siwes report of a medical hospital in laboratory, Thesis of Biochemistry

Download siwes report of a medical hospital in laboratory and more Thesis Biochemistry in PDF only on Docsity! CHAPTER ONE 1.0 INTRODUCTION TO SIWES The Students Industrial Work Experience Scheme (SIWES), is the accepted training program, which is part of the approved Minimum Academic Standard in the various degree programs for all Nigerian Universities. The scheme is aimed at bridging the existing gap between theory and practice of sciences, Agriculture, Medical Sciences (including Nursing), Engineering and Technology, Management, Information and Communication Technology, and other professional work methods, and ways of safeguarding the work areas and workers in industries, offices, laboratories, hospitals, and other organization. It is a cooperative industrial internship program that involves institutions of higher learning, industries, the Federal Government of Nigeria, the Industrial Training Fund (ITF), and the Nigerian Universities Commission (NUC). 1.1 BACKGROUND HISTORY OF SIWES The Industrial Training Fund National Conference held in Jos in the year 1988 mandated all collaborating agencies which include the National Commission for Civic Education (NCCF), National Board for Technical Education (NBTE) and National University Commission (NUC) to draw up job specifications for all degree programs including the Students Industrial Work Experience Scheme (SIWES) . As at that time, the specification of the job was to guide the industrialist and institutional supervisors in the industrial placement of students in order to meet the expected requirement of minimum industrial exposure preparatory for employment. The student Industrial Work Experience Scheme (SIWES) was established in 1973/1974 session by the Industrial Training Fund (ITF). Prior to the establishment of this scheme, there 1 was a growing concern among our industrialists that graduates of our institutions of higher learning lacked adequate practices background studies preparatory to employment in the industries. It is against this background that the aim of initiating and designing the scheme was hinged. Consequently, the scheme affords students the opportunity of familiarizing and exposing themselves, to the needed experience in handling equipment and machinery that are usually not available in the institutions. The ITF solely funded the scheme during its formative years. It withdraws from the scheme in 1978 due to the financial problem. The Federal Government handed the scheme in 1979 to both the National University Commission (NUC) and the National Board of Technical Education (NBTE). Later, in November 1984, the Federal Government changed the management and implementation of the scheme to ITF and it was effectively taken over by the Industrial Training Fund (ITF) in July 1985 with the funding being solely borne by the Federal Government. 1.2 OBJECTIVES OF STUDENTS INDUSTRIAL WORK EXPERIENCE SCHEME (SIWES) The Industrial Training Fund’s Policy Document No. 1 of 1973 which established SIWES outlined the objectives of the scheme as;  To provide an avenue for students in institutions of higher learning to acquire industrial skills and experience in their respective courses of study. To prepare students for the industrial work situation they are likely to experience after graduation.  To expose students to work methods and techniques of handling equipment and machineries that may not be available in their institutions.  To make the transition from school to the world of work easier; and to enhance students’ networks for later job placements. 2 2.3 DEPARTMENTS/UNITS IN OLALOMI HOSPITAL The various units in Olalomi Hospital includes;  The reception  The record unit  The pharmacy  The Nurses section  The Doctor’s office  The laboratory  The ultrasound unit  The wards  The theatre room CHAPTER THREE 5 3.1 THE DEPARTMENT I WAS POSTED TO AND MY DUTIES I was posted to the medical laboratory department of the hospital where I performed several duties such as; to carry out various test for patients as specified by the doctor and to give the result back to the Doctor for treatment. Firstly I was introduced to the ethics and safety precautions in the laboratory, which include;  Always wear lab coat or protective clothes in the Lab  Use your nose mask  Dispose needle after use  Don't recap used needle with both hands, use the syringe to pick the cover.  