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Principles of Medical Laboratory Science Practice 1

History of Medical Technology Profession 01

TOPIC OUTLINE

1  PART 1

o Introduction to Medical Laboratory Science o History on a Global Context o Medical Technology in the United States

2  PART 2

o Medical Technology in the Philippines o Inventions and Innovations in the Field of

Medical Technology

INTRODUCTION

Medical Laboratory Science

 it is the health profession which performs lab analysis, aid in the diagnosis, and treatment of diseases as well as in the maintenance of health

HISTORY OF THE MEDICAL TECHNOLOGY PROFESSION

HISTORY ON A GLOBAL CONTEXT

Hippocrates

 <Father of medicine=  formulated the Hippocratic oath (Duty of Physician, Code of Ethics of Practicing Physician) described the four humors of the body

Four humors of the body:

Blood
Phlegm
Black bile
Yellow bile

In ancient times, __ were recognized as the source of a person’s disposition ACCORDING TO HIPPOCRATES... Good Health

 is a result of the balance among the four humors Illness/ Disease

 is due to an imbalance of the four humors

Hindu Physicians

 began the practice of examining patients’ specimens URINE  oldest known test on body fluids was done on __  according to them, certain __ samples attracted ants, indicating a sweet taste URINALYSIS  is the oldest laboratory procedure that was performed

Galen

 is a Greek physician and philosopher who followed Hippocrates’ theory of four humors  also believed that health depended on balance  established the relationship between fluid and urine volume o ↑ fluid intake = ↑ urine volume

Rufus of Ephesus

 made the 1st description of hematuria HEMATURIA

 hema means blood and uria

means urine  means the presence of blood in urine

Types: 1. Macrohematuria 2. Microhematuria

MACROHEMATURIA MICROHEMATURIA

 aka GROSS hematuria  blood is present and can be seen in the naked eye  presented with or without pain, but it is always abnormal

 aka MICROSCOPIC hematuria  the quantity is too low  it is detected by microscopic and dipstick analysis

Frederick Dekkers

 observed that proteins in the urine are precipitated when boiled with acetic acid NOTES:  urine + acetic acid = concoction  concoction is exposed to high temperature until the sample reached the boiling point  two results: o With precipitate = presence of protein (proteinuria) o Without precipitate = absence of protein  protein is not usually excreted from the urine

Hermann Von Fehling

 is a German chemist who worked up with various analytical methods  he performed the 1 st quantitative test for urine sugar , also known as Fehling’s Test FEHLING’S TEST  it is a chemical test to detect reducing sugars and aldehydes in a solution

Ebers Papyrus

 it is a 110-page long scroll which measures 20 meters long  this is the oldest preserved Egyptian compilation of medical texts CONTENTS: √ Pregnancy √ Eye & skin problems √ Surgery √ Burns √ Intestinal diseases

√

Parasites o Hookworm infection

Vivian Herrick

 traced the beginning of MT way back in 1500 DC when intestinal parasites were first identified PARASITES: √ Ascaris - Roundworm √ Taenia - Tapeworm

Anne Fagelson

 believed that MT started at the in the 14 th century when a prominent Italian doctor at the University of Bologna employed Alessandra Giliani to perform different tasks in the laboratory  dies in a laboratory acquired infection ALESSANDRA GILIANI  1 st female anatomist & prosector

Prosector

 dissects corpse for examination/ anatomical demonstration

Antonie Van Leeuwenhoek

 <Father of Microbiology=  he is known for his work on the improvement of the compound microscope  he was able to classify bacteria according to shape SHAPES: √ Cocci (spherical) √ Bacilli (cylindrical)  he was able to identify RBC/Erythrocyte, Protozoan, and Spermatozoa

Rudolf Virchow

 <The Father of Cellular Pathology=  founder of the Archives of Pathology in Berlin  emphasized that most of the diseases can be understood in terms of their dysfunctions o When cellular changes happen in a certain individual, this will be the basis of diseases o He argued that diseases are caused by changes in normal cells ( cellular pathology ) PATHOLOGY  branch of medicine that deals with the laboratory examination of samples for diagnostic and/or forensic purposes  developed Virchow’s Autopsy wherein organs are removed one by one from the body to be examined VIRCHOW’S AUTOPSY TECHNIQUE  to determine the cause, mode, and manner of death  to evaluate any disease or injury that may be present  for research or educational purposes

MEDICAL TECHNOLOGY IN THE UNITED STATES

Dr. William Welch

 served as the 1st instructor in a laboratory course in pathology at Bellevue Hospital Medical College in 1878  first professor in pathology at John Hopkins University

Dr. William Osler

 opened the 1 st clinical laboratory at the John Hopkins Hospital in 1896 o In the laboratory, they carried out routine examinations o They also conducted research on malarial parasites present in blood

James Todd

 wrote and published Manual of Diagnosis in 1908 o The book described various techniques and procedures of laboratory tests

John Bernard Henry

 edited the book that was written by Todd and renamed it as Clinical Diagnosis and Management by Laboratory Methods o Became a fundamental source in the practice of laboratory medicine

