SYLLABUS BASED NOTES FOR THE POST OF JUNIOR LABORATORY ASSISTANT IN MEDICAL EDUCATION PART 1 BASIC LABORATORY TECHNIQUES (Module 1)

SYLLABUS BASED NOTES FOR THE POST OF JUNIOR LABORATORY ASSISTANT IN MEDICAL EDUCATION PART 1 BASIC LABORATORY TECHNIQUES (Module 1)

PART I: MLT (50 Marks) 

MODULE I- (10 Marks )


BASIC LABORATORY TECHNIQUES: Knowledge of Laboratory chemicals-
✅hazard symbols, warning symbols, safety precautions and storage of chemicals 
✅Cleaning of glassware - general glass wares, new glass wares, blood-stained pipettes, slides, culture plates etc. 
•Cleaning and disinfection of Disinfectants used and biosafety precautions in case of specimen spillage. 
✅Bio-medical waste management -categories of bio-medical waste. Bio- medical waste - color coding, types of containers, collection, transport and disposal of biomedical waste. 
✅ Basic first aid techniques for cuts & bruises, burn injury etc. 
•Sample collection and processing - barcoding, safety precautions, processing of samples etc. 
Common Instruments used in laboratories - incubators, centrifuge, semi autoanalyzer, Colorimeter, Micropipettes etc 
 Distillation and deionisation apparatus and use ✅Laboratory management system
(All syllabus based notes are available ✅)

Notes:

Lab safety 

Laboratory safety measures are designed to encourage and promote safe and efficient working practices in a lab. It protects all laboratory personnel and other people with right of entry from illness or injury. All laboratory personnel have responsibility to adhere to and observe safety programme all the time. Occupational injury and illness are caused mostly by bad practices, inexperience, ignorance and failure to follow standard practices. Safe laboratory Practice mainly depends on


1.Awareness on Signs & Symbols used in a laboratory 
2. Identification of the possibilities for common laboratory hazards 
3. Proper management of Bio medical wastes 
4. First Aid practices 


Signs and symbols used in a laboratory


To minimize accidents in the laboratory it has been made mandatory to use signs and symbols in the laboratory. These are used to indicate possible hazard during a procedure. A thorough knowledge on signs and symbols helps the laboratory personnel to deliver his duty properly. The symbols include hazard warning symbols, safety (mandatory) symbols and prohibitory symbols. Hazard warning symbols are black pictures in yellow or orange background. Safety symbols are round white pictures with blue background, prohibitory symbols are round black pictures in white background with a red edge and diagonal line


Signs and symbols used in a laboratory

Handling and storage of chemicals in a laboratory 

Proper handling and storage of chemicals and reagents is necessary to prevent hazards. Chemicals are stored according to their physical and chemical properties 

Types of chemicals 

1. Flammable Chemicals - eg:-Acetone, Ether, Xylene, Alcohol 

2. Corrosive chemicals - eg:- Concentrated Acids, Alkalies,phenol etc 

3. Oxidising Chemicals - eg:- Potassium dichromate, Chromic acid, Chlorites etc. 

4. Explosive Chemicals - eg:- Picric Acid

5. Radioactive chemicals- eg:- I 125, 131, H³ 

6. Carcinogenic chemicals-eg:- Benzidine, O- toluidine, Selenite, etc 

7. Toxic Chemicals -eg:- Potassium Cyanide 

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Handling and Storage of chemicals 


1. Label the chemicals with hazard symbol, simple instruction for use, strength and Expiry date (it is mandatory for manufacturers). 

2. Flammable chemicals are stored in fire proof metal containers at ground level in a cool dry place and always handle them away from direct flame.

 3. Corrosive chemicals are stored in amber coloured bottles at ground level. 

4. Explosive chemicals are never left in dry state. 

5. Radioactive chemicals are handled by properly trained persons only

6. Carcinogenic chemicals are stored in closed container. Exposure to such chemicals should be kept minimum. 

7. Highly toxic chemicals like Potassium cyanide are kept locked in cupboards and proper documentation is made in stock register. 

