QUIZ 1 Flashcards
requires that employers provide and pay for PPE and ensure that it is used wherever “hazards of processes or environment, chemical hazards, radiological hazards, or mechanical irritants are encountered in a manner capable of causing injury or impairment in the function of any part of the body through absorption, inhalation or physical
contact.”
The Personal Protective Equipment (PPE) standard
Laboratory chemicals include
cancer-causing agents
(carcinogens), toxins (e.g., those
affecting the liver, kidney, and
nervous system), irritants,
corrosives, sensitizers, as well as
agents that act on the blood
system or damage the lungs, skin,
eyes, or mucous membranes
Chemical Hazards
The Laboratory standard consists of five major elements:
- Hazard identification;
- Chemical Hygiene Plan;
- Information and training;
- Exposure monitoring; and
- Medical consultation and examinations.
- Biological Agents (other than Bloodborne Pathogens) and Biological Toxins
- These hazards are present in various sources throughout the laboratory such as blood and body fluids, culture specimens, body tissue and cadavers, and laboratory animals, as well as other workers.
Biological Hazards
True or false ?
- OSHA defines blood to mean human blood, human blood components, and products made from human blood
True
Bloodborne Pathogens The OSHA Bloodborne Pathogens (BBP) standard is designed to protect workers from the health hazards of exposure to bloodborne pathogens.
True
OPIM means:
(1) Other body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with
blood
* (2) Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and
* (3) HIV- or HBV-containing cell or tissue cultures, organ cultures, and HIV or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV
Besides exposure to chemicals and biological agents, laboratory workers can also be exposed to a number of physical hazards.
Physical Hazards and Others
Laboratory workers are at risk for repetitive motion injuries during routine laboratory procedures such as pipetting, working at microscopes, operating microtomes, using cell counters and keyboarding at computer workstations. Repetitive motion injuries develop over time and occur when muscles and joints are stressed, tendons are inflamed, nerves are pinched and the flow of blood is
restricted. Standing and working in awkward positions in front of laboratory hoods/biological safety cabinets can also present ergonomic problems.
Ergonomic Hazards
OSHA’s Ionizing Radiation standard, sets forth the limitations on exposure to radiation from atomic particles. Ionizing radiation sources are found in a wide range of occupational settings, including laboratories. These radiation sources can pose a considerable health
risk to affected workers if not properly controlled.
Ionizing Radiation
is described as a series of energy waves
composed of oscillating electric and magnetic fields traveling at the speed of light. Nonionizing radiation includes the spectrum of ultraviolet (UV), visible light, infrared (IR), microwave (MW), radio frequency (RF), and extremely low frequency (ELF). Lasers commonly
operate in the UV, visible, and IR frequencies. Non-ionizing radiation is found in a wide range of occupational settings and can pose a considerable health risk to potentially exposed workers if not properly
controlled.
Non-ionizing Radiation
Noise
OSHA’s Occupational Noise Exposure standard, requires employers to develop and implement a hearing conservation program that includes the use of PPE (e.g., hearing protectors), if workers are exposed to a time-weighted average (TWA) of ≥ 85 dBA over an 8-hour work shift. In addition, when workers are exposed to noise levels ≥ 85 dBA, the employer must develop a monitoring program to assess noise levels.
The majority of all centrifuge accidents are the result of user error.
True
- In the laboratory, there is the potential for workers to be exposed to electrical hazards including electric shock, electrocutions, fires and explosions.
- The potential for possible electrocution or electric shock or contact with electrical hazards can result from a number of factors, including
the following: - Faulty electrical equipment/instrumentation or wiring;
- Damaged receptacles and connectors; and
- Unsafe work practices.
Electrical Hazard
- Fire is the most common serious hazard that one faces in a typical laboratory. While proper procedures and training can minimize the chances of an accidental fire, laboratory workers should still be prepared to deal with a fire emergency should it occur.
- Laboratories, especially those using solvents in any quantity, have the potential for flash fires, explosion, rapid spread of fire, and high toxicity of products of combustion (heat, smoke, and flame).
Fire Hazard
- Worker exposure to wet floors or spills and clutter can lead to slips/trips/falls and other possible injuries.
- Keep floors clean and dry
- In addition to being a slip hazard, continually wet surfaces promote the growth of mold, fungi, and bacteria that can cause infections.
