The role of a Medical Lab Technician is critical

Cleaning and care of general laboratory Glassware and equipment. Diagnostics plays prominent role in the field of Medicine. Proper diagnosis of the disease plays an important role in concluding the patient’s condition without which medical treatment/ surgery can not be obtained. The role of a Medical Lab Technician is critical for proper diagnosis and interpretation of results. Clinical studies in the fields of Medicine, Pharamacutical Industries, and Nutrition etc. also require the technicians.

1.1. Introduction to Medical Lab Technology

Medical Laboratory Technology also called Clinical laboratory science is an allied health profession which is concerned with the diagnosis, treatment and prevention of disease through the use of clinical laboratory tests. It is a combination of the techniques along with the application of theoretical knowledge to perform complex procedures on tissue specimens, blood samples and other body fluids. They look for bacteria, parasites, and other microorganisms; analyze the chemical content of fluids; match blood for transfusions; and test for drug levels in the blood that show how a patient is responding to treatment. The tests which are performed provide critical information enabling physicians to diagnose, treat and monitor a patient’s condition.

A Medical Laboratory Technologist (MLT) do these tests by analyzing body fluids, tissues, blood typing, microorganism screening, chemical analyses, cell counts of human body etc.

The process carried out by a technician is

Collection of the patient’s information

Sampling

Testing of samples

Reporting and documentation of the results

They determine the presence, extent or absence of disease and provide data needed to evaluate the effectiveness of treatment.

The various application of medical lab technology include,

Laboratory Technicians is required in various departments in medical and Pharmacy colleges

In diagnostic centers

In hospitals of various sectors

Quality control R&D sectors of Drug Manufacturing units

Clinical studies in various laboratories

National Institute of Nutrition

Central Drug Research Laboratory

Molecular Biology Labs

With increasing automation and the use of computer technology, the work of technologists and technicians has become less hands-on and more analytical. The complexity of tests performed, the level of judgment needed, and the amount of responsibility workers assume depend largely on the amount of education and experience they have. Clinical laboratory technologists usually do more complex tasks than clinical laboratory technicians do.

There are two levels of medical laboratory workers

Technologists

Technicians

Technologists:

Medical technologists have more training and job responsibilities. They perform complex tests such as microscopic examinations of tissues, blood and other body fluids to detect evidence of disease and detect the presence of bacteria, fungi, parasites etc and chemical tests to determine blood cholesterol levels. They also match blood samples for transfusions and test drug levels in blood to determine how patients are responding to medications. They are often responsible for making sure that testing is done accurately. In some labs, technologists conduct research under the supervision of medical researchers.

Medical technologists work in five major areas of the laboratory

Blood banking

Clinical Chemistry (chemical analysis of body fluids)

Hematology (blood related)

Immunology (study of immune system)

Microbiology (study of bacteria and other disease organisms)

Clinical chemistry technologists:

They prepare specimens and analyze the chemical and hormonal contents of body fluids.

Microbiology technologists:

They examine and identify bacteria and other microorganisms.

Blood bank technologists:

Also referred as immunohematology technologists, collect, type, and prepare blood and its components for transfusions. Immunology technologists examine elements of the human immune system and its response to foreign bodies.

Cytotechnologists:

They prepare slides of body cells and examine these cells microscopically for abnormalities that may signal the beginning of a cancerous growth.

Molecular biology technologists:

They perform complex protein and nucleic acid testing on cell samples.

Technicians:

Medical technicians do routine laboratory testing manually according to instructions. They work under Technologists or supervisors. Technicians may prepare specimens and operate machines that automatically analyze samples. In addition to running tests, technicians set up, clean, and maintain laboratory equipment, such as centrifuges, microscopes etc. They also prepare standard solutions for use in the lab. This involves measuring and mixing the correct amount of various chemicals.

