SIWES REPORT AT A HOSPITAL, Cheat Sheet of Medical Biochemistry

Download SIWES REPORT AT A HOSPITAL and more Cheat Sheet Medical Biochemistry in PDF only on Docsity! A TECHNICAL REPORT ON STUDENT INDUSTRIAL WORK EXPERIENCE SCHEME (SIWES) UNDERTAKEN AT PREMIER CLINIC, KANO FROM 22 MARCH - 3 SEPTEMBER 2021.ND RD WRITTEN BY MIFTAHU UMAR ABDUL'AZIZ (LSC/17/MCB/00146) COURSE CODE: MCB 3699 SUPERVISED BY MRS. MARYAM IDRIS MUSA SUBMITTED TO THE DEPARTMENT OF MICROBIOLOGY, BAYERO UNIVERSITY,KANO COLLEGE OF NATURAL AND PHARMACEUTICAL SCIENCE FACULTY OF LIFE SCIENCE IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF DEGREE IN BACHELOR OF SCIENCE MICROBIOLOGY. DATE: SEPTEMBER 2021 DECLARATION I Miftahu Umar Abdul'aziz, declare that this technical report was written by me. It comprises of the summary of all the work done during my period of attachment in Premier Clinic, Kano. I therefore submit the report work as partial fulfillment of the requirements for the Student Industrial Work Experience Scheme of the Bayero University, Kano. ---------------------------- ---------------------------- NAME: DATE: DEDICATION This report is dedicated to the almighty God, the giver and sustainer of life, for His unconditional love and mercy granted to me throughout the period of my Industrial Training. ii ABSTRACT The Student Industrial Work Experience Scheme established by the Federal Government of Nigeria was aimed at exposing student of higher institution to acquire industrial skill and practical experience in their approved course of study and also to prepare students for the industrial work situation which they are likely to meet after graduation. This technical report is based on the experiences gained during my six(6) months of Industrial Training at Premier Clinic, Kano State. This report highlights how patients are being managed and also the several tests carried out for patients. I was opportuned to work in five (5) units which are Reception, a unit that deals with specimens collection, and results are being issued or dispatched in this unit, Hematology unit were I learned different tests such as Full Blood Count (FBC), Packed Cell Volume(PCV), Widal (Typhoid test), Genotype, ESR etc , and different tests such as RVS, HCG, HBsAg, HVS, H. pylori, VDRL, etc. I was also learned different tests in which includes Stool MCS, UrineMicrobiology unit MCS, HVS, ECS, WS, Urinalysis, MP, etc and in I learnedChemical Pathology unit tests such as RBS, FBS, OGTT, 2HPP, etc and were the blood isPhlebotomy unit being collected. These sections have exposed me to the precautions, rules and regulations of the laboratory, how to diagnose patients and how the tests are being analysed. Most importantly, it describes the activities and my experience gained during the period of the training, it also stated the problems encountered and also gave suggestion for improvement of the scheme. SOME USED ABBREVIATIONS IN THIS REPORT MCS: Microscopy culture and sensitivity HVS: High vaginal swab ECS: Endo cervical swab HVS: High virginal swab WS: Wound swab EDTA: Ethylene diamine tetraacetic acid SFA: Seminal fluid analysis RVS: Retroviral screening H. Pylori: Helicopter pylori NA: Nutrient agar MP: Malaria Parasites OGTT: Oral glucose tolerance test 2HPP: 2 hours post prandial PCV: Packed cell volume FBC: Full blood count RVS: Retroviral screening HBsAg: Hepatitis B surface antigen HCV: Hepatitis C VDRL: Veneral diseases research laboratory HCG: Human Chorionic Gonadotrophin to perform jobs or functions. 1.2 OBJECTIVES OF SIWES The Industrial Training Fund’s policy Document No. 1 of 1973 which established SIWES outlined the objectives of the scheme. The objectives are to: ü Provide an avenue for students in higher institutions of higher learning to acquire industrial skills and experiences during their courses of study. ü Prepare students for industrial work situations that they are likely to meet after graduation. ü Expose students to work methods and techniques in handling equipment and machinery that may not be available in their institutions. ü Make the transition from school to the world of work easier and enhance students’ contact for later job placements. ü Provide students with the opportunities to apply their educational knowledge in real work situations, thereby bridging the gap between theory and practice. ü Enlist and strengthen employers’ involvement in the entire educational process through SIWES 1.3 IMPORTANCE OF SIWES ü It provides students with an opportunity to apply their theoretical knowledge in real life situations. ü It exposes students to more practical work methods and techniques. ü It strengthens links between the employers, universities and industrial training fund (ITF) ü It also prepares the students for the labour market after graduation. 1.4 ROLES OF BODIES INVOLVED IN THE MANAGEMENT OF SIWES PROGRAMME The Federal Government, the Industrial Training Fund (ITF), the Supervising Agencies – National Universities Commission (NUC), the National Board for Technical Education (NBTE), National Commission for Colleges of Education (NCCE), Employers of Labour and Institutions have specific roles assigned to them in the management of the SIWES Programme. The roles are as follows: - Federal Government Ø To provide adequate funds to the Industrial Training Fund through the Federal Ministry of Industries for the Scheme. Ø To make it mandatory for all Ministries, companies and Parastatals to offer places for the attachment of students in accordance with the provisions of Decree No. 47 of 1971 as amended in 1990. The Industrial Training Fund (ITF) The Fund is to: Ø Formulate policies and guidelines on SIWES for distribution to all the SIWES participating bodies, institutions and companies involved in the scheme. Ø Regularly organize orientation programmes for students prior to their attachment, Ø Receive and process Master and Placement Lists from the Institution and Supervising Agencies, i.e. (NUC, NBTE, NCCE); Ø Disburse Supervisory and Students allowances Ø Organize biennial SIWES National Conference and Annual SIWES Review Meeting; Ø Provide insurance cover for students on attachment; Ø Provide logistics and materials necessary for effective administration of the scheme, such documents as – ITF Form 8, ITF Form 8A the SPE 1and SIP A forms. Ø Ensure the visitation (tours) of ITF officers to the Supervising Agencies, Institutions, Employers and students on attachment. Ø Vet and process students’ logbooks and ITF form 8. The supervising