Chapter – One

1. The laboratory

PREPARED BY ETHOPIAN UNIVERSITIES

MEDICAL LABORATORY SCHOOLS WITH CDC-
ETHIOPIA and ASCP

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Acknowledgment

Addis Ababa University

Jimma University
Hawasa University
Haromaya University
University of Gonder
American Society for clinical pathology
Center for disease control

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 CHAPTER ONE
THE LABORATORY

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 Objectives
After completion of this chapter, the student will be able to:
 Define laboratory.
 Identify and enumerate the different kinds of medical
laboratories.
 Explain the role of medical laboratory services.
 State the laboratory rules, ethics, professional code of
conduct and polices.

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Outlines

1.1: General overview

1.2: Classification of laboratories
1.3: Structure of laboratory services
1.4: Role of clinical laboratory services
1.5: Function & use of different medical laboratory
department/units
1.6: Role of medical laboratory personnel
1.7: Laboratory rules and policies
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1.1: General overview
 Defn: Laboratory – is a place that is equipped with different
instruments, equipments, chemicals etc for performing
either experimental works or research activities.

 Medical laboratory is part of the laboratories that is

equipped with various biomedical instruments and
chemicals for performing different lab diagnostic activities
by using biological specimens. (Whole blood, serum,
plasma, urine, stool, sputum etc). It is also called clinical
laboratory science .
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History of medical laboratory science

 Medical laboratory sciences have existed as a part of

healthcare for almost one hundred years.
 Initially laboratory physicians (pathologists) and/or

academic researchers trained individuals to perform

procedures under their guidance.

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History of …

 In the 1950s and 1960s, the explosion of knowledge in

the biological and clinical sciences, the development of
automation and more sophisticated laboratory
techniques and its relevance to the delivery of health
care, created the need for well defined and more
academically organized medical laboratory science
program.

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History…

 By the 1980s many degree granting institutions had

established curricula in medical laboratory science.
 The professional requirements of medical laboratory
science advanced from “no formal qualification” in
the 1940s and 1950s, to bachelor’s degree, followed
by the master’s degree and doctoral degree programs
in the last 30 years.

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History ….

 Today, medical laboratory science is a well developed

body of knowledge that includes portions of basic
and medical sciences, medical techniques and
research methods.
 This facilitates and ensures the production of quality
medical diagnostic testing.

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1.2: Classification of laboratories

WHO classify laboratory into 3- levels based on risk levels.

 What is risk group?
 Risk group I
 - Low individual & low community risk.
 (A pathogen is unlikely to cause disease.)

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Classification …

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Classification …

 Risk group III

 High individual & low community risk
 A pathogen that usually produces human disease
but does not ordinarily spread from one infected
individual to another.)
 E.g. Brucella, clostridium botulism

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Classification …

 Risk group IV
 High individual & community risk
 A pathogen that usually produces serious human
diseases & may be readily transmitted from an
individual to another directly or indirectly within
the community.
 No effective prophylaxis or treatment

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Classification…
1.Basic lab. (Level 1 and level 2 laboratories)
 It is the simplest kind.
 It is adequate for work at the PHC and hospital
diagnostic lab.
 It is adequate for work with organisms in risk group 1
and 2
i.e. Low risk.

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Classification …

2. Containment lab –( level 3)

 More advanced and it is used for work with infections
organism E.g. TB, salmonella – risk group -3.
 The principle is to remove from basic lab those
organisms which are particularly hazards.
 The objective is to expose as few people as possible to
the risk of infection.

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Classification …

 It is a separate room with controlled access by

authorized staff only
 It should be fitted with a microbiological safety cabinet.
 Its ventilation should be arranged.

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Classification ….

3. Maximum containment lab (level 4)

 intended for work with viruses.
 Risk group-4 for which the most strict safety
precautions are necessary.
 These labs are usually separate buildings with strictly
controlled access through decontaminant showers.
 All air from rooms is filtered before discharge to the
atmosphere
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1.3: Structure of laboratory services
A medical Laboratory service must be integrated with the
health care system which exists in the country.
- This is function as a network, which could be accessible
and provide a service that is needed by the community.
This Networking consists of:
A. community-based health center lab:-
I). comprehensive health centers lab.
 investigation controlling and preventing major
disease in a community.
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Structure of…
 staffed by lab personnel
 Promote health by health education
 Able to perform basic tests.
ii). Maternity health units (MCH)
Staffed with nursing staff trained by MLT and
responsible in :
 Screening for anemia and proteinuria.
 Collecting blood for antibody screening or for
examination of parasites
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Structure of …

B. District Hospital laboratories (DHL)

 In addition to the work stated above the laboratories
have an
important role in:
 Supervising the work of community-based health
center lab.
 Testing referred specimens
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Structure of …

 has facilities for clinical investigations and

epidemiological surveys.
 Specimen collection and transportation system .
 Patients attending health center to benefit from
the facilities of DHL.
 Epidemics to be investigated rapidly

