Chapter No.

02

Laboratory its Rules, Ethics, Code of

Conduct and Policies
Presented By:

Muhammad Farhan Hanif

Pharm.D, M.Phil. (Pharmaceutics)

Department of Medical Laboratory Technology

The Islamia University of Bahawalpur,
Pakistan
Chapter No: 02

Contents
• Introduction • Professional Code of Conduct
& Ethics
• Classification of Medical
Laboratory • Laboratory Policies
• Rules of Medical Laboratory
1. Introduction
Laboratory is a place that is equipped with different instruments, equipment’s and
chemicals (reagents) etc., for performing experimental works, research activities and
investigative procedures. Medical laboratory is one part of the laboratory that is equipped with
various biomedical instruments, equipment’s, materials and reagents (chemicals) for
performing different laboratory investigative activities by using biological specimens (whole
blood, serum, plasma, urine, stool, etc).

2. Classification of Medical Laboratories

The world Health Organization (WHO) lists four kinds of levels of laboratories based
on their biosafety.
❖ Basic Laboratory Level-I
❖ Basic Laboratory Level-II
❖ Containment Laboratory Level-III
❖ Maximum Containment Laboratory
2.1 Basic Laboratory Level-I
Basic laboratory level I is the simplest kind and adequate for work with organisms. These
organisms have low risk to the individual laboratory personnel as well as to the members of
the community. Such organisms are categorized under Risk Group I by WHO. These
organisms are unlikely to cause human diseases. Example, food spoilage bacteria, common
molds and yeasts.
2.2 Basic Laboratory Level-II
Basic laboratory level II is suitable for work with organisms that predispose to moderate
risk to the laboratory worker and a limited risk to the members of the community. Such
organisms are categorized under Risk Group II by WHO. They can cause serious human
diseases but not serious hazards due to the availability of effective preventive measures and
treatment. Example, Staphylococci, Streptococci, Entero-bacteria except Salmonella typhi and

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others. Such laboratory should be clean, provide enough space, have adequate sanitary facilities
and equipped with autoclave.
2.3 Containment Laboratory Level-III
Containment laboratory is more advanced and it is used for work with infectious organisms
that present a high risk to the laboratory personnel but a lower risk to the community. Such
organisms are categorized under Risk Group III by WHO. Example, Tubercle bacilli,
Salmonella typhi, HIV, Yersina and others. The principle is to remove from the basic laboratory
those organisms and activities which are particularly hazardous. They are easily transmitted
through airborne, ingestion of contaminated food or water and parenterally. Such laboratory
should be a separate room with controlled access by authorized staff. It should also be fitted
with microbial safety cabinet.
2.4 Maximum Containment Laboratory
Maximum containment laboratory is intended for work with viruses, which predispose to
a high risk for both laboratory personnel and the community. Such organisms are categorized
under Risk Group IV by WHO. Example, Small pox, Ebola, Lassa fever and others. Most of
these organisms cause serious disease and readily transmitted from one person to another.
These laboratories are usually a separate building with strictly controlled access.

3. Rules of Medical Laboratory

Rules for medical laboratories can be categorized as follows:
➢ Medical Laboratory Request Form
➢ Laboratory Record Keeping
➢ Delivery of Laboratory Results
3.1 Medical Laboratory Request Form
Many different types of laboratories requests are received daily in a medical laboratory.
The format of laboratory requisitions may vary from one health institution to the other. In many
health institutions, the test request form serves as a test result report form. An efficient
laboratory will be able to monitor the laboratory request and its requisition forms from the time
the specimens arrive until the time that results are released. Laboratory request form should be
made in writing and provides necessary information. The following information on request
form are:
• The patient’s identification (full name, age, sex, address).
• Inpatient or outpatient identification number.
• Specific test(s) required and date requested.
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• Type of specimen provided.