John Kolmer

 published The Demand for and Training of Laboratory Technicians o Included a description of the 1st training course in MT  aimed to certify professionals in the medical technology profession  called for the development of a method that would certify medical technologists on a national scale

Pennyslvania State Legislature  passed a law requiring all hospitals to have a fully- equipped laboratory fit for routine testing  required all hospitals to employ a full-time lab technician University of Minnesota

World War I

 increased demand for technicians  physicians with knowledge with various laboratory methods began to teach assistants  first to offer a degree program on Medical

Technology (1923)

World War II

 U. already had advanced instrumentations wherein they had automated equipments and quality control programs being implemented on laboratories American Society for Clinical Pathology (ASCP)  in the United States, one of the certifying body is known as the __  this organization was founded in 1922 and was established to improve patient care , do knowledge and collaboration, and global community

Objective:

 to unite anatomic and clinical pathologists and medical laboratory professionals to advance laboratory medicine

MEDICAL TECHNOLOGY IN THE PHILIPPINES

1 st Clinical Laboratory in the Philippines

 was established during the World War II by the 6 th Infantry Division of the US Army  was built in Quiricada Street, Sta. Cruz, Manila  when the US Army left in June 1945, the laboratory became non-operational

Dr. Alfredo Pio de Roda

 reopened the said laboratory that was non-operational DR. MARIANO ICASIANO  a Manila City Health Officer that helped Dr. Alfredo in making the reopening possible MANILA PUBLIC HEALTH LABORATORY  de Roda and Icasiano renamed the laboratory as __  offered a training program to HS graduates with Dr. Prudencia Sta. Ana o Dr. Sta. Ana prepared a syllabus that consisted a 6-month long training program with a certificate upon completion, and marked the start of the medical technology in the Philippines Philippine Union College

 offered the 1 st four-year BSMT program

Principles of Medical Laboratory Science Practice 1

Part 1: Medical Technology Profession 02

TOPIC OUTLINE

1  roles and responsibilities of medical technologists 2  employment opportunities for MT graduates

3  role of other healthcare practitioners in the clinical laboratory

ROLES & RESPONSIBILITIES OF MEDICAL TECHNOLOGISTS

 medical technologists perform laboratory tests that help physicians in disease detection , diagnosis , treatment and monitoring REPUBLIC ACT NO. 5527  in the Philippines, the scope of work of MT is defined in detail by the __  also called The Medical Technology Act of 1969  the following are some of the primary roles of MTs:

1  Perform the collection and preservation of patients’ specimens 2  Perform clinical laboratory testing

3  Perform quality control procedures in the clinical laboratory

4  Perform special procedures

COLLECTION & PRESERVATION OF PATIENTS’ SPECIMENS

Venipuncture

 process of collecting blood from vein METHODS:

 Syringe Method o Syringe with needle 1. Tie the tourniquet around the arm to make the vein more prominent 2. Disinfect the area with alcohol 3. Let the area dry and insert the needle in the vein to collect blood

 Evacuated Tube System (ETS) o Tube holder and ETS needle o Allows the collection of multiple samples from a single puncture 1. Insert the ETS needle to the tube holder 2. After assembly, tie the tourniquet around the arm 3. Disinfect the area with alcohol 4. Insert the needle in the vein 5. A blood collection tube will be inserted in the other side of the tube holder, and blood from the vein will automatically flow  both require basic blood collection equipment such as tourniquet , cotton , antiseptic , and blood collection tubes  differ in other required equipment or materials and in the procedures performed

Capillary Puncture

 process of collecting blood from the capillaries by puncturing the skin with a lancet  capillary blood is collected from the middle or ring finger of the non- dominant hand (adults) or heel of the foot (infants)  performed only when a small volume of blood is needed MATERIALS USED: 1 o lancets Used to puncture the skin

2  microcollection containers

CLINICAL LABORATORY TESTING

1  examination of tissues, secretion, & excretions 2  perform blood banking procedures

3  perform parasitologic, mycologic, & microbiologic techniques

 perform histopathologic and cytotechnologic techniques 5  perform hematologic procedures

EXAMINATION OF TISSUES, SECRETIONS, & EXCRETIONS

Blood

 fluid connective tissue  most commonly processed tissue inside the laboratory  used in routine lab tests such as complete blood count (CBC) and chemistry tests, etc.

Secretions

 useful substances formed and released by cells or glands  ex. Hormones and enzymes

Excretions

 waste materials that are removed from the body  ex. Urine and feces

PERFORM BLOOD BANKING PROCEDURES

Blood Typing

 determining a person’s ABO and Rh blood group  A+, B+, O+, AB+, A-, B-, O-, AB-

Blood Collection & Screening

 collecting blood from donors and determining if these are safe for transfusion o 450 to 500ml of blood is collected Cross matching

 compatibility testing (donor & recipient)

PERFORM PARASITOLOGIC, MYCOLOGIC, AND MICROBIOLOGIC TECHNIQUES

Microbiology

 Samples Tested: 1. Blood 2. Body Fluids 3. Urine 4. Stool 5. Sputum  examples of lab techniques to detect and identify the specific bacteria causing an infection are as follows: Bacterium Culture  allows bacteria to grow and multiply in a culture medium Gram Staining  helps in classifying bacteria according to gram reaction (gram positive or negative) and morphology (bacillus, coccus, etc.)

