Guidelines Information and Courses from MediaLab, Inc.

Important safety precautions must be observed when handling cerebrospinal fluid. The following guidelines apply:Semi-automatic micropipettes and disposable plastic chambers are the safest option for CSF testing. Many laboratories still use the hemacytometer with disposable pipets.If disposable materials are not used, soak contaminated reusable pipets, hemacytometer and coverslip in 70% alcohol or Wexide.All disposable items should be placed in a biohazard container for appropriate disposal.Wash hands thoroughly when the examination is completed.Spinal fluids which are to be discarded must be placed in biohazard containers for appropriate disposal.Careful attention to specimen processing and handling will help ensure that accurate results are obtained.

Fortunately, the great majority of collections are uneventful, but from time to time problems or the unexpected occur. This section will discuss a few examples of special situations that may take place during a collection and what the response of the collector should be. Obviously, not every special situation can be envisioned or discussed. It is strongly recommended that the collector be very familiar with the Department of Transportation publication: Urine Specimen Collection Guidelines dated August 25th, 2008.

Deciding how many classes to use for grouping the data is a compromise between the extremes of too much detail (each observation in its own category) and not enough detail (only one category). Most frequency tables are constructed according to the following guidelines: For most data, 6 to 15 classes are enough Class intervals (lengths) should be equal. Intervals such as 0.1, 0.2, 0.5, 1, 2, 5, 10, 20, 50, etc are desirable. The starting point for each class should be divisible by the interval, For example, in the class 15 - 20, the starting point, 15, is divisible by the interval, 5. Each observation must fit into only one class. When a large number of points falls around a certain value, make this value the approximate center of the frequency distribution.For the data in our example, the minimum is 65 and the maximum is 114, a range of about 50. We can therefore choose intervals of size 5, and have ten of them. Our classes are 65 - 70, 70 - 75, etc.

It is imperative to follow the individual package insert procedures when collecting and handling specimens. Reference labs provide specimen requirements as well as collection, handling and transport guidelines.The Clinical and Laboratory Standards Institute (CLSI) formerly known as NCCLS: National Committee for Clinical Laboratory Standards has published procedures for collection including those specific to molecular diagnostics.

Panlilo AI, Cardo DM, Grohskopf LA, Heneine W, Ross, CS. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis, 2005. MMWR Recomm Rep 2005 Sep 30; 54:RR-9.The 2005 Florida Statutes, Chapters 381, 384,456. Available at www.leg.state.fl.us.MediaLab Course "HIV: Structure and Replication," Garland Pendergraph.MediaLab Course "OSHA Blodborne Pathogens," Terry Jo Gile MT(ASCP),Ma Ed.

Recent events, including the terrorist attacks on September 11, 2001 and the subsequent bioterrorist releases of anthrax, have been a harsh awakening that the nation’s workplaces could be terrorist targets.Traditionally laboratory safety guidelines have emphasized use of optimal work practices, appropriate containment equipment, well-designed facilities, and administrative controls to minimize risks of unintentional infection or injury for laboratory workers. Today, in addition to the above, laboratories must make a risk and threat assessment, secure data and electronic technology systems, plus develop policies regarding specimen accountability, facility security, and emergency response.The next few pages will cover a number of things that you can do to assist in making your laboratory more risk free to a terrorist attack and some things you can do in case that security is breached. You too have a role in the security of your workplace!

Here are some guidelines for the order in which control sample testing should occur: Controls and calibration materials should not come from the same lot number. Controls should not routinely follow calibration material. Random placement of controls among patient specimens is preferred. Random placement of duplicate patient specimens, rather than consecutive, monitors reliability within the batch.

Laboratory discussion meetings help to prevent medical errors. The staff can meet periodically to discuss recent averted adverse events and ones that might have been averted.Discussion should not be about blame. Privacy must be protected, so real names should not be identified. Management can provide guidelines for discussion and analysis.A suggested format for discussion:1. Briefly describe each adverse event.2. Identify its possible causes.3. Discuss relevant guidelines.4. Suggest possible preventive actions.Discussion can include actions that do and do not work to prevent medical errors.