agencies (NUC, NBTE AND NCCE) These Agencies are to: Ø Ensure the establishment and accreditation of SIWES Units in institutions under their jurisdiction; Ø Direct for the appointment of full-time SIWES coordinators Ø Ensure adequate funding of the SIWES units in all the institutions. Ø Vet and approve master and placement lists of students from participating institutions and forward same to the ITF; Ø Develop, monitor and review job-specifications in collaboration with the institutions towards the maintenance of National minimum Academic Standard for all the programmes approved for SIWES Ø Liaise with ITF and participate in the biennial SIWES National Conference and other relevant SIWES seminars, conferences and workshops. Ø Continuously monitor and review the job specifications of all the courses Ø Research into the development of SIWES in line with advances in technological development; Ø Regularly review courses qualified for SIWES in collaboration with other bodies; Ø Liaise with the ITF, to ensure the implementation of all Federal Government policies on the scheme. it is first located at Gadon Kaya in Kano metropolitan. The clinic started with 3 beds, 1 theater and 3 consultants, later, it was relocated to no. 8th Avenue off Court road Gyadi-Gyadi, Kano, as Premier Clinic. The clinic now has 25 beds, 7 full time Doctors, 30 Nurses, and a functional laboratory with 8 staffs, 12 Pharmacists, 1 Dentist, 3 Radiologists. There were also 2 theater rooms, 2 delivery rooms, emergency room, and 6 consulting rooms. 1.4.1 PREMIER CLINIC DEPARTMENTS AND THEIR FUNCTION Premier Clinic provides the following services to people: ü Dental Known evaluation, diagnoses, prevention and treatment of diseases, disorders and conditions of the soft and hard tissues of the jaw (mandible). The oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body ü ENT (Ear, Nose, and Throat) The branch of medicine that specializes in diagnosis and treatment or ear, nose, throat and head and neck disorders. ü Laboratory This is where tests are done on clinical specimens in order to get information about the health of a patient as pertaining to the diagnosis, treatment and prevention of disease. ü Obstetrics and gynecology ü The entire scope of clinical pathology involving female reproductive organs and provision of care for both pregnant and non pregnant patients ü Ophthalmology This branch of medicine deals with the diseases and surgery of the visual pathways including the eyes, hair, and areas surrounding the eyes, such as lachrymal system and eyelids ü Paediatrics The branch of medicine that deals with the medical care of infants, children, and adolescents ü Pharmacy Charged with ensuring the safe and effective use of pharmaceutical drugs, the scope of pharmacy practice includes more traditional roles such as compounding and dispensing medications and it also includes more modern services related to health care including clinical services reviewing medications for safety and efficacy and providing drug information. ü Radiology The branch or specialty of medicine that deals with the study and application of imaging technology like X-ray and radiation to diagnosing and treating disease ü Surgery A medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury to help improve bodily function or appearance or sometimes for some other reason. CHAPTER TWO 2.0 THE LABORATORY 2.1 INTRODUCTION TO THE LABORATORY A laboratory is a facility that provides controlled conditions in which scientific researches, experiments, and measurements, may be performed. Hence the medical laboratory is a laboratory where tests are carried out on clinical specimens in other to get information about a patient’s health. There are three sections in the laboratory, they are; Clinical Microbiology section, Hematology/Serology section, and Clinical Biochemistry section. The overall significance of the laboratory diagnosis is that they guide towards the administration most effective therapy so as to restore a proper health on the patient. Laboratory safety precautions and ethics. 2.2 SAFETY RULES IN THE LABORATORY Every laboratory is expected to adopt a code of bio-safety principles and work practice which should be enforced and adhere to strictly by workers and visitors. All specimens coming into and from the laboratory are being assumed to be potentially infectious and harmful and that is why the below precautions are ensured to be taken to avoid contamination and laboratory hazard. · Avoid disrupting laboratory activities you must TURN OFF all cell phones and pagers: their use is prohibited. · All persons in laboratories, including students, staff, and visitors, shall wear safety glasses, goggles, or face shields at all times where potential eye hazards exist · Eating, drinking, chewing gum, and applying cosmetics are prohibited laboratory. · Do not store food or beverages in the same refrigerators or freezers with chemicals, biohazards, or radioactive materials. · Never conduct unauthorized experiments or engage in horseplay in a laboratory. Please immediately report any unsafe behaviour to the instructor. · Wear appropriate clothing. In particular, you must wear closed-toed shoes (i.e., NO sandals or flip-flops!) in the laboratory. If you have a long hair, tie it back. Avoid wearing dangling jewellery. · Wearing an iPod, Bluetooth, or any other device that interferes with hearing is not allowed. · Never pipette anything by mouth. · The work area must be kept clean and uncluttered. All chemicals should be labelled and stored properly. · The hazards of chemicals used should be known (e.g., corrosiveness, flammability, reactivity, stability, and toxicity). · Always pay attention to your surroundings and be aware of what others are doing. Always be courteous. · Remove contaminated gloves before touching common use devices (door knobs, faucets, equipment); discard gloves before leaving the laboratory. · Micro haematocrit reader: used to read the packed cell volume in percentage. · Tourniquet: it is tightened on patient hand in the collection of blood sample in order to get a prominent vein before incision. · Needle and Syringe: It is used for the collection of blood samples. · Macro centrifuge machine: It is used for the separation of blood samples in order to get the plasma and also used for the separation of urine sample so as to get the supernatant and the specimen · Glucometer: used to check for the sugar level in the body with the aid of its strip. · Hematology analyzer: Is used for the analysis of Full Blood Count (FBC). CHAPTER THREE 3.0 THE LABORATORY SECTIONS AND VARIOUS TESTS PERFORMED 3.1 SECTIONS IN THE PREMIER CLINIC LABORATORY The laboratory department of Premier Clinic consists of the following sections, these sections are known as benches: 1. Reception 2. Phlebotomy unit 3. Hematology/Serology unit 4. Chemistry unit 5. Microbiology/Parasitology unit These division of the laboratory into different sections or work benches makes it easier for laboratory workers to process specimens properly and avoid contamination, it also helps a great deal towards ensuring patients satisfaction by getting results ready as soon as possible and helps to minimize cases of missing results. 