Handle

Gode health Science College
TVET PROGRAM TITLE:

Medical Laboratory Assistance
MLA Level II
ETHIOPIAN SOMALI REGIONAL STATE
BUREAU OF TECHNICAL AND VOCATIONAL
EDUCATION AND TRAINING
Ethiopian TVET-System
Unit of Competence: Handle and transport specimen
Module Title: - Handling and Transporting of Specimen
LG Code: - HLT MLA2 M08 08 12 (LO.1)
TTLM Code: - HLT MLA2 M08 08 12
NOMINAL DURATION: - 68.hrs
Based on
Ethiopian Occupational Standard (EOS)
Instruction Sheet Learning Guide #7
This learning guide is developed to provide you the necessary information regarding the following content
coverage and topics –
 Introduction
 Handling sequence and any licence /permit requirements
This guide will also assist you to attain the learning outcome stated in the cover page. Specifically, upon
completion of this Learning Guide, you will be able to
 Prepare for handling
 Handling and transporting samples / items
 Maintain and transport equipment
 Maintain a safe work environment
Learning Instructions:
1. Read the specific objectives of this Learning Guide.
2. Follow the instructions described in number 3 to 20.
3. Read the information written in the “Information Sheets 1”. Try to understand what are
being discussed. Ask you teacher for assistance if you have hard time understanding
them.
4. Accomplish the “Self-check 1” in page __.
5. Ask from your teacher the key to correction (key answers) or you can request your
teacher to correct your work. (You are to get the key answer only after you finished
answering the Self-check 1).
6. If you earned a satisfactory evaluation proceed to “Information Sheet 2”. However, if
your rating is unsatisfactory, see your teacher for further instructions or go back to
Learning Activity #3
7. Submit your accomplished Self-check. This will form part of your training portfolio.
8. Read the information written in the “Information Sheet 2”. Try to understand what are
them.
11. Read the information written in the “Information Sheets 3 and 4”. Try to understand what
are being discussed. Ask you teacher for assistance if you have hard time
understanding them.
14. If you earned a satisfactory evaluation proceed to “Operation Sheet 1” in page _.
However, if your rating is unsatisfactory, see your teacher for further instructions or go
back to Learning Activity #6.
15. Read the “Operation Sheet 1” and try to understand the procedures discussed.
16. You are provided with a CD containing lessons on how to clean and maintain
equipment. Before you open the CD read the information written in the “Information
Sheets 1-2” in pages ___. You will be also provided with additional reference reading
materials regarding the cleaning of masonry handtools.
17. Request a desktop computer or laptop from your teacher. Make sure the unit is plugged
to a power source before turning on the power O. Then insert the CD in the CD drive
located in your computer. Access the information as described in the Operation Sheet 1
in page __.
18. Read all the contents of the CD and try to understand the procedures discussed.
19. Request access to the equipment and software described in the CD. Practice the steps
or procedures as illustrated in your CD. Go to your teacher if you need clarification or
you want answers to your questions or you need assistance in understanding a
particular step or procedure.
20. Do the “LAP test” in page __ (if you are ready). Request your teacher to evaluate your
performance and outputs. Your teacher will give you feedback and the evaluation will be
either satisfactory or unsatisfactory. If unsatisfactory, your teacher shall advice you on
additional work. But if satisfactory you can proceed to Learning Guide #8.
MODULE DESCRIPTION: This module of competency covers the ability to handle and transport
samples or test/calibration equipment in a way which ensures the integrity of subsequent test
results
LEARNING OUTCOMES:
At the end of the module the learner/trainee will be able to:
1. Prepare for handling
2. Handling and transporting samples / items
3. Maintain and transport equipment
4. Maintain a safe work environment
MODULE CONTENTS:
LO.1. Introduction to Handling and Transporting of Clinical Specimens
1.1 Introduction
1.2 Handling sequence and any licence /permit requirements
LO.2. Collection and preparation of required materials for sample handling and transporting
2.1 Introduction
2.1 Collection of required materials for handling and transporting
2.1.1 Materials and equipments for Parasitological specimens
2.1.2 Materials and equipments for Haematological specimens
2.1.3 Materials and equipments for Serology specimens
2.1.4 Containers for Urine specimens
2.1.5 Containers for Clinical Chemistry specimens
2.1.6 Containers for Microbiological specimens
2.1.7 Containers for Immunohematology specimens
2.2 Sample transfer sheet
LO.3. Preservatives and Transporting Medias
3.1 Introduction
3.1 Selecting appropriate
3.1.1 Preservatives for Parasitological specimens
3.1.2 Anticoagulants for Haematological specimens
3.1.3 Preservatives for Urine specimen
3.1.4 Preservatives and Anticoagulants for Clinical Chemistry specimen
3.1.5 Preservatives and Transport Medias for Microbiological specimen
LO.4. Sample transportation
4.1 Introduction to sample transportation
4.2 General procedure of dispatching
4.2.1 General Procedure of dispatching stool specimen
4.2.2 Dispatching Urine specimen
4.3 Packaging S
4.3 Means of transportation
4.4 Documentation
LO.5. Communication with Health facilities
5.1 Levels of Referral facilities /referral system
5.2 Following required policies and procedures
5.3 Maintaining confidentiality in all aspects of work
LO.6. Maintain a safe work environment
6.1 Introduction
6.2 Safety in the laboratory includes three major parts
6.3 Report problems, accidents and incidents in accordance with procedures
LEARNING METHODS:
 Discussion
 Lecture
 Role play
ASSESSMENT METHOD:
 Group work
 Assignment
 Quiz/tests
 Examination
 apprenticeship
Information Sheet-1 Handling and Transporting of Specimen
LO1. Handling and Transporting of Specimen
1.1 Introduction
Specimens:-
Specimen is a sample or part of a thing or several things, which is taken as a representative to
Show or determine the characteristics of the whole.
 Handling: - holding any clinical specimen for different purpose, it includes holding the
Specimen during transportation , processing, examination and disposing.
 Transporting: - moving clinical specimen from one place to the other for different reason.
 Transportation of specimen can be in the following situations:-
 From specimen collection area to the place where they are examined.
 from one laboratory to other referral laboratory for advanced investigation
 From place where epidemic out break stand to laboratory for examination
 Why specimen should be handle and transporting carefully?
 For quality laboratory result
The proper collection, handling, transportation and reliable processing of laboratory
Specimen is a vital part of medical laboratory diagnostic service.
This is due to the fact that the final laboratory result will depend on the initial quality
of the specimen collected, handling and transporting.
Unless the appropriate specimen is properly collected, preserved and processed

