MEDICAL LABORATORY SERVICES

Medical Laboratory Services provide a comprehensive range of testing of specimens that are useful for diagnosis, training, disease surveillance and research purposes. We aim to provide accurate results, which are produced timely and are comparable with international standards; that can meet the demands of the current trend in health care service delivery.

The Laboratory complex runs for 24 hours.

When a patient presents at the reception of the laboratory complex, the following is the summary of the patients journey to getting his/her investigation(s) done;

1.       The bill for the respective testing procedure(s) is generated

2.      The patient then pays the recommended amount to the cashiers, and obtains a receipt, which also serves as an eventual clearance for accessing their investigation results via the electronic medical records (e-MR).

3.     The patient now proceeds to the Phlebotomy room, (or secluded sample collection rooms for procedures that require high degrees of privacy;

e.g., vaginal swabs, semen collection etc.) where samples are collected appropriately.

4.      After samples have been collected, he/she may be asked to go back to their respective clinics to see their Doctors (in case of presentations that require urgent resolution), or advised to go home and report back to their clinic at the next appointed date.

5.       The general turnaround time (TAT) for the patient in the reception/phlebotomy is 20 minutes.

6.    For in-patients, their samples are sent from the wards to the lab by ward health assistants. Patients can pay either by POS terminal or cash, or they could credit their e-MR wallets at admission, from which money can be debited for each procedure. When the results are ready, they are transmitted via e-MR from where their Doctors can access them.

DEPARTMENTS OF MEDICAL LABORATORY AND THEIR FUNCTIONS/PROCEDURES

1.       CHEMICAL PATHOLOGY

The department is responsible for chemistry and immunological assays which includes metabolic profile, liver function tests, renal function tests, Glycated haemoglobin, and immunological markers.

The turnaround time (TAT) for this department is 3-5 hours, and 7-14 days for Hormonal assays

 Equipment:

Mindray BS 380 fully automated chemistry analyzer, which can analyze up to 450 tests, and can run up to 50 samples within an hour.

 

Standard Operational Procedure

•        Prepare for 'power on' by checking the daily maintenance schedule

•        Power on

•        Prepare for analysis (Run QC, calibrators)

•        Perform routine analysis

•        Shutdown

 2. HAEMATOLOGY AND BLOOD TRANSFUSION

The department is responsible for processing haematological investigations, and blood coagulation profiles.

The TAT for this department is 15 minutes to 5 hours.

Equipment:

Horiba Pentra XLR; This machine is a fully-automated 5-part differential haematology analyzer that can handle up to 80 samples per hour.

 

Backup

Horiba Pentra MS CRP; it is also a fully-automated 5- part differential haematology analyzer.

 

S.O.P

•        Check for proper external power connection

•        Power on.

•        Run background check.

•        Perform quality control.

•        Start sample analysis.

•        Shutdown. x Horiba YUMIZEN G400

Coagulometer. It can run most tests that are useful for coagulation studies.

 BLOOD BANK

This department is responsible for screening & bleeding of donors, storage of blood, crossmatching and issuing of blood and its components for transfusion to recipients.  The TAT for this department is 30 minutes for donors, and up to 11/2 hours for crossmatching.

 

Equipment

Maglumi 800; this is a fully-automated chemiluminescence immunoassay analyzer. It can analyze all the serological and immunological markers and can process up to 40 samples per hour.

 

Standard Operational Procedure

•        External cleaning of the equipment

•        Check physical power connections

•        Power on

•        Run background check

•        Ensure system is in perfect condition

•        Prepare for analysis

•        Start sample analysis

•        Shutdown

 

 BLOOD BANK REFRIGERATORS

There are two giant blood bank refrigerators with storage capacity of 250 departments of blood each and a small side blood bank storage capacity of 20 departments of blood.

•        One of the giant blood bank refrigerators is in-use while the other one is deployed as backup.

•    The side blood bank is used to store already crossmatched/tagged blood and those returned; for a maximum of 24 hours.

The in-built digital thermometers are used for temperature monitoring; temperature readings are regularly charted for monitoring purposes.

3. HISTOPATHOLOGY

Purpose

To outline the proper procedures for collecting, preserving, transportation and processing tissue/ biopsy specimens, aspirates, pap smears for evaluation by light microscopic histopathological evaluation. And also, for booking and attending  to patients scheduled for Fine Needle Aspiration Cytology (FNAC).

Responsibility

It is the responsibility of all staff to contribute to the collection, preservation, identification, and processing of specimens for histopathological processing following international best practices.

Staff: Receptionists, Histopathology Laboratory Technicians, Histo-scientists And the Histopathologists.

 BIOPSY CASES

1.    All biopsy cases must be put in proper, well covered containers, properly labelled from the theatre and accompanied by properly filled request forms before being transported to the laboratory.

2.    The medium for transportation is 10% buffered formalin. The acceptable ratio of specimen to formalin is 1: 10, this is to ensure proper fixation and prevent autolysis.

3.      The cases must be duly registered in the laboratory and assigned laboratory numbers.

4.       Payment must also be confirmed.

Steps 1 & 2 above are to be checked by the receptionist and the laboratory technician before specimens are received.

 

Where a gross specimen does not come in formalin, or formalin is inadequate or the tissue is already autolyzing, this should be duly noted by the laboratory technician and reported so that the histopathologist can communicate with the clinician. The appropriate volume of formalin should be added to the said specimen after the accompanying formalin or solution has been changed.

Step 3 & 4 above are to be carried out by the receptionist and/or the laboratory technician.