*Provide warning (caution) signs for wet floor areas. - Where wet processes are used, maintain drainage and provide false floors, platforms, mats, or other dry standing places where practicable, or provide appropriate waterproof footgear,
- The Walking/Working Surfaces standard requires that all employers keep all places of employment clean and orderly and in a sanitary condition
Trips, Slips and Falls
Storage of food or drink in refrigerators, freezers,
shelves, cabinets or on countertops or benchtops
where blood or OPIM are present
True
Appropriate PPE for workers if blood or OPIM exposure is anticipated
True
The type and amount of PPE depends on the anticipated exposure.
True
Gloves must be worn when hand contact with blood, mucous membranes, OPIM, or non-intact skin is anticipated, or when handling contaminated items or surfaces,
True
Surgical caps or hoods and/or shoe covers or boots must be worn in instances when gross contamination can reasonably be anticipated such as during autopsies or orthopedic surgery.
True
Effective engineering and work practice controls to help remove or isolate exposures to blood and bloodborne pathogens)
True
Hepatitis B vaccination (if not declined by a worker) under the supervision of a physician or other licensed healthcare professional to all workers who have occupational exposure to blood or OPIM.
True
Employers should ensure that workers are trained to do the following in order to prevent fires
- Plan work. Have a written emergency plan for your space and/or operation.
- Minimize materials. Have present in the immediate work area and use only the minimum quantities necessary for work in progress. Not only does this minimize fire risk, it reduces costs and waste.
- Observe proper housekeeping. Keep work areas uncluttered, and clean frequently. Put unneeded materials back in storage promptly. Keep aisles, doors, and access to
emergency equipment unobstructed at all times. - Observe restrictions on equipment (i.e., keeping solvents only in an explosion-proof refrigerator).
- Keep barriers in place (shields, hood doors, lab doors).
“RACE” rule in case of a fire
- R= Rescue/remove all occupants
- A= Activate the alarm system
- C= Confine the fire by closing doors
- E= Evacuate/Extinguish
Employers should ensure that workers are trained in the following emergency procedures
*Know what to do. You tend to do under stress what you have practiced or pre-planned. Therefore, planning, practice and drills are essential.
*Know where things are: The nearest fire extinguisher, fire alarm box, exit(s),
telephone, emergency shower/eyewash, and first-aid kit, etc.
* Be aware that emergencies are rarely “clean” and will often involve more than one type of problem.
*Train workers and exercise the emergency plan.
* Learn to use the emergency equipment provided.
“PASS” rule for fire extinguishers
- P – Pull the pin
- A – Aim extinguisher nozzle at the base of the fire
- S – Squeeze the trigger while holding the extinguisher upright
- S – Sweep the extinguisher from side to side; cover the fire with the spray
If a coworker’s clothing catches fire and he/she runs down the hallway in panic, tackle him/her and smother the flames as quickly as possible, using appropriate means that are available (e.g., fire
blanket, fire extinguisher)
True
If the floor is not on fire, STOP, DROP and ROLL to extinguish the flames or use a fire blanket or a
safety shower if not contraindicated (i.e., there are no chemicals or electricity involved).
True
OBJECTIVES OF QUALITY CONTROL IN HISTOPATHOLOGY
LABORATORY
- To ensure quality services that guarantees patient’s satisfaction
- To produce high quality sections within and between laboratories
- To generate accurate, timely and complete reports
- To reduce turn around time
- To promote ethics and professionalism
- To enhance improved performance
- To enahance continuous training and professional development
- Surgical pathology
- Cytopathology report
- Autopsy report
Histopath Reports
Number of copies prepared per report:
Three copies
Specimen Handling
procedures
- FIX FIRST!
- Label
Storage of Specimen, Tissue blocks, Slides
- Specimen =3-6 mos but 3 yrs if medicolegal
- Tissue Blocks= at least 10 years
- Slides= at least 10 years
Routine Turn-over of Results
- Surgical pathology and cytology
- Frozen section
- Autopsy report
- · Laboratory Design
- · Personnel
- · Equipment
- · Sampling
- · Request Form
- · Fixation
- · Transportation
- · Registration
- · Laboratory Number
- · Reagents
- · ICT
PRE-ANALYTICAL REQUIREMENTS
- Grossing
- Tissue processing
- Standard Operating Procedures
- Controls
- Equipment
- Screening of slides
- Documentation
ANALYTICAL REQUIREMENTS
- Reporting
- Interpretation
- Typing of reports
- Communication
- Auditing
- Dispatch of reports
- Block archive
- Tissue bank
- CPD
- Inventory
- Critical value reporting
- Quality assurance
- Laboratory information system
POST-ANALYTICAL REQUIREMENTS
Results details will include at least:
- Patient identification data
- Name and address of the laboratory
- Name of requesting physician
- Laboratory ID number
- Date of specimen procurement (specimen date)
- Date of arrival of the specimen in the laboratory
- Sample type
- Anatomical site of origin
- Relevant clinical details
The microscopic diagnosis will record all grades of squamous and/or glandular
intra- epithelial neoplasia, and invasive lesions. The distribution of a lesion will
note if an orientated specimen has been submitted.
