BACHELOR OF SCIENCE IN MEDICAL LABORATORY SCIENCE III A.Y.

2020-2021 | First Semester

Analysis of Urine and other Body Fluids
LEARNING OUTCOME LESSON 1
At the completion of this coverage, the students shall be Importance of Health and Safety in the Workplace
able to: The elimination, or at least minimization, of health and
1. Identify the different types of hazards that exist in safety hazards and risks is the moral as well as the legal
clinical laboratory; responsibility of employers. Ill health and injuries inflicted
2. Recognize and describe the standard warning or caused by the system of work or working conditions
symbols; cause suffering and loss to individuals and their
3. Discuss the chain of infection; dependents. Accidents and absences through ill-health or
4. Describe the different ways to break the chain of injuries result in losses and damage for the organization.
infection; Therefore, in the interest of avoiding this problem to arise,
5. Demonstrate the proper steps of hand hygiene laboratories come up with set of preventive measures
following CDC guidelines; and collated in a filed document called Laboratory Safety Plan
6. Differentiate universal precaution, body substance
isolation and standard precaution. Laboratory Safety Plan
These are plans for preventing sickness and injury to
Specific Instructions in the completion of this Chapter: personnel and damage or destruction of physical assets.
1. You must read and understand the Intended This type of laboratory precautionary measure
Learning Outcomes specified above and make it fundamentally aims to;
as a checklist of acquired knowledge and skills 1. Improve safety skills and attitude of all personnel;
after completing the entire chapter. This shall be 2. Develop a surveillance program for promptly
the basis of the teacher in the formulation of the identifying hazards;
Summative evaluation given at the end of the 3. Formulate plans for promptly correcting all
chapter. hazards; and
2. You must carefully study the given lecture notes 4. Coordinate laboratory safety efforts with the
and take note of topics that were not clearly stated overall.
or understood. These areas can be referred to the
subject teacher during consultation hours
provided.
LESSON 2
3. Study the discussions and insights given and
Accidents and Hazards in the Workplace
follow instructions for activities if there are.
Nevertheless, in spite of preventive measures and
4. After completely reading all the materials, open
practices observed in the workplace, there are still
the video links of the lessons given along with this
chances that one can become susceptible to accident or
learning package and watch the given videos to
hazards. Accident is an unintentional occurrence, an
supplement your reading. (please check your USB
unsafe act that causes property damage and interference
content).
with production and that does or could cause personal
5. Upon completion of all the lessons and topics
injury or death. But one good thing about is is that, it could
presented, answer the self-reflection questions
be prevented by a good safety program. This is why, it is
given to you. Check the instructions provided.
imperative to know the possible causes and sources of
6. Compile your outputs in your Learning Portfolio
such threats so that damage to properties is prevented and
that has to be submitted on a specific date set by
personnel can, at least, avoid getting injured or infected. In
your teacher.
fact, in order to avoid accidents, the laboratory has to be
7. Should you have any queries or clarifications with
designed according to international safety regulations and
the topics, you may contact the subject teacher in
the workers must be trained in safe working procedures
the given consultation hours which can be found
and must know their materials.
in the preliminaries of this material.
Hazard, on the other hand, is anything that is dangerous
Key Terms:
or causes damage to personnels or properties alike. The
 Laboratory Safety Plan
table below summarizes the types of hazards encountered
 Accidents and Hazards
both at home and at the workplace together with its source
 Chain of Infection
and injury
 Standard Precaution
 Personal Protective Equipment
 Hand Hygiene
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Types of Hazards nose, or mouth; and
breaks in the skin.
A. Biologic Hazard Susceptible Host A person with a decreased
Biological hazard is commonly encountered in ability to resist infection.
hospital setting. Specimens such as blood, tissues Factors that affect
and other body fluids are considered as biological susceptibility include age,
hazards. This type of hazards is potential enough health, and immune
status.
to transmit microbial infection from the reservoir
(e.g. patient and specimens) to any susceptible
host. Because of this, means were devised to
prevent the transfer of the pathogen from one
person to another. And in order for us to determine
on how to prevent the transmission of a disease,
it is necessary to know its chain of infection.

Chain of Infection is a step by step model to

conceptualize the transmission of a
communicable disease from its source to a
susceptible host. It has six key components.