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Structure of…
C. Regional (hospital) laboratories
 In addition to the work stated above the laboratories
 It assists and supervise the DHL.
 Analyses referred samples .
 Perform a range of specialized testes.
 Investigate epidemic and do more clinical and
public health facilities.
 Trains lab technicians by organizing refresher
courses. 23
Structure of …
D. Central (hospital) and public health laboratories
 In addition to the work stated above the laboratories
• It assists and supervise the DHL
• Analyses referred samples
• Perform a range of specialized testes
• Investigate epidemic and do more clinical and
public health facilities.
• Trains lab technicians by organizing refresher
courses. 24
 •N.B There are
also private
hospital, clinic&
diagnostic
laboratories Summary of laboratory service network

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1.4 Medical Laboratory and Its Function in a
Health Care System.

 Laboratory has an important role in:

I. Providing quality health care service
II. Achieving efficiency and cost effectiveness in
health care system.
III. Achieving good health planning and
management in health care system.

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Medical Laboratory and …
i. The role of laboratory in providing quality health care
1.laboratory investigation increase the accuracy of disease
diagnosis.
 Many infectious disease and serious illness can be
diagnosed by using the laboratory.
E.g. error in diagnosis of malaria is high when diagnosis is
on clinical symptoms only.

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Medical Laboratory and ...

2. Laboratory has essential role in screening for ill health

and assessing response to treatment.
 Assess a patients response to drug therapy.
 Screen individuals with infectious disease. E.g. TB,
sexually transmitted diseases.
 Screen whole blood and blood product for transfusion
transmitted pathogen .
 Screen pregnant women for anemia, infections which
may transmitted to newborn and others. 28
Medical Laboratory and...
3. The laboratory is needed to work with other in reducing
infection in the community and investigating epidemics
rapidly.
 Detecting source of infection, identifying carries
contact tracing
 Participating in epidemiological surveys
 On site testing and collection and dispatch of
specimens when an epidemic occurs
 Participating in health education
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Medical Laboratory and...

ii. The role of laboratory in achieving efficiency and cost

effectiveness in health care system.
1. The laboratory reduce the expenditure of money on
drugs.
 Drugs can be used more selectively and only
when needed.
 Drug resistance can be identified more rapidly
and monitored.
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Medical Laboratory and…

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Medical Laboratory and…

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Medical Laboratory and…
iii. The role of laboratory in achieving good health planning
and management
1.Reliable laboratory test result with relevant patient data,
provide information on the health status of a community,
health pattern and disease trend. This information is
needed to establish health care priority and plan:
 Health care program.
 Training of health personnel and delivery of
health service.
 Treatment schedule and change in drug usage.33
Medical Laboratory and…

2. public heath laboratories provide accurate

epidemiological information for health planning
 cause of the disease in the community.
 prevalence and incidence rate of infectious
disease.

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Medical Laboratory and…
With out reliable lab support:
 Patients less likely to receive the best possible care.
 Resistance to essential drugs will to continue to
spread.
 The source of disease may not be identified
correctly.
 Epidemics and spread of major communicable
diseases will not be checked reliably.
 Valuable financial and human resource may not use
properly.

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Medical Laboratory and…
 Indications (importance) of requesting lab examinations
are:
 To make a diagnosis of pathogen.
 Confirm a clinical impressions.
 To rule out (R/o)a disease and diagnosis.
 To provide prognostic information.
 To screen for disease.

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Medical laboratory and…

 To provide therapeutic guidance so that:

 Drugs can be used more selectively.
 Patterns of emerging drug resistance can be
identified.
 Side effects and progress are monitored.

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1.5: Function & use of different medical
laboratory department/units

 Hematology- deals with examination of the constituent

of blood.
 Clinical chemistry – deals with measurement of various
bio-chemicals changes in serum and body fluids.
 Immunohematology- deals with blood banking and
transfusion medicine.

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Function & use of …

 Medical microbiology - deals with microorganisms of

medically important, performing different diagnostic and
research activities on micro organisms and parasites.
Microbiology includes the following sub disciplines
 Bacteriology is a science dealing with bacteria.
 Virology is the study of virus and viral disease.
 Mycology is the study of fungi.
 Parasitology: is the study of parasites.
 Immunology: study about immune system.
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Function & use of …

 Urinalysis and body fluid analysis- deals with the analysis

of their constituents.

 Serology- is the study of antigen and antibody and their

interaction in vitro.

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Function and use of …

Molecular biology: is the branch of biology that seeks to

understand the molecular basis of life. In particular, it

relates the structure of specific molecules of biological

importance—such as proteins, enzymes, and the nucleic

acids DNA and RNA—to their functional roles in cells and

organisms.

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1.6: Role of medical laboratory personnel

Introduction:
 Medical laboratory is a health profession its goal is
to resolve patients’ problem presented to the
physician by performing laboratory analysis.
 Roles:
1. Diagnosing of diseases
 Errors occur when diagnosis of diseases
depend on clinical symptoms alone.
Role of medical laboratory ……..

