A

TECHNICAL REPORT

OF

STUDENT INDUSTRIAL WORK EXPERIENCE SCHEME(SIWES)

UNDERTAKEN AT

KHADIJAT MEMORIAL HOSPITAL LTD,

KULENDE ESTATE JUNCTION, ILORIN

KWARA STATE.

BY

ABDULRAZAQ ABDULLAHI AYOBAMI

MATRIC NO.: U19BC1040

SUBMITTED TO

DEPARTMENT OF BIOCHEMISTRY

FACULTY OF LIFE SCIENCE

AHMADU BELLO UNIVERSITY ZARIA,

KADUNA STATE.

IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE AWARD OF

BACHELOR OF SCIENCE(B.Sc) DEGREE IN BIOCHEMISTRY.

NOVEMBER,2024.

1
 ACKNOWLEDGEMENTS

As noted in the holy scripture, “And remember when your Lord proclaimed, “If you are grateful, I will

surely increase you in favor…On this note, my thanks and praises to Almighty Allah for His mercies and

compassion during this period can never be quantified. To my dear parents who were very supportive in

all ramifications through my period of industrial attachment. To my dear sister and her husband Prof.

And Mrs. Abdulrahman tawakalitu who provided me with shelter and all necessary support, I say thank

you.

Special thanks to the coordinator of all I.T students Mrs Oloyede, My supervisor Miss Oluwashola

Patience, and to all staffs of Khadijat Memorial Hospital medical laboratory who gave me the necessary

assistance and opportunities to acquire necessary experience.

Much thanks to my I.T colleagues, the chief I.T Chikwezie, Aisha, Muneerah, Khadijah, Khairat,

Jenifer, Chika Olivia, Princess, Nina, Grace, Becky, Maimunah, Amara, Fatimah, Shade, Muneerah,

Fatimah, Mubarak, Jibril, Johnson, Innocent, Lekan, Ijaida , Daniel, Simeon for all your kindness and

support.

Lastly, to my dear lecturers who make so much effort and sacrifice day and night to see that we the

future biochemists grow to become great minds and successful people in our field. The impact of your

work is being felt seriously.

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 REPORT OVERVIEW

The Student Industrial Work Experience Scheme is a skill training programme designed to prepare and

expose the students of higher institution to acquire industrial skill and practical experience in their

approved course of study and also to prepare students for the industrial work situation which they are

likely to meet after graduation.This technical report is based on the experiences gained during my 6

months of Industrial training at Khadijat Memorial Hospital, Nigeria.

This report highlights how patients are being managed and also several test carried out for patients

such as: Urinalysis, kidney functions (E/U/Cr) details, Liver function tests, Stool Examination, Full

blood Count (FBC), Packed Cell Volume(PCV), Genotype e.t.c. I was opportuned to work in 4 sections

which are the Chemical Pathology, Chemical Microbiology,Phlebotomy, and Hematology. These sections

have exposed me to the precaution, rules and regulations of the laboratory and how the tests are being

analyzed.

Most importantly, it describes the activities and my experience gained during the period of my

training. Also, the problems encountered and suggestion for improvement of the scheme.

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TABLE OF CONTENTS

Title page………………………………………………………………………………………………. 1

Letter of Transmittal………………………………………………………………………………….. 2

Acknowledgement………………………………………………………………………………………3

Report Overview……………………………………………………………………………………….4

CHAPTER ONE

1.0 INTRODUCTION

1.1 Background ……………………………………………………………………………………7

1.2 Aim and objectives of SIWES………………………………………………………………….8

CHAPTER TWO

2.0 DESCRIPTION OF THE KHADIJAT MEMORIAL HOSPITAL

2.1 Location and Brief history of Khadijat Memorial Hospital ………………………………………..8

2.2 Objectives of the Establishment………………………………………………………………...9

2.3 Organizational Structure and Organogram…………………………………………………….10

2.4 Departments in the Establishment and their Functions ………………………………………..11

CHAPTER THREE

3.0 EXPERIENCE ACQUIRED

3.1 Clinical Biochemistry Section …………………………………………………………………15

3.2 Phlebotomy Section…………………………………………………………………………….25

3.3 Hematology and Immunohematology (Blood Bank) Section………………………………….31

CHAPTER FOUR

4.0 EXPERIENCE ACQUIRED

4.1 Serology Section……………………………………………………………………………….36

4.2 Microbiology Section…………………………………………………………………………..40

CHAPTER FIVE

5.0 Summary, Challenges Encountered, Recommendation and Conclusion

5.1 Summary………………………………………………………………………………………..48

5.2 Challenges Encountered ………………………………………………………………………..48

5.3 Conclusion………………………………………………………………………………………48

5.4 Recommendation…………………………………………………………………………………....48
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 LIST OF FIGURES

Fig 2.3: Khadijat Memorial Hospital organogram

Fig 2.5: Laboratory sections in KMH

Fig 2.6 Electrolyte Analyzer

Fig 2.7 Spectrophotometer

Fig 2.8 Centrifuge

Fig 2.9 HbA1c analyzer

Fig 3.0 Pipette

Fig 3.1 Blood Collection Tubes

Fig 3.2 COBAS c311

Fig 3.3 Universal Bottle

Fig 3.4 Urinalysis chart

Fig 3.5 FOBT test kit

Fig 3.6 EDTA Tube

Fig 3.7 Plain bottle

Fig 3.8 Lithium heparin tube

Fig 3.9 Fluoride - Oxalate tube

Fig 4.0 Sodium citrate tube

Fig 4.1 Phlebotomy procedure

Fig 4.2 Hematology analyzer

Fig 4.3 PCV equipment

Fig 4.4 Anti- Sera

Fig 4.5 ABO blood grouping chart

Fig 4.6 Westergreen tube and rack

Fig 4.7 HbsAg Test strip

Fig 4.8 Pregnancy Test Strip

Fig 4.9 Swab based specimen collector, medium plates, sensitivity disc

Fig 5.0 Autoclave principle

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 CHAPTER 1

1.0 INTRODUCTION

The Industrial Training Fund was established in 1971 in accordance with the constitution of the

Federal Republic of Nigeria. Industrial Training Fund has been operated consistently within the context

of its enabling laws of Decree 47 of 1971 as amended in the 2011 ITF ACT. The objective for which the

fund was established has been pursued vigorously and efficaciously. In the four decades of its existence,

the ITF has not only raised training consciousness in the economy, but has also helped in generating a

corps of skilled indigenous manpower which has been manning and managing various sectors of the

national economy.

Over the years, pursuant of its statutory responsibility, the ITF has expanded its structures, developed

training programmes(such as SIWES), reviewed its strategies, operations and services in order to meet

the expanding, changing demands for skilled manpower in the economy.

MISSION STATEMENT

To set and regulate standards and offer direct training intervention in industrial and commercial skills

training and development, using a corps of highly competent professional staff, modern techniques and

technology.

VISION STATEMENT

To be the foremost Skills Training Development Organization in Nigeria and one of the best in the world.

1.1 BACKGROUND

The Student Work Experience Scheme (SIWES) is a skill compulsory training programme established in

1973, designed to prepare and expose students of the tertiary institution to the industrial work situation

they are likely to meet after graduation. The scheme affords students the opportunity of familiarizing and

exposing themselves to handling equipment and machinery thus enhancing how they engage and apply

themselves mentally, intellectually and physically in relation to the theoretical knowledge acquired in the

classroom in their respective institutions.

Students’ Industrial Work Experience (SIWES) is a tripartite programme, involving the students,

universities and the industries (employer of labor).The programme is funded by the Federal Government

6
of Nigeria and jointly coordinated by the Industrial Training Fund (ITF) and the National Universities

Commission (NUC).

In the race for excellence the Department of Biochemistry, Ahmadu Bello University sends her

students on a mandatory six months industrial training to equip them students with necessary practical

skills to be highly competitive, productive, competent and professional individuals in the labor

market.Consequently, this has benefited student in many ways. These includes;

a) Opportunity for students to blend theoretical knowledge acquired in the classroom with practical

hand-on application of the knowledge required to perform work in the industry;

b) Exposes the students to the working environment, i.e to enable them see how professions are

organized in practice;

c) Prepare the students to contribute to the productivity of their employers and nations economy;

d) Provision of an enabling environment where students can develop and enhance personal attributes

such as critical thinking, creativity, initiative, resourcefulness leadership, time management,

presentation of skills and interpersonal skills;

e) Enables students bridge the gap between acquired skills in the institutions and the relevant

production skills required to work in the organization;

f) Enhances students contact with potential employers while on training; and

g) Prepares student for employment and makes transition from school to the work environment easier

after graduation.

1.2 AIM AND OBJECTIVES OF SIWES

The objective of the Students’ Industrial Work Experience Scheme (SIWES) include;

a) Provide an avenue for students in institutions of higher learning to acquire industrial skills and

experience relevant to their course of study;

b) Expose student to work methods and techniques in handling equipment and machinery that may not

be available in their institutions;

c) Make the transition from school to the world of work easier, and enhance students contacts for later

job placement;

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d) Provide students with an opportunity to apply their knowledge in real work situation thereby

bridging the gap between the theory and practice; and

e) Enlist and strengthen employers involvement in the entire educational process and prepare students

for employment after graduation.