All sales offerings and/or written proposals must be in compliance with policies or guidelines or pre-approved by the sales manager or compliance officer.The manner in which a sales or marketing person presents a discount of special price is as important as the amount of the discount.Sales and marketing employees must be very aware of the language used during the sales process to insure the customer understands exactly what is being offered.The offering of an illegal discount is the same as actually giving it.If a client solicits a questionable or illegal discount, it should be reported to the sales manager or compliance officer.

Initial analysis of the peripheral blood picture is made in most clinical laboratories with an automated instrument. Samples are selected for further analysis when quantitative or qualitative abnormalities beyond a defined standard are found. The following are examples of quantitative RBC abnormalities that may prompt a blood smear review. Each laboratory, however, should develop its own guidelines: Hgb: < 8 or >18 g/dL (<10 or > 21g/dL in a newborn)Hct: <20% or > 60% in adults (<40% or >65% in a newborn)MCHC: <29 g/dLMCV: <69 femtoliters (fl) or >110flFlags generated by the hematology analyzer that indicate possible red cell abnormalities or spurious resultsAny of these findings should be followed up with a peripheral blood smear review.

Any review of a peripheral smear is highly subjective; therefore, each laboratory must establish its own guidelines for quantitating observations and issuing reports in a consistent format. The key question for the laboratory is "How will the clinician use the terms of qualitative results in the reports issued to decide on the next course of action with this patient?" Formats for reporting have been geared more toward the needs of instrumentation facilitation and computer management than toward needs of access and understanding by clinicians working to improve patient care outcomes. Evidence based medicine (EBM) is the formal term used for the process by which research evidence, collective clinical experience, and the user friendly rendering of testing results are integrated to evaluate patient care outcomes.

Safety precautions should be observed when handling seminal fluid. The following guidelines should be followed:If non-disposable items are used, soak contaminated items(e.g.hemacytometers and coverslips) in 70% alcohol or Wexide®.All disposable items should be placed in a biohazard bag for autoclaving.Gloves must be worn and hands thoroughly washed when the examination is completed.Seminal fluids that are to be discarded should be placed in biohazard bags for autoclaving.

The Centers for Disease Control (CDC) issued Guidelines for Prevention of Tuberculosis in Healthcare Settings in 2005.These guidelines have broader applications than the Guidelines for Prevention of Tuberculosis in Healthcare Facilities issued by CDC in 1994.

Pratt R, Robison V, Navin T. Trends in tuberculosis. MMWR/57(11);281 - 285; Centers for Disease Control and Prevention: March 21, 2008. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5711a2.htm Last accessed on May 23, 2008.Respiratory Protection in Health-Care Settings Fact Sheet. Available at http://www.cdc.gov/niosh/99-143.html. Last accessed May 23, 2008. Slide set - Guidelines for preventing the transmission of M. Tuberculosis in Healthcare settings, 2005. Available at http://www.cdc.gov/tb/pubs/slidesets/InfectionGuidelines/program.htm Last accessed on May 23, 2008.Tuberculin Skin Testing Fact Sheet. Available at http://www.cdc.gov/TB/pubs/tbfactsheets/skintesting.htm Last accessed on May 23, 2008.

The following are suggested guidelines directed toward white blood cell data necessitating a hematologist's review:Total white blood cell count <3000/cumm or >12,000/cummNeutrophils >85%Lymphocytes >43% or <10%Monocytes >8%Eosinophils >6%Basophils >4%,.Mixed cells >8% on a 3-part automated differentialA morphology review may also be indicated if the platelet count is <100,000/cumm or >650,000/cumm.Thus, if the granulated cells illustrated in the photograph exceed 6% of the total WBC on a five-part differential or, in combination with monoctytes and basophils, exceed 8% of the total WBC on a three-part differential, a flag would alert the operator that a morphology review or manual differential is needed.