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1.2. ROLE OF MEDICAL LABORATORY TECHNOLOGIST:

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A Clinical Laboratory Scientist’s role is to provide accurate laboratory results in a timely manner. Safeguards, such as experimental controls, calibration of laboratory instruments, delta checks and periodic surveys should be carried out.

Medical laboratory technologists work in a dynamic and evolving environment, and use technological equipment to provide information that must be processed rapidly and accurately.

The major role of clinical lab technologists is:

They perform a full range of laboratory tests – from simple prenatal blood tests, to more complex tests to uncover diseases such as HIV/AIDS, diabetes, and cancer.

They are responsible for confirming the accuracy of test results, and reporting laboratory findings to pathologists and other physicians.

The information result given by the lab technologist influences the medical treatment a patient will receive.

They operate complex electronic equipment, computers, and precision instruments costing millions of dollars.

They assist doctors and nurses in choosing the correct lab tests and ensure proper collection methods.

They receive the patient specimens, analyze the specimens, interpret and report results. A pathologist may confirm a diagnostic result, but often the medical lab technologist is responsible for interpreting and communicating critical patient results to the physician.

They should recognize anomalies in their test results and know how to correct problems with the instrumentation.

They take preventive measures to minimize errors and reject contaminated or sub-standard specimens.

Role of Medical Laboratory Technologist:

The medical technician has the job of carrying out the more basic tasks and his responsibilities include:

Ensuring that the laboratory and the equipments and glassware used in laboratory remains clean.

Proper placement of chemical, equipments and glassware.

Ensuring that there are proper labels pasted on the bottles of chemicals and reagents.

The equipment used in the lab is in proper shape and handled carefully and proper safety measures are observed when handling specimens.

All specimens and other material in the lab are disposed off in a safe and appropriate manner.

A complete record of tests carried out in the laboratory is maintained.

Fresh material is indented through a medical officer and the material is stored in a proper and safe fashion.

Common tests performed in a clinical lab are:

Complete blood count (CBC)

Comprehensive metabolic panel (CMP)

Liver function tests (LFT)

Renal function tests (RFT)

Thyroid function test (TFT)

Urine analysis

Hematological analysis

Lipid profile

Semen analysis (for fertility and post-vasectomy studies)

Serological studies

Routine cultures.

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1.3. ETHICS:

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The medical lab technologists are bound by the ethical codes. Laboratories shall not engage in practices restricted by law and should uphold the reputation of their profession.

The medical lab technologists are required to adhere to the following code of ethics

The general idea of healthcare ethics is the welfare of the patient. The laboratory should treat all patients fairly and without discrimination.

The main aim of laboratory ethics is collecting the proper information of the patient, which enables the requested examinations and other laboratory procedures to be carried out

Safety of staff and other patients are legitimate concerns when communicable diseases are possible and information may be collected for these purposes.

All the information is collected with the knowledge of the patient and the patients should be informed regarding the procedure carried out.

Forcing some one to undergo medical testing of any kind is an invasion of privacy and a violation of human rights.

Special procedures, including the more invasive procedures, will require a more detailed explanation and, in some cases, written consent.

The result of the test should be kept strictly confidential and to be reveled only with the concern of the patient.

The laboratory should endeavor to see that results with serious implications are not communicated directly to the patient without the opportunity for adequate counseling.

Procedures that are carried out should be published in established/authoritative textbooks, peer-reviewed texts or journals or in international, national or regional guidelines. Any manipulation of result is completely unacceptable.

The results should be reported to the doctor and may be reported to other parties with the patient’s consent or as required by law.

The laboratory results should be correctly interpreted and applied in the patient’s best interest.

All records should be legible and stored such that they are readily retrievable. Records may be stored on any appropriate medium subject to national, regional or local legal requirements.

As per National Accreditation Board for Testing and Calibration Laboratories (NABL) guidelines, the minimum period for retention of test reports issued shall be five years for histopathology and cytopathology and one year for other disciplines.