Parasitology

 it includes techniques that are performed to detect and identify parasites in samples Fecalysis  analysis of stool samples

Mycology

 it includes techniques that are performed to detect and identify fungal infection  KOH (potassium hydroxide)

preparation

PERFORM HISTOPATHOLOGIC AND CYTOTECHNOLOGIC TECHNIQUES  preparation, processing, and staining of biopsy specimens which are to be microscopically examined by pathologists 1. Biopsy specimens are placed inside containers with formalin 2. Tissue processing is performed 3. After tissue processing, specimens are placed in the microscopic slides and are to be examined by pathologists Biopsy specimens

 tissues or organs that are removed

from the body for examination

PERFORM HEMATOLOGIC PROCEDURES

Complete Blood Count

 evaluates the cellular components of the blood  determines the number of blood cells present  can be done manually using the microscope and cell counters, or automated procedures using the advanced equipment

Blood Smear Preparation

 used for the microscopic analysis of blood cells o Observation of normal and abnormal cells, and the

performing manual cell counting

QUALITY CONTROL PROCEDURES IN THE CLINICAL LABORATORY  involves the monitoring of the testing process to ensure that the results are valid and reproducible  it ensures the accuracy and precision of laboratory results o Closeness of the result to the true value (accuracy) o Closeness of results to each other after repeated

measurement (precision)

SPECIAL PROCEDURES Operation of advanced diagnostic equipment

 ADVANTAGES: they enable batch processing and the releasing of results as a faster rate

Molecular and nuclear diagnostics

 performed for the detection of nucleic acids (DNA or RNA) from the target microorganism  involves nucleic acid isolation and amplification where multiple copies of the target DNA or RNA are generated

Clinical Research

 contributes to the generation of knowledge regarding health and sciences  helps in improving current methods for the diagnosis, treatment, or prevention of conditions

EMPLOYMENT OPPORTUNITIES FOR MT GRADUATES

Clinical Laboratory Practice

 medical technologists in: o Hospital-based laboratories o Free-standing laboratories o Clinics

Education

 faculty members in colleges or universities offering BSMT

Specialized Fields

 Medico-legal laboratory  Drug testing laboratory  HIV/AIDS testing laboratory  Quality management system  Research

CLINICAL LABORATORY PERSONNEL

Pathologist

 duly registered physician who is especially trained in laboratory medicine methods  there are responsible for counterchecking the work done by MT

Medical Laboratory Technician

 assists MT or pathologists in the practice of medical technology  did not pass the licensure exam for MT but obtained a general rating of at least 70%

Phlebotomist  an individual trained to collect blood samples for laboratory tests

Cytotechnologist

 <CELL processor=  works with the pathologist to detect changes in body cells which may be important in the diagnosis of diseases o ex. Genital smear/ Pap smear Abnormal Changes in COLOR, SIZE, SHAPE

Histotechnologist

 <TISSUE processor=  responsible for the routine preparation, processing, and staining of biopsies and other tissue specimens

Nuclear Medical Technologists

 they administer radioactive drugs to patients  they use imaging equipment to record images of the radioactive material in the body

PhBBA  when Philippine delegates attended the 50th Annual of the American Biological Study Association last Oct. 2007, the convention shared the <Increasing need of Biosafety and Biosecurity Professionals=  the association plays a major role in harmonizing the needs and requirements of the concerned stakeholders regarding biosafety and biosecurity discipline Nov. 2008  organized in __

Advocacy

 to serve the growing needs of Biosafety professionals  to promote biosafety as a scientific discipline APBA (Asia Pacific Biosafety Association)

 acts as a professional society for biosafety in the Asia-Pacific region

INTERNATIONAL PROFESSIONAL ORGANIZATIONS

ASCP

 world’s largest professional membership organization for pathologists and laboratory professionals 1922  founded in __ Current President

 Dr. Gene Siegal

AACLS

 aims to: o foster all aspects of MLS in the ASEAN region o promote cooperation in scientific exchange among ASEAN countries o establish a closer professional and personal rapport amongst members 1985  founded in __

Current Members

 Malaysia  Indonesia  Thailand  Philippines  Brunei

PAMET

 for the body that represents the MT in the Philippines, __ is the member of AACLS

Principles of Medical Laboratory Science Practice 1

Part 1: Medical Technology Terms and Abbreviations 03

TOPIC OUTLINE

1  Prefixes, Root words, and Suffixes of common MT terms 2  Plural forms of selected MT terms

3  Abbreviations routinely used in clinical laboratory practice

INTRODUCTION

Medical Terminologies

 most are derived from Greek or Latin words  Prefix + Root word  Root word + Suffix  Prefix + Root word + Suffix

PREFIXES, ROOT WORDS, AND SUFFIXES

Prefix

 modifying syllable placed at the beginning of the word  it gives more information about the root word ADDITIONAL INFORMATION MAY BE...  Location  Time  Size  Number

Example: (Location)

 < Intra vascular= o Intra- = within o Vascular = blood vessel o Anything within the blood vessels