8
 CHAPTER 2

2.0 DESCRIPTION OF KHADIJAT MRMORIAL HOSPITAL

2.1 LOCATION AND BRIEF HISTORY OF KHADIJAT MRMORIAL HOSPITAL

The Khadijat Memorial Hospital is situated in Kulende Housing Estate Junction, Zango, Ilorin, Kwara

state, Nigeria was founded by Prof Ibrahim Gambari. The institution was formally established under the

Decree 36 of 1999 (ACT 36 of 1999). On May 22nd 2010 the hospital was commissioned by Late

Abubakar Olushola Saraki. Originally the hospital was designed to cater for the needs of women and

children in Nigeria and the West African sub-region with a view to reduce morbidity and mortality rates

and to carry out extensive research into the peculiar causes of women and children related disease in

Africa, hence the name KHADIJAT HOSPITAL for WOMEN AND CHILDREN. After the recruitment

of manpower from home and abroad, the Hospital commenced operation on 1st September 2013.

However, in order for the vast majority of Nigerians to benefit from the health care services and modern

equipment the scope of its operation expanded to accommodate male patients and the name was changed

to KHADIJAT MEMORIAL HOSPITAL, on 10th May, 2014 which now has branches across the country.

INSTITUTION’S VISION

To be recognized as world class hospital for quality patient treatment and care in Nigeria and be

exemplary model for delivery of quality patient - centered health care

2.2 INSTITUTION’S OBJECTIVES

a) To provide sustainable, effective, efficient, high-quality tertiary and specialized medical services for

local and international referred patients, as well as providing conducive environment for training

research and innovation.

b) To develop norms and standards for accreditation of the Health Care Organization and adopt means

of evaluation of such institutions so as to improve the quality of health care in the country.

c) To promote a forum for the exchange of ideas and information among health and hospital planners,

academicians, administrators, various statutory bodies and the general public for the improvement of

Hospital and Health Care delivery systems.

d) To provide advisory and consultancy services to the government and others on health related

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 matters.

INSTITUTION’S CORE VALUES

 Patient’s First

 Excellence

 Accountability

 Integrity

 Compassion

 Ethics

 Teamwork

 Professionalism

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 2.3 ORGANIZATIONAL CHART OR ORGANOGRAM

Governing Board

Medical Record
Chief Medical Director Dept. Info
Unit.Planning and
Research Statistics.
Marketing and Bus
Procurement Division Planning, Research Unit
and Development (NHIS/Retainership
)
Legal Services Unit

Information and Protocol Unit Internal Audit

Clinical Services Administration Finance and Accounts Maintenance

Industrial Human Resource

Management General Services Finance &
Relations & Staff Building &
Dept Department Accounts
Civil Dept
Pharmacy Dental

Internal Medicine Oncology Training & Stores Cash

Gynecology Radiology Development Transport Management

Services Billings &

Surgery Medical Physics Personnel
Laundry Payments
Anesthesiology Physiotherapy Administration
Services Salaries & Wages
Pediatrics Microbiology Pension &

Benefits Credit Control

F/Medical Hematology
Building &
Nuclear Medicine Chem
Staff NHIS Civil Dept
Pathology

Industrial Biomedical
Psychiatry Histopathology
Relations Engr. Dept
Nursing Dietetics
Staff Welfare Electrical &
Library Medical Welfare
Mechanical
ENT Ophthalmology
Dept

Fig 2.3 Khadijat Memorial Hospital organogram

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2.4 VARIOUS DEPARTMENT IN THE NATIONAL HOSPITAL ABUJA AND THEIR

FUNCTIONS

National Hospital Abuja provides a wide range of professional Health care services.Hence, consists

of a number of hospital departments, staffed by a wide variety of health care professionals for efficient

delivery of health care services.These departments include;

 Department of ENT ( Ear, Nose and Throat)

This department is concerned with the diagnosis and treatment or ear, nose, throat, head and neck disorders.

 Department of Ophthalmology

This department is concerned with the diseases and surgery of the visual pathways including the eyes, hair, and

areas surrounding the eyes, such as lachrymal system and eyelids.

 Department of Obstetrics and Gynecology

This department is concerned with the clinical pathology involving female reproductive organs and

provision of care for both pregnant and non pregnant patients

 Department of Family Medicine

This department is concerned with provide providing personal, comprehensive, and continuing care for

the individual in the context of the family and the community.

 Department of Surgery

This department is concerned using operative manual and instrumental techniques on a patient to

investigate or treat a pathological condition such as a disease or injury, to help improve bodily function

or appearance or to repair unwanted ruptured areas.

 Department of Physiotherapy

This department is renders services to individuals and populations to develop, maintain and restore

maximum movement possible and functional ability throughout the lifespan.

 Nursing Services Department

This department is concerned with providing preventive and screening services, health education and

assistance with decision-making about health, and immunization against preventable diseases.

 Dental Department

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This department is concerned with diagnosing oral diseases, promoting oral health and disease

prevention and creating treatment plans to maintain or restore the oral health of their patients.

 Department of Nuclear Medicine

The department of Nuclear Medicine utilizes radioactive materials to diagnose the presence of disease in

the body and to treat multiple types of cancer

 Department of Radiology

This department is concerned with the study and application of imaging technology like X-ray and radiation to

diagnosing and treating disease.

 Internal Audit Department

This department is concerned with the provision independent assurance that an organization's risk

management, governance and internal control processes are operating effectively.

 Department of Chemical Pathology

This department is concerned with the biochemical investigation of bodily fluids such as blood, urine and

cerebrospinal fluid.

 Department of Dietetics

This department is concerned with assessing patients health needs and diet.

 Department of Histopathology

This department is concerned with the diagnosis and study of diseases of the tissues, and involves

examining tissues and/or cells under a microscope.

 Department of Haematology

This department is concerned with the diagnosis and multidisciplinary treatment for many hematologic

diseases such as malignant blood diseases like leukemia, lymphoma and common myeloma; clotting

diseases and hereditary blood diseases

 Department of Internal Medicine

This department is concerned with the prevention, diagnosis, and treatment of adult diseases.

 Department of Oncology

This department is concerned with diagnosing cancers. discussing treatment options with patients.

13
arranging and supervising drug treatment and therapies including the management of any complications

that may arise

 Department of Paediatrics

This department is concerned with the physical, mental, and emotional well-being of the children under

their care at every stage of development, in both sickness and health.

 Department of Pharmacy

This department ensures the safe and effective use of pharmaceutical drugs, the scope of pharmacy

practice includes more traditional roles such as compounding and dispensing medications and it also

includes more modern services related to health care including clinical services reviewing medications

for safety and efficacy and providing drug information.

 Department of Microbiology and Parasitology

This department is concerned with the prevention, diagnoses, treatment and monitoring of infectious

diseases using the latest scientific advances in the fields of bacteriology, virology, mycology and

parasitology.

 Department of Psychiatry

This branch of medicine deals with the diagnosis, prevention, and treatment of mental disorders.

 Department of A&E

This department is also known as emergency department and is concerned with the treatment of critically

ill patients and to prevent cardiac arrest in patients presenting with signs of physiological instability.

 Department of Cardiothoracic Unit

This department is concerned with the treatment of the diseases of the heart, lungs and other organs in

the thoracic region.

 Department of In Vitro Fertilization: This department is concerned with the treatment of

infertility.

 Laboratory

This is where tests are done on clinical specimens in order to get information about the health of a patient as
14
pertaining to the diagnosis, treatment and prevention of disease.

15
3.0 EXPERIENCED ACQUIRED

INTRODUCTION

A laboratory is a facility that provides controlled conditions in which scientific researches,

experiments, and measurements, may be performed. Hence the medical laboratory or clinical laboratory

is a laboratory where tests are carried out on clinical specimens in other to get information about a

patient’s health.

There are five sections in the laboratory, they are; Clinical Microbiology section, Hematology,

Serology section, Phlebotomy and Clinical Biochemistry section. The overall significance of the laboratory

diagnosis is that they guide towards the administration most effective therapy so as to restore a proper health on

the patient. I was opportuned to work in various sections of the clinical laboratory and gained experience on how

various tests are performed in each sections, the use of various laboratory equipment, the procedures involved

and to some extent the interpretations of the results.

CHEMICAL

PATHOLOGY

PHLEBOTOMY
MICROBIOLOGY

LABORATORY

SEROLOGY

Fig 2.5 Laboratory sections in KMH

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 CHAPTER 3

3.1 CLINICAL BIOCHEMISTRY SECTION

This section deals with chemical analysis of blood fluids (serum or plasma) in which many diseases of

the major organs systems can be diagnosed such as heart attacks, hepatitis, renal failure, diabetes, liver

function, etc. Blood samples may be collected into the sodium citrate, lithium heparin, fluoride oxalate,

ethylenediaminetetraacetic (EDTA) or plain bottle depending on the test. Tests performed in this

department are;

 Blood Glucose; FBS, FBS 2HPP, RBS,OGTT

 Electrolytes; Bicarbonate, Chloride, Sodium, Potassium, Calcium etc.

 Lipid Profile; Total cholesterol, HDL- and LDL- cholesterol and triglycerides

 Renal (Kidney) function test;Urinalysis, Creatinine test and Blood Urea Nitrogen (BUN) Test

 Liver function test; Total protein, AST, ALT, GGT, ALP, Bilirubin

 Uric acid

 Fecal Occult Blood Test (FOBT)

CHEMICAL PATHOLOGY LABORATORY EQUIPMENT AND USES

Electrolyte analyzer: measures electrolyte levels in the human body to detect metabollic imbalances and

measure renal and cardiac function. Electrolyte analyzers measures electrolytes using ion selective

electrodes, colorimetric and photometric techniques.

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Fig 2.6 Electrolyte Analyzer

Spectrophotometer : is used to measure the concentration of a known substances in a solution. They do

this by passing a light through the substances and measuring light intensity as a function of wavelength.

Fig 2.7 Spectrophotometer

Centrifuge: are used for rapid separation of precipitates from reaction mixtures usually based on density.