3.2 RECEPTION UNIT The reception is a section of the laboratory where specimens are being collected, and results are issued or dispatched. This is the point where the patient gets his/her first contact with the laboratory. The scientist in charge of the reception needs to be extra careful and practice good laboratory conduct. The receptionist also needs to have a good human relation and dedication. All specimens brought to the laboratory are collected at the reception from 8:30am – 9:00pm. Before a specimen is collected, there must be an evidence of payment presented in form of receipt, one is attached to the request form and the duplicate copy is given to the patient. The specimen is checked to make sure it corresponds to the one requested and it is sufficient enough to carry out the investigation, the patient is then told when to come back for the results. The specimen is then labelled appropriately with the patients name, age, sex, and ward. This is done to avoid mixing up of specimens. After collection at the reception, the specimen is taken to the appropriate bench for investigation. At the end of specimen processing, results from each bench is taken to the reception. Below is a summary of what is being done at the reception: ü Samples are checked for consistency and evidence of payment ü Samples are labelled appropriately with patient’s details and input into the daily utilization register 7. 70% Alcohol swabs: Used as a disinfectant for the area in which incision is to be made. 8. Micropore tape: To aid hemeostatis 9. Dental rolls 10. Adhesive dressing 11. Racks 12. Disposable waste bins 13. Cotton wool Pillow or other support: Used for supporting the arm for easy blood flow 3.1.3 phlebotomy diagrams 3.1.4 Standard Operation Procedure (S.O.P) for blood collection · The frequent point of blood collection is usually from the vein (venipuncture). The materials for the patient’s identity must be checked before attempting venepuncture. This must be carried out by asking the patient their Full Name and Date of Birth. · Check that this information corresponds with that on the Request form. · Any amendment to these details or any others on the Request form must be in accordance with the Directorate Policy. · Where patient details lack legibility, staff may write the correct details clearly next to those on the form without crossing out the original details. · If tests are requested that are unfamiliar and staff are unsure of the appropriate blood tubes for specimens check the list ‘What tube guide’ available at each workstation or, when necessary contact a qualified Biomedical Scientist in the appropriate department within the Pathology Laboratory. · Examine both arms of the patient and select the one that appears appropriate · Ensure that the patient is comfortable and that the arm is well supported and examine potential venipuncture. ü Ask the patient to bare an arm, ensure that the arm is well supported and apply the tourniquet to the patient’s arm, just above the elbow and tight enough to allow two fingers behind the strap. ü Tighten the tourniquet a little more, taking care not to pinch the skin ü Ask the patient to straighten their arm and clench their fist. This will make the vein more prominent. ü If necessary rub the bend of the elbow to make the vein more visible. ü Feel with a fingertip for the ‘best’ vein at the bend of the elbow rather than plunge the needle into a poor vein that looks ‘alright’. ü If this fails a suitable vein can often be found at the side of the arm on the elbow side. ü It may be necessary, on occasion to take blood from the back of hand. · Apply the tourniquet above the elbow. The tourniquet is closed around the arm by inserting the plastic clip into the holder and then tightened appropriately by pulling the strap. · Ask the patient to straighten their arm and to make a fist in order to make the veins more prominent. · Feel with the fingertip if necessary to locate a suitable vein to puncture. · Ensure that equipment and blood tubes required are immediately within easy reach. · Remove the top plastic section of a Vacutainer multi-sample needle and screw thread into a Vacutainer needle holder. · Disinfect site with a 70% Isopropyl alcohol swab. · Leave for 30 seconds for the alcohol to evaporate and during this period assemble the blood tubes required. · Remove the cover from the multi-sample needle and discard into a clinical waste bin. · Keeping the needle holder and attached multi-sample needle in one hand use the thumb on the other hand to press on the vein just above the chosen entry point and pull the skin back slightly towards you to hold the vein firmly and stretch the skin over the chosen site. · With the needle holder and multi-sample needle almost parallel to the patient’s arm and the needle bevel uppermost, gently push the needle into the chosen venipuncture site. · Once in the vein hold the needle-holder steady and gently push the cap of the appropriate blood sample tube onto the covered sample needle at the base of the inside of the needle-holder. · Blood should enter the sample tube and fill to the appropriate level indicated. · Remove the sample tube from the sample needle when full and attach another sample tube in required. · Blood samples must be gently mixed at the earliest opportunity to ensure anticoagulation effectiveness · As the last blood sample tube is filling slacken the tourniquet by pressing down on the release clip that is on the side away from the arm. · Withdraw the needle from the vein and quickly apply a clean pad of cotton wool. · Ask the patient to keep pressure on the cotton wool to stop further bleeding. · Discard the needle and holder into a Sharps bin. · Gently mix the sample tube(s). · If the patient is unable to maintain sufficient pressure on the vene-puncture site apply this pressure for them. · Remove the tourniquet from the patient’s arm. · When bleeding from the venipuncture site has stopped apply Micropore tape tightly over the cotton wool. · The procedure is now complete and the patient can leave. 