Working with the laboratory : Working with the laboratory IDSP training module for state and district surveillance officers
Module 6 www.medicos11.com
Learning objectives (1/3) : Learning objectives (1/3) List
L1 and L2 laboratories in the district
L3 laboratories in the state
L4 and L5 laboratories in the country
Understand the need of L1 and L2 laboratories to arrange for logistical support
Identify what action is to be taken be the technician for sample collection in response to the diagnosis made by the medical officer
Learning objectives (2/3) : Learning objectives (2/3) List tests to be performed in L1 and L2 laboratories
Identify quality assurance processes within the laboratory network
Understand bio-safety issues
Identify transport modalities of samples to higher levels
Learning objectives (3/3) : Learning objectives (3/3) Understand training needs of laboratory personnel
Keep track of the flow of samples
Draw a flow diagram for reporting of the laboratory investigations
Role of laboratories in disease surveillance : Role of laboratories in disease surveillance Early diagnosis of diseases under surveillance
Epidemiological investigation
Rapid laboratory confirmation of diagnosis
Implementation of effective control measures
Factors influencing laboratory confirmation in surveillance : Factors influencing laboratory confirmation in surveillance Advance planning
Collection of appropriate and adequate specimens
Correct packaging
Rapid transport
Ability of laboratory to accurately perform tests
Bio-safety and decontamination procedure
Types of case definitions in use : Types of case definitions in use More specificity
Laboratory network for the Integrated Disease Surveillance Project : Laboratory network for the Integrated Disease Surveillance Project
Risk groups, biosafety levels, practices and equipment : Risk groups, biosafety levels, practices and equipment
Method of laboratory surveillance : Method of laboratory surveillance Routine passive surveillance
Selected diseases
Outbreak situations
Conditions under regular surveillance : Conditions under regular surveillance
Other conditions under surveillance : Other conditions under surveillance
Diagnosis of malaria : Diagnosis of malaria Laboratory criteria for diagnosis
Detection and identification malaria parasite microscopically
Sample collection for microscopy
Thick and thin blood smear
Time of collection
During fever or 2-3 hours after peak of temperature
Before patient receives anti-malarial
Laboratory tasks at each level for the diagnosis of malaria : Laboratory tasks at each level for the diagnosis of malaria
Diagnosis of cholera : Diagnosis of cholera Laboratory criteria for diagnosis
Isolation of Vibrio cholera O1 or O139 from stools in any patient with diarrhea
Sample collection
Transfer a portion of specimen to a cotton wool swab
Insert it in alkaline-buffered salt solution
If stool specimen could not be collected take a rectal swab and insert it in the above solution
Laboratory tasks at each level for the diagnosis of cholera : Laboratory tasks at each level for the diagnosis of cholera
Diagnosis of typhoid : Diagnosis of typhoid Laboratory criteria for diagnosis
Serology – Widal or Typhi-dot test positive
Isolation of S.typhi from blood, stool or other clinical specimen
Sample collection
Blood / stool
Laboratory tasks at each level for the diagnosis of typhoid : Laboratory tasks at each level for the diagnosis of typhoid
Tuberculosis : Tuberculosis Laboratory criteria for diagnosis
Demonstration of alcohol-acid fast bacilli in at least two of the three sputum smears or culture positive for Mycobacterium tuberculosis
Sample collection for microscopy
Three specimens
One spot specimen
One early morning specimen (preferably the next day)
One spot specimen when the early morning specimen is being submitted for examination.
Laboratory tasks at each level for the diagnosis of tuberculosis : Laboratory tasks at each level for the diagnosis of tuberculosis
Measles : Measles Laboratory criteria for diagnosis
Presence of measles virus specific IgM antibodies
At least four fold increase in antibody titre in paired samples
Isolation of measles virus
Sample collection
Serology
An acute phase serum specimen (3-5ml of whole blood) be soon after onset of clinical symptoms but not later than 7 days
Virus isolation
Urine collected within 5 days of rash onset (1-3days best).