Example: (Time)

 < Pre natal= o Pre- = before o Natal = birth o Anything before birth

Example: (Size)

 < Macro cyte= o Macro- = large o Cyte = cell o A large cell

Example: (Number)

 < Mono nuclear= o Mono- = one o Nuclear = nucleus o Cell containing one nucleus

Root Word

 main part of the word  this part is present in all terms

Examples:

 Hepa titis o Hepa = liver o -itis = inflammation  Hema tology o Hema = blood o Logy = the study of o The study of blood

a, i, o

 combining vowels o they do not change the meaning of the word

Suffix

 modifying word or syllable placed at the end of the word  it may indicate a condition, operation, or symptom

Examples:

 Hepat itis o -itis = inflammation o Hepa = liver o Inflammation of the liver  Hematemesis o – emesis = vomiting o Hema = blood o Vomiting of blood

Example:

 Pancytopenia o Pan- = all o Cyt(o) = cell o May also be used as a prefix or suffix; its classification is based on how it was used in the term o – penia = lack of/ deficiency o Deficiency in all (blood) cells

PLURAL FORMS OF SELECTED MT TERMS Bacterium Bacteria Nucleus Nuclei Bacillus Bacilli Coccus Cocci Ovum Ova

ABBREVIATIONS

STAT

 Statim o Immediately o Indicates that lab results are urgently needed o Can be seen in test request forms

NPO

 Nil per os o Latin word which means nothing by mouth o The patient should not be given any food or drink at all o May be requested to some patients who will undergo surgery

NOPS/ NIPS

 No ova or parasite seen  No intestinal parasite seen  Used in reporting fecalysis results

TNTC

 Too numerous to count  Used in reporting bacteria

BUN

 Blood Urea Nitrogen  Chemistry test used to detect and monitor kidney diseases

FBS

 Fasting Blood Sugar  Chemistry test used to measure glucose found in the blood  Glucose may be elevated in patients with Diabetes mellitus  It requires 8 hour fasting prior to being tested

HBV

 Hepatitis B Virus  Virus that could cause hepatitis  Attacks the liver of the patient  Bloodborne pathogen o Can be transmitted through blood transfusions and occupational needle stick injuries

PPE

 Personal Protective Equipment  Worn to minimize exposure to hazards

QNS

 Quantity Not Sufficient  Used when receiving a specimen whose quantity is not enough for testing  10-15mL of urine is needed for urinalysis

MSDS

 Material Safety Data Sheet  A technical document which provides detailed information on a controlled product Health effects of exposure

Hazard evaluation related to the handling, storage, or use

Measure to protect workers Emergency Procedures

LAB TESTS DISEASE

 Glucose o Fasting Blood Sugar o Hemoglobin A1c

Glucometer is a device for measuring blood glucose levels from a drop of blood obtained by a finger stick

Diabetes Mellitus o DM1, DM o Disease in which glucose in blood is abnormally high o People with DM often use a glucometer to check their sugar levels and called Random Blood Sugar Test  Lipid Profile o Triglyceride o Cholesterol o HDL (Good Cholesterol) & LDL (Bad Cholesterol)

Cardiovascular diseases

 BUA: Blood Uric Acid  BUN: Blood Urea Nitrogen  Creatinine

Abnormal number of these three may indicate Kidney Diseases

 Enzymes o ALT – alanine aminotransferase o AST – aspartate aminotransferase o CK – creatine kinase o ALP – alkaline phosphatase

ALT & AST – liver AST & CK – CVD ALP – liver, bone, placental, intestinal

Liver diseases, cardiovascular diseases

Immuno- Serology

 it includes laboratory tests that deals with the body’s response to bacterial, viral, and parasitic diseases through antigen/antibody detection SPECIMEN  Serum or Plasma LAB TESTS  Anti-streptolysin O test  Rapid Plasma Reagin  Dengue NS  Hepatitis Profile LAB TESTS DISEASE  Anti-streptolysin O test

Streptococcus is a spherical bacteria responsible for streptococcal infections ASO is an antibody that our body produces once infected by streptococcus

Streptococcal Infections

 Rapid Plasma Reagin

Treponema pallidum is a bacteria that causes syphilis

Syphilis

 Dengue NS1 (Non Structural Protein 1)

A positive result in this test will indicate dengue fever an detect as early as the first day of fever onset

Dengue Fever

 Hepatitis Profile

Allows testing of the different types of Hepatitis

Hepatitis B can coexist with Hepatitis D

Hepatitis A

Hepatitis B Hepatitis C Hepatitis D Hepatitis E

Immuno- Hematology or Blood Banking

 it includes tests which ensures the safety and efficiency of transfusion medicine  main goal is to ensure the safety of the donor and the recipient  its other tasks include preparation of blood components for transfusion SPECIMEN  Serum or Plasma  Whole blood LAB TESTS  Blood Typing  Cross matching  Antibody Screening LAB TESTS DISEASE

 Blood Typing

ABO Typing (Forward & Reverse) o Type A, B, AB, O ABO Typing Detection Specimen Reagent Forward Typing Antigen