Fig 2.8 Centrifuge

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HbA1c analyzer: measures the concentration of glycated haemoglobin in a blood samples for diabetes

control.

Fig 2.9 HbA1c analyzer

Pipette: is used to transfer measurable amount of liquid from one container to another.

Fig 3.0 Pipette

Blood collection tubes: set of test tubes used for collection of blood sample for further testing.

Fig 3.1 Blood Collection Tubes

Tourniquet: is a constricting device used to control venous and arterial circulation to an extremity for a
19
period of time.

Gloves: is used during laboratory procedures to prevent cross- contamination between the patients and

the laboratory scientists.

Refrigerator: is used to cool samples or specimens for preservation.

Test-tube rack: is used for holding test tubes.

COBAS c311 : is a flexible system for consolidating routine and special chemistry tests.

Fig 3.2 COBAS c311

Needle and syringe : It is used for the collection of blood samples.

Water bath: Use as heating apparatus.

Universal bottle: Used for sample collection i.e blood or urine.

Fig 3.3 Universal Bottle

SAFETY RULES IN THE LABORATORY

 Avoid eating, drinking, chewing gum, and applying cosmetics in the laboratory.

 Do not store food or beverages in the same refrigerators with chemicals, biohazards or radioactive

20
 materials.

 Always wear appropriate clothing i.e lab coat, closed - toe shoes, etc.

 Never pipette anything by mouth

 The work area should be kept clean and uncluttered

 Remove contaminated gloves after use before touching common use devices.

 Always wash hand and arms with anti-bacterial soap and water before leaving the laboratory.

BLOOD GLUCOSE TEST

Test Overview: A blood glucose test measures the amount of a type of sugar, glucose, in the blood. It is

the main source of cellular energy used by the body. Glucose derived from dietary sources is converted

to glycogen for storage in the liver or adipose tissue. The concentration of glucose in the blood is

controlled within narrow limits by many hormones, the most important of which are produced by the

pancreas (i.e Insulin and Glucagon). The most frequent cause of hyperglycemia is diabetes mellitus

resulting from deficiency of insulin secretion or action.

USES OF BLOOD GLUCOSE TEST

Blood glucose test can be used to diagnose or indicate certain medical condition such as;

a) Diabetes(gestational, type 1 and type 2 diabetes)

b) Pancreatic cancer and Pancreatitis

c) Thyroid dysfunction

d) Renal failure

e) Addison’s disease etc.

TYPES OF BLOOD GLUCOSE TEST

There are several types of blood glucose test ;

1. Fasting Blood Sugar (FBS) measures blood glucose after you have not eaten for at least 8 hours and

at most 14 hours.It is often the first test done to check prediabetes and diabetes.

Materials/Reagents: Gloves, fluoride oxalate tube, tourniquet, alcohol swab, winged infusion set

21
(butterfly needle), test tube rack, centrifuge, pipette (single channel digital fixed pipette), automated

machine (cobas c311)

Procedure: Patients is ensured to have fasted for the required period of time before sample collection into

a Fluoride oxalate tube using blood collection equipment, and then the blood samples are centrifuged in

order to obtain plasma. The plasma obtained was decanted into a small cap which is then transported into

the automated machine (COBAS c311) for analysis. The results are then deduced which is measured in

mg/dl.

Result/Interpretation: Normal result is less than or equal to 100 mg/dl. A fasting blood sugar level from

100 - 125 mg/dl is considered prediabetes and is considered diabetes if it’s more than or equal to 125

mg/dl.

2. 2-hours post-prandial blood sugar measures blood glucose exactly 2 hours after you start eating a

meal. This is not a test used to diagnose diabetes.

Procedure: After performing the same procedure for fasting blood sugar sample collection, patients are

then asked to return 2 hrs as soon as they start eating, then another venepuncture

is made and the same procedure is repeated.

Result: Normal results is less than 140mg/dl for people age 50 and younger; less than 150mg/dl for age

50-60; less than 160mg/dl for age 60 and older.

3. Random blood sugar (RBS) also known as casual blood glucose test. This test measures blood glucose

regardless of when you last ate. Several measurements may be taken throughout the day. Random testing

is useful because glucose levels in healthy people do not vary widely throughout the day. Blood glucose

levels that vary widely may mean a problem.

Procedure:Patients blood sample is collected into a Fluoride oxalate tube using blood collection

equipment, and then the blood samples are centrifuged in order to obtain plasma. The plasma obtained was

decanted into a small cap which is then transported into the automated machine (COBAS c311) for

analysis. The results are then deduced which is measured in mg/dl.

Normal Results: 80-120mg/dl before meals and 100-140mg/dl after meals. A random blood sugar of 200

mg/dl or higher suggests diabetes.

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4. Oral glucose tolerance test is used to diagnose prediabetes and diabetes. This test is a series of blood

glucose measurements taken after you drink a sweet liquid that contains glucose. This test is commonly

used to diagnose diabetes that occurs during pregnancy (gestational diabetes). This test is not commonly

used to diagnose diabetes.

Materials/Reagents: Gloves, fluoride oxalate tube, tourniquet, alcohol swab, winged infusion set

(butterfly needle), test tube rack, centrifuge, pipette (single channel digital fixed pipette), automated

machine (cobas c311)

Procedure: Similar procedure to random blood sugar. However, samples are collected five times at 30min

intervals and lastly collected once 1hr after the last sample collection of 30min intervals. The result is the

deduced by the machines.

Results: A blood sugar level less than 140 mg/dl is normal. While a reading more than 200 mg/dl after

two hours indicates diabetes and reading between 140 -199mg/dl indicates prediabetes.

5. Haemoglobin A1c (also called glycated haemoglobin) measures the percentage of blood sugar (glucose)

is attached to the haemoglobin,the oxygen carrying protein in the red blood cells. This test can be used to

diagnose diabetes. It also shows how well your diabetes has been controlled in the last 2 to 3 months and

whether your diabetes medicine needs to be changed.

Materials/Reagents: : Gloves, fluoride oxalate tube, tourniquet, alcohol swab, winged infusion set

(butterfly needle), test tube rack, centrifuge, pipette (single channel digital fixed pipette), automated

machine (cobas c311).

Procedure: Patients is ensured to have fasted for the required period of time before sample collection into

a Fluoride oxalate tube, and then the blood samples are centrifuged in order to obtain plasma. The plasma

obtained was decanted into a small cap which is then transported into the machine for analysis. The results

are then deduced which is measured in mg/dl

Result : An A1c level of 5.7% is considered normal while 6.5% or higher on two separate tests indicates

diabetes. An A1c between 5.7% and 6.4% is indicates prediabetes

ELECTROLYTES TESTS

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Test Overview: An electrolyte panel is a blood test that measures the levels of electrolytes and carbon

dioxide in your blood. Electrolytes are minerals found in the body tissues and blood in form of dissolved

salts which helps transfer nutrients into body cells and waste of them. Electrolytes also maintain a healthy

water balance and help stabilize body’s acid/base (pH) level. The main electrolytes in the body are;

Sodium, and Potassium others are; CO2- (Bicarbonate), Calcium, Phosphorus and chloride. An electrolyte

test can help determine whether there is an electrolyte imbalance in the body. Also it is used to monitor the

effectiveness of treatment for an imbalance that affect the functioning of an organ. The test is carried out

during a routine physical examination.

Materials/Reagents: Lithium heparin tube ,gloves, tourniquet, alcohol swab, winged infusion set

(butterfly needle), test tube rack, centrifuge, pipette (single channel digital fixed pipette), automated

machine (cobas c311) and electrolyte analyzer.

Procedure: Blood sample is collected in the lithium heparin tube and then the blood samples are

centrifuged in order to obtain plasma. The plasma obtained was decanted into a small cap which is then

transported into the machine for analysis. The results are then deduced which is measured in mmol/L.

LIPID PROFILE TEST

Test Overview: Lipids are group of fats and fat - like substances that are important constituents of cells

and sources of energy. A lipid panel measures the level of specific lipids i.e cholesterol and triglycerides in

the blood. These lipids when excess in the blood can clog arteries increasing the risk of having heart

diseases . A lipid panel typically includes;

a) Total cholesterol: provides an estimate of all cholesterol in the blood (i.e good HDL + bad LDL)

b) Low Density Lipoprotein (LDL): measures the cholesterol in LDL particles.This is referred to as

the “bad” cholesterol. Too much of it increases risk of heart attack, stroke and artherosclerosis.

c) High Density Lipoprotein (HDL): measures the cholesterol in HDL particles. This is referred to as

the “good” cholesterol because it helps to remove LDL cholesterol in the blood.

d) Triglycerides: measures all the triglycerides in all the lipoprotein particles

Materials/Reagents: Lithium heparin tube ,gloves tourniquet, alcohol swab, winged infusion set

24
(butterfly needle), test tube rack, centrifuge, pipette (single channel digital fixed pipette), automated

machine (cobas c311).

Procedure: Blood sample is collected in the lithium heparin tube and then the blood samples are

centrifuged in order to obtain plasma. The plasma obtained was decanted into a small cap which is then

transported into the machine for analysis. The results are then deduced which is measured in mg/dl.

Result/ Interpretation:

 Total blood cholesterol

Optimal : Less than 200 mg/dl

Borderline high: 200-239mg/dl

High : Over 240 mg/dl

 Low Density Lipoprotein (LDL)

Optimal : Less than 100 mg/dl

Borderline high: 130 - 159 mg/dl

High : Over 130 - 159 mg/dl

 High Density Lipoprotein

HDL levels greater than 60 mg/dl or higher are considered to be good.

