yellow colored serum due to increase bilirubin pigment interfere with albumin, Chol, TP and glucose.
Cause: increase bilirubin
Icteric
203
Reddish due to the rupture of RBC membrane releasing hemoglobin and other red cell components
Caused: Rupture of RBCs
Hemolyzed
204
White colored serum due to high fat content
Causes: TAG levels exceed 400 mg/dL, alcoholism, steroids
Lipemic
205
Are substances which prevent blood coagulation
They inhibit coagulation process by eliminating calcium or by binding with thrombin.
Anticoagulants/Blood anticoagulants
206
EDTA, Citrate, Calcium binds with
Calcium
207
Heparin binds with
Thrombin
208
Tubes containing sodium and potassium anticoagulants are not use in measuring concentration of electrolytes
False positive result
209
Tubes contain sodium oxalate are not used for measuring calcium level because oxalate will react with calcium and precipitated as calcium oxalate
False negative result
210
Tubes with EDTA and citrate are not suitable for enzymatic assays because it binds with calcium ion that is a cofactor for enzymes like alkaline phosphates
False Negative Result
211
Order of Draw
Blood cultures
Light blue stopper tubes
Red/gray
Green/Light green
Lavender
Gray
Yellow/Orange
212
Ideal temperature for storing serum (long term)
Rapid freezing in liquid nitrogen
213
Short term storage of serum (6 weeks)
Store at -200 degrees Celsius
214
Specimen retention
Clinical samples
1 year at -80 degrees Celsius
215
Serum/Plasma
48 hours
216
CSF/Body fluid
7 days
217
Grounds of rejecting a specimen
Unlabeled or mislabeled specimen
Insufficient volume of specimen collected
Clots in an anti coagulated tube
Hemolysis
Improper transport
Wrong blood collection tube
Discrepancies between requisition and specimen label
Non-fasting if required