Do not freeze
Laboratory tasks at each level for the diagnosis of measles : Laboratory tasks at each level for the diagnosis of measles
Polio : Polio Laboratory criteria for diagnosis
Isolation of wild polio virus from stool
Laboratory tasks at each level for the diagnosis of polio : Laboratory tasks at each level for the diagnosis of polio
Laboratory criteria for dengue : One or more of the above Laboratory criteria for dengue Isolation of Dengue virus from serum, plasma, leucocytes or autopsy samples
Demonstration of Dengue virus specific IgM antibodies or four fold or more rise in reciprocal IgG antibody titre
Demonstration of dengue antigen in autopsy tissue by Immunochemistry or immunoflourescence or in serum samples by EIA
Detection of viral genomic sequences in autopsy tissue, serum or CSF by PCR
Sample collection for the laboratory diagnosis of Dengue : Sample collection for the laboratory diagnosis of Dengue
Laboratory tasks at each level for the diagnosis of Dengue : Laboratory tasks at each level for the diagnosis of Dengue
Laboratory criteria for the diagnosis of Japanese encephalitis : Laboratory criteria for the diagnosis of Japanese encephalitis Demonstration of Japanese encephalitis virus specific IgM antibodies
Detection/isolation of antigen/virus
Demonstration of viral antigen in the autopsied brain tissue by the fluorescent antibody test
Sample collection for the laboratory diagnosis of Japanese encephalitis : Sample collection for the laboratory diagnosis of Japanese encephalitis
Laboratory tasks at each level for the diagnosis of Japanese encephalitis : Laboratory tasks at each level for the diagnosis of Japanese encephalitis
Laboratory criteria for the diagnosis of plague : Laboratory criteria for the diagnosis of plague Gram staining on smear taken from bubo, blood or lung aspirate
Detection of Y. pestis F1* antigen by direct fluorescent antibody testing or by other standardized antigen detection method
Isolation from a clinical specimen
A significant (equal or more than 4-fold) change in antibody titre to the F1 antigen in paired serum specimens * Fraction 1. Glycoprotein from the capsule. Elisa technique
Laboratory tasks at each level for the diagnosis of plague : Laboratory tasks at each level for the diagnosis of plague
Leptospirosis : Leptospirosis Laboratory criteria for diagnosis
Isolation from blood or other clinical materials by culture
Positive serology, preferably Microscopic Agglutination Test (MAT) using a panel of Leptospira strains
Sample collection
Blood
During first week of illness collect, second sample to be collected after about a week
Urine
Urine should be collected after second week of illness and transported immediately in sterile container
Laboratory tasks at each level for the diagnosis of leptospirosis : Laboratory tasks at each level for the diagnosis of leptospirosis
Laboratory tests for water samples : Laboratory tests for water samples Most Probable Number (MPN) method for coliform bacteria
H2S strip method for fecal contamination assessment
Laboratory tasks at each level for the assessment of water quality : Laboratory tasks at each level for the assessment of water quality
Functions of L1 laboratory technicians : Functions of L1 laboratory technicians Collection of samples for investigations
Perform the laboratory tests assigned to L1 labs
Microscopy for malaria
Microscopy for tuberculosis
Typhi-dot test for typhoid fever
H2S test for water quality
Transport relevant sample to L2 laboratories for culture and serological investigations
Assist Rapid Response Teams in sample collection
Participate in External Quality Assurance conducted by L2 laboratories
Functions of L2 laboratory technicians : Functions of L2 laboratory technicians Perform all tests performed by L1 laboratories
External Quality Assurance for L1 laboratories
Perform the tests assigned to L2 laboratories
Culture and sensitivity for cholera
Serological test for typhoid, Dengue, Leptospirosis
MPN test for water quality
Transport relevant samples to L3 laboratories
Transport 5% of tested samples to L3 for testing and quality assurance
Reporting test results to L1 laboratories for samples received from L1 laboratories
Reporting tests result weekly to district
Quality assurance : Quality assurance Internal quality control (Continuous, concurrent control of laboratory work) External quality assessment(Retrospective and periodic assessment) Quality assurance = +
Internal quality control : Internal quality control Test request and specimen collection
Test processing
Temperature
Reagent
Maintenance of equipment
Reporting and using test results
External quality assessment : External quality assessment Within the state IDSP system
L1 by L2
L2 by L3
Through external agency
External quality assurance scheme for selected tests
Action to be taken by the multi-purpose worker in the field : Action to be taken by the multi-purpose worker in the field
Laboratory investigations by the PHC/CHC medical officer /laboratory technician for Dengue : Laboratory investigations by the PHC/CHC medical officer /laboratory technician for Dengue
Laboratory investigations by the district and state laboratories for Dengue : Laboratory investigations by the district and state laboratories for Dengue
Laboratory investigations by the PHC/CHC medical officer /laboratory technician for Japanese encephalitis /fever with altered consciousness : Laboratory investigations by the PHC/CHC medical officer /laboratory technician for Japanese encephalitis /fever with altered consciousness
