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The kind of healthcare environment you work in will dictate how and when you will deal with the clinical laboratory. A clinical laboratory is a place where patient specimens are reviewed to help diagnose and treat a patient. In most cases, physician offices send their specimens to an outside laboratory. In other offices, there may be an in-house lab that reviews the specimens. In any case, the job of the medical assistant is usually to get the specimen from the patient so it can be reviewed by the lab.
It sounds simple enough, right? Get a specimen, like a urine sample, from a patient and send it to the lab. Easy! However, your role in handling patient specimens is an important one. Medical assistants need to ensure that the specimen is collected correctly, placed in the proper container for the specimen type, and labeled correctly. At any of those stages, even a small error can affect how a patient is diagnosed and treated. So don’t underestimate the importance of your role in the laboratory process! Also, you’ll need to follow safety regulations, rules, and guidelines for handling human specimens to avoid endangering yourself and others in the office.
When working with specimens, it’s important to understand microbiology. Microbiology is the study of microscopic organisms. Some of the microscopic organisms in our bodies can cause in illness and disease. Understanding bacteria, viruses, fungi, and other microorganisms will help you better understand the issues that they cause for patients.
The Clinical Laboratory
A clinical laboratory is a lab area where patient specimens and samples are reviewed for diagnosis, treatment, and prevention of disease and illness. In some physician offices, the clinical lab is part of the office practice. In other physician offices, the specimens and samples are sent to an offsite clinical lab for review.
Healthcare providers use clinical labs to
- Screen for diseases
- Confirm suspected conditions
- Rule out conditions
- Monitor the effectiveness of treatment
- Assess the progress of disease
Laboratories are regulated by federal, state, and local regulations. Because of the hazards of working with human tissue and fluids, it’s important that the highest standards are in place to protect healthcare workers.
One of the major federal agencies tasked with enforcing safety and health legislation is the Occupational Safety and Health Administration, or OSHA. The agency was created under the Occupational Safety and Health Act of 1970.
OSHA requires clinical laboratories to
- Provide and maintain safety equipment
- Control the risk of exposure to chemical and biological materials
- Provide sanitary lab testing
- Undergo annual inspections
- Provide a waste management program
- Implement procedures for infectious material exposure, ventilation failure, first aid, fires, and other emergencies
- Document all exposure incidents, including spills
The Clinical Laboratory Improvement Amendments, or CLIA, are federal standards that apply to clinical laboratory testing to ensure quality in laboratory testing. The CLIA program was established in 1988. The Centers for Medicare and Medicaid, or CMS, oversees the CLIA program. Labs receive certifications from CLIA based on the type of testing they perform on specimens.
Three federal agencies have ultimate responsibility for the CLIA program:
- Food and Drug Administration (FDA)
- Centers for Disease Control and Prevention (CDC)
- Centers for Medicare and Medicaid (CMS)
Working in a laboratory can be dangerous because of all the hazards present. To remain safe in the laboratory, the lab workers should be informed on the potential hazards. The three types of hazards in the laboratory are
Additionally, there are also hazards related to musculoskeletal injuries and other physical issues that result from poor work practices and behaviors.
Handling specimens may be part of the daily duties of a medical assistant, even if the assistant doesn’t work in a laboratory. At all times, precautions should be taken to maintain safety as well as the integrity of the specimen.
Standard precautions should always be used when handling specimens. These are standards that will protect healthcare workers and patients from being exposed to infectious disease. These standards require that those performing lab work assume that all specimens are potentially infections.
Standard precautions include
- Risk assessment, or evaluating the risk involved to complete the task
- Hand hygiene, such as proper hand-washing techniques
- Use of personal protective equipment (PPE) such as gloves, gowns, lab coats, or goggles
- Environmental controls, such as proper disposal of waste
- Administrative controls, such as training and policies and procedures
Microbiology is the study of microscopic organisms, or very small organisms that are too small to be seen with the naked eye and must be viewed with a microscope. Some microscopic organisms are harmful to humans and cause disease, whereas many others pose no harm to us at all.
Bacteria are single-celled organisms; that is, they’re made up of one cell. Many people think that all bacteria cause disease. However, in reality, only a very small percentage of bacteria make us sick. Many bacteria serve important roles in the body, including
- Helping us digest food
- Destroying disease
- Providing vitamins
Infectious bacteria can make people sick. Infectious bacteria include
- E. coli
Infectious bacteria are generally treated with antibiotics.