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1.4. Responsibilities of medical lab technologist

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Medical laboratory technologists perform examinations with a microscope, perform complex tests, analyze the results, and report them to the medical professional for diagnostic use. Medical Laboratory Technologists operate a variety of complicated instruments. They must have good motor skills, hand-eye coordination and manual dexterity. In addition to technical skills, they must have a strong attention to detail in order to detect subtle change to the microscopic appearance of blood, tissue and bacterial cells. MLTs must also determine the validity of the results they obtain, which requires analytical and critical thinking. MLTs work in an ever-evolving environment, and on occasion need to design new procedures to reflect the rapid pace of change in their workplace. Whether working alone or as a member of a team, the MLT must be able to manage time efficiently and communicate clearly. Responsibilities of medical lab technologists usually include:

Conducting advanced chemical, bacteriological, immunologic, biological and hematological tests

Examining specimens with microscopes

Making cultures of tissues and body fluids to reveal parasites, bacteria, fungi and other microorganisms

Analyzing chemical content, chemical reactions and blood concentrations of certain compounds

Typing and cross-matching samples of blood for transfusions

Evaluating results of tests

Establishing and modifying programs and procedures to ensure quality control and test accuracy

Supervision of medical lab technicians (also known as clinical lab technicians).

The medical technician has the job of carrying out the more basic tasks and his responsibilities include –

Ensuring that the laboratory and the equipments and glassware used in laboratory remains clean.

Proper placement of chemical, equipments and glassware.

Ensuring that there are proper labels pasted on the bottles of chemicals and reagents.

The equipment used in the lab is in proper shape and handled carefully and proper safety measures are observed when handling specimens.

All specimens and other material in the lab are disposed off in a safe and appropriate manner.

A complete record of tests carried out in the laboratory is maintained.

Fresh material is indented through a medical officer and the material is stored in a proper and safe fashion.

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1.5. Safety Measures and First Aid

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Safety is not just a concept but it is a habit which must be developed by every person associated with the medical laboratory field. One should remain attentive and cautious during the time he or she is inside the laboratory as a small mistake can lead to a grave situation. The personnel working in the medical laboratory must be aware of the how to handle the chemicals, glassware, specimen and equipments etc. as mishandling or improper handling may lead to serious injury or contamination and is dangerous to life.

Certain basic safety steps that must be followed in the laboratory are

Keep the workplace clean and organized.

Label all storage areas, refrigerators, etc., appropriately, and keep all chemicals in properly labeled containers.

Date all bottles when received and when opened.

Note expiration dates on chemicals.

Note special storage conditions.

Be aware of how to handle and store hazardous materials such as –

Flammables

Radioactive Compounds

Corrosives

Biohazards

Toxics

Carcinogens

Reactive

Compressed Gases

Follow the safety instructions for handling chemicals and segregate chemicals by compatibility groups for storage.

Be aware of the potential interactions of lab furniture and equipment with chemicals used or stored in the lab. (e.g., are oxidizers stored directly on wooden shelving?)

Post warning signs for unusual hazards such as flammable materials, biohazards or other special problems.

Use equipment only for its designated purpose.

Position and secure apparatus properly to avoid any damage to personnel or equipment.

Use protective clothing all the time (e.g. lab coat, face mask, gloves etc.)

Do not smoke, eat or drink in the laboratory.

Ensure proper disposal of waste generated from the laboratory.

Clinical lab technologists generally deal with infectious samples. Therefore proper methods of infection control and sterilization are followed, few hazards exist. Protective masks, gloves, and goggles often are necessary to ensure the safety of laboratory personnel.

First Aid in Laboratory Accidents:

Accidents in the lab may result from either chemicals including acids or alkalis coming in contact with any body part or toxic substances or from heat of flames, hot liquids, explosions etc. Broken glass or contamination from infected material or specimen and electric shock might also lead to accidents. The first thing to be followed is that one should not panic and handle the situation in a more calm and composed manner. Some of the first aid procedures for accidents from the above mentioned sources are as under –

First Aid for accident caused by acid burn or contact:

Wash immediately with good amount of water preferably running water and in case of larger spills safety shower should be used.