CHAIN OF INFECTION
Infectious It is a pathogenic microbe
Infection Control
Agent/ responsible for causing an
Once the chain of infection is understood, it will be
Causative Agent infection.
easier for laboratoreans to break it- minimizing the
Reservoir It pertains to a source of an spread of the disease. The Center for Disease
infectious agent or a place Control and Prevention (CDC) and the
where the microbe can Occupational Safety and Health Administration
survive and grow or (OSHA) devised guidelines to break the chain of
multiply. This include infection
humans, animals, food,
water, soil, and 1. Universal Precautions
contaminated articles and The Universal Precaution considers blood
equipment. and certain body fluids of all individuals to
Exit Pathway An exit pathway is a way be potentially infectious. The focus of
an infectious agent is able
infection control is the prevention of
to leave a reservoir host.
patient-to-personnel transmission.
Infectious agents can exit
a reservoir host in
secretions from the eyes, In addition, it also recommends wearing
nose, or mouth; exudates of gloves when collecting or handling
from wounds; tissue blood and body fluids contaminated with
specimens; blood from blood, wearing of face shields when there
venipuncture and skin is danger of splashing on mucus
puncture sites; and membranes and disposing all needles
excretions of feces and and sharp objects in puncture resistant
urine. containers. The UP excludes urine and
Means of It talks of the method an body fluids not visibly contaminated by
Transmission infectious agent uses to blood as potentially infectious
travel from a reservoir to a
susceptible individual. It
2. Body Substance Isolation (BSI)
include airborne, contact,
droplet, vector, and It sets guidelines that are not limited to
vehicle. blood-borne pathogens since it considers
Entry Pathway The way an infectious all body fluids and moist body substances
agent is able to enter a to be potentially infectious. In its
susceptible host. It include guidelines, personnels are recommended
body orifices; mucous to wear gloves at all times when
membranes of the eyes, encountering moist body substances
although it does not require hand washing
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 following removal of gloves unless visual because it may just cause
contamination is present. contamination to the area.

3. Standard Precautions (SP) b. Personal Protective Equipment

These set guidelines derived from Protective clothing and other items
combined major features of UP and BSI worn by an individual to protect
to minimize the risk of infection mucous membranes, airways, skin
transmission from both recognized and and clothing from contact with
unrecognized sources. It is used in the infectious substances is called
care of all patients and is meant to be the personal protective equipment (PPE).
number-one strategy for successful PPE provides a barrier against
nosocomial infection control. It applies to infection. When it is used properly, it
blood, all body fluids (including all protects those wearing it and when it
secretions and excretions except sweat, is disposed properly, it prevents
whether or not they contain visible blood), spread of infection to others. The
non-intact skin, and mucous membranes. following are essential PPEs needed
in the workplace
If there is common in all of these three
infection control strategies, it is putting  Gloves
into considerations the following; Gloves are recommended to be
worn when attending to laboratory
a. Hand Hygiene works and processes because it is
Hand hygiene is one of the most an effective means to:
important means of preventing the o Prevent contamination of the
spread of infection provided that it is hands when handling blood or
