Laboratory Service Important Circulars

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General Circular No: 01-14/2005 My No. LA/D-LS/05/004

Ministry of Healthcare, Nutrition &

Uva Wellassa Development,

“Suwasiripaya”

Colombo 10

28th

June, 2005

All

Provincial Secretaries of Health,

Provincial / Deputy Provincial Directors of Health Services,

Directors of Teaching Hospitals,

Heads of Decentralized Units / Specialized Campaigns,M.SS/D.M.OO of Provincial and Base Hospitals.

INSPECTION OF LABORATORIES

It has been observed that many laboratories have not been inspected routinely by health

authorities. It is of paramount importance that the hospital laboratories should be regularly

inspected in order to ensure proper performance of tests leading to good quality reports and

achieving of proper laboratory standards. It is also observed that Consultants in many hospitals

do not have much confidence in their respective laboratories and tend to refer many patients to

private sector laboratories.

As such, it would be essential to closely supervise and monitor the functioning of the respective

laboratories within your purview, so that whatever the existing shortcomings could be rectified

early.

All Medical Administrators including M.O. i/CC are advised to conduct routine

laboratory inspections, using the attached check list and to discuss the shortcomings at the

monthly laboratory meetings with the stakeholders for rectification.



It would be advisable to have a file of inspection reports maintained in your Office, have

them copied to the Director/Laboratory Services for purpose of monitoring.

Your immediate attention in this regard would be greatly appreciated.

Dr. Athula Kahandaliyanage

Director General of Health Services



Check list for Inspection of Laboratories

Institution -

Date -

Inspected By: -

Staff - No. in position Present on the day

Specialists

MOO

MLTTOrderlies

Laborers

Space - Approximate

floor area

Adequacy

Chemical

Pathology

Histopathology

Microbiology

Haematology

OPD

Night lab

Special lab

Design - Purpose built / improvised

Ventilation - Satisfactory / unsatisfactory

Suggested improvements

Lighting - Satisfactory / unsatisfactory

Suggested improvements

Water supply - Adequate / InadequateContinuous / Interrupted

In good Quality/ Not in good Quality

Telephone facility - Direct/intercom – No direct line

Specific infrastructure requirements -



Air Conditioning/ Voltage Stabilizing/generator backup etc..

required/not requiredMet/ unmet

Literature for reference - available/ not available

Furniture

Adequate Not adequate

Benches

Stools

Wall racks

Storage cupboards

Tables

Chairs

Staff welfare availability of separate space for changing/eating etc and toilets

Doctors

Technical Staff

Minor Staff

Reception of Specimens- Counter available/not availableTime of Reception Fixed / Open

Collected by Lab or delivery by ward

Issue of reports - Delivered by Lab or collected by wards

Computer facility available or not available

Scope of the lab - Tests performance whether compatible with approved list or not

Equipments - Deficiencies or excess compared to approved list

Safety procedures - Universal precautions- Safety apparels

- Personal Protective equipments

Waste Disposal System - Unserviceable articles accumulated removed

Storage space -

Quality Assurance Scheme - System for internal quality assurance:

Availability of SOPs,

Regular calibration

Mechanism for supervision



Whether participating in external quality assurance

Supply system - Uninterrupted / interruptedQuality of supplies satisfactory /notsatisfactory

Media Preparation Room - Satisfactory/ not satisfactory

(please specify)

Washing Room -

Procedure Room (bleeding, Bone marrow etc.)

Patients’ waiting area including toilets

Observations :-



General Circular Letter No. - 02-73/2005

My No.D/LS/09/05

Office of the Director General Health Services

“Suwasiripaya”

No. 385, Baddegama Wimalawansa Thero Mw.

Colombo 10

19th

May 2005

All




Heads of Decentralized Units / Specialized Campaigns,

M.SS/D.M.OO of Provincial and Base Hospitals.

GUIDELINES FOR USE AND MAINTENANCE OF LABORATORY EQUIPMENTS

It has been observed that in spite of the fact that expensive equipments have been provided to

laboratories, they are neither well maintained nor are functional in many hospitals due to various

reasons.