 Triglycerides

Optimal : Less than 150 mg/dl

Borderline high: 150 - 199 mg/dl

High : Over 200 - 499 mg/dl

Very high : 500mg/dl

URIC ACID TEST

Test Overview: This is a kidney or liver function test, which measures the amount of uric acid present in a

blood sample. It is produced from the natural break down of chemicals called purines.and then filtered out

by the kidneys and passes out of the body in urine but if too much is being produced in the body or the

kidney is unable to filter them normally, it becomes high and may cause solid crystals from within joint,

25
which may lead to a painful condition called gout. Gout is a form of arthritis that causes painful

inflammation around or in joints These uric crystals can build up in joint and nearby tissues, thereby

forming hard lumpy deposits called Tophi.

Uses

a. Help to diagnose gout

b. Help find the cause of frequent kidney stones

c. To monitor uric acid level of people undergoing cancer treatment

Procedure

Blood sample is collected in the lithium heparin tube and then the blood samples are centrifuged in order

to obtain plasma. The plasma obtained was decanted into a small cap which is then transported into the

machine for analysis. The results are then deduced which is measured in mg/dL.

Results:

Normal Range; in men 3.4 – 7.0mg/dl, in women 2.4 – 6.0mg/dl, in children 2.0 – 5.5 mg/dl

KIDNEY (RENAL) FUNCTION TEST

URINALYSIS

Test Overview

Urinalysis is a routine screening test which involves assessment of urine characteristics to aid in disease

diagnosis. A routine urinalysis test include the following parameters: color and transparency, specific

gravity, ph, protein, glucose, ketones, blood, bilirubin, nitrite, urobilinogen and leukocytes esterase.

Color and Transparency: Normal urine color is straw yellow to amber in color and transparent.

Abnormal color of urine such as red, bright orange, black, brown etc and turbid urine indicates abnormal

conditions such as hematuria, alkaptonuria etc.

Specific gravity: is a measure of concentration of dissolved solutes and it reflects the ability of the

kidneys to conserve water. It varies with fluid and solute intake. However, it increases to above 1.035 in

persons with diabetes mellitus.

pH: a useful indicator of kidney disease as H+ retention is increased in such condition leading to reduced

26
acidic excretion.

Glucose: Glucose is not detected in healthy patients but usually positive in patients with diabetes or

another hyperglycemic condition.

Ketones: are compounds resulting from the breakdown of fatty acids in the body. A positive test for ketone

usually indicate diabetes ketoacidosis, also present in fasting.

Blood: Blood in urine usually indicate abnormal red blood cell destruction or haemoglobin, glomerular

disease or urinary tract infection.

Bilirubin: Bilirubin is a breakdown product of haemogobin. Most bilirubin produced in reabsorbed and

reaches he general circulation to be excreted in urine. The normal level of bilirubin is below the detection

limit of the test. A positive test indicates hepatic disease or hepatobiliary obstruction.

Urobilinogen:Is a substance formed in the gastrointestinal tract by the bacterial reduction of conjugated

bilirubin. A positive test indicates prehepatic jaundice or hepatitis.

Leukocytes: The presence of white blood cells in the urine usually signifies a urinary tract infection such

as cystis or renal disease such as glomerulonephritis.

Reagent/Materials

Gloves ,Sample bottle, Combostik strip, combostik chart .

Procedure

Urinalysis test is performed using the COMBOSTIK 10 urinalysis strip following the standard of

operation given below.

a) Note the appearance (clear, turbid or cloudy) and colour of urine (amber, deep amber, yellowish or

colourless)

b) Dip the combostik strip into the urine up to the test area for no more than 2 seconds.

c) Draw the edge of the strip along the brim of the vessel to remove excess urine.

d) Turn the strip on its side and tap twice to remove any excess urine.

27
e) Hold the strip horizontally and compare the colors of the reagent pads with the color chart

Fig 3.4 Urinalysis chart

Purpose

Routine urinalysis are performed for several reasons;

 general health screening to detect renal and metabolic diseases

 diagnose of disorders or diseases of the kidney or urinary tract

 monitoring patients with diabetes

BLOOD UREA NITROGEN AND CREATININE TEST

Test Overview: This test is used to depict the function of kidney. Creatinine is the most commonly used

endogeneous marker for assessment of glomerular function. Creatinine is a by-product of creatine

phosphate in muscle, and it is produced at a constant rate by the body. For the most part, creatinine is

cleared from the blood entirely by the kidney. The calculated clearance of creatinine is used to provide an

indicator of GFR. This involves the collection of urine over a 24- hour period (24 hrs urine creatinine

clearance test).
28
 Creatinine clearance is often calculated using the equation :

C= (U * V ) / P

Where :

C= Clearance

U= Urinary concentration

V= Urinary flow rate

P = Plasma concentration

Blood urea nitrogen (BUN) measures the amount of Nitrogen in your blood that comes from the waste

product urea. Urea is made when protein is broken down in your body. Urea is made in the liver and

passed out of your body in urine. BUN to Creatinine ratio can be used to differentiate pre-renal from renal

causes when the BUN is increased. In pre renal disease the ratio is close to 20:1, while in intrinsic renal

disease it is closer to 10 : 1

Normal Results: Blood Urea Nitrogen (BUN);

Adults: 10-20mg/dl, Children: 5-8mg/dl

Blood Creatinine;

Men: 0.6-1.2mg/dl, Women: 0.5-1.1mg/dl and Children; 0.4 to 1.0mg/dl

LIVER FUNCTION TEST

Liver function tests are blood tests that help in determining normal functioning of the liver. Liver

function tests measure certain proteins, enzymes and substances and the panel includes;

 Albumin - measures the amount of albumin made by the liver and tells whether or not the liver is

making an adequate amount.

 Total protein - measures albumin and all other proteins in the blood including antibodies.

 Enzymes such as ALT (Alanine transaminase), AST(Aspartate transaminase), ALP(Alkaline

phosphatase) and GGT(gamma glutamyl transpeptidase) -

 Total Bilirubin - measures all the yellow bilirubin pigment (conjugated and unconjugated) in the

blood.

29
 Prothrombin time

CLINICAL SIGNIFICANCE OF LIVER FUNCTION TEST

a) Helps to check for damage from liver infections, such as hepatitis B and hepatitis C.

b) To monitor the side effects of certain medications known to affect the liver.

Procedure- Blood sample is collected in the lithium heparin tube and then the blood samples are

centrifuged in order to obtain plasma. The plasma obtained was decanted into a small cap which is then

transported into the machine for analysis.

Result/Interpretation

Normal ALT level: 5-40 units/L

Normal AST level: 8-46 units/L for male while 7 - 34 units/L for female

Normal Albumin level: 3.5 - 5 g/100ml

Normal ASP level: 13-39 units/L

Normal GGT level : 9 to 48 units/L

Total bilirubin level :0.3 - 1.9 mg/100 ml

FECAL OCCULT BLOOD TEST

Test Overview: The Fecal Occult Blood Test (FOBT) is used to check stool samples for microscopic

(occult) blood in normal colored faeces. Fecal occult blood usually is a result of slow bleeding from

inside the upper or lower gastrointestinal tract. The slow bleed does not change the color of the stool or

result in visible bright red blood. Occult blood in the stool may indicate colon cancer, polyps in the colon

or rectum, haemorrhoids, ulcers, Crohn’s disease, Ulcerative colitis.

Equipment/Materials: Stool samples in universal bottles, FOBT test kit ( hemoccult developing

solution, wooden applicator, hemoccult slide)

30
Fig 3.5 FOBT test kit

Procedure: Three universal bottles (Stool bottle) are given to the patient for three stool samples. To each

sample a solution containing the chemical guaiac and an oxidizing chemical is used. If blood is present in

the sample of stool, the mixing of the solution with blood causes the guaiac to turn visibly blue.

Result: A bluish colouration indicates that test is positive.

3.2 THE PHLEBOTOMY SECTION

Phlebotomy is the act of drawing or removing blood from the circulatory system through a cut (incision)

or puncture in order to obtain a sample for analysis and diagnosis. The Phlebotomy procedure facilitates

obtaining good quality specimens on the correct patient for further analysis in the laboratory.

MATERIALS USED IN THE PHLEBOTOMY AND USES

1. Disposable gloves/Hand Gel: For protection against spillage.

2. Needles: Used to make incision

3. Needle holders: For holding needle or also known as venoject

4. Vacutainers, Vacutainer holder or Syringe: Serves as blood drawer

5. Sample bottles according to Order of Draw:

 EDTA (Ethylene Diamine Tetra Acetic Acid) Alkaline phosphatase - due to chelation of metallic

cofactors which inhibits the enzyme activity. Potassium and sodium - due to the addition of

potassium to the sample. Calcium and magnesium - these are chelated by the EDTA.

 EDTA is also an unsuitable additive for samples requiring bacterial culture, since the chelation of the

divalent cations inhibits the growth of bacteria. EDTA is sometimes used to prevent cells

Fig 3.6 EDTA Tube

31
clumping in fluid samples requiring cell counts to accompany a cytology evaluation but it does not

actually 'fix' the cells. A sample fixed in formalin or alcohol/ethanol is required for accurate cytology

examination. EDTA is not suitable for samples requiring virus isolation in cell/tissue culture because it

forms a gel when added to the cell culture medium and this disrupts the cell monolayer.

 Plain (no anticoagulant)

Plain (or clotted) samples are used to provide serum for serology and most biochemistry or endocrine assays.

Serum is plasma without fibrinogen since the fibrinogen has been used' in the formation of the clot.

Fig 3.7 Plain bottle

 Lithium Heparin

Lithium heparin accelerates the action of antithrombin III which neutralizes thrombin and thus prevents the

formation of fibrin from fibrinogen (clot formation). This effect makes heparin samples unsuitable for

determination of fibrinogen or clotting factors.