After washing apply neutralizer or 5% sodium carbonate solution on skin and in case acid gets into the eye then administer 4 drops of 2% aqueous sodium bi-carbonate solution.

In case the acid is consumed then make the patient drink 5% soap solution or give him two egg whites mixed with 500 ml of milk or water. In the event of non availability of these two make the person drink lot of ordinary water.

Consult a physician.

First Aid for Alkali burns

Instantaneously wash with large amounts of water and do it repeatedly.

Once washed apply a 5% acetic acid or undiluted vinegar solution to the affected portion of the skin. In case the alkali has got into the eye then after washing use a saturated solution of boric acid and repeatedly pour drops in the eye.

In case the alkali has been swallowed then give a 5% acetic acid or lemon juice or diluted vinegar solution to the patient and after that make the person drink 3 to 4 glasses of ordinary water.

Refer to a physician.

First aid in case of Poisoning

In case of oral poisoning induce vomiting by making the patient drink warm salt water to drink and keep on repeating it till the vomit is clear. However in case of the chemical which the person has consumed is a acid, solvent or alkali or the person in unconscious then do not try to induce vomit. Call for medical aid immediately.

If the poisoning is caused by gas then instantaneously take the victim out of the affected area and make him or her lie down in a horizontal position. Consult a doctor urgently.

In the event of percutaneous poisoning, remove the contaminated clothes immediately and wash the affected region. Call for medical aid immediately.

In all the cases of poisoning, awareness of the toxicity of chemical substance can be helpful while administering medical aid.

Burns resulting from Heat

The burns that occur due to heat arising flames or hot liquids or explosions etc. can be majorly classified into two categories i.e. the major or severe burns where a large part of the body is affected and it is mostly 2nd or 3rd degree burn and the other is minor or small burns in which a small portion of the body gets affected and it is mostly a 1st degree burn.

In case of minor burns dip the affected part in ice cold water for some time and repeat the same. After that apply ointment on it.

Refer to a physician.

For major burns if the person is on fire then roll the person in a blanket to douse the flames. After that make the person lay down and try to calm him.

Call for medical help immediately and do not apply any medicine.

First aid for injuries resulting from broken glass

In case of small cuts or injuries wash the wound at the same time and try to remove glass pieces if any.

Apply mercurochrome or acriflavine ointment on it and cover the wound with gauze and adhesive tape.

In case of deep cuts or when there is plenty of bleeding then try to stop the bleeding by pressing down on it with a compress.

Call for immediate medical help.

Contamination by infected material

Injuries resulting from broken glassware which contained infected material or specimen fall under this category. For these types of injuries the advisable first aid is

Instantaneously wash the wound with clean water.

In case the cut is not bleeding then make it bleed by squeezing hard for a couple of minutes.

Using antiseptic lotion wash the complete area including the edges of the cut and the wound. After that wash it with soapy water and then again with antiseptic lotion.

Refer a doctor.

First aid in case of electric shock

Electric shock might result from faulty equipment or carelessness like using wet hands on electrical equipment etc. and can cause the person to faint or asphyxia. In such a case first switch off the main switch.

Immediately start giving mouth to mouth respiration.

Call for medical help simultaneously.

Every laboratory must have the first aid equipment which includes,

1. First Aid Box containing instruction sheet with general guidance, sterile adhesive dressings in different sizes, a bottle containing eye drops, scissors, sterile eye pads, safety pins, antiseptic lotion, sterile eye pads and first aid manual.