achieved properly and when required. body fluids or when touching
Hand hygiene measures include the mucous membranes or non-
frequent use of antiseptic hand intact skin;
cleaners or hand washing or hand o Reduce the chance of
disinfection, depending upon the transmitting organisms on the
degree of contamination. hands of personnel to patients
during invasive or other
 Hand washing procedures that involve
A routine hand-washing procedure touching a patient’s skin or
uses plain soap and water to mucous membranes; and
mechanically remove soil and o Minimize the possibility of
transient bacteria. Hand transmitting infectious
antisepsis requires the use of an microorganisms from one
antimicrobial soap to remove, kill, patient to another
or inhibit transient
microorganisms. A 2-minute  Gowns and Laboratory Coats
surgical hand scrub uses an It is recommended that clean,
antimicrobial soap or equivalent to nonsterile, fluid-resistant gowns
remove or destroy transient are worn by healthcare personnel
microorganisms and reduce levels to:
of normal flora prior to surgical o Protect the skin and prevent
procedures. soiling of clothing during
patient-care activities in which
 Hand disinfection splashes or sprays of blood or
It is basically done with antiseptics body fluids are possible or
(70% Isopropanol) when there is when entering isolation
no visual contamination of hands. rooms.
When doing this, make sure that o Protect certain patients (such
all parts of the hands should be as newborns and patients with
rubbed with disinfecting agent. compromised immune
Then allow it to air dry. Never systems) from contaminants
attempt to wipe it with anything
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 on the healthcare worker’s f. Providing free immunization for HBV.
clothing. g. Establishing a daily disinfection protocol for
o Protect skin and prevent work surfaces; an appropriate disinfectant
soiling of healthcare workers’ for BBPs is sodium hypochlorite (household
clothing during patient-care bleach diluted 1:10)
activities in which splashes or h. Providing medical follow up for employees
sprays of blood or body fluids who have been accidentally exposed to
are possible. BBPs.
i. Documenting regular training in safety
 Masks, Face Shields and Goggles standards for employees.
A mask is worn to protect against
droplets generated by coughing or If ever that accidental exposure to a possible BBP
sneezing. To put on a mask, place happens, it must be immediately reported, so that
it over your nose and mouth. evaluation of the incident must begin right away to
Adjust the metal band (if ensure appropriate Post-exposure Prophylaxis (PEP).
applicable) to fit snugly over your
nose. For masks with ties, fasten B. Sharp Hazard
the top ties around the upper Sharp hazard is one of the most common type of
portion of your head; then tie the hazard that can be encountered in the clinical
lower ones at the back of your laboratory since medical technologists or medical
neck. If the mask has elastic laboratory scientists are fond of using sharp
fasteners, slip them around your materials (e.g. hypodermic needles, lancets, etc)
ears. A face shield or a mask and in specimen collection and processing. These
goggles are worn to protect the sharp objects serve as a potential cause of
eyes, nose, and mouth from lacerations, cuts and other injuries to any
splashes or sprays of body fluids. personnel who is less cognizant of the hazard it
If an activity requires goggles, it may cause. Therefore, it is recommended that
also requires a mask. Some sharp objects in the laboratory must be disposed
masks have plastic eye shields of in puncture-resistant containers in order to
attached. prevent related accidents in the workplace.