As the capital vote is a cumulative fund, assets acquired under this vote should be carefully

maintained, to ensure that the maximum benefit would be achieved until the value of the

equipment is written off from the capital assets register, after being certified to be no longer

functioning. Following guidelines should be strictly adhered and practiced in all institutions with

regard to usage and maintenance of laboratory equipments, of which the value exceeds Sri

Lankan rupees 100,000/- irrespective of whether they are procured or being donated .

Since late there had been many audit queries on high-tech, costly equipment being repaired on

state expenses without a justification.

As such the following precautionary steps are being recommended to ensure the safety of

laboratory staff and to prevent any audit queries being raised at a latter usage.



1. The equipment must be handed over to an officer in the laboratory (e.g.:- senior MLT)

and signature should be obtained.

2. Those that are trained in the use of the machine are held responsible for the smooth

functioning of the machine /equipment.

3. The names of responsible officers must be typed and list displayed near the machine.

4. This trained team must be responsible for routine maintenance of equipment.

5. The responsible person must communicate with the maintenance biomedical engineer/

Local Agent, though head of laboratory/ Head of Institute and ensure the routine checks

and calibration done by the engineer/ agent.

6.

Each item of equipment must have a log book. The maintenance checks repairs, servicerecords and comments must be logged onto the book. All entries should be initialed by

the responsible officer and endorsed by the head of laboratory. All consumables received

should be entered itemizing the quantity, expiry date & cost, respectively.

7. The automated analyzer need to be housed away from the main laboratory with separate

access from outside. This room must be locked and a key kept in the Director‟s /Medical

Superintendent‟/ Head of the Institution‟s room, when the machine is not in use.

8. If there is a functional problem, the engineer/ local agent should be informed in writing

though head of laboratory. A copy of the letter and any communication must be noted in

the above log book and copies of letters attached.

9. If there is a breakdown due to negligence on the part of the technical staff or sabotage or

the machine made non usable by a willful act of a staff member, then the responsible

officer should report this to the Head of Division / Head of the Hospital where Punitive

action will be taken as per provisions in the establishment code, and other relevant

circulars. Acton should also be taken to get the offender to bear the cost of repairs.

10. An operator log book must be maintained and entries should be made whenever the

equipment is over for usage and is being handing back to another officer clearly

indicating.

Name of the officers handing over and taking over



Date and time of taking over

Any comments at the time of handing over

Please ensure that all laboratory staff would be informed on this circular.

Please bring the contents of this circular to the notice of all officers concerned in your

province/ region/ institution.

Dr. H.A.P.Kahandaliyanage




General Circular No: 01 – 24/2004

My No. LA/NLP/05/004

Office of the Director General of Health Services,

Department of Health Services“Suwasiripaya” Colombo 10

15th

October, 2004

To, All

Provincial Directors of Health Services,

Deputy Provincial Directors of Health Services,

Directors of Teaching Hospitals,Medical Superintendents of GHH

Strengthening & Re-Organization of Laboratories

It has been brought to the notice of the Ministry of Health that due to the ordering of unlimited

numbers of investigations by Junior Medical Officers, institutional laboratories are being overburdened with work decreasing efficiency. This has also resulted in shifting the investigations to

be carried out after duty hours by some of MLTT, purely to obtain the advantage of carrying out

the investigations under piece rate payment scheme, as complained by the Heads of institutions.

To streamline the management, Ministry of Health has taken policy decision to enforce shift dutysystem with payment of overtime as for other categories of officers. In the meantime, an expert

committee has been entrusted the responsibility to develop norms including the numbers of investigations to be performed by MLTT.During this intern period where Strengthening & Re-Organization of Laboratories are being

performed, it would be recommended to attend to the following guidelines.

A committee should be appointed in all institutions for review of laboratory performancecomprising of laboratory users (Consultants/MOO/Matrons etc.) laboratory officials and

representatives from administration.

Committee should meet monthly, preferably in the laboratory premises, to discuss on theexisting problems, steps to rectify these issues and on future development plans (manpower,equipment etc.)

Consultants and other medical officers in-charge should ensure that essential tests required

for the management of patients would be ordered and the reports would be utilized for thispurpose. The practice of ordering routine investigations for each and every patient by some

MOO should be stopped.



All intern medical officers, House Officers and Senior Medical Officers should be welladvised, guided and monitored by all consultants in this regard.