Lithium heparin is a standard anticoagulant used to obtain plasma for biochemistry analysis. Lithium heparin is

the most suitable anticoagulant for the isolation of viruses in cell/tissue culture. This anticoagulant is not suitable

for haematology as the heparin alters the cell morphology. Whilst measurement of haemoglobin and blood cell

counts can be obtained using this anticoagulant an accurate white cell differential and morphology comments are

32
not possible.

Fig 3.8 Lithium heparin tube

 Fluoride-Oxalate

Fluoride-oxalate samples are used for glucose (and lactate) determination only. Sodium fluoride functions

by stabilizing the blood cell membrane and inhibiting the enzyme systems involved in glycolysis, which

prevents red blood cells metabolising any glucose present in the sample. For this reason it is the only

suitable sample for accurate glucose analysis. Fluoride is a potent inhibitor of many enzymes and the

inhibition of glycolysis tends to cause fluid shifts.

Fluoride is a weak anticoagulant on its own, so potassium oxalate (another powerful enzyme inhibitor) is

usually added to supplement its action. Other plasma or serum samples may be used for glucose analysis

ONLY if the plasma/serum is separated from the cells within 1 hour of sample collection. Without an

antiglycolytic agent, the blood glucose concentration decreases by approximately 0.56 mmol/l per hour at

25°C.

Fig 3.9 Fluoride - Oxalate tube

 Sodium citrate

Sodium citrate is the standard anticoagulant for coagulation assays. Citrate functions by chelating calcium. The

effect is easily reversed by the addition of calcium to the sample. Other anticoagulants are not suitable for

coagulation assays as they interfere with coagulation factors. Citrate also inhibits ALP, ALT and interferes with

the measurement of phosphate.

33
 Fig 4.0 Sodium citrate tube

6. Tourniquet: Used to search vein. Prolonged venous occlusion can cause changes in concentrations of

blood constituents. Therefore, the use of a tourniquet should be minimized. If a tourniquet is used to search

for a vein, it should be released before withdrawal of blood begins. In any case, the use of a tourniquet

should be limited to less than one minute.

7. 70% Alcohol swabs: Used as a disinfectant for the area in which incision is to be made.

8. Micropore tape: To aid hemeostatis

9. Test tube Racks

10. Disposable waste bins

STANDARD OPERATION PROCEDURE (S.O.P) FOR BLOOD COLLECTION

 The frequent point of blood collection is usually from the vein (venipuncture).

The materials for the patient’s identity must be chec1ked before attempting venepuncture.

This must be carried out by asking the patient their Full Name and Date of Birth.

 Check that this information corresponds with that on the Request form.

 Any amendment to these details or any others on the Request form must be in accordance

with the Directorate Policy.

 Where patient details lack legibility, staff may write the correct details clearly next

to those on the form without crossing out the original details.

 If tests are requested that are unfamiliar and staff are unsure of the appropriate blood tubes for

specimens check the list ‘What tube guide’ available at each workstation or, when necessary contact

a qualified Biomedical Scientist in the appropriate department within the Pathology Laboratory.

 Examine both arms of the patient and select the one that appears appropriate

 Ensure that the patient is comfortable and that the arm is well supported and examine potential

34
 venepuncture.

 Ask the patient to bare an arm, ensure that the arm is well supported and apply the tourniquet to the

patient’s arm, just above the elbow and tight enough to allow two fingers behind the strap.

 Tighten the tourniquet a little more, taking care not to pinch the skin

 Ask the patient to straighten their arm and clench their fist. This will make the vein more prominent.

 If necessary rub the bend of the elbow to make the vein more visible.

 Feel with a fingertip for the ‘best’ vein at the bend of the elbow rather than plunge the needle into a poor

vein that looks ‘alright’.

 If this fails a suitable vein can often be found at the side of the arm on the elbow side.

 It may be necessary, on occasion to take blood from the back of hand.

 Apply the tourniquet above the elbow. The tourniquet is closed around the arm

by inserting the plastic clip into the holder and then tightened appropriately

by pulling the strap.

 Ask the patient to straighten their arm and to make a fist in order to make the veins

more prominent.

 Feel with the fingertip if necessary to locate a suitable vein to puncture.

 Ensure that equipment and blood tubes required are immediately within easy reach.

 Remove the top plastic section of a vacutainer multi-sample needle and screw thread into

a vacutainer needle holder.

 Disinfect site with a 70% Isopropyl alcohol swab.

 Leave for 30 seconds for the alcohol to evaporate and during this period assemble the

blood tubes required.

 Remove the cover from the multi-sample needle and discard into a clinical waste bin.

 Keeping the needle holder and attached multi-sample needle in one hand use

the thumb on the other hand to press on the vein just above the chosen entry point

and pull the skin back slightly towards you to hold the vein firmly and stretch the

skin over the chosen site.

35
 With the needle holder and multi-sample needle almost parallel to the patient’s arm and the needle

bevel uppermost, gently push the needle into the chosen venepuncture site.

 Once in the vein hold the needle-holder steady and gently push the cap of the appropriate blood

sample tube onto the covered sample needle at the base of the inside of the needle-holder.

 Blood should enter the sample tube and fill to the appropriate level indicated.

 Remove the sample tube from the sample needle when full and attach another sample tube in

required.

 Blood samples must be gently mixed at the earliest opportunity to ensure anticoagulation

effectiveness

 As the last blood sample tube is filling slacken the tourniquet by pressing down on the release clip

that is on the side away from the arm.

 Withdraw the needle from the vein and quickly apply a clean pad of cotton wool.

 Ask the patient to keep pressure on the cotton wool to stop further bleeding.

 Discard the needle and holder into a Sharps bin.

 Gently mix the sample tube(s).

 If the patient is unable to maintain sufficient pressure on the vene-puncture site apply this pressure

for them.

 Remove the tourniquet from the patient’s arm.

 When bleeding from the venepuncture site has stopped apply Micropore tape tightly over the cotton

wool.

 The procedure is now complete and the patient can leave.

36
PHLEBOTOMY DIAGRAMS

37
Fig 4.1 Phlebotomy procedure

3.3 HEMATOLOGY AND IMMUNOHEMATOLGY (BLOOD BANK) SECTION

Hematology section deals with the analysis of blood sample of patient for the diagnoses and

management of a wide range of benign and malignant disorders related to the blood.

Immunohematology (blood bank) section is a branch of hematology that deals antigen -

antibody reactions associated with blood transfusions, storage and preservation of blood for later use. In

this section blood samples are usually collected in the EDTA bottle. The tests carried out in this section

include; Full blood count, Erythrocyte sedimentation rate, ABO blood group determination and Genotype,

Packed cell volume etc.

MATERIALS USED IN HAEMATOLOGY AND IMMUNOHEMATOLOGY SECTION

Pipette, Haematocrit centrifuge machine for PCV, Haematocrit centrifuge reader for PCV, Micro Haematocrit

analyzer for Full Blood Count, Microscope, Microscopy slide, Electrophoresis machine, Cover slip, Bunsen

38
burner, Plasticine, Sterile capillary tube, Wash bottle, Westergren tubes, Stop watch, Test tubes, Refrigerator,

Racks, Various disposable waste bins, Tiles, Scissors, Ethylene diamine tetra acetic acid (EDTA), Leishman stain,

Normal saline, Water, Antisera for blood group, Buffer solution, Oil immersion.

FULL BLOOD COUNT TEST

Test Overview: Full blood count test is a test carried out to evaluate the total number of erythrocytes,

hemoglobin, hematocrit, leukocytes and platelets present in the blood.

Equipment/Materials: EDTA bottle containing blood sample, automated hematology analyzer

Fig 4.2 Hematology analyzer

Procedure: Blood sample is collected by the phlebotomist through venepuncture, into EDTA tube.

The blood is then mixed thoroughly inside the tube. It is then placed in automated hematology analyzer.

Results:

Red blood cell count: Male: 4.7 - 6.1 million cells per liter (mcL)

Female: 4.2 - 5.4 million cells per liter(mcL)

White blood cell count : 4,000 - 11,000 per microliter of blood

Hemoglobin: Male: 13.5 - 17.5 g/dL

Female: 12.0 - 15.5 g/dL

Hematocrit: Male: 38.3% - 48.6%

Female: 35.5% - 44.9%

Platelet count: Male: 150,000-450,000 per microliter of blood

Clinical significance:

a) To diagnose a medical condition i.e one may take complete full blood count when experiencing fever,

inflammation, fatigue etc.

39
b) To review overall health condition of the patient i.e a decrease or increase than normal may indicate

underlying diseases

c) To monitor a medical condition e.g leukaemia etc.

PACKED CELL VOLUME (PCV) TEST

Test Overview: Packed cell volume is the fraction of the whole blood that consists of the red blood cells. The

PCV test is carried out to determine the percentage of red blood cells in the body. If the percentage of the red

blood cells is below 30%, the need for blood transfusion becomes imperative.

Reference values for blood range (Red blood cells) are ;

Normal blood range for males………………………. 42-52%

Normal blood range for females…………………….. 37-48%

Low blood range…………………………………….. < 33%

High blood range……………………………………. >56%

Critical range……………………………………….. 18% or below

Materials/Equipment: Haematocrit reader, Bunsen burner, Micro haematocrit centrifuge, Heparinised capillary

tube, whole blood in an anticoagulant bottle (EDTA), Micro haematocrit reader, an absorbent cotton wool.

Fig 4.3 PCV equipment

40
Procedures: The blood sample was collected into an EDTA bottle. The heparinized capillary

tube was filled to 2/3 length of the tube from the blood sample and One end of the tube was

the tube before placing in the centrifuge. The sealed tube was placed in the micro- haematocrit

centrifuge machine, thereby placing the sealed end outward to touch the base of the spinner.