reliability cannot be placed on subsequent laboratory results even if the test
It self is performed carefully.
Therefore, in order to obtain as accurate result as possible the specimen should
exactly represent the current condition of the place where it is originated and the path
where it is passing through.
 For safety
Apart from the quality purpose specimen should also be handling carefully for safety reason.
Great care is needed in handling all laboratory specimen and protective material such as :-
glove; gown etc should always be wear.
All specimens are potentially can transmit serious infectious pathogen such as:-
 HIV, HBV from blood specimen.
 V. cholera, Salmonella, Shigella, parasites from stool specimen.
 M. tuberculosis, S. pneumonia from sputum specimen etc…
Type of specimen
- The proper collection, handling and reliable processing of laboratory specimen is a vital
of medical laboratory diagnostic service .
This is due to the fact that the final laboratory result will depend on the initial quality of the
specimen collected.
Unless the appropriate specimen is properly collected, preserved and processed reliability can not be
placed on subsequent laboratory results even if the test itself is performed carefully.
To obtain reliable laboratory result the following conditions should be considered before
Collection of a specimen:-
 the type of specimen
 time of collection
 the method of collection (collection technique)
 site of collection
 Method and time of dispatch to the laboratory.
 Amount of specimen required
 Adequate information about the patient‘s condition and any therapy taken must also be
sent with the specimen.
  Common examples of specimens
- Stool - Urine
- Skin scrapping - urethral discharge
- Blood - Skin snip
- Peri-anal swab - vaginal discharge
- Sputum - CSF
1.2 Handling sequence and any licence /permit requirements
SEQUENCE OF SAFE HANDLING AND TRANSPORT OF
SPECIMEN
Glove Goggles Respirator Apron/gown always wears PPE prior to clean up spillages
and discard PPE after use.
 Never use a mixture of detergents and disinfectants to clean a spill.
 Inform other people with in the department/ward of the spillage and what has
been spilt.
Blood group Immunology Microbiology etc…
Vacuum tubes Charcoal swab 25ml plastic universal Blood culture bottles
Handling and Transporting Sample
Is the lid of the specimen container sealed / tightened properly?
 Check for any leakages around the specimen container.
 Check the correct request card is used for the requested test (i.e. keep specimen(s) for
microbiology separately from biochemistry).
 State URGENT on the request card. If necessary inform the laboratory registrars and / or
Biomedical Scientists.
 For interpretative specimens (i.e. frozen sections) and urgent fresh/unfixed biopsies - DO
NOT place in formalin, make sure they are package separately and deliver directly to cellular
Pathology and inform the laboratory.
Check there is no additional risk to laboratory staffs if so label accordingly
e.g. Danger of Infection (see below)
Label request card and specimen with the ‘Danger of Infection’ Sticker if the patient is known or
suspected to have hazard group 3 or group 4 pathogen(s) and state on the request card the risk.
Some Examples:-
- Hepatitis B virus (HBV)
- Hepatitis C virus (HCV)
- Human immunodeficiency virus (HIV) and
- Creutzfeldt-Jakob Disease (CJD)
- Brucella spp.
- Mycobacterium tuberculosis (TB)
- Salmonella typhi (Typhoid) and
- Salmonella paratyphi,
- Escherichia coli O157,
- Taenia solium,
- Histoplasma capsulatum.
The standard packaging method
 Place the specimen container into the plastic bag attached to the request card and seal it
properly.
( If multiple specimens are placed into the same bag, please cushion them to prevent breakage )
 Specimens are then placed into a second, large, transparent plastic bag. Please add sufficient
absorbent material to absorb any fluid in case of breakage.
( Place all specimens for one specific department into the same secondary bag i.e. all
microbiology specimens in one bag and immunology in another bag )
The bag of specimens can be put together with other bags of specimens into a rigid
transport box.
The Pod on the right hand side is for the Pneumatic (Air) System. A limited number of
specimens can be placed in it. Ensure specimen is well cushioned with absorbent material
There are two main methods of transportation within the hospital
Pneumatic (air) tube system Portering staff
Highly reliable system that allows Please use the portering service in the
rapid transport of specimens from event of a breakdown or for any
wards to laboratories. specimens not suitable for transport
by the pneumatic (air) tube system
Handling and Transporting Sample
Taxi Ambulance Public Transport plane
Specimen must be double bagged and the outside bag clearly labeled ‘URGENT’
before placing in the transport box.
A member of staff transporting clinical specimens via public transport as part of
their work must comply with the ‘Carriage Regulations
TVET PROGRAM TITLE:

MLA Level II
Based on
Instruction Sheet Learning Guide #
coverage and topics
 Collection of required materials for handling and transporting
 Materials and equipments for Parasitological specimens
 Materials and equipments for Haematological specimens
 Materials and equipments for Serology specimens
 Containers for Urine specimens
 Containers for Clinical Chemistry specimens
 Containers for Microbiological specimens
 Containers for Immunohematology specimens
 Sample transfer sheet
them.
them.
understanding them.
in page __.
Collection and preparation of required

Information Sheet-1 materials for sample handling and
transporting
LO.2
2. Collection and preparation of required materials for sample
handling and transporting
2.1 Introduction
 Specimens must be collected in an appropriate specimen container to maintain the integrity

of the specimen.
 A properly collecting and handling specimen there is critical to quality test results.
 Test Information Sheets provide comprehensive instructions and specify the type of
container or collection kit that should be used to collect the sample
 After collection, specimens must be labelled with the patient’s full name (or unique code
number in the case of anonymous testing) and one other unique identifier such as the
admission/identification or accession number.
 Most specimens should be stored between 2-8°C. Specific handling/storage

information is included in the test-specific Kit Instruction Sheets and Test
Information Sheets.
 The type and quality of material for handling and transporting specimen will vary
based on different factors , such as :-
 Type and amount of specimen.
 Type of test to be performed.
E.g. is it culturing test? Serological? Microscopic?
 Purpose of specimen collection.
E.g. is it for routine examination? For epidemic investigation? For refereeing?
 Distance and condition of referred site.
 Method of specimen collection.
 Means of transports etc…
There are different types of material for handling and transportation of specimen in different
quality and size/volume. Therefore, identification and use of appropriate type of material is
very important factor for the quality of laboratory test result.
2.1 Collection of required materials for handling and transporting
2.1.1 Materials and equipments for Parasitological specimens
 Types of parasitological specimens
The most common clinical specimens for parasitological examination are Stool, Blood, and
Urine, sputum, discharge and biopsy materials.
o The following specimens are the most common for selected for parasitological examination.
a) Blood:-
- Examination of blood film is one of the main procedures for specific diagnosis. For
Example: - in malaria the parasites are found inside the red blood cells.
b) Stool:-
- Examination of the stool forms an important part in the diagnosis of intestinal
parasitic infections and also for those helminthic parasites that localize in the biliary tract
and discharge their eggs into the intestine.
Example: - Amoebiasis , Giardiasis, etc.
In the case of helminthic infections, the adult worms, their eggs, or lar.vae are found in the stool.
c) Urine:-
- when the parasite localizes in the urinary tract, examination of the urine will be of
help in establishing the parasitological diagnosis.
Example: - in urinary Schistosomiasis,
eggs of Schistosoma haematobium are found in the urine.
d) Sputum:-
– Examination of the sputum is useful in the following:
• In cases where the habitat of the parasite is in the respiratory tract, as in Paragonimiasis,
the eggs of Paragonimus westermani are found.
• In amoebic abscess of lung or in the case of amoebic liver abscess bursting into the
lungs, the trophozoites of E. histolytica are detected in the sputum.
e) Biopsy material:-
- varies with different parasitic infections.
Example:- muscle biopsy in cases of Cysticercosis, Trichinelliasis, and Chagas’ disease, Skin
snip for Onchocerciasis.
f) Urethral or vaginal discharge
– for Trichomonas vaginalis
Material and equipments
- Depend on the purpose of the specimen
o Specimen containers ( test tube, small bottle with lid)
Note: - the container should be
 leak-proof
 clean
 dry
 Free from traces of antiseptics and disinfectants.
o An anticoagulant
Note: - use a suitable anticoagulant,
 Sodium citrate for microfilaria and
 EDTA for malaria parasites and trypanosomes.
o A suitable preservative
o Transporting plastic bag
o Specimen transporting form/sheet
o Personal protective materials
 Glove, gown, apron, eye goggle, mask, face shield etc....
o Absorbent materials
o Refrigerator
o Trolley
o Communication devices
o Means of transportation/ vehicle
o Test tube rack
o Labelling materials/ sticker
o Aseptic and disinfectant solutions Etc....
Note:-
 Protect specimens from direct sunlight and heat.
 Thick blood films require special protection from dust, flies, and ants.
 Label the specimen carefully with the patient’s name and identification number, and also the
date and time of collection.
2.1.2 Materials and equipments for Haematological specimens