All the monthly meetings:

- Tests ordered by parallel units should be compared and analyzed.- Unused investigation reports should be reviewed and the officer responsible should be

advised to be cost conscious.- Steps to be taken to fix the responsibility of all items in the laboratory, so that

accountability could be maintained.

- Arrangements should be made to repair all out of order equipment as early as possible.- Out of stock chemicals/ kits should be got down immediately.

Damage to equipment due to negligence and vandalism should be strictly dealt with and thecost should be surcharged from the officers concerned.

Your proposal attention in getting the above steps implemented would be greatly appreciated.

Dr. H. A. P. Kahandaliyanage




Gen. Circular No. 01-13/2005

My No: D/LS/05/04

ministry of Healthcare, Nutrition and

Uwa wellassa Development,

“Suwasiripaya”

No. 385, Baddegama Wimalawansa Thero Mw.

Colombo 10

28th

June, 2005

All




Heads of Decentralized Units / Specialized Campaigns,

M.SS/D.M.OO of Provincial and Base Hospitals.

Norms for equipment and Investigations in laboratories

It has been observed that the laboratory services provided by State Hospital differ vastly among

hospitals. Depending on the availability of resources and that the allocation of resources have

not been done according to the service provisions expected from various categories of hospitals.

On the recommendation of the Technical Advisory Committee involved in Re-Organization and

Strengthening the laboratories, guidelines were developed with the participation of all

stakeholders in identifying the types of investigations which should be performed in various

categories of hospitals and the type of equipment required accordingly. Details of found in the

annexure.

You are expected to use this annexed document as a guideline and to ensure strengthening the

laboratories under your purview within a period of 05 years, taking into consideration the

budgetary allocations available.



It would also be recommended to inform the contents of this circular to all Consultants, MOO,

intern MOO, MLTT and to ensure that all future intern HOO would be briefed before

commencing the internship.

Your personal attention in this regard would be greatly appreciated.

Dr. H. A. P. Kahandaliyanage


N.B

Lists updated in year 2010 as per the Norms For Laboratory Investigations and laboratory

equipment are available under the following titles in this manual.

Title 4 (page 2-10) Investigations Performed in Various Categories of Hospitals

Title 6 (page 12-13) List of Laboratory Equipment for different categories of Hospitals



Gen. Circular No 02 – 01/2007My No: D/LS/05/04(T)

Ministry of Healthcare and Nutrition

“Suwasiripaya” No. 385, Baddegama Wimalawansa Thero Mw.Colombo 10

05.01.2007

All



Directors of Teaching Hospitals,Heads of Decentralized Units / Specialized Campaigns,

MSS / DMOO of Provincial and Base Hospitals

DUTIES AND RESPONSIBILITIES OF MEDICAL OFFICERS (LABORATORY

MEDICINE)

Ministry of health has initiated a comprehensive programme to Reorganize and strengthen the

laboratory services in order to improve the quality through achieving standards. A national

accreditation strategy has been planned with an ultimate goal of reaching international standards.As an important component of this series of activities certain actions will be taken to improve the

organization development of the laboratory. A trained MO in laboratory medicine will function

within the laboratory to assist the laboratory consultant to liase with clinical divisions as well as

improving the quality of reporting. All heads of institutions are advised to plan the recruitmentof MOO for your own laboratory.

Medical Officer (Laboratory Medicine) shall,

1. be designated as a Medical Officer (Laboratory Medicine)

2. serve in the post for a minimum period of 04 years3. under go a training for a period of 06 months in all four basic disciplines in the medical

diagnostic laboratory that is Microbiology, Bio-chemistry, Histopathology and

Haematology.

4 serve in either of four divisions as per instructed by the Head of the Laboratory.5. perform an investigation for which he is trained if instructed to do so by the laboratory

consultant for the benefit of the patients whose investigations are under his/ her purview.

6. be responsible to the Consultant of the Division he/she is attached to or Head of the

Laboratory or any other officer designated by the Head of the Institution for deliveringhis/her duties optimally.



7. be responsible to carry out effective programmes for liaison of clinical and laboratory

staff in relation to sample collection and report generation under the guidance of theConsultant/Head of the Laboratory

8. be responsible for clinical validation of laboratory reports under the guidance of

Consultant In-charge9. carry out effective programmes among medical and nursing team on rational use of laboratory investigation and role of Medical Officers and Nursing Officers in assuring

quality of lab reports.