Don't put any laboratory object in your mouth  Transportation of chemicals, samples must be done carefully  Don't store food or drinks inside the lab refrigerator  Don't eat, drink or smoke in the laboratory  Always remove your lab coat before leaving the laboratory. Secondly, I was introduced to the reception section of the laboratory, were the patients data is recorded accordingly to avoid mistakes. After which I was taught how to collect a patients samples. specimens from humans, including blood, stool, urine, sputum, skin snips, and other tissue biopsies, and swabs or smears collected from skin or mucosal surfaces. Accurate laboratory results depend on proper collection, processing, and handling of samples. The method of collection, timing, and handling of samples will be determined by the purpose of the test and specified in the test procedure. We are different human samples BLOOD SAMPLE COLLECTION There are basically two major method of blood sample collection, they are; 6  Intravenous collection method; Intravenous blood sampling, a needle is inserted into a vein to collect a sample of blood for testing. Peripheral veins, typically the antecubital veins, are the usual sites for venous blood sampling.  Capillary collection method; Capillary blood is obtained by pricking a finger in adults and a heel in infants and small children. The specimen is then collected with a pipette, placed on a glass slide or a piece of filter paper, or is absorbed by the tip of a microsampling device. Capillary blood collection method is mostly used for PCV, RBS, FBS etc SAMPLE BOTTLES Most blood collection tubes contain an additive that either accelerates clotting of the blood (clot activator) or prevents the blood from clotting (anticoagulant). A tube that contains a clot activator will produce a serum sample when the blood is separated by centrifugation and a tube that contains an anticoagulant will produce a plasma sample after centrifugation. Some tests require the use of serum, some require plasma, and other tests require anticoagulated whole blood. Examples of sample bottles include;  EDTA bottle; Ethylenediaminetetraacetic acid (EDTA) is a polyprotic acid containing four carboxylic acid groups and two amine groups with lone-pair electrons that chelate calcium and several other metal ions.This bottle contains EDTA as an anticoagulant - These bottle are preferred for molecular tests.It inhibits clotting by removing or chelating calcium from the blood. EDTA most important advantage is that it does not distort blood cells, making it ideal for the most hematological tests. Such as; Full blood count (FBC), Erythrocyte sedimentation rate (ESR), Blood film for abnormal cells or malaria parasite etc 7  Cotton wool that contain 70% ethanol (swap) was used to disinfect the thumb of a patient  lancet pin was used to prick the thumb finger, rubber pipette was then used to collect the blood sample  a drop of blood was dropped on the HIV kit.  A chase buffer solution was then added for easy migration on the kit.  At this point, it was left for 10-15 minutes before the reading was taking in order to get accurate result. Conclusion; if the patient was tested HIV positive, there will be lines appearing on both control line and test line. But if the patient was tested negative, only the control line will appear. And if there is no line in between the control and test line, the test is invalid in this case the patient is required to repeat the test. For confirmation purposes, it is advisable to use another product of HIV test kit aside the one used earlier. Before the patient is finally sent to the counseling unit. 3.2.2 HEPATITIS C VIRUS (HCV) TEST A blood test, called an HCV antibody test, is used to find out if someone has ever been infected with the hepatitis C virus. The HCV antibody test, sometimes called the anti-HCV test, looks for antibodies to the hepatitis C virus in blood. Antibodies are chemicals released into the bloodstream when someone gets infected. Test results can take anywhere from a few days to a few weeks to come back. Rapid anti- HCV tests are available in some health clinics and the results of these tests are available in 20 to 30 minutes. Mode of transmission 10 The hepatitis C virus is a bloodborne virus. It is most commonly transmitted through:  the reuse or inadequate sterilization of medical equipment, especially syringes and needles in healthcare settings;  the transfusion of unscreened blood and blood products; and  Injecting drug use through the sharing of injection equipment. How to carry out test Materials and apparatus; Cotton wool contain 70% ethanol (swap), sterile needle, rubber pipette (tourniquet), blood sample, HCV test strip and buffer solution. Procedure;  Cotton wool that contain 70% ethanol (swap) was used to disinfect the thumb of a patient  lancet pin was used to prick the thumb finger, rubber pipette was then used to collect the blood sample  a drop of blood was dropped on the HCV test strip.  