 Types of Haematological specimen
- The most common clinical specimen for hematological examination is Blood.
- Other body fluids ( CSF, pleura fluid, peritoneal fluid etc...), bone marrow.
- It must be collected with care and adequate safety precautions in order to obtain reliable test
result, to avoid contamination of the sample and to protect infection from blood transmissible
pathogens.
- Care must be taken when handling the blood specimen, needles and lancets during specimen
collection, do not recap used needles by hand.
Material and equipments
o Specimen containers ( test tube, small bottle with lid)
 leak-proof
 clean
 dry
o Anticoagulant/ preservative
 Glove, gown, apron, eye goggle, mask, eye shield etc....
o Absorbent materials
o Refrigerator
o Trolley
o Test tube rack
o Labelling materials
o Aseptic and disinfectant solutions Etc....
2.1.3 Materials and equipments for Serology specimens
 Types of Serological specimen
- The most common clinical specimen for serological examination are:-
 Blood
 Whole blood
 Serum
 plasma
 Cerebrospinal fluid
NB: - Should be collected by a physician or a trained nurse
 csf
Note:
- To obtain serum or plasma first collect about 2-3 ml venous blood using sterile syringe
and needle.
 For serum separation:-
- Allow the whole blood to clot at room temperature for at least one hour and centrifuge the clotted
blood for 10 minutes at 2000 rpm. Then transfer the serum to a labelled tube with a pasture pipette
and rubber bulb.
 For Plasma separation: -
-Sample is obtained by treating fresh blood with an anticoagulant, centrifuge and separates the
supernatant.
- Finally, seal the specimen containing tube; the tube should be labelled with full patient’s
identification such as Age, Sex, and code no, etc.
The test should be performed with in hours after sample collection, if this could not be done preserve
it at- 20c0.
 Before transporting specimen the following things should be considered.
 Don’t ship whole blood unless the tests to be performed require whole blood.
 Do not inactivate serum or plasma.
 Keep the specimen and packing container in the refrigerator until time of shipment but if
shipment requires several days, freeze the specimen.
 Then ship the specimen by the fastest route.
 Material and equipments
o Specimen containers ( test tube, neck tube)
 leak-proof
 clean
 dry
o An anticoagulant
o Transporting plastic bag/ Ice bag
o Refrigerator
o Centrifuge
o Aseptic and disinfectant solutions
o Shockproof and waterproof boxes etc....
2.1.4 Containers for Urine specimens
- Types of Urine specimen
1. First morning specimen
2. Random specimen
3. 24hr urine –specimen
4. Clean –catch –specimen
5. Mid-stream specimen
6. Post prandial specimen
7. Catherized specimen
 Container for urine specimen collection and transportation
 Plastic cup
 Glass cup
 Conical urine jar
 Wide mouthed bottle with stopper
 Catheter
o NB:- The container should be
- Cleaned and dried
- With lids to reduce contamination
- With wide mouth
o Shockproof and waterproof boxes etc....
2.1.5 Containers for Clinical Chemistry specimens
 Specimen for clinical chemistry analysis
 Whole blood
 Serum most common
 Plasma
 Other specimen includes
 Urine
 Body fluids (CSF, Synovial. Pleural, Pericardial, Peritoneal fluids)
 Saliva etc…..
Containers
o Specimen containers for clinical chemistry tests must be
- Leak proof
- Chemically clean.
- well washed with detergent
- rinsed in several changes of clean water
- Finally rinsed in distilled or deionised water before being allowed to dry.
- Dry glass test tube with stopper
- Brown bottle
NB: - Avoid collecting blood into a plastic container if serum is required. Blood takes much
longer to clot and clot retraction is poorer in a plastic tube or bottle than in a glass one.
 Fluoride-oxalate container
 Lithium heparin container
 Large bottle containing 5 ml HCl, 6 mol/l.
 Large brown bottle containing 10 ml glacial acetic acid.
 Centrifuge
 Pastuer pipette
 anticoagulants / preservatives
 Transporting plastic bag
 Communication devices
 Specimen transporting form/sheet
 Personal protective materials
 Aseptic and disinfectant solutions
 wrapping container in foil to exclude light
 Means of transportation/ vehicle
 Shockproof and waterproof boxes
2.1.6 Containers for Microbiological specimens
The value and reliability of microbiological reports are directly affected by the quality of the
specimen received by the laboratory and the length of time between its collection and processing
 Points to be considered during microbiological specimen collection and processing
 The amount and type of specimen required.
 Container to use, and need for any preservative or transport medium.
 Best time to collect a specimen.
 Aseptic and safe methods of collection to avoid contamination and accidental infection.
 Labelling of the specimen container.
 Conditions in which specimens need to be kept prior to and during their transport to the
laboratory.
 Arrangements for processing specimens that are urgent and those collected outside of
normal working hours, e.g. blood cultures collected by medical staff.
Specimens for microbiological examination
 Sputum
 Throat swab
 Skin and ulcer specimens
 Skin and nasal smears for leprosy
 Pus and effusions
 Urogenital specimens
 Faecal (stool) specimens
 Urine
 Cerebrospinal fluid (CSF)
 Blood for culture
 Seminal fluid
Containers
- Sterilized materials
o Test tube with lid
o Petridish
o Syringe with needle
o Cup with lid
o Transport media
o Test tube with test tube rack
-glove, gown, apron, eye goggle, mask, eye shield etc....
o Shockproof and waterproof boxes
o Communication devices etc…
2.1.7 Containers for Immunohematology specimens
 Containers
o Insulated cold box
NB: - To transport blood, always use a well insulated cool box with sufficient freezer packs.
o Ice pack/ freezer packs.
o Plastic bag
Note: - It is essential to prevent the blood bags touching directly the freezer packs. the freezer
packs can be wrapped in paper to avoid their direct contact with the blood bags.
o Thermometer
o Refrigerator
- Glove, gown, apron, eye goggle, mask, eye shield etc....
o Shockproof and waterproof boxes
o Communication devices etc…
2.2 Sample transfer sheet
Definition: -
- sample transfer sheet is forms of paper in which detail information about the specimen,
The patient who give the specimen , and the environment where the specimen collected
will be describe and send together with specimen.
 Sample transfer sheet may contain information about
 Types of specimen
 Patient information (age, sex, address, health status etc…)
 Date of specimen collection
 Test to be performed
 Safety information etc.....
Collecting, preserving and shipping specimens for the diagnosis of avian influenza
A(H5N1) virus infection Guide for field operations
(Source: -
Collecting, preserving and shipping specimens for the diagnosis of avian influenza A
(H5N1) virus infection Guide for field operations
Group assignment
1. Define the advantage of test information sheets ?
2. Write the most common specimens for selected parasitological examination ?
3. Write the necessary materials of blood collection ?
4. What is the consideration of before transporting specimen ?
5. Write 2 or 3 of them haematological anticoagulant ?
TVET PROGRAM TITLE:

MLA Level II
Based on Ethiopian Occupational Standard (EOS)