8. Do not open flammable chemicals near flame

9. Do not add water to acid 

10. Avoid mouth pipetting. 

Laboratory Hazards


Laboratory hazards are mainly Physical, Chemical, Biological, Electrical, Fire, Radiation hazards. Physical hazards include Cutting with broken glassware, sharps, Electric shocks, Falling on wet floor, Burns and scald. Burns usually caused by flammable chemicals, faulty electric equipment, Burners, corrosive chemicals, and hot dry objects. Scalds are caused by hot liquids. General precautions to prevent physical hazard in a laboratory are, 

1. Proper storage and handling of glassware 

2. Adopt Standard electrification methods

3. Proper storage and handling of chemicals

4. Proper handling of lab equipment, 

5. Prevent spillage of hot fluids 

6. Use quartz chips to prevent violent boiling of liquids


7. Use thick walled glass containers and round bottomed flask for heating purpose 

8. Use hazard symbols Chemical hazards are caused by physical contact, ingestion and inhalation of chemicals, leads to from minor burns to even life threatening. 


General precautions to prevent chemical hazard in a laboratory are 


1. Awareness on the physical and chemical properties of laboratory chemicals 
2. Proper storage of chemicals 
3. Mouth pipetting should be avoided 
4. Dangerous chemicals (toxic chemicals) are kept in small amount for routine use
5. Use hazard symbols 

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Biological hazards can be caused by infectious agents like Human immunodeficiency virus (HIV), Hepatitis B virus (HBV), Hepatitis C virus (HCV), Mycobacterium tuberculosis, Herpes simplex virus etc. 


Contaminated food and water, Needle pricks and cuts, Laboratory animal bite can also cause bio hazard. 


General precautions to prevent Biological hazards in a laboratory are 


1. Consider all specimens in the laboratory as potentially dangerous 

2. Use gloves, masks, apron and eye protectors in the laboratory 

3. Proper waste disposal or management

4. Vaccinate laboratory staff against infectious diseases like HBV 

5. Mouth pipetting should be avoided 6. Do not eat, drink, smoke or apply cosmetics in the laboratory 

7. Proper washing of hands after work, Cleaning and disinfection of work bench on completion of work 

Electrical hazards are mainly caused by faulty operation and improper maintenance of electrical equipment. It may result in minor burns to severe injuries that may lead to death. 

General precautions to prevent electrical hazard in a laboratory are,


1.All Electrical equipment should be properly grounded 
2. Overload circuits should be avoided, do not use extension cords 
3. Electrical equipment should not be handled with wet hands 
4. Do not disable any electrical safety features
5. Repair or services should be done by authorized persons only Do not use Equipment for a task not designed for it 
6. Do not leave equipment switched on when not in use 
7. Fire in the laboratory may occur due to naked flames, electrical overloading, flammable reagents and smoking in the laboratory. 


General precautions to prevent Electrical hazard in a laboratory are, 


1. Instead of open flames use hot plates 
2.Store flammable and explosive chemicals properly 
3. Install fire extinguisher in the laboratory. 
All lab personnel should know the location of fire extinguisher and how to use it 
4. In case of fire, escape through fire exit route

Fire Extinguishers 

A fire extinguisher is a fire protection device used to control small fires in emergency situations. Typically, a fire extinguisher consists of a hand-held cylindrical pressure vessel containing agents which can be discharged to extinguish a fire. 
fire extinguisher


Different type of fire extinguishers are now available for managing different classes of fires. Fire extinguishers for ABC type fires are commonly used in the laboratories

Cleaning of Glassware for biochemical analysis 
Good laboratory technique demands clean glassware. Tests may lead to erroneous result if dirty glassware is used. The used glass wares should be washed with water immediately after use, soak in mild detergent solution, wash in running tap water and rinse with distilled water and dry. 
If lab-ware is not cleaned immediately, it may become impossible to remove the residues. Such glass wares should be soaked in water or special cleaning solutions. Special cleaning solutions such as chromic acid solutions are suggested in the case of more dirty glass wares

Most new glass wares are slightly alkaline in reaction. New glassware should also be soaked in several hours in acid water (a 1% solution of hydrochloric or nitric acid) before use. 

Pipettes should be placed in a vertical position with the tips up in a jar of cleaning solution. A pad of glass wool is placed at the bottom of the jar to prevent breakage. After soaking for several hours, the tips are drained and washed under running tap water until all traces of cleaning solution are removed. The pipettes are then rinsed in distilled water and are dried in an oven at not more than 110°C. 

