PMLS1 Notes PDF

PMLS MIDTERMS Courses: Definition of Curriculum 1. Understanding the self 2. Readings in Philippine History - Latin currere which means to run...

PMLS MIDTERMS Courses: Definition of Curriculum 1. Understanding the self 2. Readings in Philippine History - Latin currere which means to run 3. The Contemporary World a. Systematic and organized 4. Mathematics in Modern World b. States outcomes the learners/students 5. Purposive Communication have to achieve and learn (outcome 6. The Life and Works of Rizal based) 7. Science, Technology and Society c. Consists of a planned process of 8. Art Appreciation measurement, assessment, and 9. Ethics evaluation to gauge student learning d. Designed for students Professional Courses R.A. No. 7722 - Taken to develop the knowledge, technical competence, professional - Higher Education Act of 1992 attitude and values necessary to practice - Established CHED on May 18, 1994 and meet the demands of the profession Commission on Higher Education (CHED) 1. Principles of Medical Laboratory Science 1: Introduction to Medical - The government agency under the Laboratory Science, Laboratory Safety Office of the President of the Philippines and Waste Management that covers institutions of higher - Basic concepts and principles related to education both public and private MT/MLS Technical Committee for Medical Technology 2. PMLS 2: Clinical Laboratory Assistance Education (TCMTEE) and Phlebotomy - Concepts and principles of the different - Setting standards among institutions assays performed in the clinical offering BS Medical Technology/Medical laboratory Laboratory Science program and in 3. Community and Public Health for monitoring and evaluating such MT/MLS institutions - Study the foundations of community CHED Memorandum Order (CMO) No. 13, health series of 2017 4. Cytogenetics - Study the concepts and principles of - Policies, standards and guidelines for the heredity and inheritance BS in MT/MLS program 5. Human Histology - Contains the goals, program outcomes, - Study the fundamentals of cells, tissues performance indicators and the and organs with emphasis on minimum course offerings microscopic structures, characteristics, General Education differences and functions - Theoretical - Aims to develop foundational - Tissue processing, cutting of processed knowledge, skills, values and habits tissue, staining, mounting of stained necessary for students tissue for microscopic examination, PMLS REVIEWER FOR MIDTERMS | GABITO MT1C  performing biosafety and waste 12. Medical Technology Laws and management Bioethics 6. Histopathologic Techniques of 13. Hematology 1 Cytology - Study of concepts of blood as a tissue - Covers the basic concepts and principles - Physiologic characteristics (normal) of disease processes, etiology, and the 14. Hematology 2 development of anatomic, microscopic - Concepts and principles of hemostasis, changes brought about by the disease and abnormalities involving RBC, WBC process and platelets 7. Clinical Bacteriology *Hemostasis – blood stopping - Study of the physiology and morphology of bacteria and their role in infection and 15. Clinical Microscopy immunity - Study of urine and other bodily fluids - Preparation of culture media, collection 16. Clinical Chemistry 1 of specimen, preparation of bacterial - Concepts and principles of smear, staining smear, etc. physiologically active soluble substances 8. Clinical Parasitology and waste materials present in body - Study of animal parasites in humans and fluids, particularly in blood their medical significance in the country - Study includes formation, laboratory - Emphasis on the pathophysiology, analyses, reference values and clinical epidemiology, life cycle, prevention and correlation with pathologic condition control and the identification of ova 17. Clinical Chemistry 2 and/or adult worms - Study of endocrine glands and - Unholy trinity: nematodes (round hormones and their formation, worms), trematodes (flat worms), laboratory analyses, and clinical cestodes correlation 9. Immunohematology and Blood Bank 18. Seminars 1 and 2 - Identification of red cells antigens and - Taken during the student’s fourth year in their corresponding antibodies the program - ABO and Rh typing, Coombs test (direct 19. Molecular Biology and Diagnostics and indirect), blood donation process, Research Courses etc 10. Mycology and Virology 1. Research 1: introduction to laboratory - Study of fungi and viruses science research - Emphasis on epidemiology and 2. Research 2: research paper writing and laboratory identification and presentation characterization and prevention and Clinical Internship training control 11. Laboratory Management - 32 hours of duty per week not exceeding - Concepts of laboratory management a