A chase buffer solution was then added for easy migration on the strip.  At this point, it was left for 10-30 minutes before the reading was taking in order to get accurate result. Conclusion; if the patient was tested HCV positive, there will be lines appearing on both control line and test line. But if the patient was tested negative, only the control line will appear. And if there is no line in between the control and test line, the test is invalid in this case the patient is required to repeat the test. 3.2.3 HEPATITIS B VIRUS (HBsAg) TEST 11 Hepatitis B surface antigen (HBsAg) is a protein that appears in the blood when you have a hepatitis B infection. An HBsAg blood test can detect this antigen. If you're positive, it means you have the virus and can pass it to others through your blood or body fluids. The HBsAg test is used along with other tests to confirm hepatitis B and whether or not you're contagious. Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). For some people, hepatitis B infection becomes chronic, meaning it lasts more than six months. Having chronic hepatitis B increases your risk of developing liver failure, liver cancer or cirrhosis—a condition that causes permanent scarring of the liver.1 Most people infected with hepatitis B as adults recover fully, even if their signs and symptoms are severe. Infants and children are more likely to develop a chronic hepatitis B infection. Mode of transmission The hepatitis B virus is passed from person to person through blood, semen, or other body fluids. With a positive HBsAg, transmission routes for infection include:  Sexual contact: You may become infected if you have unprotected sex with an infected partner whose blood, saliva, semen, or vaginal secretions enter your body.  Sharing of needles: HBV is easily transmitted through needles and syringes contaminated with infected blood. Sharing intravenous (IV) drug paraphernalia puts you at high risk of hepatitis B.  Accidental needle sticks: Hepatitis B is a concern for healthcare workers and anyone else who comes in contact with human blood. 12  At this point, it was left for 10-15 minutes before the reading was taking in order to get accurate result. Conclusion; if the patient was tested positive, there will be lines appearing on both control line and test line. But if the patient was tested negative, only the control line will appear. And if there is no line in between the control and test line, the test is invalid in this case the patient is required to repeat the test. 3.2.5 SERUM PREGNANCY TEST A qualitative blood serum test confirms whether or not hCG is present in the blood, basically offering a yes (you're pregnant) or a no (you're not pregnant) result. The qualitative hCG blood test is about as accurate as a home urine test. A home urine tests are also extremely accurate, blood pregnancy tests are more sensitive and can detect a pregnancy earlier. Blood pregnancy tests yield a positive result if they detect 1 to 2 mIU/mL (milli-international units per milliliter) of hCG, while urine tests require hCG levels to reach 20 to 50 mIU/mLs. How to carry out test Materials and apparatus; Cotton wool contain 70% ethanol (swap), sterile needle, rubber pipette (tourniquet), blood sample, PT test strip and buffer solution. Procedure;  Cotton wool that contain 70% ethanol (swap) was used to disinfect the thumb finger of a patient  lancet pin was used to prick the thumb finger, rubber pipette was then used to collect the blood sample 15  a drop of blood was dropped on the PT strip.  A chase buffer solution was then added for easy migration on the kit.  At this point, it was left for 10-15 minutes before the reading was taking in order to get accurate result. Conclusion; if the patient was tested positive, there will be lines appearing on both control line and test line. But if the patient was tested negative, only the control line will appear. And if there is no line in between the control and test line, the test is invalid in this case the patient is required to repeat the test. 3.2.6 WIDAL TEST The Widal test measures the capacity of antibodies against LPS and flagella in the serum of individuals with suspected typhoid fever to agglutinate cells of S. Typhi; the test was introduced over a century ago and it is still widely used. It is simple, inexpensive, and takes only a few minutes. The Widal test, developed in 1896 and named after its inventor, Georges- FernandWidal, is an indirect agglutination test for enteric fever or undulant fever whereby bacteria causing typhoid fever is mixed with a serum containing specific antibodies obtained from an infected individual. Mode of transmission  Through contaminated food  Poor