The sealed tube was spun in the haematocrit centrifuge at 12,000/13,000rpm for 5 minutes.

The spun tube was placed on the micro haematocrit reader to read the result in percentage,

positioned in slot so that the base line intersects the base of red cells and tube holder was

moved so that the top line intersects the top of plasma, then knob was adjusted so that the

middle line intersects the top of red cell.

Clinical Significance: Low PCV means reduction in red blood cell, indicating anaemia.

BLOOD GROUP DETERMINATION AND GENOTYPE TESTING

Test Overview: Blood typing is used to determine an individual’s blood group, to establish

whether a person is blood group A, B, AB or O and whether he/she is Rhesus positive(Rh+)

or Rhesus negative (Rh-). Blood grouping of the A B O system is determined with Anti-A,

Anti-B, and Anti-D sera, which form agglutination complex with antibodies found in the

blood sample.

Equipment/Material: Clean free grease tile, Pasteur pipette, Whole blood sample

in an EDTA bottle, distilled water, applicator stick, test tube rack, electrophoresis machine

and tank, clean white tile, cotton wool, applicator stick, cellulose filter paper, gloves.

Reagents: Anti-A, Anti-B, Anti-D sera, Buffer for balancing, normal saline

Fig 4.4 Anti- Sera

41
Procedure:

For blood group determination: The blood sample was collected into an EDTA bottle through venipuncture.

10ul of blood was placed 3 spots on the tile with the aid of Pasteur pipette. The antisera A, B and D were placed

carefully on each spots, ABO of the grouping system on the tile respectively and an applicator stick was used to

thoroughly mix the drop of blood with the anti-sera

one after the other without contamination. The tile was gently rocked from side to side for

3 minutes to allow agglutination occurrence, then result was observed.

Fig 4.5 ABO blood grouping chart

For Genotyping: Cells were washed two to three times in a test tube containing normal saline after which, a

drop of washed cells were placed on a tile. This is followed by the hemolysis of blood on the tile and the

placement of AS and AA control using applicator stick, after making sure that the buffer inside the

electrophoresis tank covered the electrode, the cellulose paper was placed on the tank, which is then covered and

mains (current) switched on. Reading was recorded after 5-10mins

Result: The result for blood genotype was taken by studying the movement and separation

Conclusion:The result was observed according to the agglutination that occurred in each spots on the tile. Anti D

determines the present of the rhesus ‘D’ factor in blood group.

42
Factors that affect blood grouping are; wrong labeling of spot and confusion of anti-sera with spots,

contamination of test card or tiles with detergents, Expired anti-sera

Clinical significance; Blood transfusion, Blood compatibility, Antenatal screening

ERYTHROCYTE SEDIMENTATION RATE

Test Overview: The erythrocyte sedimentation rate (ESR) also called the Westergreen ESR is the rate at

which red blood cells sediment in a period of 1 hour. It is a common hematology test, and non - specific

test used to determine inflammation associated with conditions such as infections, cancers, tuberculosis,

and autoimmune diseases.

Equipment/Materials : Westergreen tubes and rack, disposable pipette, stopwatch, sodium citrate

bottle

Fig 4.6 Westergreen tube and rack

Procedure: Blood sample is collected inside an EDTA tube. The tube it is inverted 8 times to make sure

the blood and saline are well mixed and is then poured into the Westergren tube containing sodium

citrate and was mixed gently again by inverting the tube 8 times. The Westergreen glass rod was forced

into the tube and blood rises to zero mark. The sample was placed in a vertical stand on the ESR rack

and timed for one-hour. The result was recorded just after one-hour in millimeters.

Result: The normal range of the sedimentation in adult

Men under 50 years………………………..less than 15mm/hr

Men over 50 years………………………….less than 20mm/hr

43
Women under 50 years………………..........less than 20mm/hr

Women over 50 years……………………….less than 30mm/hr

The normal range of the sedimentation in children

New born ………………………………………… less than 2mm/hr

Neonatal to puberty ……………………………..3- 13mm/hr

4.1 SEROLOGY SECTION

Tests done in this department are designed to detect the body's response to the presence of bacterial, viral, fungal,

parasitic and other conditions which stimulate detectable antigen-antibody reactions in a test system to aid in the

diagnosis of the patient. Most tests performed in this section are carried out under the principles of Immunoassay,

some of them are; Cold agglutinins (CAG) - specimen must be kept warm, Rheumatoid arthritis (RA), VDRL, to

diagnose syphilis, Pregnancy Testing, Widal.

HBs.Ag TEST FOR HEPATITIS, VDRL (VENERAL DISEASES RESEARCH LABORATORY)

TEST FOR SYPHILIS USING STRIPS

Test Overview : HBsAG is a rapid immunochromatographic test for the qualitative detection of Hepatitis B

surface Antigen in human serum/plasma, it can be used for prenatal or transfusion screening and during acute

infection or chronic carriage of the Hepatitis B virus. Early detection of infection is essential for rapid initiation

of adequate treatment.

VDRL test is a screening test for syphilis. It measures substances called antibodies that body may

produce if it comes in contact with the causative agent of syphilis, which is called Treponema pallidium

Aim: To determine the presence or absence of hepatitis and syphilis in the body system.

Equipment/ Materials: HBsAG Test strips, VDRL test strip EDTA bottle, Centrifuge, clean test tube

Specimen: Serum.

Procedure: The patient blood sample was collected into a plain bottle through venepuncture. The blood sample

was spun in a centrifuge for 5 minutes, after spinning the serum was separated carefully into a clean test tube by

the use of Pasteur pipette and then test strip was immersed vertically into the serum for 10 minutes. The

44
observation was taken after 10mins.

Result: Appearance of a line at the Control region and another at the Test indicates positive result, while an

appearance of a line at the Control region only, indicates negative result. When there is no appearance

of any line, means the test in invalid and as to be redone using new kits

.Fig 4.7 HbsAg Test strip

BLOOD PREGNANCY AND URINE PREGNANCY TEST, USING TEST STRIP.

Introduction: A pregnancy test is done to determine if a woman is pregnant, pregnancy hormone called the

Human Chorionic Gonadotrophin (HCG) in to the blood and urine. Pregnancy test detects the hormone HCG and

confirms the pregnancy.

Aim: to determine the presence of pregnancy hormone (HCG) in the blood and urine.

Materials:pregnancy test strip, plain bottle, needle and syringe, wet swab, cotton wool, centrifuge, clean test

tube.

Specimen: blood (serum) and urine

Procedure for Blood Pregnancy Test: Patient’s blood was collected through venipuncture into plain bottle,

blood sample was spun in a centrifuge for 5 minutes, and the serum was separated carefully into a clean test tube

by the use of Pasteur pipette. The pregnancy test strip was immersed vertically into the serum for 5 minutes. The

strip was removed and the reaction was observed.

Procedure for Urine Pregnancy Test: The patient’s urine sample was collected into universal sterile

bottle and the pregnancy test strip saw immersed into the urine for 3 seconds, then removed and left
45
 for 5mins and the result was observed.

Result: An appearance of a line at the Control region and another at the Test indicates positive result, while an

appearance of a line at the Control region only, indicates negative result. When there is no appearance of any line,

means the test in invalid and as to be redone using new kits

Fig 4.8 Pregnancy Test Strip

WIDAL TEST

Introduction:Typhoid fever is an infectious disease caused by the Salmonella typhi, it is diagnosed by Widal test

which employs an antigen-antibody reaction to screen for the presence of Salmonella typhi, and paratyphi

antibodies in the sample serum.. the organism is transmitted by water or food contaminated by faeces of typhoid

victims or carriers, that is a person who harbor it without showing signs and symptoms.

Aim: To investigate the presence of Salmonella typhi and paratyphi in the serum of patient

Materials: Test card/white tiles, Pasteur pipette, centrifuge, antigen kit and stop watch

Procedure: 3-5ml of blood was collected from the patient through venipuncture into a plain bottle and the blood

was spun at 3000rev per min for 5minutes so as to separate out the plasma. A dropper was used to carefully

drawn the antigen kits and a drop was placed on each of the test card in pairs of four spots labeled O, OA, OB,

OC and H, HA, HB, HC and a drop of serum was carefully added into the antigen respectively with the aid of

Pasteur pipette and mixed together with the aid of an applicator stick the test card was rocked gently, the rate of

reaction and agglutination was observed at an interval of 30sec, 1min, 2mins, and 5mins

Result

46
Reactive: visible agglutination on spot H and others indicate the present of Salmonella antibodies

Non reactive: no visible agglutination indicates absence of Salmonella antibodies

Widal test: Positive

Highly reactive……………………………….1:320 (agglutination reaction before 60 seconds)

Very reactive……………………………….1:160(agglutination reaction before 120 seconds)

Reactive ………………………………………1:80(agglutination reaction before 180 seconds)

Widal test: Negative

Non significant…………………………………1:40

Non significant………………………………….1:20

Not reactive…………………………………….Nil

RETROVIRAL TEST

Introduction: This is the diagnosis for Human Immunodeficiency Virus, an infectious agent that causes

Acquired Immunodeficiency Syndrome (AIDS), a disease that leaves a person vulnerable to life threatening

infection. HIV transmission occurs when a person id=s exposed to body fluids infected with virus, such as blood,

semen, vaginal secretions and breast milk.