total of 1,664 hours in one year which are planning, organizing, staffing, directing and controlling PMLS REVIEWER FOR MIDTERMS | GABITO MT1C Professional Regulation Committee with situations, problems, and conflicts in the practice of their profession - Government agency, under the Office of 4. Actively participate in self-directed life- the President of the Philippines, tasked long learning activities to be updated to administer licensure examinations to with the current trends in the profession different professionals 5. Actively participate in research and Professional Regulatory Board community-oriented activities 6. Be endowed with leadership skills - Under PRC, tasked to prepare and 7. Demonstrate collaboration, teamwork, administer the written licensure integrity, and respect when working in a examinations for graduates qualifies to multicultural environment take the examination Function of Assessment Techniques R.A. 5527 1. Provides feedback - The Medical Technology Act of 1969 2. Identifies flaws Courses in the Licensure Examination 3. Serves as a diagnostic tool 4. Serves as a motivation to further Clinical Chemistry 20% improve a student’s skill Microbiology and 20% 5. Provides information on students’ Parasitology Hematology 20% response to a particular learning Blood Banking and 20% strategy Immunology and Serology 6. Provides information to the teacher if Clinical Microscopy 10% there is need to improve teaching and Histopathologic 10% learning strategies Technologies MTLaws and Bioethics and Not included in Types of Assessment Laboratory Management R.A. 5527, but 1. Formative assessment are now - Done during and/or within the included in the instructional process of a course board exam 2. Summative assessment Program outcomes of BSMT/BSMLS degree - Done at the end of instruction expect students to: 3. Diagnostic assessment 1. Demonstrate knowledge and technical - Given prior to instruction skills needed to correctly perform History of Laboratory Safety laboratory testing and ensure reliability of test results 1943 2. Be endowed with the professional - US Biological Weapons Program (Cold attitude and values enabling them to War) under President Franklin Roosevelt work with their colleagues and other - Ira L. Baldwin – 1st scientific director of members of the health care delivery Camp Detrick (now known as Fort system Detrick) 3. Demonstrate critical thinking an - Establish biological weapons program problem solving skills when confronted for defensive purposes. PMLS REVIEWER FOR MIDTERMS | GABITO MT1C 1969 1976 - Termination of program by President - NIH published Guidelines for Research Richard Nixon Involving Recombinant DNA Molecules. - Newell A Johnson – designed 1983 modifications at Camp Detrick. o Class III safety cabinets - Laboratory Biosafety Manual (WHO). o Laminar Flow Hoods 1984 1984 - Biosafety in Microbiological and - American Biological Safety Association Biomedical Laboratories (CDC, NIH) (ABSA) 1996 1907 and 1908 - US government enacted the Select - Arnold Wedum Agent Regulations o One of the pioneers of Biosafety - Monitor transfer of select list of o use of mechanical pipettors to biological agent from one facility to prevent laboratory acquired another. infections. 2001 1909 - Amerithrax - Pharmacy Company in Pennsylvania - Revised Select Agent Regulations developed a ventilated cabinet to - required specific security measures for prevent MTB. any facility that used or stored one or more agents on the new, longer list of 1967 agents. - smallpox outbreak 2012 - WHO aggressively pursued eradication of virus - Revision of Select Agent Regulations - Remaining virus stocks were - Creation of two tiers of select agents consolidated in the following locations: - Tier 1 agents pose greater risk of o Center for Disease Control and deliberate misuse. Prevention (CDC) Guidelines on Laboratory Biosafety and o State Research Center of Biosecurity Virology and Biotechnology VECTOR (SRCVB VECTOR) Comité Européen de Normalisation (CEN) 1974 - CEN Workshop Agreement 15793 (CWA 15793), February 2008. - CDC published Classification of - Updated in 2011 and expired in 2014. Etiological Agents on the Basis of Hazard World Health Organization - Laboratory Biosafety Manual, 1983 - Contaiment levels 1-4. PMLS REVIEWER FOR MIDTERMS | GABITO MT1C Cartagena Protocol on Biosafety (CPB), 2003 Biosafety - Provides international regulatory - “Protecting People from Bad Bugs” framework to ensure “an adequate level Principles: of protection in the field of safe transfer, handling, and use of living modified To protect: the patient, you, environment organisms (LMOs) resulting from Biosafety level modern biotechnology”. - Level of the biocontainment precautions National Committee on Biosafety of the required to