5.    Grossing/Surgical cut up will be done within 72 hrs of tissue reception by the Histopathologist.

6.    The Histopathologist will be assisted during the surgical cut up above by the laboratory technician and the Histo-scientist.

7.       The manual tissue processing, embedding, sectioning and staining will be done and completed between 3 to 5 days. The procedure will be carried out by the histo-scientist and assisted by the laboratory technician.

8.    Where automated tissue processing and staining is available the step 7 procedure above can be shortened to 48 to 72 hours.

9.       The stained slides will be sent to the histopathologist as soon as they are dry.

10.     They will be assessed microscopically/ histologically and reported within 48 hours expect for cases requiring 2nd opinion, re-processing and in cases where further ancillary tests are needed.

11.   Reports will be dispatched by the laboratory technician or the receptionist to the patients or requesting clinicians as soon as the histopathologist issue them.

12.    Where the electronic medical record is functional, the histopathologist will upload the reports immediately.

 

 PAP SMEARS AND ASPIRATES

1.     The glass slides bearing the smears must be properly and legibly labelled with the patient's name. This must be written with HB pencil.

2.     These glass slides must be dropped immediately in Kopplin jars containing alcohol. This is the appropriate transport medium. This is to prevent drying up of the smears.

3.       The request forms must also be properly labelled with all the detailed clinical history supplied.

4.     Aspirates are usually sent in universal bottles. They must be properly labelled and accompanied with properly labelled request forms. Time of collection must be stated.

5.    Aspirate must be sent to the laboratory within 2 hours of collection to prevent degeneration of the cells.

Note: Steps 1 — 5 above must be checked by the receptionist and the laboratory technician. Time of reception of aspirate in the laboratory must be written on the form.

Payment must also be confirmed before the specimens are received.

 

6.     Specimens must be duly registered and assigned laboratory numbers immediately they are received - receptionist and the laboratory technician.

7.    Aspirate must be centrifuged and smeared immediately or within 30 minutes of reception. The smears will then be allowed to fix in alcohol for 24 hrs after which they will be stained and mounted without delay

8.       Pap smear slides received in alcohol will be allowed to fix for 24 hours and will be stained and mounted the next day.

          Steps 8 and 9 above will be carried out by the histo-scientist.

9.       The stained slides will be sent to the histopathologist as soon and they are dry. They will be assessed microscopically/histologically and reported within 48 hours.

10.   Reports will be dispatched by the laboratory technician or the receptionist to the patients or requesting clinicians as soon as the histopathologist issues them.

11.    Where the electronic medical record is functional, the histopathologist will upload the reports immediately.

 

FINE NEEDLE ASPIRATION CYTOLOGY (FNAC)

1.    FNAC procedure will be carried out Mon to Friday between the hours of 10am     and 1pm (except in cases of emergency) in the allocated room within the laboratory complex.

2.   Patients are to come with properly filled request forms and copies of relevant ancillaryradiological and laboratory investigations that has been done.

Note:  Steps 2 above must be checked by the laboratory technician before the attention of the histopathologist is called.

 3.   The histopathologist will determine the suitability of the patient for FNAC and determine that the relevant ancillary investigations have been done and copies of the report/results seen before the patient can be registered.

4.      Payment will be made; patient will be registered and assigned a laboratory number before the procedure is carried out.

5.    The FNAC procedure will be performed by the histopathologist assisted by the laboratory technician and/or the histo-scientist.

6.       The smeared slides with be fixed in alcohol (except for diff quick) for a minimum of 1 2 hours before staining and mounting by the histo-scientist.

7.    The dried stained slides will be sent to the histopathologist and the case will be assessed microscopically/histologically and reported within 48 hours.

8.    Reports will be dispatched by the laboratory technician or the receptionist to the patients or requesting clinicians as soon as the histopathologist issues them.

9.      Where the electronic medical record is functional, the histopathologist will upload the reports immediately.

 

4. MEDICAL MICROBIOLOGY AND PARASITOLOGY

This department is responsible for all microbiological and parasitological analysis.

The TAT for this department is between 30 minutes to 1 week.

 

Equipment:

 Render MAI 20:

This machine is for bacterial identification and antibiotic susceptibility testing with up to 96 antibiotic discs.

 

 Cells check:

This is an automated malaria parasite detecting machine with the ability to speciate, and quantify parasite density and can handle up to 25 tests in less than 50 minutes.

 FUS-1000:

 

This is an automated machine for urinalysis and microscopy. It can run up to 50 tests in less than an hour. It also shows a panoramic view of the inclusion bodies present in the urine.

  Render BC32;

 

This an automated blood culture machine with a reduced incubation period and can accommodate 32 samples at a go. It has an in-built alarm system that detects positive samples.

 

Standard Operational Procedure

•        Check physical power connections

•        Power on

•        Prepare for analysis

•        Start sample analysis

•        Shutdown

 

LABORATORY STORE

The function is stock management of Laboratory reagents, consumables and equipment. The reagents are sourced from the company that placed the equipment, while consumables are supplied from the hospital store.

Equipment

 •       Two big, customized refrigerators for storage of reagents

 •       Medium size deep freezer

 •       Cabinets and shelves

Standard Operational Procedure

I.       The reagents are arranged in labelled compartments according to their uses.

ii.       Shelves are provided for storage of consumables; these are labelled accordingly.

iii.      The system of arrangement is 'first in, first out' (FIFO).

iv.      Registers and bin cards are maintained to ensure proper documentation. But this will give way to electronic documentation in the near future.

v.       Record of Lot number, date of manufacturing, date of expiry, and 'date opened' are kept for each batch of reagents.

vi.      Expired reagents/consumables are properly documented and kept separately, while awaiting boarding by the environmental department.