Whole Blood

Anti-A or Anti-B Reverse Typing Antibody Serum

A cells or B cells

Rh Typing o D antigen; (+) or (-)  Cross matching  Antibody Detection

Ensures the safety of the patient who will receive the blood component

Clinical Microscopy

 it includes tests focused on the analysis of urine and body fluids SPECIMEN  Urine  Body Fluids LAB TESTS  Routine Urinalysis  Body Fluid Analysis o Cerebrospinal Fluid o Synovial Fluid o Seminal Fluid o Serous Fluid

ROUTINE URINALYSIS

 Physical Exam

allows the person to check the urine color and turbidity

urine color can be seen in a white background while turbidity can be seen in a printed background

 Chemical Exam

makes use of reagent strip method providing a rapid chemical analysis of Glucose, Proteins, and Ketones

 Microscopic Exam

checks for cells, crystals, and bacteria

 Color and Turbidity

 Glucose, Proteins, Ketones, etc.

 Cells, Crystals, Bacteria

DISEASES ASSOCIATIONS

Cystitis o Lower UTI o Inflammation in the Urinary Bladder Pyelonephritis o Upper UTI o Inflammation in the Kidney Glomerulonephritis o Inflammation affecting the Glomerulus (coil of capillaries in the kidneys which filters blood by

removing waste products)

Parasitology

 it includes laboratory tests which detect and identify parasitic infections

Parasite is an organism that lives on or in a host organism and gets its food from or at the expense of its host

SPECIMEN  Stool  Blood LAB TESTS  Routine Fecalysis  Thin and Thick Blood Smear Examination (Malaria)

Microbiology

 it includes laboratory tests which aim to identify microorganisms causing specific diseases SPECIMEN  Blood  Sputum  Urine  Body Fluids  Stool LAB TESTS  Gram Staining  AFB Staining  Biochemical Tests  Culture & Sensitivity  KOH Preparation LAB TESTS DISEASE  Gram Staining o Will determine if the bacteria is gram positive or negative  Biochemical Tests o Used for the identification of bacterial species based on the differences in the biochemical activities of different bacteria Bacterial Physiology o Differs from one type of organism to another Protein Test o Include tests for carbohydrate fermentation, methyl red, citric acid utilization, and hydrogen sulfide production  Culture & Sensitivity o Identifies the pathogen causing the disease and the most appropriate antibiotic for medication

Bacterial Infections

 AFB (Acid Fast Bacilli) Staining

Most commonly performed to detect mycobacterium tuberculosis in sputum samples

Tuberculosis

 KOH (Potassium Hydroxide) Preparation o Specimen used:  Skin scrapings  Nails  Hair Samples

This test is done to identify suspected fungal infections such as Candida albicans

Fungal Infections

Types of BSC:

BSC Class II
BSC Class III

BSC Class II  most commonly used in clinical laboratories

BSC Class III

 provides the highest level of containment  used for bioweapons development

Note:

 BSC Class II and III are used for handling and processing pathogenic biologic agents Types of Laminar Flow Hood:

Horizontal Laminar Flow Hoods
Vertical Laminar Flow Hoods

Horizontal Laminar Flow Hoods

 discharge HEPA (high efficiency particulate air) filtered air from the back of the cabinet across the work surface and toward the user  this serves to protect the research or materials from contamination Vertical Laminar Flow Hoods

 useful in hospital pharmacies when a clean area is needed for preparation of intravenous solutions

Note:

 laminar flow hoods are not biosafety cabinets and must never be used as a substitute for BSC when manipulating potentially infectious or

toxic materials

1907

 people started to focus in prevention of LAIs through the use of laboratory equipments

Arnold Wedum

 1907-1908: he described the use of mechanical pipettors in order to prevent (LAIs)  1944: he was the director of Industrial Health and Safety at US Army Biological Research Laboratories  recognized as one of the pioneers of biosafety; he provided basis for: o Evaluating risks of handling infectious microorganisms o Recognizing biological hazards o Developing practices, equipment, and facility safeguards for their control

1909

 development of a ventilated cabinet by a pharmaceutical company in Pennsylvania o Was initially designed to prevent mycobacterium tuberculosis o The ventilated cabinets are early progenitors to the nearly ubiquitous engineered control now known as the biological safety cabinet Morton Reitman & Arnold Wedum

 in 1966 , they analyzed multiple epidemiological studies of laboratory- based outbreaks

BRIEF HISTORY OF LABORATORY BIOSECURITY

 it all started in the idea to guarantee the safety of vicinities, apparatus, specimens, and date from person with harmful intentions Select Agent Regulations

 in 1996 , __ was founded to monitor the transfer of a select list of biological agents from one facility to another

Select Agents

 biological agents and toxins that have been determined to have the potential to pose a severe threat to public health and safety

Amerithrax

 anthrax attacks of 2001  causative agent: Bacillus anthracis (gram positive, rod shaped bacteria)

 7 days after the terrorist attacks on September 11, 2001 , anonymous letters laced with deadly anthrax forced began arriving at media companies and congressional offices  over the ensuing months, 5 Americans died from inhaling anthrax ; 17 others were infected after the exposure  Inhaling anthrax is considered to be the deadliest formed