isolate dangerous biological Philippines (NCBP)-established under EO.430 agents in an enclosed facility. s 1990. Biohazard Symbol - National Biosafety Framework (NBF), March 17, 2006 - Developed by the Dow Chemical - Combination of policy, legal, Company in 1966 administrative, and technical - Characteristic of the symbol instruments developed to attain o Striking – to draw immediate objectives of CPB. attention o Unique and unambiguous Department of Agriculture (DA) – AO No. 8 o Quickly recognizable and easily - Policies on importation and release of recalled plants and plant products derived from o Easily stenciled modern biotechnology. o Symmetrical o Acceptable to groups of varying Department of Health (DOH)– AO No. 2007- ethnic backgrounds 0027 - There are four circles within the symbol, - Policy guidelines on laboratory biosafety signifying the chain of infection. and biosecurity. o Agent: The type of - Minimum standards and requirements microorganism, that causes for clinical laboratories. infection or hazardous condition. o Host: The organism in which the Different Organizations in the Field microorganism Infect. The new 1. American Biological Safety Association host must be susceptible. (ABSA) o Source: The host from which the 2. Asia-Pacific Biosafety Association (A- microorganism originate. The PBA) carrier host might not show 3. European Biological Safety Association symptoms. (EBSA) o Transmission: The means of 4. Philippine Biosafety and Biosecurity transmission, mostly direct or Association (PhBBA) indirect. Some routes of 5. BioRisk Association of the Philippines transmission include air, insect, (BRAP) direct contact and contaminated surfaces. PMLS REVIEWER FOR MIDTERMS | GABITO MT1C Risk Groups to another, directly or indirectly. Effective treatment and  Risk Group 1 (no or low individual and preventive measures are not community risk) usually available. o A microorganism that is unlikely cause human or animal disease. Biosafety Cabinets  Risk Group 2 (moderate individual risk, - Primary means of containment, low community risk) developed for working safely with o A pathogen that can cause infectious microorganism human or animal disease but is - BSCs are only one overall part of unlikely to be a serious hazard biosafety program, which requires o Laboratory exposures may cause consistent use of serious infection, but effective o Good microbiological practices treatment and preventive o Primary containment equipment measures are available and the o Primary containment facility risk of spread of infection is design limited.  Risk Group 3 (high individual risk, low BSC Class 1 community risk) - Allows room air to pass into the cabinet o A pathogen that usually causes and around the area and material within, serious human or animal disease sterilizing only the air to be exhausted but does not ordinarily spread o Effective treatment and BSC Class 2 preventive measures are - Sterilizes air that flows over the available. infectious material, as well as air to be  Risk Group 4 (high individual and exhausted. community risk) o A pathogen that usually causes BSC Class 3 serious human or animal disease - Air coming into and going out of the and that can be readily cabinet is filter sterilized, and the transmitted from one individual infectious material within is handled with rubber gloves that are attached and sealed to the cabinet. Biosecurity - “Protecting Bad Bugs from Bad People” Challenges - One of the major challenges of biosecurity is that harmful technology is becoming more available and accessible. PMLS REVIEWER FOR MIDTERMS | GABITO MT1C  - Biomedical advances can make it easier o Melioidosis (Burkholderia for terrorists to produce biological pseudomallei) weapons o Psittacosis (Chlamydia psittaci) o Q fever (Coxiella burnetii) Achieved Through o Ricin toxin from Ricinus  Physical barriers communis (castor beans)  Psychological barriers o Abrin toxin from Abrus  Monitoring Activities precatorius (Rosary peas)  Personnel Clearance o Staphylococcal enterotoxin B o Typhus (Rickettsia prowazekii) Bioterrorism  Category C - is terrorism involving the intentional - Category C agents are emerging release or dissemination of biological pathogens that might be engineered for agents. mass dissemination because of their availability, ease of production and Types of Agents dissemination, high mortality rate, or  Category A ability to cause a major health impact. - These high-priority agents pose a risk to o Nipah virus national security, can be easily o Hantavirus transmitted and disseminated, result in o SARS high mortality, have potential major o H1N1 (a strain of influenza) public health impact, may cause public o HIV/AIDS panic, or require special action for public BIOSAFETY + BIOSECURITY = BIORISK health