Laboratory investigations by the district and state laboratories for Japanese encephalitis : Laboratory investigations by the district and state laboratories for Japanese encephalitis
Laboratory investigations by the PHC/CHC medical officer /laboratory technician for malaria or fever : Laboratory investigations by the PHC/CHC medical officer /laboratory technician for malaria or fever
Laboratory investigations by the district and state laboratories for malaria : Laboratory investigations by the district and state laboratories for malaria
Laboratory investigations by the PHC/CHC medical officer /laboratory technician for cholera /loose watery diarrhea : Laboratory investigations by the PHC/CHC medical officer /laboratory technician for cholera /loose watery diarrhea
Laboratory investigations by the district and state laboratories for cholera : Laboratory investigations by the district and state laboratories for cholera
Laboratory investigations by the PHC/CHC medical officer /laboratory technician for typhoid /fever > 7 days : Laboratory investigations by the PHC/CHC medical officer /laboratory technician for typhoid /fever > 7 days
Laboratory investigations by the district and state laboratories for typhoid : Laboratory investigations by the district and state laboratories for typhoid
Laboratory investigations by the PHC/CHC medical officer /laboratory technician for hepatitis/ acute jaundice : Laboratory investigations by the PHC/CHC medical officer /laboratory technician for hepatitis/ acute jaundice
Laboratory investigations by the district and state laboratories for hepatitis : Laboratory investigations by the district and state laboratories for hepatitis
Laboratory investigations by the PHC/CHC medical officer /laboratory technician for measles / fever with rash : Laboratory investigations by the PHC/CHC medical officer /laboratory technician for measles / fever with rash
Laboratory investigations by the district and state laboratories for measles : Laboratory investigations by the district and state laboratories for measles
Laboratory investigations by the PHC/CHC medical officer /laboratory technician for tuberculosis /cough > 3 weeks : Laboratory investigations by the PHC/CHC medical officer /laboratory technician for tuberculosis /cough > 3 weeks
Laboratory investigations by the district and state laboratories for tuberculosis : Laboratory investigations by the district and state laboratories for tuberculosis
Laboratory investigations by the PHC/CHC medical officer /laboratory technician for acute flaccid paralysis : Laboratory investigations by the PHC/CHC medical officer /laboratory technician for acute flaccid paralysis
Laboratory investigations by the district and state laboratories for acute flaccid paralysis : Laboratory investigations by the district and state laboratories for acute flaccid paralysis
Laboratory investigations by the district and state laboratories for HIV/HBV : Laboratory investigations by the district and state laboratories for HIV/HBV
Laboratory investigations by the PHC/CHC medical officer /laboratory technician for plague : Laboratory investigations by the PHC/CHC medical officer /laboratory technician for plague
Laboratory investigations by the district and state laboratories for plague : Laboratory investigations by the district and state laboratories for plague
Laboratory investigations by the PHC/CHC medical officer /laboratory technician for leptospirosis : Laboratory investigations by the PHC/CHC medical officer /laboratory technician for leptospirosis
Laboratory investigations by the district and state laboratories for leptospirosis : Laboratory investigations by the district and state laboratories for leptospirosis
Laboratory investigations by the health workers and medical officer of the PHC for non communicable diseases : Laboratory investigations by the health workers and medical officer of the PHC for non communicable diseases
Laboratory data management : Laboratory data management Recoding
Details of specimens received
Tracking of samples
Results of tests performed
Analysis and interpretation of tests
Timely and accurate communication of results
Information to be recorded on each specimen/ accompanied with each specimen : Information to be recorded on each specimen/ accompanied with each specimen Name, age, sex
Address in detail
Reporting unit referring the sample
Syndromic diagnosis
Date of onset of illness
Nature of sample, date of collection, date of receipt and condition of sample
Investigation requested
Whether convalescent specimen or not
Sample laboratory register : Sample laboratory register
The L form : The L form Weekly reports from laboratories to the district surveillance officer
Prepared on the basis of the laboratory register
Filled by nodal person in the laboratory
Sent every Saturday of each week
Zero/NIL reporting
Electronic link between
District public health laboratory
District surveillance unit
Points to remember (1/2) : Points to remember (1/2) Categorization of labs - List of L1 and L2 labs in the districts & List of Disease wise L3 labs in the state
List of tests that can be done at L1 and L2 labs
List of diseases that can be confirmed only by L3 labs
Points to remember (2/2) : Points to remember (2/2) Sourcing the consumables required by the labs
Samples that have to be collected for specific disease
Bio Safety and waste management
Quality assurance