coverage and topics
Selecting appropriate

Preservatives for Parasitological specimens
 Anticoagulants for Haematological specimens
 Preservatives for Urine specimen
 Preservatives and Anticoagulants for Clinical Chemistry specimen
 Preservatives and Transport Medias for Microbiological specimen
Follow the instructions described in number 3 to 20.
them.
them.
understanding them.
in page __.
Do the “LAP test” in page __ (if you are ready). Request your teacher to evaluate your performance
and outputs. Your teacher will give you feedback and the evaluation will be either satisfactory or
unsatisfactory. If unsatisfactory, your teacher shall advice you on additional work. But if
satisfactory
Information Sheet-1 Preservatives and Transporting Medias
LO.3
3. Preservatives and Transporting Medias
3.1 Introduction
 Preservative: -
A means by which the natural characteristic of the substance will be maintained unchanged in the
given clinical specimen. Can be chemical or physical
 Preservation: - the process of maintaining the normal state of organism (parasite).
Transporting media: -
Media containing ingredients to prevent the over growth of commensals and ensure the survival of
pathogenic bacteria when specimens can not be cultured soon after collection.
- Example:-
 Amies transport media:-
 Cary Blair transport media
 Stuart transport media
3.1 Selecting appropriate:
3.1.1 Preservatives for Parasitological specimens
Purpose of preservation
- If faces need to be sent to referral lab
- If delay of examination beyond 30 minute
- If microscopic examination are not available locally
- For quality assurance
- For specimen collecting in the field
- For teaching purpose
Methods of preservation
I) Physical method
- Refrigeration
- 3-5oc can preserve trophozoites for several days in dysenteric stool.
II) Chemical method
A) Bayer’s solution
- Preserve cyst and egg stage
- Mix 1ml stock and 9ml distilled water
- Emulsify 1gm of faces in 3-4ml of Beyer’s working solution
B) Polyvinyl alcohol solution (PVA)
- Excellent preservation of protozoan trophozoites and cysts.
- Mix 1 part of fecal specimen with 9 part of PVA
C) 10% formal saline
- Preserve larva & adult worm
- Preserves cyst & egg for short time
- Five parts of 10% formal saline for 1 part of suspension
D) Merthiolate Iodine Formaline (MIF)
- A good stain preservative for most stages of the parasite
- Used In the field survey
- Preserve for a year or months
- Add 1 part of faces to 9 part of MIF
E) Sodium acetate acetic acid
- Used for preserving protozoa trophozoites, helminthes aggs and larva
- Mix 1 gm of stool with 10ml of the solution
3.1.2 Anticoagulants for Haematological specimens
Definition: -
Is a chemical substance which is important to prevent coagulation of blood So that,
maintains blood in the fluid state.
 In most hematological test most analysis need anticogulated blood.
 An ideal anticoagulant should not affect the test going to be done.
 SBut, using wrong amount and type of anticoagulant may affect prevention of coagulation.
Such as: - small amount, may result partial coagulation
 excess amount, may cause dilution or hemolysis
 Oxalate may affect morphology of blood cell.
Types of Anticoagulants
1. EDTA (Ethylene Diamine Teteraacetic Acid)
- Tri.sodium or dipotassium salt of EDTA are used as anticoagulant
- It is standard and strong hematological anticoagulant because:-
i) It is efficient for complete anticoagulation
ii) It lacks effect on or interference with cell number and morphology
Function: - EDTA used for
a. Blood cell count
b. Morphologic study of cell
c. Hemoglobin determination
Note:- not use EDTA for coagulation factor study.
Amount: - 1.5 + 0.25 mg EDTA per ml of blood ( ~1.5 mg EDTA per 1 ml of blood)
Or 0.02ml of 10% w/v EDTA solution for 1ml of blood
Mode of action
by bind calcium (Ca2+)ion
Chelating of Ca2+
2. Sodium citrate
- Disodium or trisodium salts used as anticoagulant
- Trisodium citrate is the choice of salt
Function: - It is used for
 ESR determination
 Coagulation study (bleeding disorder)
Amount
-Concentration 3.1% (30.88g/l) solution is isotonic
-For ESR:- 1 part of citrate to 4 part of blood (1:4)
- For clotting disorder:- 1 part of citrate to 9 part of blood (1:9)
Mode of Action
It keeps the calcium (Ca2+) in soluble form.
3. Balanced Oxalate /Double Oxalate/
- It is called balanced oxalate because it is a combination of two salts i,e ammonium oxalate
and potassium oxalate in 3:2 Proportion.
Function: -
 It is used for many hematological analysis
Note: - not preferred for cell morphology
Amount: - 1-2 Mg double oxalate per 1ml of blood
Mode of Action
-It will precipitate calcium (Ca2+) ions as calcium oxalate.
-Double oxalate avoids cellular swelling by the ammonium oxalate and shrinkage of red
blood cell by potassium oxalate.
4. Heparin
- It is an excellent natural anticoagulant that extracted from mammalian liver or pancreas.
- It is more expensive and has a temporary effect of only 24 hours.
Function:-
- best when minimal hemolysis is required:
E.g. - Osmotic fragility
- Haematocrite determination (heparainated tube)
Note:- Not preferred for blood film preparation for hemoparasities investigation and morphology
study as it forms blue back ground (Cause diffuse blue coloration).
Amount:- 0.1 -0.2 mg of heparin salt for 1ml of blood
Mode of Action
- Inactive thrombin, thus inhibit conversion of fibrinogen to fibrin (Act as anti-thrombin ,
and prevent clotting)
3.1.3 Preservatives for Urine specimen
1. Urine should be examined immeditely as much as possible after it is passed because some
urinary components are unstable, if urine specimen cannot be examined immediately
must be refrigerated or preserved by using different chemical preservatives.
2. The maximum time that urinary contents to be maintained in urine specimen is one hour.
3. Long standing of urine at room temperature can cause :-
 Growth of Bacteia
 Break down of urea to ammonia by bacteria leading to an increase in the pH of the
urine and this may cause the precipitation of calcium and phosphates.
 Oxidation of urobilingen to urobilin.
 Destruction of glucose by bacteria.
 Lysis of RBCs, WBCs and casts.
Method of Preservation of Urine Specimen
A) Physical Method
- Refrigeration
- Freezing
B) Chemical Method
- Thymol - Boric acid
- Hydrochloric acid - Toluene
- Formaldehyde - Sodium carbonate
Table. Methods of preservation and their advantages and disadvantages
Method Amount advantage disadvantage

Refrigeration 2-6oc  No chemical  Use for a short period of
interference time(3-6 hours) for
 Prevent bacterial growth prolonged periods additional
preservatives must be used
Freezing -200c  For specimen transports  May destroy formed

elements
Toluene Till it forms thin  Preserve acetone  Flammable
layer over the reducing substance ,
urine proteins
 Prevent bacterial growth
Small crystals  Preserve most  Can cause false positive for
Thymole 5mm diameter/100 constituents proteins
ml of urine
Chloroform 1.tablet/60ml of  Preserve urine  Settles to the bottom of urine
urine Aldestrole level containers
Formal dehyde 1drop/30ml of  Preserve formed  Interfes with glucose
urine elements evaluation
1 drop /15ml of  Stabilize steroids  Formed elements are
HCL urine catecolamines destroyed
Boric acid 5g/30ml of urine  Preserve chemicals and  Precipitate uric acid
formed elements
Sodium  Preserves porphrines Interfers with other urine
carbonate and urobilirogen cnositiuents
3.1.4 Preservatives and Anticoagulants for Clinical Chemistry specimen
- Blood is the most common specimen for clinical chemistry and if blood standing for long
time the following Change may occur :-
1. Change due to enzyme action
2. Decrease in concentration of glucose, if sodium fluoride
3. Change due to bacterial action
- Decomposition of glucose to lactose
- Decomposition of urea to ammonium
4. Interchanges of substance between cells and plasma/serum. Biochemical substances in blood
are found in both cells and plasma/serum, but not necessarily in equal concentration.
 Analytes more concentrated in cells: - potassium(k), phosphate, aminotransferase,
proteins, amino acids, lactate dehydeogenase.
 Analytes more concentrated in plasma:- Na, Cl- CO2, Fluoride
 Analytes more concentrated in cells:- glucose. Creatinin, uric acid.
5. Decomposition of some constituents by day light. E.g. photo-oxidation of bilirubin
Hemolysis can be avoid by:-
 Checking that needle and syringe are dry.
 Avoid the use of needle with too fine bore.
 Avoiding withdrawing blood too rapidly.
 Removing the needle from the syringe before dispensing the blood in to the test tube.
 Adding the correct amount of anticoagulants.
 Avoiding shaking blood with anticoagulants.
 Using clean and dry test tube or bottle for blood collection.
 Centrifuge blood for minimum period of time.
 Avoiding freezing of whole blood sample
Preservation of blood for clinical chemistry
- Collect the blood specimen carefully using sops, then separate serum or plasma and
aseptically transfer the plasma or serum to a sterile tube or bottle for transport.
A) Physical methods
 Refrigerate 2-8oC
B) Chemical methods
 Anticoagulants
- Sodium fluoride
Most commonly used anticoagulants
1. Heparin: -
The most widely used and it cause least interference as it is the normal constituent
of blood and found in most tissues of the body. It is available as the sodium, potassium
and ammonium salt.
2. Oxalates:-
-Such as sodium, potassium, ammonium or lithium, inhibit blood coagulation by
forming rather insoluble complex with calcium ions.
- Potassium oxalate used at a concentration of about 1 2mg/m of blood.
3. Sodium fluoride:-
- Although usually considered as a preservative for blood glucose determinations also act as
weak anticoagulants. When used as a preservative along with an anticoagulant such as
potassium oxalate, it is effective in a concentration of about 2mg/m of blood
- It exerts its action by inhibiting the enzyme system involves in glycol sis.
N.B. sodium fluoride should not be used when collecting specimens for enzyme determination.
3.1.5 Preservatives and Transport Medias for Microbiological specimen
- In general, specimens for microbiological investigations should be delivered to the laboratory
with out delay and processed as soon as possible.
- When a delay in delivery is unavoidable, a suitable chemical preservative or transport culture
medium must be used.
. This will help to prevent organisms from
 dying due to enzyme action,
 change of pH, or
 Lack of essential nutrients.
Selecting appropriate Transporting Medias