Note:

 infection usually develops within a week after an exposure  without treatment, only about 10-15% of patients survived

Revised Select Agent Regulations

 after the terrorist attacks of anthrax attacks, the US made revisions in the said regulations which resulted in the formation of the ___ in 2002  required specific security measures for any US facility that used or stored any agents on the new, longer list of agents  creation of two (2) tiers of select agents  this change was intended to make the regulations more risk-based, mandating additional measures for tier 1 agents, and present more severe risks, and therefore more severe consequences

Tier 1 Agents

 materials that pose greater risk of deliberate misuse Original Select Agent Regulations

 made use to limited facilities  had only a limited list of agents

Revised Select Agent Regulations

 inclusion of additional select agents and additional safety  created 2 tiers of select agents

LOCAL & INTERNATIONAL GUIDELINES ON LABORATORY

BIOSAFETY & LABORATORY BIOSECURITY

Laboratory Biosafety Manual

 1983

 WHO’s 1st Edition Biosafety in Microbiological and Biomedical Laboratories

 1984

 CDC and NIH ’s jointly published 1st edition  these two documents lead the establishment of the model of biosafety containment levels with certain agents which increased the biosafety levels for biological agents that post risks to human health NIH Guidelines for Research involving Recombinant DNA Molecules

 published by NIH (with updated versions)

WHO and NIH  developed Risk groups (classification for microorganisms)

CDC and NIH  founded the BSL (Biosafety levels)

WHO: World Health Organization CDC: Centers for Disease Control and Prevention NIH: National Institutes of Health

BIOSAFETY AND BIOCONTAINMENT

 our goal is to contain a certain pathogen through standard and special microbiological practices, with the use of safety equipment , that is inside a safe facility design  there should be a combination of these three in order to contain a certain pathogen  ex. In the case of covid-19, it is not enough that we have a certain facility but we lack safety equipment, and vice-versa

Bio containment

 physical containment of highly pathogenic organisms usually by isolation in secure cabinets or rooms

 to prevent accidental infection of

workers or release into the surrounding community o Protection of different workers handling the specimen, and for the protection of public health

Biosafety Levels (BSLs)

 The primary risks that determine levels of containment are: 1. Infectivity 2. Severity of disease 3. Transmissibility 4. Nature of the work conducted

Infectivity

 pertain to the ability of microorganisms to infect a susceptible host  based on a strategy that is employed by different microorganisms in order to them to cause an infection

Severity of disease

 refers to the presence and extensiveness of a disease that a cause of a particular pathogen

Transmissibility

 pertains to the different methods of transmission a specific pathogen is able to be carried  examples:

Transmitted through droplets
Transmitted through direct contact

 these four are considered in order to determine the different type of biosafety levels that should be imposed in a specific microorganism  this pyramid could pertain to different things o It can be utilized to compare the number of BSL labs in the world o Ex. BSL-1 is placed on the base of our pyramid. Therefore, there is a higher number of BSL- laboratories than the rest of the BSL labs

IMPORTANCT OF KNOWING AND CLASSIFYING THE

RISKS GROUP OF MICROORGANISMS

 if you are not able to determine the risk group of a certain microorganism, we will not be able to contain this particular pathogen  it is important that we know and identify the risk group o As we go up, the higher infectivity, the higher the risk is specific microorganism has, the higher requirement is specific laboratory need to have in order for us to successfully contain the microorganism o Higher risk = higher biosafety lab  each biosafety level has its own specific containment controls that are required for the following: 1. Laboratory practices 2. Safety equipment 3. Facility design/ construction  these three are necessary for us to successfully contain the specific pathogen

BSL 1 MICROBES HANDLED CONTAINMENT CONTROLS

 not known to consistently cause disease in healthy adults  present minimal potential hazard to lab personnel and the environment  ex. Non-pathogenic strain of E. coli

 standard microbiological practices are followed  work is done in an open lab bench or table  sink available for hand washing  lab should have doors to separate the working space  PPE is needed  AUTOCLAVE:  It is a machine that uses steam under pressure in order to kill microorganism  It is used to decontaminate certain biological waste and sterilize media, instrument and lab ware BSL 2 MICROBES HANDLED CONTAINMENT CONTROLS

 pose moderate hazards to laboratory personnel and the environment  associated with disease of varying severity  ex. Staphylococcus aureus

 all procedures must be performed in the biological safety cabinet (BSC)  There are some procedures that could actually aerosols or splashes.  Therefore, this is to minimize the exposure of a lab personnel by using a physical containment equipment  Autoclave used to decontamination  with sink and eye wash readily available  lab must have a self- closing door  access to lab is restricted when work is done  PPE: eye protection & face shields can be worn BSL 3 MICROBES HANDLED CONTAINMENT CONTROLS  can cause serious or potentially lethal disease through inhalation or respiratory transmission  ex. Mycobacterium tuberculosis

 all work must be done in appropriate BSC  PPE: respirators are required

 access to the lab is restricted and controlled at all times  entrance to the lab: 2 sets of closing and locking doors  lab must have a sustained directional airflow BSL 4 MICROBES HANDLED CONTAINMENT CONTROLS

 dangerous and exotic  can cause a high-risk of aerosol transmitted infection  cause infected which is frequently fatal without treatment or vaccine  ex. Ebola Virus

 all work should be done in a Class III BSC  wear a full-body, air- supplied positive pressured suit  lab is in separate building (isolated or restricted zone)  changing clothing before entering: shower upon exiting  decontaminate all materials before exiting