OSHA Standard for Blood-Borne Pathogens C. Chemical Hazard

OSHA requires implementation of engineering Other than sharp objects, chemicals are also one
controls and work practice controls to prevent of the most common materials we handle at the
exposure incidents, availability and use of PPE, clinical laboratory since we utilize it as reagents in
special training, medical surveillance, and the processing patient’s specimen. OSHA mandated
availability of vaccination against HBV for all at that every laboratory must develop and implement
risk employees. In addition, it also recommends a chemical hygiene plan and an exposure control
the use of engineering controls in the hospital plan in 1991. The purpose of the chemical hygiene
setting. These are devices that isolate or remove plan is to detail the following:
a BBP hazard. Work practice controls that change 1. Appropriate work practices
the way tasks are performed to reduce the 2. Standard operating procedures
likelihood of BBP exposure is also suggested. In 3. PPE
summary, OSHA enforces and recommends the 4. Engineering controls (fume hood and
following to be observed at the workplace: flammable safety cabinets)
a. Requiring all employees to practice UP/SP. 5. Employee training requirements
b. Providing laboratory coats, gowns, face 6. Medical consultation guidelines
mask and respiratory protections and
gloves to employees and laundry facilities HazCom Labelling Requirements
for non-disposable protective clothing. Although labelling format may vary by company, all
c. Providing sharps disposal containers and chemical manufacturers must comply with labelling
prohibiting recapping of needles. requirements set by the Manufacturers Chemical
d. Prohibiting eating, drinking, smoking and Association. Labels for hazardous chemicals must
applying cosmetics, lip balm, and contact contain:
lens in the work area. 1. A statement of warning such as “danger” or
e. Labelling all biohazardous material and “poison”
containers.
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 2. A statement of the hazard (e.g., toxic, may include radioactive isotopes
flammable, combustible) (Radioimmunoassay), X-rays and UV sources
3. Precautions to eliminate risk (Lack of proper shield and from human
4. First aid measures in the event of a spill or carelessness).
other exposure
E. Electrical Hazard
NFPA Hazardous Material Symbols This is a type of hazards that can be encountered
The National Fire Protection Association (NFPA) both at home and at the workplace. It is attributed
presented a diamond-shaped, color-coded to improper grounding, inadequate wiring and
symbol that contains information relating to health, improper insulation equipment. There are several
flammability, reactivity and personal guidelines to remember in order to be safe when
protection/special precautions. Each category is dealing with electrical hazard.
graded on a scale of 0-4 based on the extent of 1. Avoid the use of extension cords.
concern. 2. Do not attempt to make repairs to
equipment if you are not trained to do so.
It is advised that this has to be placed on doors, 3. Do not handle electrical equipment with
cabinets and containers so that it will be easily wet hands or when standing on a wet
noticed by laboratory personnel. floor.
4. Do not overload electrical circuits.
OSHA Hazard Communication Standard 5. Do not touch electrical equipment in
It is primarily developed to protect employees who patient rooms, especially when in the
may be exposed to hazardous chemicals. process of drawing blood. An electrical
Accordingly, all chemicals must be evaluated for shock could pass through the
health hazards, and all chemicals found to be phlebotomist and the needle and shock
hazardous must be labelled as such and the the patient.
information communicated to employees. 6. Inspect cords and plugs for breaks and
fraying. Make certain all electrical cords
Material Safety Data Sheets (MSDS) have three-prong plugs and that the third
In addition, Material Safety Data Sheets (MSDS) prong (grounding prong) is functional.
should be available to employees so that they can 7. Know the location of the circuit breaker
be aware of any risks posed by chemicals present box.
in the workplace and can utilize the recommended 8. Unplug and do not use equipment that is
protective equipment. malfunctioning.
9. Unplug equipment that has had liquid
Moreover, MSDS contains general information as spilled in it. Do not plug in again until the
well as precautionary and emergency information spill has been cleaned up and you are
for the product. Every product with a hazardous certain the wiring is dry.
warning on the label requires a MSDS to help 10. Unplug equipment when you are servicing
ensure that it will be used safely and as intended. it, including when you are replacing a
Informations contained in the MSDS include: lightbulb.
a. Physical and chemical characteristics
b. Fire and explosion potential Actions to take if Electrical Shock Occurs
c. Reactivity potential 1. Shut off the source of electricity.
d. Health hazards 2. If the source of electricity cannot be shut
e. Methods for safe handling off, use non-conducting material (e.g.,
hand inside a glass beaker) to remove the
D. Radioactive Hazard source of electricity from the victim.
Radiation is also another hazard that may cause 3. Call for medical assistance.
injuries to laboratory personnel when improperly 4. Start cardiopulmonary resuscitation if
handled. The principle involved in radiation indicated.
exposure are distance, shielding, and time. The 5. Keep the victim warm.
amount of radiation you are exposed to depends
upon how far you are from the source of F. Fire/ Explosive Hazard
radioactivity, what protection you have from it, and Fire or explosive hazard is one of the most
how long you are exposed to it. Exposure time is dangerous type of hazard that is present
important because radiation effects are anywhere. Even workplaces are highly vulnerable
cumulative. Sources of radiation in the laboratory to this type of hazard. That is why all employees
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of any institution should be aware of procedures to extinguish (they are the most difficult fires to
follow in case of fire. They should know where fire control and frequently lead to explosions).
extinguishers are located and how to use them.
They should know where the fire blankets are kept 5. Class K fires
and how to use them or heavy toweling to smother It is a type of fire that occurs with high-
clothing fires. They should know the location of temperature cooking oils, grease, or fats. It
emergency exits and be familiar with evacuation requires agents that prevent splashing and
routes. cool the fire as well as smother it.