personal hygiene  Contaminated water  Contaminated or unripe fruits How to carry out test Materials and apparatus; to prepare for a Widal test, we would require the following: 16  Patient’s serum  Pipette (lab tool)  S. Antigen ( O, H, A(H), A(O),B(H),B(O), C(O), C(H),)  Slide (tile)  Mix Stick  Stopwatch Procedure;For this test, you will use a slide with 8 reaction circles, marked as O, H, AH, BH. To begin with, 1. Add sample a drop each to "O", "H", "AH", "AO","BO","BH","CO","CH" 2. Add "O" antigen a drop to "O" circles, "H" antigen a drop to "H" circles, "A(O)" antigen a drop to "A(O)" circle, "A(H)" antigen a drop to "A(H)" circles, "B(O)" antigen a drop to "B(O)" circle, "B(H)" antigen a drop to B(H) circles, "C(O)" antigen a drop to "C(O)" circle and "C(H)" antigen a drop to "C(H)" circle. 3. Next, Mix well using separate disposable plastic sticks for each circle. Care should be taken to avoid cross contamination. Do not allow the fluid to dry out. 4. Observe agglutination within 5 minutes under a bright light source. 5. Run negative control using normal saline as sample. 6. Run a positive control using the positive control as sample. Interpretation of Widal test After mixing the serum and reagent properly and rotating the slide, wait for the results to show. The result will be positive if it shows positive in more than 100 in the O circle and 200 in the case of H. 17 Conclusion: Plasmodium falciparum can be detected by means of Malaria parasite kit. 3.2.8 FASTING BLOOD SUGAR TEST (F.B.S) A test that measures blood sugar levels. Elevated levels are associated with diabetes and insulin resistance, in which the body cannot properly handle sugar (e.g. obesity). This test requires a 12-hour fast.The blood sugar level is the measure of the amount of glucose present in the blood of a human body. Blood sugar levels can either be normal, high or low. Having high blood sugar or low blood sugar can be troublesome. The test is done in the morning, before the person has eaten. Diabetes is a group of metabolic disease whereby a person has high blood sugar due to inability of produce or metabolizes sufficient quantities of the hormone insulin. The major cause of diabetes in a patient is when the pancreas has damaged and cannot be replaced. The pancreas do secrete insulin in other to neutralized the normal level of glucose in body system. Symptoms of Diabetes  Frequent urination  Extreme thirst  Fatigue  Increase appetite  Blurred vision  Loss of feeling in hands or feet How to Carryout Fasting Blood Sugar Test (F.B.S) Aim: To rule out the sugar level (GLUCOSE) present in the blood of a patient. 20 Material And Apparatus: Alcohol pad, sterile needle, glucometer machine, blood sample, glucometer strip. Procedure:  Alcohol pad was used to disinfect the finger thumb of a patient  The glucometer strip is inserted into the glucometer machine, waiting for blood  The patient's thumb was pricked with a sterile needle.  The Blood was placed at the tip of the test strip or on the strip.  The glucometer machine process the sample within 10seconds  Then the result was shown on the meter display.  Then results would be read. Reading of Result The glucometer has been calibrated to mg\dL which needs to be converted to mm\L to get the actual value of the patient fasting blood sugar in mmol\Litre. Normal range of FBS The range for normal blood glucose is 70 to 100 mg/dl which is equivalent to 3.9mmol/l to 5.6mmol/l. Readings between 100 and 126 mg/dl which is equivalent to 5.6mmol to 7mmol/l are considered as impaired fasting glucose or pre-diabetes. Diabetes is generally diagnosed when fasting blood glucose levels are 126 mg/dl or higher. Conclusion; A pre-diabetic patient can be taken care of with adequate medications and controlled diet. It is important to always check our glucose level frequently to avoid complications. 21 3.2.9 RANDOM BLOOD SUGAR TEST (R.B.S) A random blood sugar test is the testing of the blood sugar level at any time or random time of the day. It is a test performed outside the regular testing schedule. RBS test is performed to confirm diabetes mellitus, during the treatment and after the treatment of diabetes mellitus. A level of 200 mg/dl or higher is an indication of diabetes mellitus. The main goal behind random blood sugar test is to check random blood sugar levels. Having a random blood sugar range of 200mg/dl or more is a clear indication of the presence of diabetes mellitus. With the diagnosis of diabetes, random blood sugar test helps in the timely treatment of the disease through monitoring during and after the treatment. A doctor can prescribe RBS test if the person complains of the following symptoms;  Unintended Weight loss  Dehydration