3.2.4 ERYTHROCYTE SEDIMENTATION RATE (ESR) · Introduction: Erythrocyte Sedimentation rate test is used to detect inflammation infections, cancer, and autoimmune diseases; it is also use to monitor whether an illness is responding to treatment. It is a screening test so cannot be used to diagnose a specific disorder · Aim: To determine the rate of inflammation of blood using Westergren method. · Equipment/Apparatus: Sodium Citrate bottle, ESR rack, Westergren glass rod. · Procedue: Blood sample was collected into an EDTA bottle and inverted 8 times to enable the action of the additive and then poured into the Westergren tube containing sodium citrate and was mixed gently again by inverting the tube 8 time. The Westergren glass rod was forced into the tube and blood rises to zero mark. The sample was placed in a vertical stand on the ESR rack and timed for one-hour. The result was recorded just after one-hour in millimeters · Conclusion: The ESR test does not diagnose a particular kind of infection but rather tell if further medication should be given. It is usually done to indicate if there are abnormal proteins in the body 3.2.5 BLOOD GROUPING AND GENOTYPING TEST · Introduction: Blood grouping of the A B O system is determined with Anti-A, Anti-B, and Anti-D sera, which form agglutination complex with antibodies found in the blood sample. · Aim: To determine the group and the rhesus of a patient’s blood · Equipments/Materials: Clean free grease tile, Pasteur pipette, Whole blood sample in an EDTA bottle, distilled water, applicator stick, test tube rack, electrophoresis machine and tank, clean white tile, cotton wool, applicator stick, cellulose filter paper, gloves. · Reagents: Anti-A, Anti-B, Anti-D sera, Buffer for balancing, normal saline. · Procedure: For blood Grouping: The blood sample was collected into an EDTA bottle through venipuncture. 10ul of blood was placed 3 spots on the tile with the aid of Pasteur pipette. The antisera A, B and D were placed carefully on each spots, ABO of the grouping system on the tile respectively and an applicator stick was used to thoroughly mix the drop of blood with the anti-sera one after the other without contamination. The tile was gently rocked from side to side for 3 minutes to allow agglutination occurrence, then result was observed. For Genotyping: Cells were washed two to three times in a test tube containing normal saline after which, a drop of washed cells were placed on a tile. This is followed by the hemolysis of blood on the tile and the placement of AS and AA control using applicator stick, after making sure that the buffer inside the electrophoresis tank covered the electrode, the cellulose paper was placed on the tank, which is then covered and mains (current) switched on. Reading was recorded after 5-10mins · Result: The result for blood genotype was taken by studying the movement and separation of hemoglobin molecule. · Conclusion: The result was observed according to the agglutination that occurred in each spots on the tile. Anti D determines the present of the rhesus ‘D’ factor in blood group. Factors that affect blood grouping are; wrong labeling of spot and confusion of anti-sera with spots, Contamination of test card or tiles with detergents, Expired anti-sera Blood grouping Anti-A sera, Anti-B Sera and Anti-D sera 3.3 SEROLOGY SECTION Tests done in this department are designed to detect the body's response to the presence of bacterial, viral, fungal, parasitic and other conditions which stimulate detectable antigen-antibody reactions in a test system to aid in the diagnosis of the patient. Most tests performed in this section are carried out under the principles of Immunoassay, some of them are; Cold agglutinins (CAG) - specimen be keptmust warm, Rheumatoid arthritis (RA), VDRL, to diagnose syphilis, Pregnancy Testing, Widal 3.3.1 HBs.Ag TEST FOR HEPATITIS, VDRL (VENERAL DISEASES RESEARCH LABORATORY) TEST FOR SYPHILIS USING STRIPS · Introduction: HBsAG is a rapid immunochromatographic test for the qualitative detection of Hepatitis B surface Antigen in human serum/plasma, it can be used for prenatal or transfusion screening, and during acute infection or chronic carriage of the Hepatitis B virus. Early detection of infection is essential for rapid initiation of adequate treatment. VDRL test is a screening test for syphilis. It measures substances called antibodies that body may produce if it comes in contact with the causative agent of syphilis, which is calledTreponema pallidium · Aim: To determine the presence or absence of hepatitis and syphilis in the body system. · Materials: HBsAG Test strips, VDRL test strip EDTA bottle, Centrifuge, clean test tube · Specimen: Serum. · Procedure: The patient blood sample was collected into a plain bottle through venipuncture. The blood sample was spun in a centrifuge for 5 minutes, after spinning the serum was separated carefully into a clean test tube by the use of Pasteur pipette and then test strip was immersed vertically into the serum for 10 minutes. The observation was taken after 10mins. · Aim: To investigate the presence of HIV 1 and 2 in patient’s blood · Materials: Determine kits, Plain bottle, pipette · Specimen used: Serum · Procedures: The blood sample, collected in a plain bottle was centrifuged at 3000rev/min to allow separation. The serum was picked with a pipette and two drops was placed on the RVS test strip determine kit and allowed to penetrate then left for 5min. · Result: The appearance of a line at the Control region and another at the Test region indicates a Positive result, while the appearance of a line on the Control region only, and indicates a Negative result. 3.4 CHEMISTRY SECTION This section deals with chemical analysis of serum or plasma in which many diseases of the major organs systems can be diagnosed such as heart attacks, hepatitis, renal failure, diabetes, Liver function, etc Blood sample samples may collected into the Serum Separator Tube or Lithium Heparin. Test performed in this department are: · Blood Glucose; FBS, FBS2HPP, RBS, OGTT · Blood lipids (fat) Cholesterol level. · Electrolytes - sodium, potassium, CO (Bicarbonate), and chloride2- · Uric acid · Creatinine and Blood Urea Nitrogen (BUN) · Liver function tests -AST, ALT, alkaline phosphatase, and bilirubin. 