When you look at bacteria under a microscope, they may be shaped like spheres, rods, or spirals. In fact, bacteria are often named for their shape:
- Cocci means “spherical”
- Bacilli means “rod shaped”
- Spirilla means “spiral shaped”
The following are just a few of the diseases and infections caused by bacteria:
- Toxic shock syndrome
- Strep throat
- Lyme disease
Everyone carries Staphylococcus, or staph, on their body. Many of us carry it without it ever developing into an infection. Methicillin-resistant Staphylococcus aureus, or MRSA, is one strain of the staph bacteria that usually starts out as a skin infection. It’s dangerous because this strain has become resistant to commonly used antibiotics, which makes it difficult to treat.
Experts believe that this strain of bacteria developed due to overuse of antibiotics. Some of this came from physicians overprescribing antibiotics and using them as broad-spectrum treatment, but it also resulted from patients
- Not completing their full course of antibiotics
- Skipping doses
- Saving the antibiotics for later
Although MRSA started out affecting patients and people mainly in healthcare settings, we’re now seeing an increase in MRSA in healthy people who’ve never been hospitalized or who don’t work in health care.
Viruses are the smallest of all microbes. They differ from other microbes because they have to be inside of living organisms to survive and replicate. Viruses work by attaching to a host and then growing from there. The cells then multiply in the body with the virus. Eventually, the virus will kill those cells and the person will get sick.
Different viruses spread in different ways. Viruses can be spread through the following mechanisms:
- Exchange of saliva
- Sexual contact
- Contaminated food or water
- Transmitters such as mosquitoes
The following diseases are caused by viruses:
- Cold (rhinovirus)
- Cold sores
- Influenza (“flu”)
Viruses are difficult to treat because they live inside the body’s cells, which are designed to protect what’s inside of them. This means that medications that are sent into the bloodstream generally don’t make it to the virus inside the cell.
A number of antiviral medications are available that can be used to treat certain kinds of viral infections. However, for most non-life-threatening viral infections, the physician may tell the patient to get rest and fluids and just let the virus “run its course.”
Fungi are classified in their own kingdom; they’re not plants or animals. Examples of fungi include
Many fungi are beneficial to humans and to the environment. In nature, they break down dead and decaying materials and return nutrients to the soil. In the healthcare setting, fungi produce substances such as the antibiotic penicillin and some chemotherapy drugs. Fungi also give flavor to some soft cheeses and blue cheese. Yeast are often used in bread making.
Despite their important beneficial roles, fungi can also cause a number of diseases in humans, including
- Thrush (oral candidiasis)
- Athlete’s foot
Protozoa are single-celled organisms that are found mainly in water and soil. Some protozoa are parasitic, which means they can only live on or in other things or people—the host—and cause disease. In humans, they can multiply, which can lead to serious infection. Protozoa can be transmitted by
- Contaminated food or water
- Transmitters such as mosquitoes or flies
Diseases and illnesses caused by parasites include
- Bed bug bites
- Lice, including crabs (pubic lice)
Algae are similar to plants. They live mainly in water. They’re important to our ecosystem and generally pose no danger to us. However, colonies of algae may form harmful algal blooms, or HABs, that produce toxins that are harmful to people, animals, and the environment. People become exposed to the toxins when swimming, playing, or working in the infected water; drinking the water; inhaling the water droplets; or getting the contaminated water on the skin.
The full effect of HABs on humans isn’t completely understood, and researchers are continuing to study them. However, we do know that the toxins produced by HABs can affect the nervous system, skin, and liver in humans and animals. Those infected may experience gastroenteritis with vomiting and diarrhea, skin and eye irritation, or respiratory issues. In some cases, there will be no symptoms until serious issues, such as liver damage, are found.
Archaea look a great deal like bacteria. In fact, before 1970 archaea were actually classified as bacteria. It’s unclear whether archaea cause disease in humans.
Archaea are found in extreme environments, including
- Sulfurous lakes
- Hot geysers
- Salt lakes
Collecting and Preparing Specimens
Collecting specimens is an important part of the diagnosis and treatment process. The diagnosis of disease actually begins at the collection of a specimen. If a specimen is collected or prepared improperly, then it could result in a tainted sample.