Most laboratories that use large numbers of pipettes daily, use a convenient automatic pipette washer. These devices are made of metal or polyethylene and can be connected directly to hot and cold water supplies. Polyethylene baskets and jars may be used for soaking and rinsing pipettes in chromic acid cleaning solution

It is important that the necks of volumetric flasks above the graduation mark be clean because, when solutions are diluted in the flask, drops of water may adhere to an unclean wall and may invalidate the measurement of volume.
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DISINFECTANTS USED IN LABORATORY


Different chemicals used as disinfectants includes 


ALCOHOLS: Eg: Ethyl alcohol, isopropyl alcohol and methyl alcohol.70% ethyl alcohol (spirit) is used as antiseptic on skin. 

ALDEHYDES Eg: Formaldehyde, and Gluteraldehyde 40% Formaldehyde (formalin) is used for surface disinfection and fumigation operation theatres, biological safety cabinets, wards, etc. 

PHENOL. Examples: 5% phenol, Cresol, Lysol, chlorhexidine, Dettol 

HALOGENS:. Examples: Chlorine compounds (chlorine, bleach, hypochlorite) and iodine compounds Tincture of iodine (2% iodine in 70% alcohol)chlorine is used for disinfecting water supplies 

HEAVY METALS: Eg. Mercuric chloride, silver nitrate, copper sulfate 

SURFACE ACTIVE AGENTS: Examples: These are soaps or detergents. 

DYES: Eg: Aniline dyes such as crystal violet, malachite green and brilliant green 

ETHYLENE OXIDE (EO): It is an alkylating agent capable of killing spores rapidly. 

BETA-PROPIOLACTONE (BPL): It is an effective sporicidal alkylating agent and is a carcinogen
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Biomedical Waste Management in Laboratory


Biomedical waste is generated during the diagnosis, testing, treatment, research or production of bio materials. Management of biological wastes consists of the collection, segregation and proper treatment of individual type of waste. The wastes are colour coded according to the nature of waste and their method of disposal .






First Aid Practice in Laboratory


First aid is the help given immediately to an injured person. For example First aid helps an injured to avoid excessive bleeding from an injury until medical attention has been obtained. A quick and confident approach of first aider can save life from many emergency conditions. Common first aid procedures are given below 

Injuries caused by broken glass: Wash the wound immediately to remove any glass pieces. Apply mercurochrome or acriflavine ointment to the wound. Cover with gauze and adhesive tape 

Acid/Alkali splashes on the skin: Wash thoroughly; bath the affected skin with cotton wool soaked in 5% aqueous sodium carbonate if acid and 5% acetic acid or undiluted vinegar, if alkali.

 Acid/Alkali splashes in the eye: Water spray from a wash bottle or rubber bulb into the medial corner of the eye. Put 4 drops of 2% Aqueous Sodium bicarbonate into the eye, if acid, and saturated solution of boric acid, if alkali

Swallowing acid: Make the patient drink some 5% soap solution immediately. Make him gargle with the soap solution. Give him 3 or 4 glasses of ordinary water. If the lips and tongue are burned by the acid, rinse thoroughly with water. Bathe with 2% aqueous sodium bicarbonate. 

Swallowing alkalies: Make the patient drink 5% solution of acetic acid or lemon juice or dilute vinegar. Make him gargle with the same acid solution. Give him 3 or 4 glasses of ordinary water. If the lips and tongue are burned by the alkali, rinse thoroughly with water; bathe with 5% acetic acid


Poisoning:-Send for a physician or qualified nurse, specifying the toxic substance involved. Place the victim in open air while waiting for the physician. 

Minor burns: Plunge the affected part in cold water or ice-water to soothe the pain. Apply Mercurochrome or Acriflavine ointment to the burn. Apply dry gauze dressing loosely. If the burn becomes infected or does not heal, refer the patient to a physician. Never tear off the blisters that form over the burns. 

Severe burns: If the victim is on fire, roll him in a blanket or overall to smoothen the flames. Inform the physician. Lay the victim on the ground. Do not remove his clothing. Cover him if he is cold. Do not apply any treatment to the burns. This must be left to the physician. 

Unconsciousnes: If the victim is breathing then lay him face down with his head on one side and arm and the leg of that side in the bent position. This posture makes breathing easier and provides better blood circulation to all body parts. If the victim


Artificial respiration: The procedure should be started quickly as brain infarction occurs within few minutes of oxygen deficiency. 
Steps of artificial respiration is 
1. Lay victim on back 
2. Clear any obstruction of the mouth 
3. Place an object under the shoulder so the head is tilted back 
4. Pinch the nostrils and apply mouth to mouth resuscitation 10 times a minute until breathing starts


Distillation and Deionisation apparatus 


The quality of water used in the laboratory is very crucial. In medical laboratory work, water of an appropriate quality and quantity is required for the preparation of Standard solutions, buffers and controls, Reagents for rinsing of cleaned glass and plastic wares, cuvettes, etc. 