2. Sodium Carbonate 5% solution.

3. 2% sodium bi-carbonate solution

4. Boric Acid saturated solution.

5. Antiseptic lotion

6. Soap powder solution (per liter of water add 5g)

7. 5% Acetic acid solution

8. Cotton wool and gauze

9. Rolled Bandage

10. Adhesive tape

11. Mercurochrome and iodine tincture.

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1.6. CLEANING AND CARE OF GENERAL LABORATORY GLASSWARE AND EQUIPMENTS

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Cleaning of Glassware:

For getting successful results from the experiments performed in a laboratory it is essential that the glassware gets perfectly cleaned. However cleaning of laboratory glassware is not a very easy task. Glassware has to be clean physically, chemically as well as free of any germs. Much of the time, detergent and tap water are neither required nor desirable. You can rinse the glassware with the proper solvent, and then finish up with a couple of rinses with distilled water, followed by final rinses with deionized water.

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Washing Glassware:

Rinse the glassware with the appropriate solvent. Rinse with other solvents as needed, followed by ethanol and finally deionized water. If the glassware requires scrubbing, scrub with a brush using hot soapy water, rinse thoroughly with tap water, followed by rinses with deionized water.

Some of the commonly used lab glass wares are:

Burette:

Wash with hot soapy water, rinse thoroughly with tap water, and then rinse 3-4 times with deionized water. Be sure the final rinses sheet off of the glass. Burettes need to be thoroughly clean to be used for quantitative lab work.

Pipettes:

The glassware is soaked overnight in soapy water. Clean the pipettes using warm soapy water. The glassware may require scrubbing with a brush. Rinse with tap water followed by 3-4 rinses with deionized water.

Volumetric Flasks:

Wash the flask with soapy water and then rinse 3-4 times with deionized water.

Glassware should be allowed to air dry on the shelf. It should not be dries using a paper towel or forced air since this can introduce fibers or impurities that can contaminate the solution.

If glassware is to be used immediately after washing and must be dry, rinse it 2-3 times with acetone. This will remove any water and will evaporate quickly.

Glass Slides & Cover Glass

Slides should first be washed, and then placed in solution containing glacial acetic acid for around 10 minutes. Afterwards the slides and cover glass are thoroughly rinsed with distilled water and then wiped perfectly dry using paper towels or clean cloth. As soon as this is done they should be placed in a wide jar containing alcohol.

Culture Tubes

Culture tubes should be sterilized prior to cleaning. Culture tubes should be autoclave it for half an hour at around 121°C (15 p.s.i. pressure). The tubes when emptied must be brushed with water and detergent and then rinsed with running tap water. After this it should be rinsed with distilled water, and placed properly for drying.

Detergents used for washing

Most detergents are very effective for most cleaning problems encountered. However for best results the detergents made especially for laboratory glassware must be used. Some of the commonly used detergents are sulfuric dichromate and acid-alcohol.

Maintenance of Equipments

The increasing level of technical sophistication and complexity found in clinical laboratory instrumentation today more than ever demands careful attention to maintenance service needs. The time-worn caution for careful definition of requirements for acquisition of a system should also carry over to maintenance & service of these equipments. Certain common type of laboratory equipment and their proper usage & care is as under:

Microscope –

Microscope the most vital equipment in the laboratory which is used for magnifying a small object or image by 100, 400 or even 1000 times of the original size. Microscope is made up of two words – micro & scope wherein micro means small and scope means to view. A laboratory may have various microscopes depending upon what is their power, usage etc. Being aware of the importance of microscope its care and cleaning must also be give due importance so that the equipment gives correct results. Some of the cleaning procedures to be followed are –

Dust should be cleaned off with pressurized air or with a soft brush

Clean smudges, fingerprints, oils, etc from the lens with clean lens paper or a soft clean cloth moistened with a small amount of absolute alcohol-ether mixture. If an alcohol-ether mixture is unavailable, use isopropyl alcohol

Clean the microscope body and stand using a moist, soft cloth with a small amount of detergent.

Working temperatures are: 32° F-104° F (0°C-40°C). Max. relative humidity: 85%

Use water only on plastic surfaces

Do not use paint thinner or other solvents

Do a final wipe with a moist soft cloth

Dry all surfaces after cleaning

Besides these cleaning processes the daily care which must be ensured while handling the microscope include –

Always cover the microscope with the supplied dust cover when not in use

Store in a dry place

In humid or moist environments, it is advisable to store the microscope in a waterproof container with a drying agent

Do not touch the optical lens with bare fingers

Do not store the microscope in direct sunlight. Sunlight can influence the quality of the specimen imaging.