Aim: To investigate the presence of HIV 1 and 2 in patient’s blood

Materials: Determine kits, Unigold kit, Stat pack Buffer, Plain bottle, pipette

Specimen used: Serum

Procedures: The blood sample, collected in a plain bottle was centrifuged at 3000rev/min to allow

separation. The serum was picked with a pipette and two drops was placed on the sample pad of the

determine kit and allowed to penetrate then left for 15min. If result proves positive, the Unigold kits

would be used following the same procedure. After using Unigold to confirm the result and proves

negative the Stat pac kit would be used to as a confirmer.

Result: The appearance of a line at the Control region and another at the Test region indicates a Positive result,

while the appearance of a line on the Control region only, and indicates a Negative result.

47
4.2 MICROBIOLOGY SECTION

Microbiology involves the study of microbes. Although, microorganisms are generally beneficial and

essential to life some are, however, pathogenic and cause infectious diseases. The diagnostic microbiology

laboratory is engaged in the identification of infectious agents. These infectious agents are broadly classified as

viruses, bacteria, mycostic agents and parasites (Protozoans and Helminthes) also this section analyses body

fluids and tissues for the presence of pathogenic microorganisms primarily by means of culture and sensitivity

(C&S). Results of the C&S tell the physician the type of organisms present as well as the particular antibiotic

that would be most effective for treatment.

BASIC RULES FOR WORKING IN THE MICROBIOLOGY LABORATORY

While working in the laboratory, it is important that you must adhere to the following basic rules;

Be methodical and orderly in habits; keep the work area clean especially before leaving the laboratory and

disinfectant it thoroughly at the end of day. Wash hands frequently with soap and water

Before leaving the laboratory, place the discarded glassware into the designated place. Cultures are kept under

incubation and should be inspected in the morning and findings must be carefully.

Send the laboratory reports promptly. In case of emergency a special report is dispatched or communicated by

telephone.

GENERAL REMARKS

 All specimens for culture must be collected prior to the therapy. If the patient is on antibiotic, inform the

microbiologist so that he/she can take measures.

 Collect the specimen in adequate amount from the infectious site. This usually instructed by the

physician.

 Always use the sterile bottle to transporting the specimen.

 All specimen must be accompanied by a request slip with complete information, h on the patient

name, age,sex, hospital number, source of specimen and clinical information is very important in order to

choose the appropriate medium for the culture.

 Enter the details in the laboratory register and performed direct examination of the specimen before

choosing the media for the culture.

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  All containers used for holding microbiological specimens must be sterilized before used. Such as

test tube, culture tube with and without cap, and plates, container to collect sputum specimen, blood

specimen for microbial culture, penicillin bottles for collection of spinal fluid and other specimen container

(universal bottle) for collection of urine specimen and stool specimen.

MATERIALS/APPARATUS USED IN MICROBIOLOGY SECTION

Inoculating loop, Bunsen burner, Incubator, Weighing balance, Spatula, Microscopy slide, Cover slip,

Staining rack, Medium plates, Sensitivity disc, Forcep, Cotton wool swab.

Fig 4.9 Swab based specimen collector, medium plates, sensitivity disc

INTRODUCTION LABORATORY GROWTH MEDIA

These are classified into six types: (1) Basal media, (2) Enriched media, (3) Selective media,

(4) Indicator media, (5) Transport media, and (6) Storage media.

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 1. Basal Media. Basal media are those that may be used for growth (culture) of bacteria that do not need

enrichment of the media. Examples: Nutrient broth, nutrient agar and peptone water. Staphylococcus and

Enterobacteriaceae grow in these media.

2. Enriched Media. The media are enriched usually by adding blood, serum or egg.

Examples: Enriched media are blood agar and Lowenstein-Jensen media. Streptococci grow in blood agar

media.

3. Selective Media. These media favour the growth of a particular bacterium by inhibiting the growth of

undesired bacteria and allowing growth of desirable bacteria. Examples: MacConkey agar, Lowenstein-Jensen

media, tellurite media (Tellurite inhibits the growth of most of the throat organisms except diphtheria bacilli).

Antibiotic may be added to a medium for inhibition.

4. Indicator (Differential) Media. An indicator is included in the medium. A particular organism causes

change in the indicator, e.g. blood, neutral red, tellurite. Examples: Blood agar and MacConkey agar are

indicator media.

5. Transport Media. These media are used when specie-men cannot be cultured soon after collection.

Examples: Cary-Blair medium, Amies medium, Stuart medium.

6. Storage Media. Media used for storing the bacteria for a long period of time. Examples: Egg saline

medium, chalk cooked meat broth. The survival and growth of microorganisms depend on available and a

favorable condition environment. Culture media are nutrient solutions used in laboratories to grow

microorganisms. The method for the preparation of basic microbiology media is given below. Sterilization

is at 121c for 15minutes.pH values are 7.0 unless stated otherwise.

COMMON MEDIA IN ROUTINE USE

1. CLED Agar (Cysteine Lactose Electrolyte Deficient): is a non-selective differential plating medium for the

growth and enumeration of urinary tract microorganism.

Preparation: 36.0g of medium is suspended in one liter of distilled water, slowly heated and frequently stirred.

Boiled for a minute and sterilized at 121OC for 15minutes and poured into Petri dishes. Plates were inverted

when solidified for storage purposes and to avoid moisture

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2. MacConkey Agar. Most commonly used for enterobac teriaceae. It contains agar, peptone, sodium

chloride, bile salt, lactose and neutral red. It is a selective and indicator medium:

a) Selective: as bile salt does not inhibit the growth of enterobactericeae but inhibits growth of many other

bacteria.

b) Indicator: medium as the colonies of bacteria that ferment lactose take a pink colour due to

production of acid. Acid turns the indicator neutral red to pink. These bacteria are called 'lactose fermenter',

e.g. Escherichia coll. Colourless colony indicates that lactose is not fermented, i.e. the bacterium is

non-lactose fermenter, e.g. Salmonella. Shigella, Vibrio.

Preparation: 50g of the Agar was suspended and measured into one liter of purified water and mixed

thoroughly and was heated with frequent agitation, then boiled for one minute to completely dissolve the

powder. The Agar was autoclaved at 121OC for 15minutes.

3. Chocolate Agar or Heated Blood agar. Prepared by heating blood agar. It is used for culture of

pneumococcus, gonococcus, meningococcus and Haemophilus. Heating the blood inactivates inhibitor

of growths.

Preparation: 2litres of distilled water was added to 144g of agar powder. Autoclaving was done at 121OC for

15minutes and cooled till 45OC then 5% of defribrinated blood was added. Heated slowly and evenly to 65OC,

cooled till 45OC and poured into plates

4. Blood Agar. Most commonly used medium. 5-10% defibrinated sheep blood is added to melted agar at

45-50°C. Blood acts as an enrichment material and also as an indicator. Certain bacteria when grown in blood

agar produce haemolysis around their colonies. Certain bacteria produce no haemolysis. Types of changes:

a) Beta () haemolysis. The colony is surrounded by a clear zone of complete haemolysis,

e.g. Streptococcus pyogenes is a beta haemolytic Streptococci.

(b) Alpha () haemolysis. The colony is surrounded by a zone of greenish discolouration due to formation of

biliverdin, e.g. Viridans streptococci.

(c) Gamma () haemolysis, or, No haemolysis. There is no change in the medium surrounding the colony.

5. Nutrient Broth. 500 g meat, e.g. ox heart is minced and mixed with 1 litre water. 10g peptone and

5 g sodium chloride are added, pH is adjusted to 7.3. Uses: (1) As a basal media for the preparation of other

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media, (2) To study soluble products of bacteria.

DISPOSAL

Once the Petri dishes have been taped shut, they should not be opened again. All microorganisms grown during

the experiment should be killed before discarding. The best way to dispose of bacterial cultures is to pressure

sterilize them in a heat stable biohazard bag. If autoclaves or pressure cookers are not available or large enough

to make this convenient, an alternative is to bleach the plates. Sat0urate the plates with a 20% or "1 in 5"

household bleach solution (in other words, 1part bleach and 4 parts water). Let them sit and soak overnight in the

bleach solution before disposing of them. Please note that the bleach solution is corrosive and needs to be

thoroughly removed afterwards. In addition, the plates can be incinerated if access to an incinerator is available.

PRECAUTIONS TAKEN WHEN PREPARING MEDIUM

Do not talk when pouring medium on plates and when culturing the sample on plates to avoid

contaminants as a result of unwanted bacterial or enzymes through saliva.The degree at which we

incubate any cultured sample is always at 37c to avoid the death of the microorganism.

GRAM STAINING

Introduction: In this section, the staining of bacteria as a means for identification is done. Bacteria are

being identified as Gram-Negative or Positive on the basis of their cell wall thickness after staining.

Gram positive bacteria hold the dye and appear purple while Gram-Negative bacteria release the dye

and appear red.

Aim: To identify the gram-negative and the gram positive bacteria.

Apparatus: Stop watch, Normal saline, Clean grease free microscopic slide, Gentian violet, Lugol’s

iodine, 95% ethyl alcohol, Neutral red, Microscope, Sterilized inoculating loop.

Procedure: The organism was isolated and smeared using the sterilized inoculating loop in a drop of

normal saline on a clean grease free microscopic slide. It was left to Air-dry.

The smear was placed on a staining rack, and was flooded with Gentian violet solution for 30seconds. It was

rinsed with water. The smear was again flooded with Lugol’s iodine for 30 seconds. It was rinsed with water and

the smear was decolorized with 95% ethyl alcohol for 30 seconds, It was rinsed with water again.

The decolorized smear was counter-stained by flooding with neutral red for 30 second and was rinsed

52
with water. The back of the slide was cleaned with cotton wool and allowed to Air-dry. The slide was

mounted on the microscope after air-drying and was examined under ×100 immersion objectives. The result was

recorded.