preparedness. o Tularemia or "rabbit fever“ Real-life Scenarios o Anthrax  2003 o Smallpox o Severe Acute Respiratory o Botulinum toxin Syndrome (SARS) o Bubonic plague o infected over 8,000 people and o Viral hemorrhagic fevers killed almost 800  Category B o Laboratory acquired SARS - Category B agents are moderately easy outbreaks to disseminate and have low mortality o Singapore –September 2003 rates o Taiwan –December 2003 o Brucellosis (Brucella species)  Mainland China (Beijing and Anhui) – o Epsilon toxin of Clostridium March 2004 perfringens o Food safety threats (for example, Infection: Salmonella species, E coli  Who: Singapore Male graduate student O157:H7,  Where: BSL3 lab, Environmental Health o Shigella, Staphylococcus aureus) Institute o Glanders (Burkholderia mallei) PMLS REVIEWER FOR MIDTERMS | GABITO MT1C   How: Inappropriate lab procedures and AMP Model of Biorisk Management cross-contamination of West Nile virus Assessment with SARS CoV  Who: Taiwan Male lab scientist - Risk  Where: BSL4 lab, Inst.Of Preventive identification Medicine, National DefenseMedical - Hazard/threat Center identification  How: Was working on SARS CoV. Found - Likelihood a spillage of material disinfected with evaluation 70% ethanol and cleaned manually - Consequences evaluation o (+) SARS -Environmental Mitigation samples from handle of alcohol spray bottle and switch panel of - Elimination or substitution cabinet - Engineering controls - Administrative controls The risk associated with biological materials in - Practices and procedures the laboratory has a safety and a security - Personal protective equipment component Performance Laboratory Biosafety - Control Assurance Improvement - containment principles, technologies, and practices implemented to prevent 5Ps unintentional exposure to pathogens 1. Pathogen and toxins, or their unintentional release 2. Procedures - PROTECTING PEOPLE FROM 3. Personnel DANGEROUS PATHOGENS 4. PE Laboratory Biosecurity 5. Place - institutional and personal security Risk Management measures designed to prevent the loss, - Identify the specific hazard or threat theft, misuse, diversion, or intentional - Determine the consequences of an release of pathogens and toxins identified risk - PROTECTING PATHOGENS FROM - identify all the existing controls and any DANGEROUS PEOPLE additional ones that need to be applied Laboratory Biorisk Management Hazard - System or process to control safety and - is an object that can cause harm security risks associated with the handling or storage and disposal of Threat biological agents and toxins in - a person who has intent and/or ability to laboratories and facilities cause harm to other people, animals, or the institution PMLS REVIEWER FOR MIDTERMS | GABITO MT1C Risk - can be based on either a hazard and/or a Engineering Controls threat - Physical changes to work stations, - the likelihood of an event/incident with a equipment, materials, production hazard that has consequences facilities, or any other relevant aspect of the work environment that reduce or prevent exposure to hazards Administrative Controls - Policies, standards and guidelines Likelihood Practices and Procedures - The probability an event occurring - Processes and Activities Consequence Personal Protective Equipment Devices - The severity of an event - worn by the worker to protect against hazards Implementing Mitigation Measures - Ideally, you should first consider elimination or substitution - A combination of control measures should be used based on their effectiveness and your ability to implement them Advantages and Disadvantages Control Advantages Disadvantage Risk Mitigation Control Measures Measure s Engineering Efficient, Cost, *arranged by the most difficult to implement to eliminates complexity easiest hazard Significantly * arranged by the most effective to least reduces the effective potential Elimination and the level of exposure - Removing the risk to pathogens. Substitution Administrativ Authority Indirect - Substitution of a serious pathogen with e Approach approach, one that is much less pathogenic addressed the human factor PMLS REVIEWER FOR MIDTERMS | GABITO MT1C  Practices and SOP Based Training and - Actively involved in research, Procedures (Standardize supervision community outreach programs, d approach) requirements surveillance, infection control in the PPE Ease of use, Does note hospital and community settings, relative cost eliminate information dissemination, and hazard: if PPE evaluation of the applicability of current fails exposure and innovative diagnostic technologies happens, - It is the place where specimens (e.g. uncomfortabl Blood and other body fluids, tissues, e, limits ability feces, hairs, nails) collected from individuals are processed, analyzed, preserved