3.4.1 MATERIALS AND EQUIPMENTS USED IN CLINICAL BIOCHEMISTRY SECTION Personal Protective Equipments (PPE), Blood collection materials Different tubes like; Lithium Heparin, Serum Separator and Fluoride Oxalate tubes, Chemical reagents and detergents, automated machines, centrifuge, Glucometer and Accu check. 3.4.2 BLOOD GLUCOSE Test Overview: A blood glucose test measures the amount of a type of sugar, called glucose, in your blood. Glucose comes from . It is the main source ofcarbohydrate foods energy used by the body. is a that helps your body cells uses theInsulin hormone glucose. Insulin is produced in the and released into the blood when thepancreas amount of glucose in the blood rises. Normally, your blood glucose levels increase slightly after you eat. This increase causes your pancreas to release insulin so that your blood glucose levels do not get too high. Blood glucose levels that remain high over time can damage your eyes, kidneys, nerves, and blood vessels. There are several different types of blood glucose tests. 1. Fasting blood sugar (FBS) measures blood glucose after you have not eaten for at least 8 hours and at most 14 hours. It is often the first test done to check for andprediabetes diabetes. 2. Materials/Reagents: Glucometer or Accu Check, lancet, 70% alcohol pad, Accu test strip. Procedure: Glucometer or Accu Check was used to perform this test. The Glucometer corresponding code strip is inserted and loaded, Patient’s thumb is disinfected using a 70% alcohol pad and pricked with lancet. The blood is wiped off in order to avoid sampling error, pressure is applied below to enable blood flow again and the blood is placed on the strip. The result is then taken. Normal Result: Normal result is less than or equal to 100mg/dl 3. 2-hours post-prandial blood sugar measures blood glucose exactly 2 hours after you start eating a meal. This is not a test used to diagnose diabetes. Procedure: After performing the same procedure for FBS sample collection, patients are then asked to return 2hrs as soon as they start eating, then another venepucture is made and the same procedure is repeated. Result: Normal results is less than 140mg/dl for people age 50 and younger; less than 150mg/dl for age 50-60; less than 160mg/dl for age 60 and older. 4. Random blood sugar (RBS) also known as casual blood glucose test. measuresRBS Blood glucose regardless of when you last ate. Several random measurements may be taken throughout the day. Random testing is useful because glucose levels in healthy people do not vary widely throughout the day. Blood glucose levels that vary widely may mean a problem. Materials/Reagents: Same materials as FBS. Procedure: Glucometer or Accu Check was also used to perform RBS test. The Glucometer corresponding code strip is inserted and loaded, Patient’s thumb is disinfected using a 70% alcohol pad and pricked with lancet. The blood is wiped off in order to avoid sampling error, pressure is applied below to enable blood flow again and the blood is placed on the strip. The result is then taken. Normal Results: 80-120mg/dl before meals and 100/140mg/dl after meals 5. Oral glucose tolerance test is used to diagnose prediabetes and diabetes. This test is a series of blood glucose measurements taken after the patient was given 75g of glucose powder in 250ml of clean water immediately. This test is commonly used to diagnose diabetes that occurs during pregnancy (gestational diabetes). This test is not commonly used to diagnose diabetes in a person who is not pregnant. Materials/Reagents: : Glucose solution, Glucometer or Accu Check, lancet, 70% alcohol pad, Accu test strip. Procedure: Patient is asked to take 75g of sugar solution before sample collection. Samples are collected five times at 30min intervals and lastly collected once 1hr after the last sample collection of 30min intervals. The result for each 30mins wasResults: recorded in mg/dl 3.5 MICROBIOLOGY SECTION Microbiology involves the study of microbes. Although, microorganisms are generally beneficial and essential to life some are, however, pathogenic and cause infectious diseases. The diagnostic microbiology laboratory is engaged in the identification of infectious agents. These infectious agents are broadly classified as viruses, bacteria, mycostic agents and parasites (Protozoans and Helminthes) also this section analyses body fluids and tissues for the presence of pathogenic microorganisms primarily by means of culture and sensitivity (C&S). Results of the C&S tell the physician the type of organisms present as well as the particular antibiotic that would be most effective for treatment 3.5.1 BASIC RULES FOR WORKING IN THE MICROBIOLOGY LABORATORY, · While working in the laboratory, it is important that you must adhere to the following basic rules; · Be methodical and orderly in habits; keep the work area clean especially before leaving the laboratory and disinfectant it thoroughly at the end of day. · Wash hands frequently with soap and water · Before leaving the laboratory, place the discarded glassware into the designated place. · Cultures are kept under incubation and should be inspected in the morning and findings must be carefully. · Send the laboratory reports promptly. In case of emergency a special report is dispatched or communicated by telephone. 3.5.2 GENERAL REMARKS · All specimens for culture must be collected prior to the therapy. If the patient is on antibiotic, inform the microbiologist so that he/she can take measures. · Collect the specimen in adequate amount from the infectious site. This usually instructed by the physician. · Always use the sterile bottle to transporting the specimen. · All specimen must be accompanied by a request slip with complete information, on the patient name, age, sex, hospital number, source of specimen and clinical information is very important in order to choose the appropriate medium for the culture. · Enter the details in the laboratory register and performed direct examination of the specimen before choosing the media for the culture. · All containers used for holding microbiological specimens must be sterilized before used. Such as test tube, culture tube with and without cap, and plates, container to collect sputum specimen, blood specimen for microbial culture, penicillin bottles for collection of spinal fluid and other specimen container (universal bottle) for collection of urine specimen and stool specimen. 