• Name of medical officer requesting the test and to whom the report should be sent.
• Any other information relevant to the test requested.
3.2 Laboratory Record Keeping
The laboratory must keep a record of all results. It should contain:
• Patient’s identification (name, age, sex, full address).
• Type of the specimen.
• Type of test done.
• Date and result of the test.
A record of a test results must be kept by the laboratory as carbon copies, work sheets, or
recording test results in registers. Whichever system is used, it must enable patient results to
be found quickly. Records of tests and results are required in the laboratory to issue copies to
patients who have lost their results. Moreover, they are also required when preparing duty
reports and estimating the workload of the laboratory.
3.3 Delivery of Laboratory Results
Laboratory staff should provide as much relevant information as possible to assist those
requesting tests. Reports should be clearly and neatly written, particularly figures.
Standardization in the presentation of reports and use of units is important because it helps in
the interpretation and comparison of results, contributes to the efficiency of a laboratory
service, and is of great value when patients are referred from one health unit or hospital to
another. Therefore, to ensure the validity and accuracy of test results, the following points
should be taken into consideration.
• Experienced member of medical laboratory professional must check all laboratory
results before dispatching them to respective departments or units.
• Any unexpected result should be investigated and repeated if necessary.
• If possible, reference values (normal ranges) should be included in reports.

4. Professional Code of Conduct and Ethics

The code includes those attitudes and practices which characterize a responsible medical
laboratory technician and ensure that a person works up to the level of a recognized standard.
Major codes of professional conduct are enumerated below:
➢ Place the well - being and service of the sick above your own interests.

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➢ Be loyal to your medical laboratory profession by maintaining high standards of work

and by improving your professional skills and knowledge.
➢ Work scientifically and with complete honesty.
➢ Do not misuse your professional skills or knowledge for personal gain.
➢ Never take anything from your place of work that does not belong to you.
➢ Do not disclose to a patient or any unauthorized person the results of your investigation.
➢ Treat your results and your patient’s information with strict confidentiality.
➢ Respect colleagues and work in harmony.
➢ Be sympathetic and considerate to the sick and their relatives.
➢ Promote health care and the prevention and control of disease.
➢ Follow safety precautions and know how to apply first aid.
➢ Use equipment and laboratory wares correctly and with care.
➢ Do not consume alcohol or any other abusive substances during working hours or when
on emergency standby.
➢ Do not waste reagents or other laboratory supplies.

5. Laboratory Policies
Laboratory policies are those decisions, which are taken in consultation with other
medical staff to enable a laboratory to operate reliably and effectively in harmony with other
departments.
5.1 Laboratory Hours and Emergency Work
• There should be definite laboratory working hours.
• In peripheral laboratories, it is often more difficult to maintain working hours.
• This is because of large outpatient flow and the emergency nature of much of the work.
• Outside of normal working hours, each laboratory should organize a system for testing
urgent specimens.
• Only those investigations that are essential for the immediate care and assessment of a
patient should be requested urgently.
5.2 Range of Test to be Performed
• Range of test to be performed depend on:
✓ The number of staff available.
✓ The availability of material resources.
✓ The types of health institutions (hospital or health center).

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• Referral of specimens (when necessary). Example, specimens for HIV detection and
water samples for bacteriological analysis.
5.3 Collection of Laboratory Specimens
• Many different types of specimens are received daily in a laboratory and it is necessary
to ensure that specimens collected appropriately.
• The specimen containers should be clearly labeled with the patient’s name,
identification number, date and time of collection.
• A fully completed, request form should accompany each specimen with the detail.
• Specimens received in a laboratory should fulfill the following requirements.
✓ The specimen containers must be clean and leak proof and also sterile when
necessary.
✓ Special collecting trays or boxes must be used and they must able to with stand
repeated autoclaving or disinfection.
✓ Request forms should be kept separate from the specimens to prevent
contamination.
✓ Enough amount of specimen should be collected to perform laboratory test(s).
5.4 Workload Capacity of Laboratory
• Workload capacity should be matched to the number of staff and their level of training,
the size of the laboratory and the availability of laboratory facilities.
• Ideally, microscopic work (which is universal to all level of laboratories) per day should
not exceed a total of four hours.
• When the amount of work requested is beyond the capabilities of a laboratory, testing
of specimens become unreliable and safety measure tend to be ignored.
• On the other hand, too little work can also lead to unreliable test results due to lack of
concentration.

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