and properly disposed Performance Evaluation - A medical technologist/clinical - A systematic process intended to laboratory scientist plays a very achieve organizational objective and significant role in the performance of goals laboratory testing and ensuring the - The model ensures that the reliability of test results implemented mitigation measures are Classification of Clinical Laboratories indeed reducing or eliminating risks  According to function Performance management 1. Clinical Pathology – reevaluation of overall mitigation - It focuses on the areas of clinical strategy chemistry, immunohematologyand blood banking, medical microbiology, immunology and serology, hematology, parasitology, clinical microscopy, toxicology, therapeutic drug monitoring and endocrinology. - Concerned with the diagnosis and treatment of diseases performed through laboratory testing of blood and other body fluids. 2. Anatomic Pathology - It focuses on the areas of histopathology, immunohistopathology, cytology, autopsy and forensic Clinical Laboratory pathology - An essential component of a health - Concerned with the diagnosis of institution diseases through microscopic - Its main task is to provide accurate and examination of tissues and organs reliable information to medical doctors for the diagnosis, prognosis, treatment, and management of diseases PMLS REVIEWER FOR MIDTERMS | GABITO MT1C  According to Institutional  According to Service Capability Characteristics: 1. Primary Category 1. Institution-based - Licensed to perform basic, routine - it operates within the premises or part of laboratory testing – routine urinalysis, an institution such as a hospital, school, routine stool examination, routine medical clinic, medical facilities for hematology, complete blood count, overseas workers and seafarers, birthing blood typing and gram staining (if home, psychiatric facility, drug rehab hospital-based) center, etc. - Equipment requirements –microscopes, - Most common example: hospital-based centrifuge, hematocrit centrifuge clinical lab - Space requirement –at least 10 square 2. Free standing meters - It is not part of an established institution 2. Secondary Category - Most common example: free-standing - Licensed to perform laboratory tests outpatient clinical laboratory being done by the primary category clinical labs along with the following: Routine clinical chemistry tests like  According to Ownership o blood glucose concentration 1. Government-owned o Blood urea nitrogen (BUN) - These laboratories are owned, wholly or o Blood uric acid (BUA) partially, by national or local o Blood creatinine government units o Cholesterol determination - Examples are clinical and anatomical o Gram staining, laboratories of DOH-run government o KOH and hospitals: o cross matching(if hospital-based) o San Lazaro Hospital, Jose R. - Minimum equipment requirements - Reyes Memorial Medical Center, same with primary category plus UP-PGH semiautomated chemistry analyzer, - Examples are LGU hospital-based autoclave, incubator and oven clinical laboratories - Minimum space requirement –20 square o Ospital ng Maynila Medical meters Center, Sta. Ana Hospital, 3. Tertiary Category Bulacan Medical Center - Licensed to perform all the laboratory 2. Privately Owned tests in the secondary category plus: - Owned, established and operated by an o Immunology and serology individual, corporation, institution, o Microbiology, bacteriology and association, or organization mycology o Examples: St. Luke’s Medical o Special clinical chemistry (clinical Center, Makati Medical Center, enzymology, antimicrobial drug MCU-FDTMF Hospital, monitoring, markers) UERMMMCI o Special hematology(bone marrow studies, special staining PMLS REVIEWER FOR MIDTERMS | GABITO MT1C  for abnormal blood cells, red cell o CHD–Center for Health morphology) , Development o Immunohematology and blood - Issues a valid license to operated based banking on compliance with the minimum - Minimum equipment requirements – licensing requirements those seen in secondary category Sections in the Clinical Laboratory laboratories along with automated chemistry analyzer, biosafety cabinet 1. Clinical Chemistry class II, serofuge - Intended for the testing of blood and - Minimum space requirement –at least other body fluids to quantify essential 60 square meters soluble chemicals including waste 4. National Reference Laboratory products useful for the diagnosis of - a laboratory in a government hospital certain diseases. designated by the DOH to provide - Most common specimen: blood (serum special diagnostic functions and services or plasma) and urine for certain diseases - One of the most busiest section in the - These functions include: lab; in majority of tertiary level lab, this o referral