and dry mouth  Slow healing of wound  Blurry vision  Frequent urination How to carry out RBS test Aim; to rule out the level of glucose present in the patient's blood. Materials and apparatus; Alcohol pad, sterile needle, glucometer machine, blood sample, glucometer strip. Procedure;  Alcohol pad was used to disinfect the finger thumb of a patient  The glucometer strip is inserted into the glucometer machine, waiting for blood 22 Visual exam A lab technician examines the urine's appearance. Urine is typically clear. Cloudiness or an unusual odor can indicate a problem, such as an infection. Protein in urine can make it appear foamy. Blood in the urine can make it look red or brown. Urine color can be influenced by what you've just eaten or by certain drugs you're taking. For example, beets or rhubarb might tint your urine red. Dipstick test A dipstick — a thin, plastic stick with strips of chemicals on it — is placed in the urine. The chemical strips change color if certain substances are present or if their levels are above typical levels. A dipstick test checks for: Acidity (pH); the pH level indicates the amount of acid in urine. The pH level might indicate a kidney or urinary tract disorder. Concentration; A measure of concentration shows how concentrated the particles are in your urine. A higher than normal concentration often is a result of not drinking enough fluids. Protein; Low levels of protein in urine are typical. Small increases in protein in urine usually aren't a cause for concern, but larger amounts might indicate a kidney problem. Sugar; the amount of sugar (glucose) in urine is typically too low to be detected. Any detection of sugar on this test usually calls for follow-up testing for diabetes. Ketones; as with sugar, any amount of ketones detected in your urine could be a sign of diabetes and requires follow-up testing. 25 Bilirubin; Bilirubin is a product of red blood cell breakdown. Usually, bilirubin is carried in the blood and passes into your liver, where it's removed and becomes part of bile. Bilirubin in your urine might indicate liver damage or disease. Evidence of infection;either nitrites or leukocyte esterase — a product of white blood cells — in your urine might indicate a urinary tract infection. Blood; Blood in your urine requires additional testing. It may be a sign of kidney damage, infection, kidney or bladder stones, kidney or bladder cancer, or blood disorders. Urobilinogen;urobilinogen in urine test measures the amount of urobilinogen in your urine (pee). Normal urine contains some urobilinogen. Too much urobilinogen in urine may be a sign of a liver disease, such as hepatitis or cirrhosis, or certain types of anemia. Microscopic exam Sometimes performed as part of a urinalysis, this test involves viewing drops of concentrated urine — urine that's been spun in a machine — under a microscope. If any of the following levels are above average, you might need more tests: White blood cells (leukocytes) might be a sign of an infection. Red blood cells (erythrocytes) might be a sign of kidney disease, a blood disorder or another underlying medical condition, such as bladder cancer. Bacteria, yeast or parasites can indicate an infection. Casts — tube-shaped proteins — can be a result of kidney disorders. 26 Crystals that form from chemicals in urine might be a sign of kidney stones. 27 CAPILLARY TUBE NORMAL PACKED CELL VOLUME RANGE For male (Adult) = 40% - 54% For female (Adult) = 35% - 46% Infant = 40% - 60% 30 MICRO HEMATOCRIT READER Conclusion; A lower number of the PCV means that the RBC count loss is due to reasons such as blood loss, cell destruction and less bone marrow production. Increased PCV can generally mean that a person is dehydrated and there is a higher number of RBC production By looking at the tube out of the centrifuge, you can get an idea of the WBC content as well. This buffy coat normally lies between the plasma and red cell layer. (This shouldn't be counted as a part of the PCV test). 31 3.2.12 BLOOD GROUPING TEST Blood is a red fluid that circulates round the body and enables man to perform its function. Blood contain plasma, red blood cells, white blood cells, and the platelets. In blood grouping the most common rhesus factors is D-positive the aim of doing this test is to ensure that a donor blood will not give reaction from anti body which the recipient may have formed to any other blood group system. Blood grouping is a classification of blood, based on the presence or absence of inherited antigenic substances on the surface of red blood cells. There are various types of blood group which are: Group A Group B Group AB Group O Aim: To know the particular blood group which