3.5.3 MATERIALS/APPARATUS USED IN MICROBIOLOGY SECTION Inoculating loop, Bunsen burner, Incubator, Weighing balance, Spatula, Microscopy slide, Cover slip, Staining rack, Medium plates, Sensitivity disc, Forcep, Cotton wool swab. water and mixed thoroughly and was heated with frequent agitation, then boiled for one minute to completely dissolve the powder. The Agar was autoclaved at 121 CO for 15minutes. 3. Chocolate Agar or Heated Blood agar. Prepared by heating blood agar. It is used for culture of pneumococcus, gonococcus, meningococcus and Haemophilus. Heating the blood inactivates inhibitor of growths. Preparation: 2litres of distilled water was added to 144g of agar powder. Autoclaving was done at 121 C for 15minutes and cooled till 45 C then 5% of defribrinated bloodO O was added. Heated slowly and evenly to 65 C, cooled till 45 C and poured into platesO O 4. Blood Agar. Most commonly used medium. 5-10% defibrinated sheep blood is added to melted agar at 45-50°C. Blood acts as an enrichment material and also as an indicator. Certain bacteria when grown in blood agar produce haemolysis around their colonies. Certain bacteria produce no haemolysis. Types of changes: (a) Beta haemolysis. The colony is surrounded by a clear zone of complete haemolysis, e.g. Streptococcus pyogenes is a beta haemolytic Streptococci. (b) Alpha haemolysis. The colony is surrounded by a zone of greenish discolouration due to formation of biliverdin, e.g. Viridans streptococci, and (c) Gamma haemolysis, or, No haemolysis. There is no change in the medium surrounding the c 5. Nutrient Agar (NA). This is general purpose agar for the culture of non – fastidious organisms. Formulation Peptone ===== 5.0g/litre Yeast extract ===== 1.5g/litre Beef extract ===== 1.5g/litre NaCl ===== 5.0g/litre Agar no.2 ===== 15.0g/litre pH ===== 7.4 Preparation: Weigh 28g of powder and dispense it in 1 litre of distilled water. Allow it to soak for 10 minutes. Swirl to mix and then sterilize it by autoclaving at 121 C0 for 15 minutes cool to 47 C. Mix well and pour into plates 20ml per each plate.0 3.6.6 DISPOSAL Once the Petri dishes have been taped shut, they should not be opened again. All microorganisms grown during the experiment should be killed before discarding. The best way to dispose of bacterial cultures is to pressure sterilize them in a heat stable biohazard bag. If autoclaves or pressure cookers are not available or large enough to make this convenient, an alternative is to bleach the plates. Saturate the plates with a 20% or "1 in 5" household bleach solution (in other words, 1part bleach and 4 parts water). Let them sit and soak overnight in the bleach solution before disposing of them. Please note that the bleach solution is corrosive and needs to be thoroughly removed afterwards. In addition, the plates can be incinerated if access to an incinerator is available. 3.5.6 PRECAUTIONS TAKEN WHEN PREPARING MEDIUM Do not talk when pouring medium on plates and when culturing the sample on plates to avoid contaminants as a result of unwanted bacterial or enzymes through saliva. The degree at which we incubate any cultured sample is always at 37c to avoid the death of the microorganism. 3.5.7 GRAM STAINING · Introduction: Gram’s staining was done to find the reactions of the bacterial isolates to Gram reagents. Bacteria are being identified as Gram-Negative or Positive on the basis of their cell wall thickness after staining. Gram positive bacteria hold the dye and appear purple or blue while Gram-Negative bacteria release the dye and appear red or pink. · Aim: To identify the gram-negative and the gram positive bacteria. · Apparatus: Stop watch, Normal saline, Clean grease free microscopic slide, Gentian violet, Lugol’s iodine, 95% ethyl alcohol, Neutral red, Microscope, Sterilized inoculating loop. · Procedure: The organism was isolated and smeared using the sterilized inoculating loop in a drop of normal saline on a clean grease free microscopic slide. It was left to Air-dry and heat fixed by passing a slide over the flame three times. The smear was placed on a staining rack, and the crystal violet (Primary stain) stain was flooded over the culture for 60 seconds, the stain was washed with water. The smear was again flooded with Lugol’s iodine for 60 seconds, poured off and rinsed with water. A few drops of decolorizer (ethyl alcohol) was added and washed immediately after 5 seconds and finally safaranin (Secondary stain) was added for 60 seconds and washed, the smear was allowed to dry. After drying the slides was mounted under microscope and viewed under ×100 immersion objectives. The stain differentiates bacteria species into two groups; Gram-positve, which take up crystal violet dye (primary stain) and are stained violet and Gram-negative, which pick up safaranin (secondary stain) and are stained red after decolourization with water. v Sensitivity Test (Result): If the bacteria are gram positive, a positive sensitive disc is used while a negative sensitive disc is used for gram negative bacteria. A pure colony was sub-cultured on a Nutrient medium and sensitive disc was picked with the aid of a sterile forceps, and placed on the medium, then the plate was incubated for 24 hours at 37 C. The plate was read after 24hours of incubation to observe zoneO of inhibition and resistance. Sensitivity test is also done for pathogens that grow on the media by taking a colony of the organism, streak on the sensitivity agar and add antibiotics discs and incubate for 24hours at 37 C.O 3.5.8 PROCEDURE FOR AUTOCLAVING The inner element was filled with water and allowed to cover the surface of the element, The medium were arranged in the sample bucket and the machine was covered and screwed tightly by holding the screw opposite each other and the wing nut was screwed tightly. The switch on button was on and also the outlet valve was opened down so as to increase the temperature of the steam on the workload. It was sterilized at 121⁰C for 15minutes. The safety valve was closed at 120⁰C and at 121⁰C, button was switched off. The medium were allowed to cool for 47⁰C before pouring in the petridish Principle behind Autoclaving. The principle behind these sterilization methods is based on the temperature and the type of autoclaving operation performed. Autoclaving operation at 121⁰C is referred to as culture media autoclave. 