DIFFERENT ORGANIZATIONS IN THE FIELD OF BIOSAFETY

American Biological Safety Association (ABSA)

 promotes biosafety as a scientific discipline and provides guidance to its members on the regulatory regime present in North America

Asia-Pacific Biosafety Association (A-PBA)

 acts as professional society for biosafety professional on the Asia- Pacific Singapore Brunei China Indonesia

Malaysia Thailand Philippines Myanmar European Biological Safety Association (EBSA)

 focuses on encouraging and communicating among its members information and issues on biosafety and biosecurity as well as emerging legislation and standard

properly monitor the spread of the disease in the affected population

Category C

 emerging pathogens o these could be engineered for mass dissemination in the future  most of the agents have not been used yet for this purpose of bioterrorism attacks, but these emergency pathogens are potential target for bioterrorism  relatively easy to produce and disseminate  poses a potential for high morbidity and mortality rates , thus, their negative implications on public health may truly be detrimental  readily available DISEASES CAUSED BY BIOTERRORISM AGENTS

Category A

These are caused by bacterial agents  Anthrax  Botulism  Plague  Tularemia This is caused by viruses  Ebola

Category B

 Brucellosis  Microbes Ingestion of contaminated food or water  Food safety threats  Water safety threats  Typhus fever  Viral encephalitis

Category C

 Emerging infectious diseases  Nipah virus  Hantavirus

OVERVIEW ON SELECTED BIOTERRORISM AGENTS

Category A: Anthrax

 Causative Agent: Bacillus anthracis o It is a spore-forming bacterium MODE OF TRANSMISSION

Direct contact with infected animals and humans
Ingestion or inhalation of spores produced by a bacterium
Occupational exposure to infected animal products (farmers and livestock handlers)

Types of Anthrax

Cutaneous Anthrax
Inhalation Anthrax
Gastrointestinal Anthrax

All types require immediate medical interventions

Cutaneous Anthrax

 enters through the skin or through direct contact  most common type  least dangerous type

Inhalation Anthrax

 if the spores are breathed in or inhaled , then they will ultimately reach the lungs that may lead to death at a faster rate if the condition is not treated immediately  most deadly form or dangerous type

Gastrointestinal Anthrax

 spores are ingested  infect organs found in the gastrointestinal tract  not commonly or least encountered

When anthrax is used as a biological weapon:

 spores can be easily isolated and can evenly produce on special laboratories  can be released quietly  spores could be put into powders, sprays, food, and water (without any notice), and cannot be seen, smelled, or tasted o People are unaware

Category A: Plague

 Causative Agent: Yersinia pestis MODE OF TRANSMISSION

Bite of infected fleas
Inhalation of infected respiratory droplets  Can be transmitted through infectious droplets may be dispersed into the air via: coughing and sneezing

Types of Plague

Bubonic Plague
Septicemic Plague

If these two (2) types of plague are left untreated, the bacteria can spread to the lungs which can cause...

Pneumonic Plague

Bubonic Plague

 common form  characterized by the presence of buboes

Buboes

 painful, swollen, lymph nodes  bacteria can infect and multiply inside these lymph nodes which causes them to become enlarge  if left untreated, these will spread into other parts of the body and become more severe

Septicemic Plague

 darkening of the skin and of other tissues particularly found in fingers and toes  bacteria enter and spread in the blood stream

Pneumonic Plague

 can also be developed from untreated bubonic or septicemic plague and if the person becomes infected due to the inhalation of infectious droplets  only type of plague which can be transmitted from one person to another  can be spread by infectious respiratory droplets  most serious form since most untreated cases lead to death

When plague is used as a biological weapon:

 Aerosol dissemination  Can cause pneumonic plague (lethal, easy to spread a lot quicker)  It would take 6 days after exposure before the symptoms will trigger

Category B: Food Borne Illness: Salmonellosis

 Causative Agent: Salmonella MODE OF TRANSMISSION

Consumption of contaminated foods of animal’s origin  Egg, meat, poultry, and milk  can cause food poisoning SYMPTOMS  Fever  Abdominal pain  Diarrhea  Nausea and vomiting PREVENTIVE PRACTICES  Ensure food is properly cooked  Drink only pasteurized or boiled milk When salmonellosis is used as a biological weapon:

 food poisoning

Salmonellosis Attack in 1984: USA

 Put the agent on salad bars of 8 different restaurants  Infected more than 700 people within that area  No one died  Largest outbreak in the state of foodborne disease back then

Category B: Waterborne Illness: Cholera

 Causative Agent: Vibrio cholera  acute diarrheal disease MODE OF TRANSMISSION  ingestion of contaminated water SYMPTOMS  Acute watery diarrhea – rapid loss of fluids  Severe dehydration (if not managed immediately)