Lift the microscope with both hands.

As almost all the procedures of a medical laboratory require the use of microscope so as such handling it in a proper fashion is mandatory.

Photometer or Calorimeter –

The photometer is a device which is used to measure optical density or color intensity or absorbance of solutions. Based on the arrangement of obtaining monochromatic light, the photometers are categorized as filter photometers or spectrophotometers. The normal precautions to be observed while handling photometers are as under –

Do not pour out samples or prepare the tests directly over the instrument.

Always cap the test tubes after preparing the blank and test sample.

Wipe test tubes with a clean tissue to remove drips or condensation before placing in the photometer.

Do not leave tubes standing in the photometer test chamber. Remove the tubes immediately after each test.

Immediately wipe up any drips or spills on the instrument or in the test chamber with a clean tissue.

Keep the instrument clean. Clean the test chamber regularly using a moistened tissue or cotton ball.

Keep the instrument away from all chemicals and cleaning materials.

Keep the instrument in a clean, dry place when it is not in use. Keep it on a clean, dry bench away from chemicals, place it in a storage cupboard or keep it in a carrying case.

Keep the carrying case in a clean, dry condition. Make sure that the carrying case is dry before the case is closed up and the instrument is put away.

Centrifuge –

A centrifuge is a an equipment, generally driven by an electric motor or spun by hand, that puts an object in rotation around a fixed axis, applying a force perpendicular to the axis. The centrifuge works using the sedimentation principle, where the centripetal acceleration causes more dense substances to separate out along the radial direction. By the same token, lighter objects will tend to move to the top. There are various types of centrifuges –

preparative centrifuge

analytical centrifuge

angle fixed centrifuge

swing head centrifuge

haematocrit centrifuge

Industrial centrifuges may otherwise be classified according to the type of separation of the high density fraction from the low density one

Screen centrifuges, where the centrifugal acceleration allows the liquid to pass through a screen of some sort, through which the solids cannot go (due to granulometry larger than the screen gap or due to agglomeration). Common types are:

Pusher centrifuges

Peeler centrifuges

Decanter centrifuges, in which there is no physical separation between the solid and liquid phase, rather an accelerated settling due to centrifugal acceleration. Common types are:

Solid bowl centrifuges

Conical plate centrifuges

In order to ensure proper working of the equipment certain care and maintenance procedures should be followed like –

Inspect the centrifuge chamber for accumulations of sample, dust of glass particles from broken glass tubes and clean appropriately to ensure that no unwanted particle is left in the chamber.

Centrifuge tubes made of strong glass must be used in the machine.

The centrifuge speed should be increased gradually.

Disinfecting centrifuges is very necessary to maintain the precision of the tests being carried out.

Take proper care of the rotor in terms of cleaning and keeping it scratch free by not using steel wool, wire brush or abrasives etc for cleaning.

Never pour water directly into the sample chamber.

Autoclave –

An autoclave is a device to sterilize equipment and supplies by subjecting them to high pressure steam at 121 °C or more, typically for 15 to 20 minutes depending on the size of the load and the contents. There are mainly two types of autoclaves –

Stove Type Autoclave

Front Loading Autoclave

Following are recommendations for the care and use of autoclaves –

The steam should be saturated and free from corrosion inhibitors or other chemicals, which could contaminate the items being sterilised.

All materials to be autoclaved should be in containers that allow ready removal of air and permit good heat penetration; the chamber should not be tightly packed or steam will not reach the load evenly. Bags should allow the steam to reach their contents.

For autoclaves without an interlocking safety device that prevents the door being opened when the chamber is pressurized, the main steam valve should be closed and the temperature allowed to fall below 80C