services section is fully automated o provision of confirmatory testing - Internal Quality Assurance (IQA) , o assistance for research activities Continuous Quality Improvement (CQA) o implementation of External and participation in National External Quality Assurance Programs Quality Assurance Program (NEQAP) (EQAP) are important activities that med tech o Resolution of conflicts regarding performs tests of different labs 2. Microbiology o Training of medical technologists - Subdivided into 4 sections: o Bacteriology, R.A. No. 4688 o mycobacteriology, - An act regulating the operation and o mycology and maintenance of clinical laboratories and o virology requiring the registration of the same - Specimens usually submitted –blood, with the department of health, other body fluids, stool, tissues and providing penalty for the violation swabs from different sites in the body thereof, and for other purposes. - Tests includes: o Microscopic visualization after Administrative Order No. 59 s. 2001 staining - Rules and Regulation Governing the o Isolation and identification of Establishment, Operation and bacteria and fungi using different Maintenance of Clinical Laboratories in culture media and biochemical the Philippines tests o BHFS/HFSRB–Health Facilities o Antibacterial susceptibility and Services Regulatory Bureau testing (AST) PMLS REVIEWER FOR MIDTERMS | GABITO MT1C  3. Hematology and Coagulation Studies o Tests for hepatitis C and Dengue - Deals with the enumeration of cells in fever the blood and other body fluids 7. Anatomic Pathology - Tests include: - Activities performed include: o Complete blood count (CBC) o Tissue processing (removed o Hemoglobin and hematocrit surgically as in biopsy and determination autopsy o WBC differential count o Cutting into sections o Red cell morphology and cell o Staining indices o Preparation for microscopic o Platelet count examination by a pathologist Coagulation studies –testing for the Specialized Sections in the Laboratory determination of various coagulation factors 1. Immunohistochemistry 4. Clinical Microscopy - Combines anatomical, clinical and biochemical techniques where 2 major areas: antibodies (monoclonal and polyclonal) a) for routine and other special bounded to enzymes and fluorescent examinations in urine –macroscopic, dyes are used to detect presence of microscopic examination and chemical antigen in tissue. examination in urine - Useful for diagnosing some types of b) for the examination of stool or routine cancer fecalysis– detection and examination of 2. Molecular Biology and Biotechnology parasitic worms and ova - DNA and RNA are identified and 5. Blood Bank/Immunohematology sequenced to detect any pathologic - Two main activities -blood typing and conditions/disease processes. compatibility testing - Most common technique –polymerase - Screening and identification of chain reaction (PCR) antibodies as well as the blood components used for transfusion - Considered as the most critical in the clinical lab - Hospital-based clinical lab o blood donation activities prompt other activities such as donor recruitment and screening, bleeding of donor and post- donation care 6. Immunology and Serology - Analyses of serum antibodies - Tests include (but not limited): o Hepatitis B profile tests o Serological test for syphilis PMLS REVIEWER FOR MIDTERMS | GABITO MT1C Quality Assurance (QA) San Lazaro Infectious immunology Hospital STD- hepatitisB surface antigen - encompasses all activities performed by AIDS (HBsAg), human the laboratory personnel to ensure Cooperative inmmunodeficiency virus reliability of test results. Center (HIV), hepatitis C virus - It is an organized, systematic, well- Laboratory (HCV) planed and regularly done with the (SACCL) results properly documented and consistently reviewed  2 Major components 1. Internal Quality Assurance System (IQAS) - day-to-day activities that are undertaken in order to control factors or variables that may affect the test results 2. External Quality Assurance System (EQAS) - System for checking performance among clinical laboratories and is facilitated by designated external agencies - National Reference Laboratories (NRL) is the DOH-designated EQAS Designated NRL-EQAS Institution National Kidney Hematology and and Transplant Coagulation Institute (NKTI) Research Microbiology Institute of (identification and Tropical antibiotic susceptibility Medicine (RITM) testing) and Parasitology(identification of ova and quantitation of malaria Lung Center of Clinical Chemistry (for the Philippines testing 10 analytes– (LCP) glucose, creatinine, total protein, albumin, BUN, BUA, cholesterol, Na, K, Cl) East Avenue Drugs of abuse Medical (methamphetamine and Center(EAMC) cannabinoids) PMLS REVIEWER FOR MIDTERMS | GABITO MT1C