All water used in medical laboratory should be free from substances that could interfere with the tests being performed. Depending on the requirements, available facilities and quality of the laboratory's water supply, the following instruments can be used to obtain water of adequate purity and quality. 
Water distilling apparatus is an instrument that is used to purify impure water by a process known as distillation. 

Distillation is a process by which impure water is boiled and the steam produced is condensed on a cold surface (condenser) to give chemically pure distilled water that is water from which non-volatile organic and inorganic materials are removed. Distillation does not remove dissolved ionized gases such as ammonia, carbon dioxide, and chlorine. Distilled water should be clear colorless and odorless Deionizer is an apparatus used to produce ion free water. 


Deionization is a process in which chemically impure water is passed through anion and cation exchange resins to produce ion free water. Deionized water has low electrical conductivity, near neutral pH and is free from water-soluble salts but is not sterile


Laboratory Management 


Code of Ethics of a laboratory Professional The laboratory personnel should be aware of the code of ethics which is the minimum standard about his professional skill. It includes the do's and dont's in the laboratory. 
It is a set of principles of right conduct. 
1. Treat patients and colleagues with respect, care and thoughtfulness 
2.Perform duties in an accurate, precise, timely and responsible manner 
3. Safeguard patient information as confidential, within the limits of the law 
4. Prudent use of laboratory resources
5. Advocate the delivery of quality laboratory services in a cost effective manner 
6. Work within the boundaries of laws and regulations 7. Strive to improve professional skills and knowledge


Role of communication in laboratory

 A laboratory must maintain a healthy relationship between patients, physicians, nursing staff, sales representatives, administrative staff etc. A trained laboratory technologist must know the following aspects of communication 
1. Speak to patient clearly with pleasing manners so that his confidence towards the technician increases 
2. Communicate correct knowledge to hospital staff on laboratory tests, results and significance of tests.
 3. Communication with physicians on interpretation of lab requests and labora- tory results 
4. Good interpersonal relationship to be observed with co workers


Organization of a Laboratory 

Only a well-designed laboratory can provide reliable and timely results for the diagnosis of diseases. The laboratory should be properly planned, so that it will be functional and convenient. The laboratory should have adequate space, ventilation, light, power supply, water supply, work benches, Reagents, Equipment and Laboratory personnel


An accessible space adequate for setting a desired laboratory is identified. Good ventilated laboratory has reduced risk of infection. Laboratory should have uninterrupted power supply, good lighting system. Good supply of running water and water drainage facility is essential in a laboratory. Work benches should be made at suitable heights with enough leg space. Surface polished Cement benches or wooden benches can be used. Wooden benches are acid proofed. Basic laboratory equipment, glassware and reagents should be made purchased from reputed suppliers. Well trained qualified staff is the back bone of laboratory and the quality of the result depends on the quality of workmanship


A laboratory should have staff pattern including administrator, laboratory technologists, technicians and laboratory assistants for its proper functioning. 

Components of a Laboratory: The components of a clinical laboratory include various departments like hematology, blood bank, microbiology, biochemistry, serology and clinical pathology. It also includes reception area, room for specimen collection, refreshment room and toilets 

Lay out plan of a multi- room laboratory: The working area for different departments as well as sample reception should be conveniently arranged making the necessary reagents and apparatus easily accessible


Maintenance of Stock Registers- Consumables , Non-consumables: Every laboratory should maintain stock register and each purchase of commodities to the laboratory should be included in it. It is mandatory to maintain separate stock registers for consumables and non-consumables. Reagents chemicals and glass wares are included in consumables. Instruments and machineries used in laboratory and items which will not be exhausted on usage are included in non-consumables


Ordering and Utilization of supplies.

 A medical laboratory needs an uninterrupted supply of chemicals and reagents for the smooth functioning. Hence prompt ordering and purchasing is important. For this purpose every laboratory personnel should know the details of the item to be purchased and details of various suppliers in that area and merits and demerits of each brand, shelf life period etc. 

Accreditation and Certification of Laboratories:Accreditation is used to grade the laboratories having an appropriate quality management system and can properly perform certain test methods and calibration parameters according to their scopes of accreditation. Example for accreditation agencies are NABL, ISO, CAP, CRISIL etc

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