10. attend the Laboratory Management Committee Meetings and carry out any specialactivities assigned to him/her by the Committee

11. carry out the duties related to maintenance of records and archiving of reports, research

works and maintenance of laboratory standards as instructed by the Head of the

Division/Head of the Laboratory12. perform the duties in relation to internal and external quality assurance of the

laboratory as instructed by the Head of the Division/Head of the Laboratory

13. collect pre examination samples for investigation as instructed by the consultant/ Head of Laboratory.

Job Description of Medical Officers in Laboratory Medicine

Duties of MO/ Path in Microbiology

1. Shall work under the supervision and guidance of a consultant microbiologist

2. Develop bench skills –

o learn procedures which will help to liase with technical and ward staff.

o detect clinically significant isolates and inform ward staff

o validate and sign urgent reports

o respond to clinical queries

3. Clinical liason

Visit wards when required for microbiological and infection control purposes

provide assistance to clinical staff regarding collection and transport of specimens

to laboratory and also to reference units

assist authorities in matters relating to control of out breaks of infection

4. Teaching



participate in teaching /training activities relating to infections/ infection control

activities

5. Perform other tasks delegated by the supervising officer, such as

assisting in improving the diagnostic service

setting up and maintaining a laboratory data base

Duties of MO/ Path in Histopathology

1. Performance of fine needle aspirations

Should write a short clinical history and relevant data on the request form.

Mention the nature of the aspirateSelect difficult and complicated cases and refer to Reg./ SR/ Pathologist

Select cases where „Urgent‟ reporting is necessary and refer for urgentstating and reporting.

2. Surgical cut-up

Should learn to handle biopsy sample

Refer difficult cases to the pathologistSelect urgent cases and instruct the technical staff to expedite processing.

3. Performing pathological autopsies

4. Assist with writing/ typing of reports and validation of reports.

5. Informing the wards about urgent reports6. Maintaining good report with the clinical and laboratory staff.

7. Supervise records and submit cancer statistics on time.

8. General supervision of laboratory work, waste disposal and cleanliness.

Duties of MO/ Path in Chemical Pathology

1. Clinical liasion

a. giving information about test protocolsb. checking whether protocols have been correctly followed

c. checking on justification and appropriateness of a test

d. answering queries on reports issued

e. interpretation of testsf. ringing to inform urgent or highly abnormal results to the ward

2. Collection of blood samples from out door patients and for special function tests



3. Clinical validation of reports before they are dispatched to the clinician (signing-out)

4. Including interpretative comments on reports where appropriate.5. Help with quality assurance work.

6. Help with clinical audits.

7. General supervision – ex. Waste disposal, laboratory safety8. Maintaining good report with the rest of the staff.9. Teaching

10. Observation:





General Circular Letter No: 02 - 17 / 2006

My No: D/LS/12/05Ministry of Healthcare and Nutrition

“Suwasiripaya”

385,Baddegama Wimalawansa Mawatha,Colombo 10,

20.01.2006To: All Provincial Secretaries of Health,

Provincial Directors of Health Services,Deputy Provincial Directors of Health Services,


MSS of General & Base Hospitals,

Heads of Decentralized Units / Specialized Campaigns,Heads of Institutions.

DUTIES OF MEDICAL LABORATORY TECHNOLOGISTS

Please note that this circular replaces the contents of my general circular letter no;

02/12/99 dated 12th

February 1999 on the same subject.

Medical Laboratory Technologists belong to Professions Supplementary to Medicine andare supposed to perform activities that are essential to complete the cycle of Patient management

in most of diseases by means of assisting either in diagnosis, treatment or rehabilitation. The

quality of the work delivered by these officers directly affects the quality of Medical officers‟performance hence affecting the quality of life of the patients. Therefore they are bound to

follow the directions of Medical officers, in order to be reliable, accurate, timely and up to date

as far as the technique is concerned.

These officers

1. have to perform for 8 hours a day during week days and attend to work during weekends asrequired by the institution.

2. should enjoy a scattered lunch interval so that their services will not be denied/ or interrupted

to patients at any time of the day.3. should be responsible to their superior officer in general administrative matters affecting day

to day work while in technical matters they should be responsible to the Consultant Medical

officer or to the delegated officer in the unit.