- Transport media:- are Media containing ingredients to prevent the over growth of commensals
and ensure the survival of pathogenic bacteria when specimens can not be cultured soon after
collection.
Types of transport media
1) Amies transport media:-
- It is a modification of Stuart’s transport
- For the transport Neisseria gonorrhoea from site of specimen collection to
. Microbiology laboratory
2) Cary Blair transport media:
- Used to transport enteric pathogens in faeces such as Salmonella & Shigella,
Campylobacter and Vibrio species
TVET PROGRAM TITLE:

MLA Level II
Based on Ethiopian Occupational Standard (EOS)
coverage and topics
 Introduction to sample transportation
 General procedure of dispatching
 General Procedure of dispatching stool specimen
 Dispatching Urine specimen
 Packaging S
 Means of transportation
 Documentation
them.
them.
understanding them.
materials regarding the cleaning of masonry hand tools.
in page __.
Information Sheet-1
Sample transportation
LO.4
4. Sample transportation
4.1 Introduction to sample transportation
- Transportation also known as dispatching
- It is moving or sending clinical specimen from one place to the other for different reason.
Transportation of specimen can be in the following situations:-
 From specimen collection area to the place where they are examined.
 From one laboratory to other referral laboratory.
 From field to laboratory.
Purpose of sending specimen
 For further investigation
 For external quality control.
 For investigation of epidemic outbreak.
 For teaching or research Etc...
4.2 General procedure of dispatching
4.2.1 General Procedure of dispatching stool specimen
1) Place each specimen in leak- proof of glass bottle with rubber screw up
2) Label carefully each bottle with
- Pt. name - Sex
- Age - Date of collection etc…
3) Prepare a form (specimen transfer sheet) with the following information: patient full
name, age, sex, lab no, date of collection, investigation requested, types of specimen
test to be performed etc…
4) Store the specimen under the correct condition.
5) When you ready to transport the specimen, pack the specimen bottle with absorbent
material (gauze, cotton etc…) which will prevent breakage of tube and absorbs any
leakage.
6) Place bottle in cold box with ice pack.
7) Place the requests paper (specimen transfer sheet) inside the cold box.
8) Label the cold box with
a. Name of reference a lab. on the side
b. Name of sending lab.
c. Safety symbol
9) Send the specimen without delay
Note:- If the stool specimen for parasitological examination
 Collect stool specimen carefully using stool cup.
 Keep it in appropriate preservative in screwed caped container.
 Labelled the container either by using adhesive tape or by using markers with
- Name, ID of patients
-Time of collection of specimen,
-Preservative used
For microbiological investigations
 Transfer portion of the specimen to a cotton wool swab.
 Insert the swab into a container of suitable transport medium
Carry-Blair medium can survive Salmonella, Shigella, & Yersina species for up to 48 hours.
Alkaline peptone water 10ml + 1ml specimen=survive V. cholera for 8 hrs.
Note:-If viral enteritis is suspected mix about 1ml of specimen with 9ml of sterile
phosphate buffered saline, allow the sediment for about 40 minute (or centrifuge)
transfers the supernatant fluid to a sterile container, label and send in an insulated
cold box to reach the virology laboratory within a few hours.
4.2.2 Dispatching Urine specimen
- When sending the urine specimen labels the container with, Patient name, Lab. No, Data &
time of collection, Name of referral lab, Preservative added, Amount of urine specimen to
referral lab etc....
1) For biochemical examination  sent 20-55ml of urine (It can be preserve for 2 hours)
2) For urinary deposit  30 ml of urine with 10% formalin (Preserve for 2 hours)
3) For bacteriological culture  20 ml of urine without preservative (Preserve for 1 hour)
4) For pregnancy test  20ml of 1st urine of the day preserve for 12 –24hrs if refrigerated
(preserve for 4 days)
4.3 Packaging
General principles of packaging
Packaging: -
Is the process of preparing the specimen to be transported, using appropriate method and
procedure to maintain the quality and safety issues during specimen handling and transporting.
 All infectious substances must be packed using a triple layer system:
a) Primary receptacle – a primary watertight, leak-proof (or sift-proof for solids) containing the
infectious substance, packaged with enough absorbent material to absorb all fluid in case of
breakage;
b) Secondary packaging – a second durable, watertight, leak/sift-proof packaging to
enclose and protect the primary receptacle(s). Several cushioned primary receptacles can
be placed in one secondary packaging, but sufficient absorbent material should be used to
absorb all fluid in case of breakage.
c) Outer packaging – secondary packaging is placed in an outer shipping packaging with
suitable cushioning material. Outer packaging should protect contents from physical
damage during transit. outer packaging must be rigid
Infectious substances:
-Infectious substances are substances that are known or are reasonably expected to contain
pathogens. Pathogens are defined as micro‐organisms (including bacteria, viruses, parasites,
fungi) and other agents such as priors, which can cause disease in humans or animals.
- Infectious substances are divided into two categories:
a) Category A Infectious Substance:-
A substance which is transported in a form that is capable of causing permanent disability, life‐
threatening or fatal disease in otherwise healthy humans or animals if exposure occurs.
A shipment of Yersinia pestis cultures is an example of a Category A Infectious Substance.
b) Biological Substance, Category B:
A substance that contains or is suspected to contain pathogens but does not meet the criteria
for inclusion in Category A. Hepatitis B infected blood, adenoviral vectors, or bodily fluids
being shipped to diagnose an unknown (non‐life threatening) illness are all examples of Category B
substances.
NB: - Each category of infectious substance should be packaged and labelled in accordance with
the relevant Packing Instruction along with relevant documentation.
Packing Instruction (For category B infectious substance)
1. The packaging shall be of good quality, strong enough to withstand the shocks and loadings
normally encountered during transport, Which including:-
trans-shipment between transport units and
trans-shipment between transport units and warehouses
Any removal from a pallet or over pack for subsequent manual or mechanical
handling.
Note: - Packaging shall be constructed and closed to prevent any loss of contents that might be
caused under normal conditions of transport by vibration or by changes in temperature,
humidity or pressure.
2. The packaging shall consist of three components:
a) A leak proof a primary receptacle
b) A leak proof a secondary packaging
c) A rigid an outer packaging
Note:-
- Outer packing must be rigid - of which either the secondary or the outer packaging
shall be rigid.
- Primary receptacles shall be packed in secondary packaging in such a way that,
under normal conditions of transport, they cannot break, be punctured or leak their
contents into the secondary packaging.
- Secondary packaging shall be secured in outer packaging with suitable cushioning
material. Any leakage of the contents shall not compromise the integrity of the
cushioning material or of the outer packaging.
3. For transport, the safety mark shall be displayed on the external surface of the outer
packaging on a background of a contrasting colour and shall be clearly visible and legible.
Note:-
- The mark must be in the form of a square set at an angle of 45° (diamond-shaped) with
each side having a length of at least 50 mm;
- The width of the line shall be at least 2 mm and the letters and numbers shall be at least
6 mm high.
Example:- for Category A For Category B
4. An itemized list of contents must be enclosed between the secondary and outer packaging.
5. At least one surface of the outer packaging must have a minimum dimension of 100 mm ×
100 mm.
6. The completed package shall be capable of successfully passing the drop test Regulations at a
height of 1.2 m.
- Following the appropriate drop sequence, there shall be no leakage from the primary
receptacle(s) which shall remain protected by absorbent material, when required, as
specified in the secondary packaging.
7. For liquid substances:

a. The primary receptacle(s) shall be leak proof and must not contain more than 1 litre;
b. The secondary packaging shall be leak proof.
c. If multiple fragile primary receptacles are placed in a single secondary packaging, they
shall be either individually wrapped or separated to prevent contact between them.
d. Absorbent material shall be placed between the primary receptacle(s) and the secondary
packaging. The absorbent material shall be in quantity sufficient to absorb the entire
contents of the primary receptacle(s) so that any release of the liquid substance will not
compromise the integrity of the cushioning material or of the outer packaging.
e. The primary receptacle or the secondary packaging shall be capable of withstanding,

without leakage, an internal pressure of 95 kPa (0.95 bar) in the range of -40°C to +55°C
f. The outer package must not contain more than 4 litres. This quantity excludes ice, dry ice
and liquid nitrogen when used to keep specimens cold.
8. For solid substances

a. The primary receptacle(s) shall be sift proof and must not exceed the outer packaging
mass limit;
b. The secondary packaging shall be sift proof;
c. If multiple fragile primary receptacles are placed in a single secondary packaging, they
shall be either individually wrapped or separated to prevent contact between them.
d. Except for packages containing body parts, organs or whole bodies, the outer package
must not contain more than 4 kg. This quantity excludes ice, dry ice or liquid nitrogen
when used to keep specimens cold;
e. If there is any doubt as to whether or not residual liquid may be present in the primary
receptacle during transport, then packaging suitable for liquids, including absorbent
materials, shall be used.
9. Refrigerated or frozen specimens: Ice, dry ice and liquid nitrogen
a. When dry ice or liquid nitrogen is used to keep specimens cold, all applicable
requirements of these Regulations shall be met. When used, ice or dry ice shall be
placed outside the secondary packaging or in the outer packaging or an over pack.
- Interior supports shall be provided to secure the secondary packaging in the

original position after the ice or dry ice has dissipated.
- If ice is used, the outside packaging or over pack shall be leak proof.
- If carbon dioxide, solid (dry ice) is used, the packaging shall be designed and
constructed to permit the release of carbon dioxide gas to prevent a build-up of
pressure that could rupture the packaging and the package (the outer packaging
or the over pack) shall be marked “Carbon dioxide, solid” or “Dry ice”.
b. The primary receptacle and the secondary packaging shall maintain their integrity at
the temperature of the refrigerant used as well as the temperatures and the pressures
which could result if refrigeration were lost.
10. When packages are placed in an over pack, the package markings required by this packing
instruction shall either be clearly visible or be reproduced on the outside of the over pack.
11. Clear instructions on filling and closing such packages shall be provided by packaging
manufacturers and subsequent distributors to the consignor or to the person who prepares
the package (e.g. patient) to enable the package to be correctly prepared for transport.
Note:-
- Other dangerous goods shall not be packed in the same packaging as infectious substances
unless they are necessary for maintaining the viability, stabilizing or preventing degradation or
neutralizing the hazards of the infectious substances.
-A. quantity of 30 ml or less of dangerous goods included in flammable liquids, corrosives or

miscellaneous dangerous substances and articles may be packed in each primary receptacle
containing infectious substances.
-When these small quantities of dangerous goods are packed with infectious substances in
accordance with this packing instruction no other requirements in these Instructions need be met.
Packing specimen for dispatching
- Always observe the regulation of in your country
- During packing processes
 Check that the bottle is labelled with the patient name and the date of specimen
collection.
 Then Place the sealed bottle in an aluminium tube with a screw cap
 Wedge it in the tube with absorbent cotton wool
 Wrap the request paper/ sample transfer sheet around the metal tube.
 The request form/sample transfer sheet should show
- The patient’s name
- Date of birth (age)
- Nature of specimen
- Date of specimen collection
- The address of health center where the specimen was collected
- Type of test requested
 The metal tube should be placed in a strong cardboard/wooden box for dispatch.
 Wedge the tube in tightly with non-absorbent cotton wool
 Label the out side of the box with
- “URGENT”
- ‘’FRAGILE’’
- ‘’INFECTIUOS MATERIAL ‘’
4.3 Means of transportation
Transport of Clinical specimen flow chart
- Transporting of clinical specimen without hospital/health center such as:-
Specimens sending for quality control purpose or for further investigation from
One laboratory to other laboratory (which may be regional, central or international
laboratory which may be found with the same region or nation or abroad)
- Specimen collected at field and sending to laboratory.
With in hospital
Porter air tube
Laboratory
- Therefore, depending on the distance where specimen to be travelled and the availability of
required means of transportation, the following means of transportation may be used.
Specimen
From one laboratory to from field to laboratory from one laboratory to

other referral laboratory other laboratory
- Taxi -Taxi -Airplane
- Ambulance -Ambulance -Train
- Public transport -Public transport
- Motor bike -Motor bike
4.4 Documentation
Definition: -
-Collection and classification of information.
There is different information to be documented during sample transportation, such as:-
1. Patient information
 Name
 Identification number (ID)
 Sex
 Address
 Clinic symptom
 Underline disease
 Family history etc....
2. Specimen information
 Type of specimen
 Amount of specimen
 Collection site and time
 Specimen collection techniques etc...
3. Packaging instruction
4. Material and equipment required for sample transportiton
5. Occurrence of accident
 What has been happened?
 What was the cause of accident?
 What action has been taken? etc....
6. Check lists
NB:-
-Each of the above information and any other activities during specimen transportation
should be documented and should not be disclose for unauthorized person and organization.
TVET PROGRAM TITLE:

MLA Level II
Based on
Instruction Sheet Learning Guide #7
coverage and topics
 Levels of Referral facilities /referral system
 Following required policies and procedures
 Maintaining confidentiality in all aspects of work
them.
them.
understanding them.
in page __.
Information Sheet-1 Communication with Health facilities
LO.5
5. Communication with Health facilities
Communication: -
The process of exchange/ transfer information from source to receiver through different places.
Health facility:-
A place that provide health care service, which includes clinics, hospital, health center, referral
hospital, specialized hospital etc…
Organization: -
Is defined as a system an orderly structure, putting things together into a working order, and
marking arrangements for under taking that involve cooperation.
Medical laboratory: -
Is a branch of medical science which deals with the representative biological or clinical samples
(blood, stool, urine, sputum, etc). to detect and determine any an abnormally or health condition
of the respective patient.
Means of communication: -
the communication between health facilities can be done through different things, such as paper,
phone, internet, meeting, etc….
5.1 Levels of Referral facilities /referral system
- There are different health facilities at different level. The difference among these levels can be:-
 In purpose and responsibility
 In resource quality and quantity
 In human resource
 Degree of professional
 Job description etc...
- Medical laboratory among the organization within the health facility and responsible for
provides mainly diagnostic, monitoring & screening service for the clients.
- Medical lab is one of the most significance diagnostic department and which encompass
different discipline such as
1. Hematology 5. Mycology 9. Immunohematology
2. Serology 6. Urinalysis etc…
3. Virology 7. Bacteriology
4. Clinical chemistry 8. Parasitology
-In Ethiopia laboratories are organized at different level based on their purpose, facility, human
resource and others factors.
Structure and function of lab. Service in developing countries.
- Lab. Service net work:- consists of
1. Community based primary health care lab.
2. District hospital lab
3. Regional or referral hospital lab.
4. Central and public health lab
I) Community based primary health care lab.
- In Ethiopia these laboratories are called zonal or district and health center laboratories
- The work of the community based PHC lab. Is to support health care workers by
investigating, controlling, and preventing major diseases in the community and
by promoting health care through integrated health education.
Staff: - junior lab. Tech or Local community health worker
Function :-
1. To investigate, refer or testing on site, important disease and health problem affecting the
local community.
2. To promote health care and assist in community health education, of e.g. by demonstrating
microscopically the parasites of important local disease.
3.To keep records and to send a simple informative monthly report to the district
National research
institute
Regional health research
Regional public health laboratory
Hospital laboratory
Health center laboratory
Health station laboratory
Fig.1 organization of health laboratory in ethio / world
II). District hospital lab.
In Ethiopia these lab are called sub-regional public health laboratories.
Staff: - at least one senior lab. Technician, 2-4 laboratory assistants, several laboratory aids
The main function:-
1. To perform a range of tests relevant to the medical, surgical, and public health activities of
the district hospital.
2. To support the work of the community based lab. By
 Testing referred samples
 Providing reagents, control, standards specimen containers and other essential lab.
Supplies
 Training community health lab. worker
3. To refer specimens to the regional lab.
4. To participate in the external quality assurance program organized by the regional lab.
III). Regional or referral hospital lab.