Most cases are mild in nature. However, there are very rare instances of severe forms of this disease where it became fatal due to lack of treatment PREVENTIVE PRACTICES  Drink clean and safe water  Observe good hygiene practices In terms of bioterrorism:  it has been weaponized before

During WWII (Cholera):

 This was used to poison people by contaminating 1,000 water wells (which at that time is the primary source of water)

Category C: Nipah Virus

 Emerging Pathogen CLINICAL PRESENTATIONS

Asymptomatic Infections
Respiratory Infection
Fatal encephalitis Respiratory Infection

 acute respiratory illness if the infection reaches the lungs

Fatal Encephalitis

 severe manifestation  develops when the virus spreads through the brain  those who developed in encephalitis have a chance to recover o Those individuals who recovered are expected to experience other neurologic manifestations, such as: seizures due to their previous infection with the virus

Mode of Transmission

This was observed in the outbreak which previously occurred in India.  Consumption of fruits contaminated with urine or saliva from infected fruit bats  Direct contact with infected pigs

Fruit bats are considered as natural host of the virus (they don’t develop any disease even though they harbor the virus). However, they have caused diseases among pigs and other domestic animals which were infected.

Nipah Virus Attack in Malaysia

 The very first outbreak that involved an animal to human transmission which occur when the individuals came in direct contact with infected pigs. There are still no reported cases of Nipah Virus being used a biological weapon, but it is among the emerging pathogens which has high chances of being weaponized due to:

Availability
Transmissibility
Potential to cause high mortality

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Principles of Medical Laboratory Science Practice 1

History of Medical Technology Profession 01

HANNAH SANCHEZ | BSMT 1-E | VIDEO-BASED

TOPIC OUTLINE

 PART 1

o Introduction to Medical Laboratory Science

o History on a Global Context

o Medical Technology in the United States

 PART 2

o Medical Technology in the Philippines

o Inventions and Innovations in the Field of

Medical Technology

INTRODUCTION

Medical

Laboratory

Science

 it is the health profession which

performs lab analysis, aid in the

diagnosis, and treatment of diseases as

well as in the maintenance of health

HISTORY OF THE MEDICAL TECHNOLOGY PROFESSION

HISTORY ON A GLOBAL CONTEXT

Hippocrates

 <Father of medicine=

 formulated the Hippocratic oath

(Duty of Physician, Code of Ethics of

Practicing Physician)

described the four humors of the body

Four humors

of the

body:

1. Blood

2. Phlegm

3. Black bile

4. Yellow bile

In ancient times, __ were recognized as

the source of a person’s disposition

ACCORDING TO HIPPOCRATES…

Good

Health

 is a result of the balance

among the four humors

Illness/

Disease

 is due to an imbalance of

the four humors

Hindu

Physicians

 began the practice of examining

patients’ specimens

URINE

 oldest known test on body fluids

was done on __

 according to them, certain __

samples attracted ants, indicating a

sweet taste

URINALYSIS

 is the oldest laboratory procedure

that was performed

Galen

 is a Greek physician and philosopher

who followed Hippocrates’ theory of

four humors

 also believed that health depended

on balance

 established the relationship between

fluid and urine volume

o ↑ fluid intake = ↑ urine volume

Rufus of

Ephesus

 made the 1st description of hematuria

HEMATURIA

 hema means blood and uria

means urine

 means the presence of blood in

urine

Types:

1. Macrohematuria

2. Microhematuria

MACROHEMATURIA

MICROHEMATURIA

 aka GROSS hematuria

 blood is present and

can be seen in the naked

eye

 presented with or

without pain, but it is

always abnormal

 aka MICROSCOPIC

hematuria

 the quantity is too low

 it is detected by

microscopic and dipstick

analysis

Frederick

Dekkers

 observed that proteins in the urine are

precipitated when boiled with acetic

acid

NOTES:

 urine + acetic acid = concoction

 concoction is exposed to high

temperature until the sample

reached the boiling point

 two results:

o With precipitate = presence of

protein (proteinuria)

o Without precipitate = absence

of protein

 protein is not usually excreted from

the urine

Hermann

Von Fehling

 is a German chemist who worked up

with various analytical methods

 he performed the 1st quantitative test

for urine sugar, also known as Fehling’s

Test

FEHLING’S TEST

 it is a chemical test to detect

reducing sugars and aldehydes in a

solution

Ebers

Papyrus

 it is a 110-page long scroll which

measures 20 meters long

 this is the oldest preserved Egyptian

compilation of medical texts

CONTENTS:

√

Pregnancy

√

Eye & skin problems

√

Surgery

√

Burns

√

Intestinal diseases

√

Parasites

o Hookworm infection

Vivian

Herrick

 traced the beginning of MT way back

in 1500 DC when intestinal parasites

were first identified

PARASITES:

√

Ascaris - Roundworm

√

Taenia - Tapeworm

Anne

Fagelson

 believed that MT started at the in the

14th century when a prominent Italian

doctor at the University of Bologna

employed Alessandra Giliani to perform

different tasks in the laboratory

 dies in a laboratory acquired infection

ALESSANDRA GILIANI

 1st female anatomist & prosector

Prosector

 dissects corpse for

examination/ anatomical

demonstration