4. should be responsible for maintaining all relevant registers and documents pertaining to theservice.

5. should be collectively responsible and accountable for all assets, equipments and

consumables used in the unit in general unless otherwise the total responsibility is assigned to a

particular officer.6. being medically related professionals, are supposed to display a behavior of ethical

acceptance towards clients and other professionals.



7. should inform the Medical officer in charge of the patient immediately, about any activity

required to be taken to save life of the patient if so considered by you.8. should take the maximum possible effort to ensure the quality of the service offered while

catering to the real needs of patients.

9. should involve in continuous education as required by institution and the service.10. should perform any other duties related to service/institution as requested by Head of theInstitution.

** Special Grade MLT

1. The Special Grade Medical Laboratory Technologist shall be designated as

„Superintendent Medical Laboratory Technologist‟ in the Hospital or Institution.

2. He/She shall be held responsible to the Head of the Laboratory for supervision and

administration of all MLTT. However for the matters of interest mentioned above hemay discus with the Head of the Institution in consultation with Head of the Laboratory.

3. He shall supervise the maintenance of Attendance Registers of Medical Laboratory

Technologists and minor grades of the unit.4. He shall be a member of the Management Committee of the Hospital or Institution.

5. He shall under the direction of the Head of the Laboratory, co-ordinate with other

Institutions such as other hospitals, MSD, BME and Specialized Institutions etc. for

activities pertaining to maintenance and improvement of laboratory services in the unit.6. He shall also be responsible for the effective use of manpower related to laboratory

services within the unit.

7. He shall supervise duty arrangements and recommend leave, short leave, off days of allMLTT subordinate and minor grades of his unit.

8. He shall advice and guide all MLTT and other minor grades of the laboratory.

9. He shall make arrangements and co-ordinate the training programmes for the staff in his

unit.10. He shall supervise the dispatch of specimens to reference laboratories.

11. He shall take all precautions to minimize laboratory risks and hazards and educate the

laboratory staff on safety precautions.12. He shall supervise the maintenance of registers pertaining to the receiving of specimens,

maintenance of records and issue and dispatch of laboratory reports.

13. He shall co-ordinate the preparation of annual requisitions of equipment, glassware andchemicals for the Unit. He is expected to co-ordinate with MSD and obtains the annual

requisitions ordered by the different sections of the unit.

14. He shall make arrangements for the test checks of equipment, glassware, reagents and

chemicals of the lab.15. He shall supervise and make periodical reports on effective inter and intra institutional

use of equipment, glassware reagents, culture media and chemicals.

16. He shall supervise inventories, stores and consumable registers in the laboratory and

ensure they are in order.17. He shall make recommendations to the Head of the Laboratory on unserviceable

laboratory equipment and take steps to dispose.



18. He shall with the consultation of the Head of Laboratory make recommendations to the

Head of the Institutions with respect to local purchase of glassware, chemicals, reagents,culture media, laboratory supplies, library books etc.

19. He shall supervise the laboratories in small institutions in the region at the request of the

Provincial Health Authority made to the Head of Institution and report appropriately.20. His duty hours will be from 8.00 a.m. to 4.00 p.m. with 1 ½ hours lunch interval.21. He shall carryout any other duties related to his field assigned to him by the Head of the

Institution.

Please treat the contents of this circular as the duties of Medical Laboratory

Technologists approved to date.

** Senior Medical Laboratory Technologist (SMLT) (Preferably Class 1 MLT)

Senior Medical Laboratory Technologist Shall,

1. be in charge of a laboratory section is responsible for maintaining inventories of

equipments, registers of consumables, reagents etc.

2.

act and cover the duties of special grade MLT whenever he is requested to do so.3. Assist the laboratory administration in maintaining leave registers and supervise staff

attendance.

4. Supervise the work of other MLTT, lab orderlies and minor staff attached to the Lab.

5. be responsible for allocation of duties and compiling duty rosters.6. Responsible in maintaining laboratory statistics and other records.

7. assist the Consultants/Medical Officers in implementation of special projects, research

projects and studies,8. consult and convey matters of importance to superintendent MLT/ MO/Sectional Heads

or other delegated officer in the laboratory.