3.6 MICROSCOPY, CULTURE AND SENSITIVITY TESTS Microscopy involves the examination of specimen under the microscope, Culture refers to the microorganisms that grow on the culture medium after inoculation and incubation while sensitivity tests determines the antibiotics which will be administered to the patients. The cultured plates are incubated for 24hours at 37 C to facilitate the growth of theo organism and chocolate plates were incubated in a candle jar to facilitate the growth of both aerobic and anaerobic microbes while other plates were incubated aerobically. or parasite should be reported. Color: Normally, stool is brown in color. Variation from this color may occur under certain condition. Consistency: A normal stool specimen is formed or semiformed in consistency. Loose or watery stool may be seen in diarrhea. Trophozoite of intestinal protozoa are usually seen in loose or watery specimens while cysts are found in formed and semifromed stool. Microscopic examination: The microscopic examination is performed to detect ova, cyst or parasites, pus cells and red blood cells. Microscopy is done by wet preparation method. Procedures: ,Sample was collected into a bottle a drop of normal saline was mounted on a clean microscopic slide and mixed it with a small portion of fresh faeces with a loop. The slide was covered with a cover slip and the viewed under the low-power objective by using x10 and x40 for clear viewing. Culture: Routine stool culture involves inoculating the specimen on the following media: ü Deoxycholate citrate agar (DCA) ü Using a sterile wire loop, the stool sample is picked and streaked evenly on DCA ü The inoculated plates are incubated aerobically at 37 c for 18-24 hourso ü After incubation, a sub culture of SSA is done on MacConkey agar and re incubated for another 18-24 hours. ü The plate is read for significant growth of Salmonella or Shigella organisms. ü Sensitivity is set on Chocolate agar for 18-24 hours. ü Appropriate biochemical tests are carried out simultaneously with sensitivity. N.B: When the patient is an infant, is considered pathogenic, but in the case ofE.coli adults, it is considered a normal flora of the GIT. 3.6.3 URINE ANALYSIS: Specimen collection and preparation Urine is collected in a clean, dry container that allows complete immersion of all the fields on the test strip. Do not add preservatives. The specimen is tested as soon as possible, with the sample well mixed but not centrifuged. The use of fresh morning urine is recommended for optimal nitrite tests, as well as for the valid determination of bilirubin and urobilinogen, since these compounds are unstable when exposed to light. If immediate testing is not possible, the sample should be kept in the refrigerator, but not frozen, and then brought to room temperature before use in the test.(Ochei, J et al; 2000). Urine Macroscopy The appearance of the specimen is examine macroscopically such as color (whether it is pale amber, amber, deep amber, colorless urine, bloody or xanthochromic and their turbidity such as (whether it is clear, slightly turbid or turbid. Cloudy urine usually has an unpleasant smell and at times contains few red blood cells. This may be due to kidney or bladder infection, bloody and cloudy urine may be due to red blood cells and possibly caused by bacteria or parasitic infection. Urine Analysis using Combostiks Reagent Strips Combostiks Reagent strips are deep-and-read test strips for in vitro Diagnostic use only for testing of Urobillinogen, bilirubin, ketones, glucose, protein, nitrite, leukocytes, blood, pH, and specific gravity in urine. Test result may provide information regarding the status of carbohydrate metabolism, Kidney and liver function, acid-base balance and urinary tract infection. It is measured by comparison of test paper attached to a plastic strip with the colour chart blocks printed on the vial label. The strips are read visually. They can also be read instrumentally, using urine chemistry analyzers. (Braunstein G. D. et al; 1976): Visual Test Procedure Remove from the bottle only strip for immediate use and replace the cap tightly 1. Completely immerse reagent areas of the strip in fresh, well mixed urine. Remove the strip immediately to avoid dissolving out the reagent areas. 2. While removing, touch the side of the strip against the rim of the urine container to remove excess urine. 3. Compare each reagent area to its corresponding colour blocks on the colour chart and read at the times specified. Proper read time is critical for optimal results. 4. Obtain results by direct colour chart comparison. (Catt, K. J. et al; 1975). Chemical Principles of Procedure Urobillinogen: The test is based on Ehrlich`s reaction. Colour changes from light orange-pink to dark pink. Glucose: Glucose oxidase catalyzes the oxidation of glucose to form hydrogen peroxide. The hydrogen peroxide thus formed then oxidizes a chromogen on the reaction pad by the action of peroxidase. Bilirubin: Azo-coupling reaction of bilirubin with a diazonium salt in an acid medium to form an azodye. Colour changes from light tan to beige or light pink Ketones:Legal`s test-nitroprusside reaction. Acetoacetic acid in an alkaline medium reacts with nitroferricanide to produce a colour changes from beige to purple. pH: Double indicator system. Indicator`s methyl red and bromothymol blue are used to give distinct colour, changes from orange to green to blue. (pH 5.0 to 9.0) Blood: The test is based on the pseudo-peroxidase activity of the haemmoiety of haemoglobin and myoglobin. The chromogen is oxidized by hydro peroxide in the presence of haem and changes colour from yellow (or greenish yellow) to blue. Specific Gravity (SG): Ionic solutes present in the urine cause protons to be released from a polyelectrolyte. As the protons are released, the pH decreases and produces colour changes of bromothymol blue from blue-green to yellow-green. Protein:The test area is more sensitive to albumin than to globulin, haemoglobin, Bence-Jones proteins and mucoproteins; a negative result does not rule out the presence of these other proteins. For urine with high specific gravity, the test area may most closely match the trace colour block even though only normal concentrations of protein are present. Clinical judgment is needed to evaluate the significance of trace results. False positive result may be obtained with highly alkaline urine. Contamination of the urine specimen with quaternary ammonium compounds may also produce false positive results. streptococcus etc. Ø Ear swab: , etc.Escherichia coli Proteus sp 3.6.6 HIGH