- The main role of the regional lab. Is to assist and supervise the district lab. To test referred
specimens and to perform a range of specialized tests and other required tests.
Staffing:-
 One coordinating chief lab. Officer
 Med. Lab. Technologist (BSC or MSC)
 Experienced specialist lab. Tech.
 Two or three lab. Tech in each department
 Safety office
 Clerical steel
 Several aids
Functions:-
1. To perform a range of tests are required by the medical and health needs of the region.
2. To operate a regional blood transfusion center.
3. To prepare reagents, culture media, controls, clinical chemistry standards, and specimen
Containers.
4. To investigate epidemic and perform tests of public health importance in the region.
5. To perform bacteriological and chemical analysis of foods, water, beverages and other
industrial products.
6. To support the work of the district hospital labs in the region
7. To send specimens those require specialized investigation to the central and public health
labs.
8. To participate in external quality assessment programs organized by the central lab.
IV). Central public health laboratory
- This lab is responsible for the planning, expenditures, and co-ordination of the national lab
service. In Ethiopia which know as Ethiopian Health and Nutrition Research Institute
(EHNRI) also called “Pasteur institute”.
- It has equally important roles in ensuring the reliability of the service.
- The appropriateness of its technology, training and motivation of its work force, and insuring
that the service extends into the area of health needs and that its facilities are made
available to as many people as possible.
Staffing:-
 Senior coordinating officer
 Several research scientists
 Several senior lab. Tech
 Several lab aid etc.
Main function:-
1. To formulate a professional ethics formed. Lab. personnel.
2. To perform tests not normally under taken in regional lab.
Such as: - Viral, Histopathological, Cytological, Immunological, Hormonal, Nutritional,
Molecular investigation etc….
3. To carry out appropriate research an important national health problem.
4. To evaluate new technologies, standardize techniques, and test the appropriateness of new
equipment.
5. To purchase supplies and equipment for national lab. Services and to organize an efficient
system of requision distribution and maintenance of equipment.
5.2 Following required policies and procedures

Polices: - a general and broad document which tell us what to do, and which include the mission
and goal of the organization. Example health police in Ethiopia.
Procedure: - Step-by step instruction for performing a single activity.

Example: - Specimen collection sops
- Specimen transportation instruction communicate with different level of health facilities should
be done based on the police and standard procedures in the given country or region.
Therefore, the communication between different levels of laboratory in the following case needs
to be performed using standard procedures.
 Sending specimen for quality control, further investigation or advanced examination.
 Receiving quality control specimen materials or standards.
 Sending quality control result, laboratory test result
 Receiving feedback etc…
EHNRI
Regional referral hospital

laboratory
Regional reference
Health center laboratory
laboratory
Private
Zonal/regional laboratory
laboratory
Fig 2. Flow chart for implementation of lab. Net working
5.3 Maintaining confidentiality in all aspects of work

Confidentiality: -
-Is a set of rules that limits restriction on certain type of information.
- A code of professional conduct for medical laboratory personnel should include those practices
and attitudes which characterize a professional and responsible laboratory worker and necessary to
ensure a person works to recognized standards which patients and those requesting laboratory
investigations can expect to receive.
- Patient/client and test result information must be kept strictly confidential and therefore
shouldn’t be disclosing to unauthorized person. It is one the laboratory professional ethics to
be obeys during specimen handling and transporting process too.
Mechanism to keep patient information confidentially

 Use code /code number for patient identification.
 Request form or sample transfer sheet should not be given for unauthorized person
 Access to patient result form should be restricted
 Sample handling and transporting process should be performed only by professionals.
 Access to Laboratory examination area should be restricted for unauthorized person
 Test result report should be given to the right person on the right time. Etc…
TVET PROGRAM TITLE:

MLA Level II
Based on
coverage and topics
them.
104.If you earned a satisfactory evaluation proceed to “Information Sheet 2”. However, if
them.
109.Read the information written in the “Information Sheets 3 and 4”. Try to understand
what are being discussed. Ask you teacher for assistance if you have hard time
understanding them.
112.If you earned a satisfactory evaluation proceed to “Operation Sheet 1” in page _.
114.You are provided with a CD containing lessons on how to clean and maintain
materials regarding the cleaning of masonry hand tools.
115. Request a desktop computer or laptop from your teacher. Make sure the unit is
plugged to a power source before turning on the power O. Then insert the CD in the
CD drive located in your computer. Access the information as described in the
Operation Sheet 1 in page __.
117. Request access to the equipment and software described in the CD. Practice the
steps or procedures as illustrated in your CD. Go to your teacher if you need
clarification or you want answers to your questions or you need assistance in
understanding a particular step or procedure.
Information Sheet-1 Maintain a safe work environment
LO.6
6. Maintain a safe work environment
6.1 Introduction
Safety in the laboratory
All specimens and body fluids are considered potentially hazardous. They should be
treated as if capable of causing disease. Thus safety system should be applied in
laboratory always.
Safety should applied in all three laboratory activity phases
1. Pre-analytical activities Such as:-
 Patient identification
 Specimen collection
 Specimen transportation
 Specimen receipt
 Specimen preparation/processing
2. Analytical activities such as:-
 Performing the test
 Interpretation of the result
3. Post-analytical activities
 Result reporting
 Recording result and patient information on registration book
 Decontamination and disposal of specimen.
The main potential hazards and accidents associated with laboratory work
 Infection
 Cuts and prinks
 Electric shock
 Burn
 Toxic chemical
 Injury from explosion
 Fire
The most common cause of infection in laboratory
. Inhalation:- being inhaled in aerosol/ air born particles during
 Snap close specimen containers
 Dispensing
 Pipetting infectious materials
.Ingestion:- being ingested from contaminated
 Finger
 Food store in laboratory
. Pathogens entering through skin during
 Needle puncture
 Cuts: - From breakage or cracked or damage edges of glass.
 Scratch
 Sore/lesion
6.2 Safety in the laboratory includes three major parts.
1. Creating/maintain safe working environment
2. Safe working practice
3. Aware and follow correct method of decontamination and disposal of lab. Waste.
1. Creating/maintain safe working environment
- To create safe working environment, apply the following mechanisms such as:-
 first identify potentially hazardous area and materials
 use safety sign and symbol
 avoid access to the laboratory
-Use sinks separately for
 hand washing with gloved handed
 laboratory activity
 hand washing without gloved handed
-Avoid overcrowding of work area and bench
2. Safe laboratory practice
Following safe working practice in every laboratory activities.
 Safe practice includes
 Practice of personal hygiene
 Wash hand and arms with soap and water
 After handling specimen
 After handling infectious materials
 When leaving laboratory
 At the end of the day’s work
 Cover any cut, open sore or wound
 Wearing closed shoes
 Not eat , drink, chewing gum or apply cosmetics in the laboratory
 Cleaning work space (bench) before and after work with 0.1-0.5% disinfectant
 Wear protective clothing ( gown/apron) to protect
 Splashes
 Droplets
 Hazardous chemical
 Using personal protective materials such as:-
 Glove
 Should be worn for all procedure that has contact with body fluids.
 Select proper size
 Shorten finger nail
 Avoid ring from finger
 One glove per patient or change the glove when ever you think it is
contaminated.
 Use double glove during handling high infectious materials
 Safety goggle
 Plastic apron
 Foot wears
 Using safety equipments
 Biological safety cabinet
 To protect lab. Worker from aerosol and air born particles
NB: - safety cabinet cannot protect the person from spillage and
consequence of mishandling and poor techniques.
 Transport container
 To transport specimen from ward to lab or other referral lab
 Modified container can be used within hospitals.
 Sharp disposal containers
 For needle, lancet disposal
 Should be puncture proof
 Recap single handed/ or dispose without recap the needle
3. Aware and follow correct method of decontamination and disposal of lab. Waste
Waste management
-Health care facility such as hospital and clinical laboratory generate large amount
of waste materials that can be harmful to the community at lager if proper
precaution are not taken for its disposal.
This waste is collectively called ‘medical waste.
Non-contaminated waste
Pose no infectious risk to persons who handle them. Examples of non-contaminated
waste include paper, trash, boxes, bottles and plastic containers, which contain
products delivered to the clinic.
Contaminated waste
Potentially infectious or toxic, if not disposed of properly Contaminated waste
include, blood, body fluids, secretions and excretions and items that have come in
contact with them, such as sharps and used dressings, as well as medicines, medical
supplies or other chemicals that may be toxic.
Medical waste (contaminated waste): -