In general, for each specimen collection, you’ll perform the following steps:
- Determine the type of collection that’s needed.
- Provide or use the appropriate container for the specimen.
- Label the specimen.
- Package the specimen in a biohazard bag.
- Complete any paperwork for the lab.
The kidneys produce urine. The production of urine is important, because it provides a way for our body to eliminate excess fluid and waste by filtering blood through the kidneys. Urine can be used to determine what kinds of foods we’ve eaten and what types of fluids we’ve consumed. More important, it can be used to screen for disease or illness. The color and odor of urine can help determine if bigger issues are going on within a patient’s body.
Urine can come in a variety of colors. The color of urine is affected by what we are (or aren’t) eating and drinking. In addition, the color of urine may be affected by certain medications, vitamins, or diseases or illness. The normal color of urine is pale yellow, but the color may vary from day to day based on the factors discussed.
In general, urine with the following colors might indicate the following:
- Clear: Excess fluid or a liver disorder
- Gold: Dehydration or an increase in vitamin B
- Bright yellow: Use of certain medications or vitamins
- Pink: Blood in urine or dyes from foods
- Orange: Dehydration or dyes from foods
- Greenish: Certain foods (e.g., asparagus) or medications
- Dark brown: Liver disorders, presence of blood, consumption of certain foods or medications
- Cloudy: Urinary tract infection or kidney stones
Like urine color, the odor of urine can also vary. The odor of urine will reflect consumption of certain medications, foods, or liquids or disease or illness. In general, urine shouldn’t have an odor.
Sometimes, the smell of a patient’s urine can indicate the presence of an underlying problem. For example, if a patient has a urinary tract infection, then the urine may have a strong, foul odor. If the patient’s urine has a very sweet odor, it may indicate uncontrolled diabetes.
Physicians can use the results of urine tests in developing diagnoses. However, just like any specimen, how and when the urine is collected and handled can greatly influence the outcome of the testing.
Obtaining a urine sample involves much more than just having patients collect their urine in cup. Depending on the type of testing, specific collection techniques, containers, and storage guidelines must be used to ensure the integrity of the sample. For example, if the patient is being tested for light-specific analytes, then the urine must be collected in a container that protects the urine from light.
How and when urine samples are collected depends on what kind of testing needs to be done. The following are the different types of collection methods:
- Random specimen: The specimen is collected at any time and by any means as long as the patient doesn’t touch the inside of the cup or the lid. This is the easiest collection to obtain, but it can sometimes give an inaccurate picture of the patient’s health.
- First morning specimen: This is the urine that is collected first thing in the morning after the patient wakes up. First morning specimens are often used for urinalysis or microscopic analysis. Because of the time that it spends in the bladder, the urine is often higher in things like protein.
- Midstream clean-catch specimen: For this method, the patient first cleans the urethral area. Then, the patient should void some of urine and then collect the urine in the next stream. This is done in hopes of reducing contaminates. Midstream clean catch can be done at any time of the day or night and is generally the preferred method for culture or sensitivity testing.
- Timed-collection specimen: The patient collects urine at different times throughout a period, generally over 24 hours. The urine is kept refrigerated until it’s given to the medical office for testing. Timed collection is often used to measure the production of certain substances over time, such as creatinine, urea nitrogen, glucose, sodium, potassium, and analytes.
- Catheter collection specimen: This technique is used for bedridden patients. The collection is collected via a Foley catheter and then transferred to a cup for the testing.
Phlebotomy and Hematology
Hematology is the branch of medicine that studies, diagnoses, and treats diseases of the blood. Physicians who specialize in hematology are called hematologists.
Blood is composed of white blood cells, red blood cells, platelets, and plasma. All of these can be affected by different diseases or conditions. The following are diseases that may affect the different blood components:
To collect blood, a process called venipuncture, or phlebotomy, is used. Venipuncture is simply puncturing the vein as a way to withdraw a blood sample. Blood samples are drawn as a way to help diagnose disease and illness.
The following are some of the more common blood tests:
- Complete blood count (CBC)
- Blood chemistry tests
- Blood enzyme tests
- Blood tests for heart disease
- Blood clotting tests