VAGINAL, URETHRAL AND ENDOCERVICAL SWAB. · Test Overview: This is use to detect the causative organisms of female reproductive system infections and their sensitivity to antibiotics. · Procedure: A swab stick was used to collect specimen from the affected area and then inoculated into sterile media which include Chocolate and MacConkey agar. These plates were incubated at 37c for 24hours and were examined for any pathogenic growth, if there is any growth then a sensitivity disc is placed on a pure culture of isolate. · Gram staining is then carried out on each specimen, a wet preparation of the swab can be made by dropping normal saline into the swab container and the swab stick is rubbed on a slide covered with a slip and viewed under the microscope; pus cells, epithelial cells, yeast cells etc can be viewed. · Result: Possible pathogens include; , ,Neisseria gonorrhea Trichomonas vaginals Candida spp Clostridium perfrigens, etc. Colonial appearance of some pathogens on culture media: Escherichia coli and most of the enteric bacteria have circular, convex, smooth colonies with distinct edges but somewhat more mucoid thanE. coli. Staphylococcus species grow readily on most bacteriological media. Colonies on solid media are round, smooth, raised and glistening. Staphylococcus aureus forms gray to deep golden yellow colonies and on CLED medium produces deep yellow colonies of uniform colour. Enterococcus faecalis on CLED medium produces small yellow colonies The and produce colonies similar to that of but doSalmonella Shigella E. coli not ferment lactose. Pseudomonas aeroginosa is an obligate aerobe that grows readily on many types of culture media. It forms smooth, round colonies with a fluorescent that is greenish in colour. It often produces non fluorescent bluish pigment pyocyanin. Klebsiella species – colonies are large and very mucoid and tend toKlebsiella coalesce with prolonged incubation. Proteus species - produce translucent blue to grey coloniesProteus species on CLED agar. CHAPTER FOUR 4.0 SUMMARY, CHALLENGES ENCOUNTERED, AND CONCLUSION RECOMMENDATION 4.1 SUMMARY OF ATTACHMENT ACTIVITIES During my period at the Premier Clinic Laboratory, Kano, as a SIWES student, cataloguing some information materials for the laboratory and I also did some activities at the reception such as: attending to patients, confirming and examining their request forms, entering their details into the register, detailing them concerning the test they are to undergo and directing them to where is to be carried out. I was later transferred to the laboratory and was introduced to the departments, safety precautions and tests carried out in each department. 4.2 CHALLENGES ENCOUNTERED The main problems encountered were getting placement and transportation. It was quite challenging for me that live in far place to get to the organisation every working day. I was not given any remuneration or allowance, other problems encountered during the training was attending to different people with different personalities at the reception. 4.3 CONCLUSION My six months industrial attachment with Premier Clinic Kano has been one of the most interesting, productive, instructive and educative experience in my life. Through this training, I have gained new insight and more comprehensive understanding about the real industrial working condition and practice and also improved my soft and functional skills. All these valuable experiences and knowledge that I have gained were not only acquired through the direct involvement in task but also through other aspects of the training such as: work observation, supervision, interaction with colleagues, supervisors, superior and other people related to the field. It also exposed me to some certain things about medical environment. And from what I have undergone, I am sure that the industrial training programme has achieved its primary objective. As a result of the programme, I am now more confident to build my future career which I have already started with Premier Clinic, Kano. 4.4 RECOMMENDATION I recommend that all institutions or bodies involve in Student Industrial Working Experience Scheme, should provide places for industrial attachment for Student Industrial Training Fund and also pay some allowances to students and the company should provide more safety equipments to prevent further environmental and health hazards. Also, to students that are to undergo the training, I recommend that they should take it very seriously, because it is one of the most important parts of their studies which will help them build a very significant and effective meaning in their career pursuit. 4.5 References 1. Baker, F.J. Silverton R.E. and Pallister, C.J. (1998): Introduction to Medical Laboratory Technology, 7th edition, Edward Around Publisher, London. Page 223 2. Batzer FR 1980: Hormonal evolution of early pregnancy, Fertil. Steril.; 34(1): page 1-13 3. Braunstein GD, J Rasor, H. Danzer, D Adler, ME (1976): Wade Serum human chorionic gonadotropin levels throughout normal pregnancy, American. J. Obstet. Gynecol.; 126(6): Page 678-681 4. Catt KJ, ML Dufau, JL Vaitukaitis(1975): Appearance of hCG in pregnancy plasma following the initiation of implantation of the blastocyte, J. ClinEndocrinol. Metab.; 40(3): Page 537-540 5. Cheesbrough, M. (1998): District Laboratory Practice in Tropical Countries. Part 1 & 2.Cambridge University Press. Page 110-114 6. Dawood MY, BB Saxena, R Landesman(1977): Human Chorionic gonadotropin and its subunits in hydatidiform mole and choriocarcinoma, Obstet. Gynecol.; 50(2): Page 172-181 7. HowanitzPJ, Howanitz JH. Carbohydrates. In : Henry JB, ed. Clinical diagnosis and mana-gement by laboratory methods. 17thed Philadelphia: WB saunders 1984: 165-179. 8. ITF, "Guideline for writing Industrial Training/SIWES Report," 2017 9. ITF (2011). An evaluation of the impact (SIWES) on technical skill development in Nigeria. A Joint Study by ITF and University of Jos. 10.Jawetz, Melnick and Adelbergs, (2004): Medical Microbiology (23th edition) McGraw Hill Companies. 11.Ochei, J. and Kolhatkar, A. (2000): Medical Laboratory Science. Theory and Practice.6th edition Tata McGraw-Hill Pub. Company Ltd. 12.SIWES, "Introduction to Students" Industrial Work Experience Scheme(SIWES)," 2016.Tietz NW, ed. Clinical guide to laboratory tests. 3rd ed. Philadephia:sreekumari S. KV 7th edition. 13.Prescott, M. L. Harley P.J. and Klein, AD (2002): Microbiology 5th Edition. McGraw Hill Higher Education; New York. Page 120-123