Is defined as special waste from health care facilities that may transmit infectious
disease.
The purpose of waste management is to:
 Protect people who handle waste items from accidental injury,
 Prevent the spread of infection to healthcare workers who handle the waste,
 Prevent the spread of infection to the local community, and
 Safely dispose of hazardous materials.
Steps of waste management
1. Segregation
- Contaminated and non-contaminated wastes should be separated at origin, to
reduce the volume of contaminated waste and minimize the cost to the institution for
more expensive procedures required for managing and disposing of contaminated
waste properly.
2. Collection
3. Transportation
4. Disposal
Handling of medical waste
The following practice should be considered in proper handling of biohazard wastes.
a) Biohazard warning sign must be posted
b) Biohazard bags should be used
c) All lab waste must be decontaminated prior to disposal
d) Infectious waste should not be buried.
e) All medical waste should be placed in leak proof, puncture resistance
containers.
f) All sharp instruments such as needle, blades and glass object should be placed in a
puncture proof/resistance container before placing the in plastic bag.
g) Spills waste must immediately be decontaminated with disinfectant.
h) Liquid waste should be denominated by autoclaving or by chemical
disinfectant.
i) Waste should be handling only by trained workers.
j) If the medical waste needs to be stored for some time before disposal, it should be
store in secure place where it is not accessible for other individuals or worker.
Decontamination of lab wastes
 Decontaminate properly by :-
E.g. Autoclaving
 Chemical (sodium hypochlorite)
E.g. add sodium hypochlorite to sputum or blood specimen before disposing
them.
Waste disposal methods

a) Incineration: -
 the process of distraction of waste by burning and it is effective
method of disposing lab waste.
 Incineration provides high temperatures and destroys microorganisms; and
therefore, is the best method for disposal of contaminated wastes; incineration
also reduces the bulk of wastes to be buried.
b) Waste pit/land fill :-
 it is burial waste in deep cover
 All infectious lab waste should be decontaminated before discard in pit /land
fill.
 Plastic lab waste best incinerated before burial.
 Access to the disposal site should be restricted.
 Select site at least 50 meters away from any water source to prevent
contamination of the water table.
 The site should have proper drainage, be located downhill from any wells, free
of standing water and not in an area that flood.
How to Dispose of Liquid Waste
 Liquid contaminated waste requires special handling, because it may pose an
infectious risk to healthcare worker who handle the waste.
 Wear PPE when handling and transporting liquid waste.
 Pour waste down a utility sink drain or a flushable toilet and rinse with water.
Avoid splashing.
 If no sewage system available, dispose of liquid in a deep, covered hole, not
into open drains.
 Decontaminate containers by placing them in a 0.5% chlorine solution before
washing them.
 Remove utility gloves, wash and dry hands or use antiseptic hand rub.
How to Dispose of Solid Waste
 Dispose of contaminated wastes separately from non-contaminated waste,
because contaminated wastes needs special handling as follows:
 Wear heavy duty or utility gloves when handling and transporting solid wastes.
 Dispose of solid wastes by placing them in a plastic or galvanized metal
container with a tight fitting cover.
 Collect the waste containers on a regular basis and transport the burnable ones
to the incinerator or area for burning.
 Remove gloves and wash and dry hands or use an antiseptic hand rub.
6.3 Report problems, accidents and incidents in accordance with
procedures
 Any accident in the laboratory involving personal injury, even minor ones,
should be immediately reported to the person in charge of the laboratory.
 This first report of injury should be followed by an accident investigation
report.
 The injury report should contain the name of the injured person.
 Time and place of injury, and nature of injury.
 The investigation report should include the information on the injured person,
an account of the accident, the cause of the accident, the nature of the injury and
the actions to be taken to prevent a recurrence.
Occupational Standard
This unit of competency covers the ability to handle and transport samples or
test/calibration equipment in a way which ensures the integrity of subsequent test
results.
Critical Aspects of Competence
 Assessment requires evidence that the candidate:
 follow required policies and procedures to maintain the integrity of collected
samples or equipment during transport
 deal with customers effectively and courteously
 work safely
 maintain confidentiality and report problems, accidents and incidents in
accordance with procedures.
Knowledge and Attitudes
 Demonstrates knowledge of:
 the relationship between effective communication with clients and customers
and enterprise business
 the need for appropriate and timely transport
 control measures for minimizing exposure to hazardous materials and
equipment
 effect of changes in environmental conditions, vibration and shock on samples
 procedures for the containment and cleanup of spillages and breakages
 efficient waste containment and disposal practices
 maintenance requirements of equipment used in the processes of handling and
transporting samples
 relevant health, safety and environment requirements
 enterprise procedures for responding to emergencies
 contact details for key personnel
Skills
 Demonstrates skills on:
 planning the picking up of items in conjunction with a supervisor
 preparing a vehicle for the required journey
 using communication devices so contact is possible between the courier,
reception centre and routine pickup locations
 communicating effectively and courteously with individuals, customers, clients
and reception staff
 recording details of item exchange in relevant sections of chain of custody
forms, as required
 maintaining the integrity of collected samples or equipment during transport
 containing and cleaning up spillage or breakages
 using appropriate techniques and equipment to safely dispose of waste
materials
 maintaining confidentiality in all aspects of work
 reporting of problems, accidents or incidents in accordance with enterprise
procedures

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Gode health Science College

TVET PROGRAM TITLE:

Instruction Sheet Learning Guide #7

LO1. Handling and Transporting of Specimen

Unless the appropriate specimen is properly collected, preserved and processed

Gode health Science College

TVET PROGRAM TITLE:

Instruction Sheet Learning Guide #

Collection and preparation of required

 Specimens must be collected in an appropriate specimen container to maintain the integrity

 Most specimens should be stored between 2-8°C. Specific handling/storage

2.1.2 Materials and equipments for Haematological specimens

Gode health Science College

TVET PROGRAM TITLE:

Based on Ethiopian Occupational Standard (EOS)

Table. Methods of preservation and their advantages and disadvantages

Method Amount advantage disadvantage

Freezing -200c  For specimen transports  May destroy formed

Selecting appropriate Transporting Medias

TVET PROGRAM TITLE:

Based on Ethiopian Occupational Standard (EOS)

Instruction Sheet Learning Guide #

7. For liquid substances:

e. The primary receptacle or the secondary packaging shall be capable of withstanding,

8. For solid substances

- Interior supports shall be provided to secure the secondary packaging in the

-A. quantity of 30 ml or less of dangerous goods included in flammable liquids, corrosives or

- Specimen collected at field and sending to laboratory.

Porter air tube

From one laboratory to from field to laboratory from one laboratory to

TVET PROGRAM TITLE:

Instruction Sheet Learning Guide #7

II). District hospital lab.

In Ethiopia these lab are called sub-regional public health laboratories.

III). Regional or referral hospital lab.

5.2 Following required policies and procedures

Procedure: - Step-by step instruction for performing a single activity.

Regional referral hospital

Fig 2. Flow chart for implementation of lab. Net working

5.3 Maintaining confidentiality in all aspects of work

Mechanism to keep patient information confidentially

Gode health Science College

TVET PROGRAM TITLE:

Instruction Sheet Learning Guide #

Medical waste (contaminated waste): -

Waste disposal methods

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