The fire tetrahedron shows us that there are three Types of Fire Extinguishers and Contents
(3) major components needed before fire is Fire extinguishers are commercially produced
produced. materials used to smother fire. The types of fire
 Oxygen: At least 16% of Oxygen is required extinguishers vary since there are different types
to sustain the oxidation process of fuel- in the of fires to be extinguished.
presence of heat- in order to produce fire.
 Fuel: Any material that can be considered as 1. Type of Fire Extinguisher Contents
either flammable or combustible and is a. Water Type: Useful for types of all
consumed when fire is produced. ordinary combustibles (wood, paper,
 Heat: It is needed to raise the temperature of rugs)
the material until it ignites or catches fire. b. Dry Chemical Type: Effective against
Some of the possible sources of heat includes most fires but particularly those involving
direct exposure to sunlight, cigarette butt, flammable liquids, metals and electric
electricity, candles, lighters etc. fires
c. Carbon Dioxide Type: Useful for small
Based on the requirements for fire to be produced, fire due to flammable liquids
fire, then, is defined as the constant oxidation of
an ignited fuel due to the presence of heat. It is 2. Type of Fire Extinguishers
noteworthy that fire is classified based on the type a. Class A Extinguishers: Use soda and
of fuel to be burnt. Thus, fire extinguishers are also acid or water to cool the fire.
classified depending on the type of fire to be b. Class B extinguishers: Use foam, dry
smothered. chemical, or carbon dioxide to smother
the fire.
Classification of Fire c. Class C extinguishers: use dry
1. Class A fires chemical, carbon dioxide, Halon, or other
It is a type of fire that occurs with ordinary non-conducting agents to smother the
combustible materials, such as wood, papers, fire.
or clothing. It requires water or water-based d. Class ABC (multipurpose)
solutions to cool or quench the fire to extinguishers: use dry chemical
extinguish it. reagents to smother the fire. They can be
used on class A, B, and C fires.
2. Class B fires e. Class K extinguishers: use a potassium-
It is a type of fire that occurs with flammable based alkaline liquid specifically
liquids and vapors, such as paint, oil, grease, formulated to fight high-temperature
or gasoline. It requires blocking of the source grease, oil, or fat fires by cooling and
of oxygen or smothering the fuel to extinguish smothering them without splashing. Some
it. class K extinguishers can also be used on
class A, B, and C fires.
3. Class C fires
It is a type of fire that occurs with electrical The Joint Commission on Accreditation of
equipment. It requires nonconducting agents Healthcare Organizations (JACHO) requires that
to be extinguished. all healthcare institutions have post evacuation
routes and detailed plans to follow in the event of
4. Class D fires fire. In addition, all laboratory personnel should
It is a type of fire that occurs with combustible also be familiar with the following procedures.
or reactive metals, such as sodium,
potassium, magnesium, and lithium. It
requires dry powder agents or sand to
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 G. Physical Hazard tools and equipment. Here the practitioner follows
The laboratory contains many mechanical devices the simple philosophy of “a place for everything,
which cause accidents if they malfunction or are and everything in its place”. This will help the other
used improperly. In addition, there are also staff members locate the required resources
hazards that are associated to structural or easily and swiftly. This concept can be applied to
mechanical defects as slippery floors, projections any sector. In other words, the practitioner of 5S
that cause cuts and bruises like nails, inadequate concepts arranges all the resources and tools in a
lighting, machinery with unprotected moving parts, systematic manner.
etc.
In order to avoid untoward injury, it is recommended to; Step 3: Shine (Seiso)
1. Avoid running or rushing In this step, the practitioner ensures that the
2. Watch for wet floors equipment and tools are tidy and they can be
3. Avoid dangling jewelry readily used by other staff members. If this
4. Tie back long hair concept is applied in the information technology
5. Operate laboratory equipment as recommended sector, then the practitioner has the responsibility
by the manufacturer to delete all the irrelevant files and folders and
6. Maintain an organized and clean workspace clean the file system. In simple words, this concept
7. Get enough help when lifting heavy items and focuses on tidiness and cleanliness at the
remember to bend your knees when lifting workplace.
anything awkward or heavy.
Step 4: Standardize (Seiketsu)
The practitioner can combine similar work
LESSON 3 activities in their facility and allot a workspace for
Importance of 5s that particular process in the work facility. For
In order to avoid accidents and hazards in the laboratory, instance, if there are five microscopes scattered
it is recommended that 5S have to be incorporated in our across different locations doing the same work,
daily activity in the workplace then the practitioner can place all these units at
one place so that better results can be achieved
5S housekeeping technique that is adopted from the through constant monitoring of work processes.
Japanese. It was popularised by Taichi Ohno (designer of This concept can be applied in any section of the
Toyota Production System) and Shigeo Shingo laboratory to reduce the redundancy.
(associated with the concept of Poka-yoke). 5S is a set of
5 Japanese words starting with S. Translated into English, Step 5: Sustain (Shitsuke)
by which all the words start with S as well. This is the final step or stage in 5S concept
implementation. In this stage, the practitioner has
Step 1: Sort (Seiri) to ensure that tools, equipment and resources are
In this step, the 5s concept practitioner has the in neat and tidy condition and they are placed
responsibility to go through all the equipment, where they are meant to be.
tools and resources they have and determine
which equipment or resources have to be retained
on the work floor and which resources have to be
eliminated. When they find tools that are not
relevant to their work they can simply place back
that equipment to the storeroom or return them
back to the concerned departments. If they feel
that some resources need to be completely
eliminated from the workspace, then they have to
put a red tag on that particular item and get
authorization or permission from their senior
officials before they dispose it or recycle the item.
In simple words, the practitioner has to segregate
the important or useful things from the
unnecessary thing and discard the unnecessary.

Step 2: Straighten or Set in Order (Seiton)

In this step, the 5S practitioner has to re-organize
their workplace after eliminating unnecessary
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