individual belongs to. Apparatus and Materials: A white clean dry tile, EDTA sample bottle, swab, small pipette, stirrer, needle and syringe, anti-seraA reagent, anti-sera B reagent, anti-sera D reagent, blood sample. Procedure: Hand glove was put on, the patient thumb was sterilized with the cotton wool that contained alcohol and the thumb was pricked with the sterile lancet. The pricked capillary area was squeezed and the blood was spotted in three different area on a clean white dry tile. A drop of each antisera A,B and D was dropped separately on the spotted blood sample and a small pipette was used to add a drop of each antisera A,B and D respectively 32 @ A B ap) C) map Group B CO) cy mae Group A ap) a) map Group O C) C) map Group AB Agglutination is present ) No agglutination ANTISERA REAGENT 35 SLIDE SHOWING BLOOD GROUP TEST 3.2.13 KNOWLEDGE GAINED  Learnt about the equipment used in the laboratory and their functions  Learnt how to locate a vein and collect blood samples from different kinds of patient.  Learnt the different kinds of collection bottles in the laboratory and when each is required for a particular test.  Learnt how to carry out series of tests; urinalysis, blood glucose level, screening tests, malaria parasite test, widal etc.  Learnt about the ethics and precautions to take in the laboratory. 36 CHAPTER FOUR 4.1 EQUIPMENT USED AND THEIR FUNCTIONS Equipment used in the laboratory unit;  Glucometer machine  Blood collection tubes  Microscope  Bucket Centrifuge  Incubator  Electrophoresis machine  Microhematocrit reader  Widal kit  Blood group antigens  Micro hematocrit tube  Malaria kit  Refrigerator  Safety box Glucometer machine and strip; Is a small,portable device that lets you check your blood sugars(glucose levels). These device can tell you in seconds if your blood sugar is low, too high, or on target. 37 ElectricMicroscope A very powerful microscope that uses a beam of electrons to produce a large image of a very small object.The lenses used in the electron microscope are magnetic coil. It is used to investigate the ultra structure of a wide range of biological and inorganic specimens including microorganisms,cells,large molecules,biopsy samples, metals and crystals. BUCKET CENTRIFUGE This machines is used to separate the content of blood sample based on densities i.e. to separate the serum from the red blood cell. 40 INCUBATOR: It is used for incubating cultured plate for 24 hours -48 hours at the temperature between 37oc-4000c so as to obtain proper growth of microorganisms. 41 Electrophoresis machine This is a machine used for running genotype test. MICRO-HAEMATOCRIT READER: It is used to determine the micro hematocrit value. It measures red cell layer in terms of packed cell volume (PCV). Widal test kit; Widal Kit Salmonella Ha, Hb, Hc, Hd, OA, OB, OC, OD Rapid Labs Widal antigen set contains ready to use concentrated smooth antigen suspensions of the bacilli; S. typhi ‘O’. S. typhi ‘H’. S, paratyphi ‘AO’. S. paratyphi ’BO‘. S. paratyphi ’AH’, S. paratyphi ‘BH’. S. paratyphi ‘CH’. S. paratyphi ‘CO’ and/or polyspecific positive control reactive with these antigens.When the Widal antigen suspensions are mixed and incubated with the patient’s serum, anti salmonella antibodies present in the patient serum react with the antigen suspensions to give agglutination. Agglutination is a positive test 42 CHAPTER FIVE 5.1 SUMMARY The six months I spent at OLALOMI HOSPITAL was one of the best times of learning in my life, I was able gain a lot of experience and exposures, and also to build relationships with people. The educative moments has prepared me a little for the work load ahead after my education. I was able to learn theoretical aspect of the things taught in school which is one of the main objectives of SIWES. 5.2 CONCLUSION Student industrial work experience scheme (SIWES) is an educative and enlightenment program. It exposes student to various experience which cannot be undertaking in the class room. It helps in applying practical knowledge to feed of study and theoretical knowledge of the study. 5.3 CHALLENGES ENCOUNTERED  Inadequate equipment for proper training.  Adjusting to the working schedule. 5.4 RECOMMENDATIONS FOR IMPROVEMENT OF SCHEME  I recommend that SIWES program is a program that student should undergo in other to be aware of some aspect based on their field of discipline.  Connection should be created with facilities/organization by the institution to make placement easy for students. 45  The SIWES letter should be made available for students earlier so that they can get placement early. 46 REFERENCES Billett HH(1990). Hemoglobin and Hematocrit. 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