true
Any invasive lesions are classified and
graded according to national protocols and
guidelines.
true
Other significant pathologic features, such as
significant inflammatory changes will be
recorded
true
QUALITY ASSURANCE IN HISTOPATHOLOGY
TURNAROUND TIME (TAT)
- Time between date of reporting results of the specimen from date of
specimen arrival within the laboratory. - Small specimens
- Large specimens
QUALITY REQUIREMENT INTERNAL QUALITY CONTROL
Performance evaluations
* Periodic audit of histopathology
outcomes
* Monitoring of non-conformities
* MDT review of slides
* Monitoring histopathology detection and reporting rates
* Correlation of cytology with clinical/histological outcome.
12/13 steps of tissue process
NUMBERING
FIXATION
DECALCIFICATION (for bones only)
DEHYDRATION
CLEARING
IMPREGNATION
EMBEDDING
BLOCKING
TRIMMING
SECTIONING
STAINING
MOUNTING
LABELLING
NFDCIEBTSSML
Automated Tissue Processors
Tissue-transfer processors
(carousel-type)
* characterized by the transfer of
tissues, contained within a
basket, through a series of
stationary reagents arranged inline or in a circular carousel plan.
* 9-10 reagent positions and 2-3
wax positions
* Capacity: 30-110 cassettes
Automated Tissue Processors
Automated Tissue Processors
- Characterized by processing fluids
pumped to and from a retort in which the
tissues remain stationary -
10-12 reagent stations with temperatures
adjustable between 30-45°C - 3-4 paraffin wax stations with variable
temperature settings between 48-68°C - Capacity: 100-300 cassettes
Fluid-transfer processors
basic instrument used that is capable of cutting
section at a predetermined thickness by sliding the block into a cutting tool which is fixed and attached to the machine
Microtome
A spring balance teeth or pawl is brought into contact with, and turns a ratchet feed wheel connected to a micrometer screw, which in turn rotated, moving the tissue block at a predetermined distance towards
the knife for cutting sections at uniform thickness
Microtome
Kinds of Microtome
Consist of a heavy base and two arms:
Rocking Microtome
Kinds of Microtome
- Cambridge rocking microtome
- Invented by Paldwell Trefall in 1881
- Simplest among the different types of microtome
Rocking Microtome
Kinds of Microtome
- Minot microtome
- Invented by Minot in 1885-1886
- Most common type used for both routine and research laboratories
Rotary Microtome
Kinds of Microtome
*Used to cut small and large blocks of paraffin
tissues.
*Not recommended for serial sections because
tissues are cut in slightly curved planes
*Disadvantage:
* Restrictions in size of tissue block that can be cut
* Difficulty of reorienting the block
Rocking Microtome
Kinds of Microtome
- Consist of two movable pillars holding the adjustable knife clamps, allowing the knife to be set at an angle for cutting celloidin sections
- Favored in laboratories where very hard tissue or large blocks are usually sectioned.
- Suited for sectioning specimens embedded in all forms of media
- Comparatively more stable
Base-sledge Microtome
Kinds of Microtome
*Operated by the rotation of the flywheel
* Causes reciprocal motion of the knife over the block
* Thickness of the section being automatically regulated by the ratchet feed wheel
Rotary Microtome
- Developed by Adams in 1789.
- Especially recommended for cutting extremely hard and rough tissue blocks.
- Most dangerous type of
microtome
Sliding Microtome
- Difference from the Rocking Microtome:
- The knife and the block holder are brought together
by upward and vertical motions - Cuts sections in a perfectly flat plane.
- Heavier and more stable
- More complex in design and construction
- More expensive
- The blade is placed in a blade-up position which is
relatively dangerous
Rotary Microtome
Is Base-sledge Microtome classified as sliding microtome ?
Yes