2. Treating of diseases
 Antibiotic sensitivity testing
 Monitoring of patients response to
treatment
3. Screening of diseases
 Detection of in apparent infections

4. Control of epidemics
 Early detection of pathogens 44
Role of medical laboratory …

5. Surveillance & provision of health information

 Source identification
 Water supply testing
 Carrier identification
 Risk factor assessment
6. Controlling field trials
 New drug/vaccine testing

 Vaccine potency test

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Role of medical laboratory ……..

7. Management of finance, equipment and supplies

8. Ensuring a reliable and quality lab practice
Such a comprehensive commitment to quality is essential
to achieve –
 Best possible service to patients
 User confidence
 Effectiveness and efficiency
 Accountability
 Optimal use of resources 46
Role of medical laboratory ……..

 Therefore, the physician or other health professional is

dependent up on the skill and ability with which the
laboratory personnel perform his/her duties.
 YOU AS A LAB. TECHNOLOGIST HOLDS LIFE AND
DEATH IN YOUR HANDS, BECAUSE THE INFORMATION
YOU GIVE TO THE PHYSICIAN INFLUENCES THE
MEDICAL TREATMENT A PATIENT RECEIVES.

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Role of medical laboratory …

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.

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1.7: Laboratory rules, ethics and policies

 Ethics-moral principle or rules of behavior that govern or

influence a person’s behavior.
 Rule-a statement of what, should or must be done in
particular circumstance.
 Code of conduct -a set of professional standards agreed
on by members of a particular profession.

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Laboratory rules……

Code of conduct for medical laboratory personnel

 Should include those practices and attitudes which
characterize a professional and responsible lab officer.
 Adopting it helps to remind medial laboratory personnel
of their:
 Responsibility to patients.
 Duties to up holds professional standards and.
 Need to work with complete integrity.
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 Laboratory rules…

1. Place the wellbeing & service of the patient above

your own interest.
2. Be loyal to your profession by maintaining high
standard of work & striving to improve professional
skill & knowledge.
3. work scientifically & with complete honesty.
4. don’t misuse your professional skill or knowledge for
personal gain.
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Laboratory rules…
5. Never take anything from your place of work that does
not belongs to you.
6. Don’t disclose to a patient or any other unauthorized
person the result of your investigation.
7. Treat your patient with strict confidentiality.
8. Respect & work in harmony with other members of
your staff or health center team.
9. Be any time courteous, patient, considerate to the
sick & their relatives. 53
Laboratory rules…..

10. Follow safety procedures & know how to apply first

aid.
11. Don’t drink alcohol or unprescribed drugs that would
interfere to your work performance during laboratory
working hours.
12. Use laboratory equipments with care.
13. Don’t waste reagents & other supplies.
14. Safeguarded the dignity & privacy of the patient.
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Laboratory rules…..

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.
 These policies usually cover:
A. Laboratory hour and emergency work.

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Laboratory rules…..

B. Range of tests to be performed and those to be referred

to higher level.
 Range of tests to be performed depend on
 The number of material resources
 The availability of material resources
 The types of health institution
 Referral of specimen

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Laboratory rules….
C. Collection of Specimen
 Correct collections of specimens are essential for
reliable test results.
 During receiving specimens observe certain details to
insure that appropriate specimens are collected.
 The containers should be labeled with patients name I.d
number, date and time of collection
 A fully completed, request form should accompany each
specimen with the detail mentioned above. 57
Laboratory rules….

D. Work load capacity of the laboratory

It should be matched to the:-
 Number of a staff and their level of training.
 The size of the laboratory.
 The availability of laboratory facilities.
 The available man power.

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 Laboratory rules….

E. Delivery of report of results

 Laboratory staff should provide valid result of tests.
 Result should be clearly and neatly written.
 To ensure the validity and accuracy of test results the
following points should be taken in to consideration:

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laboratory rules …

 The result before they leave the laboratory must be

checked by the most experienced member of the
laboratory technical staff.
 Any unexpected result should be investigated and
repeated if necessary.
 Reference values (normal range) should be included
in the reports.

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Summary Question

1. Discuss about the history of medical laboratory service .

2. Explain the current status of medical laboratory service
in Ethiopia.
3. What is the role of medical laboratory personnel?
4. State laboratory rules, ethics and professional code of
conduct.

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Reference
1. Linne Jean Jergenson, Basic techniques of medical
laboratory 4th ed. 2000.
2. WHO, Manual of basic techniques for a health
laboratory 2000.
3. Chees brough M.District Laboratory manual for
tropical courtiers, Cambridge Univerity press, 2000 (Vol )
.
4. Chees brough M.District Laboratory manual for
tropical courtiers, Cambridge Univerity press, 2000 (Vol
II).
5. Seyoum B. Introduction to medical laboratory
technology students lecture note series 2002.
6. www.CDC.gov
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Next : will be on : Lab
equipment and wares
End of slide
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