Sensitivity Test (Result): If the bacteria are gram positive, a positive sensitive disc is used while a

negative sensitive disc is used for gram negative bacteria. A pure colony was sub-cultured on a Nutrient

medium and sensitive disc was picked with the aid of a sterile forceps, and placed on the medium, then the plate

was incubated for 24 hours at 37OC. The plate was read after 24hours of incubation to observe zone of inhibition

and resistance. Sensitivity test is also done for pathogens that grow on the media by taking a colony of the

organism, streak on the sensitivity agar and add antibiotics discs and incubate for24hours at 37OC.

PROCEDURE FOR AUTOCLAVING

The inner element was filled with water and allowed to cover the surface of the element, The medium

were arranged in the sample bucket and the machine was covered and screwed tightly by holding the

screw opposite each other and the wing nut was screwed tightly. The switch on button was on and also the outlet

valve was opened down so as to increase the temperature of the steam on the workload. It was sterilized at 121⁰C

for 15minutes. The safety valve was closed at 120⁰C and at 121⁰C, button

was switched off. The medium were allowed to cool for 47⁰C before pouring in the petridish.

Principle behind Autoclaving.

The principle behind these sterilization methods is based on the temperature and the type of autoclaving

operation performed. Autoclaving operation at 121⁰C is referred to as culture media autoclave.

Fig 5.0 Autoclave principle

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 MICROSCOPY, CULTURE AND SENSITIVITY TESTS

Microscopy involves the examination of specimen under the microscope, Culture refers to the

microorganisms that grow on the culture medium after inoculation and incubation while sensitivity

tests determines the antibiotics which will be administered to the patients.

The cultured plates are incubated for 24hours at 37oC to facilitate the growth of the organism and

chocolate plates were incubated in a candle jar to facilitate the growth of both aerobic and anaerobic

microbes while other plates were incubated aerobically.

STOOL ANALYSIS

Introduction: Stool analysis involves the collection and analysis of faecal matter to diagnose the

presence or absence of a medical condition. During the outbreak of cholera or diarrhea,food

microbiologist collect stool sample into sterile universal bottle from victims for faecal examination in

the laboratory.

Aim: To determine cysts and ova in the stool of a patient.

Materials/Apparatus: Clean microscopic slide, drop of saline, binocularmicroscope, swabstick,

coverslip, and a loop.

Procedures: Sample was collected into a bottle, a drop of normal saline was mounted on a clean

microscopic slide and mixed it with a small portion of fresh faeces with a loop. The slide was covered

with a cover slip and the viewed under the low-power objective by using *10 and *40 for clear viewing.

Results: The results were viewed in two ways which are microscopic and macroscopic;

1.Macroscopic-----------------Hard, dark ,brown stool formed with no mucus or blood seen.

2.Microscopic-----------------Present of Ascaris lumbricoides .

URINE MICROSCOPY CULTURE AND SENSITIVITY (M/C/S)

Urine for microscopy culture and sensitivity is an array of tests performed on urine samples to

examine the presence or absence of cells such as; epithelial cells, pus cells, red blood cells, yeast cells,

crystals, and bacteria.It is one of the most common methods of medical diagnosis.

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Aim: To identify parasites and Bacteria cell in the urine of individual.

Materials: Microscope, microscopy slide, centrifuge, inoculating loop, urine sample, medium plates;

Macconkey agar and CLED agar, Nutrient agar, Gram staining reagents, Sensitivity disc, Incubator,

source of heat.

Procedures:

Microscopy: 5ml of the urine was transferred for spinning in a bench centrifuge at 30000rev/min for

5minutes. The sediment was concentrated in the test tube by decanting off the supernatant.

A small drop of the sediment was placed on a clean slide covered with a cover slip as wet preparation

and then mounted on a microscope. The slide was examined using x40 objective lens.

Culture: A loopful of the sample was used to make a streak on the Agar plates.

The plates were then incubated for 24hours at 37OC. The culture media were removed from the incubator

after 24hours and visible bacteria growth was read and recorded.

Gram Staining: Primary and secondary gram staining was done on the smear of a colony of the bacteria.

This is to identify if the bacteria is Gram positive or Gram negative.

Results:

Macroscopy: The following parameters are examined

1.Appearance: Clear, turbid ,slightly turbid,

2.Colour: Yellow, straw, Amber yellow, pale yellow.

Microscopy: Presence or absence of ; Pus cells, Epithelia cells, Red blood cells, Yeast cells, Bacteria

cells and Crystals can be seen in the wet preparation.

Culture: The following Bacteria can be isolated from Urine samples; Klebsiella spp, Staphylococcus

aureus, Coniforms

EYE, EAR NOSE AND THROAT, WOUND AND PUS SWAB

Procedure: These samples are collected using a dry sterile cotton wool swab; they are then inoculated

into Chocolate and Macconkey agar. Gram staining is then carried out on each specimen. Pathogen that are

likely to be observed include;

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Wound and Pus swab: Staphylococcus aureus, Sreptococcus pyogenes, Clostridium perfrigens

Eye swab: Haemophilus influenza, Pseudomonas aeruginosa, Betahaemolytic streptococcus etc.

Ear swab: Escherichiacoli, Proteussp etc.

Throat Swab: Throat cultures are submitted primarily for the detection of Group A Streptococcus. When

obtaining the specimen, depress the tongue with a tongue blade, and swab the tonsillar pillars and behind the

uvula including any inflamed or purulent sitesAvoid touching the tongue, cheeks or teeth. Immediately place the

swab back into the culturette sleeve and crush the ampule

HIGH VAGINAL, URETHRAL AND ENDOCERVICAL SWAB.

Test Overview: This is use to detect the causative organisms of female reproductive system infections

and their sensitivity to antibiotics.

Procedure: A swab stick was used to collect specimen from the affected area and then inoculated into

sterile media which include Chocolate and MacConkey agar. These plates were incubated at 37c for

24hours and were examined for any pathogenic growth, if there is any growth then a sensitivity disc is

placed on a pure culture of isolate.

Gram staining is then carried out on each specimen, a wet preparation of the swab can be made by

dropping normal saline into the swab container and the swab stick is rubbed on a slide covered

with a slip and viewed under the microscope; pus cells, epithelial cells, yeast cells etc can be viewed.

Result: Possible pathogens include; Neisseria gonorrhea, Trichomonas vaginals, Candida spp,

Clostridium perfrigens etc.

MANTOUX SKIN TEST

Introduction: The Mantoux test or Mendel-Mantoux test (also known as the tuberculin sensitivity test, or

PPD test for purified protein derivative) is a screening tool for tuberculosis (TB) It is one of the major tuberculin

skin tests used around the world, largely replacing multiple-puncture tests such as the Tine test. Tuberculin is a

glycerol extract of the tubercle bacillus. Purified protein derivative (PPD) tuberculin is a precipitate of

species-nonspecific molecules obtained from filtrates of

sterilized, concentrated cultures.

Material/Equipments: Millimeter rule, tuberculin injection, Personal protective equipment,

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cotton wool.

Procedures: A standard dose is 5 tuberculin units (TU - 0.1 ml) is injected intradermally (between the layers

of dermis) and read 48 to 72 hours later. This intradermal injection is termed the Mantoux

technique. A person who has been exposed to the bacteria is expected to mount an immune response in the skin

containing the bacterial proteins. If a person has had a history of a positive tuberculin skin test, or had a recent

tuberculin skin test (within one year), another skin test should be used.

Result: Within two days of injection, the reaction is read by measuring the diameter of induration

(palpable raised, hardened area) across the forearm (perpendicular to the long axis) in millimeters.

If there is no induration, the result should be recorded as 0mm. Erythema (redness) should not be

measured. A tuberculin test conversion is defined as an increase of 10 mm or more within a two-day

period, regardless of age. Alternative criteria include increases of 6, 12, 15 or 18mm.

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 CHAPTER FIVE

5.0 SUMMARY, CHALLENGES ENCOUNTERED, AND CONCLUSION

RECOMMENDATION

5.1 SUMMARY OF ATTACHMENT ACTIVITIES

During my period at the Khadijat Memorial Hospital, I was engaged cataloguing some information

materials for the laboratory and I also did some activities at the dispatch such as: attending to patients,

confirming and examining their request forms, entering their details into the register and the Inbox,

detailing them concerning the test they are to undergo and directing them to where is to be carried out. I

was later transferred to the laboratory and was introduced to the departments, safety precautions and tests

carried out in each department.

5.2 CHALLENGES ENCOUNTERED

The main problems encountered were getting placement and transportation. It was quite challenging for me

that live in far place to get to the organization every working day. I was not given any remuneration or

allowance, other problems encountered during the training was attending to different people with different

personalities at the reception.

5.3 CONCLUSION

My Six(6) months industrial attachment with Khadijat Memorial Hospital Ltd has been one of the

most interesting , productive, instructive and educative experience in my life. Through this training,

I have gained new insight and more comprehensive understanding about the real industrial working condition

and practice and also improved my soft and functional skills.

All these valuable experiences and knowledge that I have gained were not only acquired through the direct

involvement in task but also through other aspects of the training such as: work observation, supervision,

interaction with colleagues, supervisors, superior and other people related to the field. It also exposed me to

some certain things about medical environment and from what I have undergone,I am sure that the industrial

training programme has achieved its primary objective.

5.4 RECOMMENDATION

I recommend that all institutions or bodies involve in Student Industrial Working Experience Scheme,

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should provide places of placement for industrial attachment for Student Industrial Training Fund and also

pay some allowances to students and the company should provide more safety equipments to prevent

further environmental and health hazards.

Also, to students that are to undergo the training, I recommend that they should take it very seriously,

because it is one of the most important parts of their studies which will help them build a very significant

and effective meaning in their career pursuit.

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