9. educate other MLTT on daily maintenance, calibration and proper use of laboratory

equipment, proper laboratory procedures and safety precautions.10. be responsible in ensuring timely calibration of equipments and making arrangements for

timely services and repairs of laboratory equipment.

11. take action to ensure proper disposal of all unserviceable in the laboratory. (forwardingGeneral 47 forms, obtaining condemned certificates, removal of unserviceable stores

from the laboratory and obtaining authority for writing off from inventories..

12. handle all duties pertaining to Health 500, 501, 503 & 605 and other relevant printedregisters .

13. assist the Head of the Institute/General Audits or stock verification officers in periodical

inspections of laboratory stores under his/her charge.

14. be responsible in preparation of annual estimates and laboratory indents for equipments,chemicals and glassware, diagnostic kits, consumables, stationeries etc. in consultation

with all stakeholders.

15. assist in the evaluation of glassware, chemicals, reagents kits etc when requested to do so

by the TEC.16. be responsible in distributing and issuing of laboratory items such as specimen

containers, bone marrow needles to wards and regional laboratories etc.

17. Ensure the quality of prepared and ready made reagents.



18. Participate in the Infection Control Committee when necessary or for an out break

investigation if requested to do so.19. arrange his staff to work in accordance with the laboratory workload.

20. be responsible for maintaining cordial relationship within the laboratory staff.

21. ensure essential safety measures are being practiced in the laboratory for decontamination(Glassware & Plastic ware) before being washed, recycled, reused and disposed of aslaboratory waste.

22. ensure that personal protective equipment (PPE) is supplied and safety measures for

healthcare workers are made available.23. assists in preparation and updating of relevant Tests Protocols and Standard Operating

Procedures (SOP) and ensure adherence to protocols.

24. be responsible for releasing accurate validated laboratory reports within the shortest

possible time.25. be responsible for proper dispatching and transportation of specimens to reference

laboratories.

26. be responsible for conducting quality assessments (Internal and External) in thelaboratory and maintaining relevant documents.

27. engage in routine laboratory work in addition to S/MLT duties whenever possibility.

** Other Medical Laboratory Technologists (Class I, II A & II B)

A. General1. Most senior officer should act as the MLT in charge, in addition to his/her

normal duty.2. He/She shall attend to ensure preparation and storage of all laboratory reagents and stains

(routine & special)

3. Operation, calibration and routine maintenance of all laboratory equipment, as per

relevant SOPs.4. Be responsible for preparation of glassware for laboratory investigations

5. Ensure adherence to standard operating procedures.

6. Maintain records of laboratory investigations.7. Prepare & issue containers for the collection of specimens for laboratory investigations.

8. Perform quality control tests.

9. take part in teaching and training programmes conducted by the laboratory.10. assist the consultants in setting up and conducting all training programmes.

11. supervise the duties of minor grades.

12. Adhere to standard safety practices in the lab.

13. be responsible for the proper treatment and disposal of laboratory waste and spillages.14. be responsible for the general cleanliness of the laboratory.

15. ensure standard procedures in receipt and allocation of samples to various sections.

16. ensure dispatch of relevant samples to reference laboratories without delay.

17. maintain good rapport with the hospital staff and the patients.18. Bring any deviation from normal procedure of any fault in the lab to the notice of the

senior MLT immediately.



19. ensure that the laboratory is properly opened and closed as instructed by the Head of

Laboratory.20. be collectively responsible with all other MLTT for the safety of laboratory belongings.

21. Shall perform the tests listed below and / or annexure

22. Shall perform any other new test as identified by the TAC from time to time.

B. Chemical Pathologya. Carrying out all investigations on specimens of blood, urine, cerebro spinal fluid and

other body fluids as identified by the TAC and the Head of the Laboratory (as perannexure – Tests to be performed by MLTT at various categories of hospitals, page No i

& ii)

b. In hospitals identified to carry out Immuno Assay, the MLTT should perform test

identified by the Head of the Laboratoryc. To perform endocrinological estimation as identified by the Head of the Laboratory

d. To perform other tests as identified in the annexure

e.

Preparation of specimen bottles for blood collection and 24 hours urine collection

C. Haematology

1. When medical officers are not in attendance, collection of blood specimens for

investigations2. Preparation of sample containers for haematological investigations eg. EDTA bottles

3. Full blood count; manual and mechanized

a) White blood cell countb) Differential cell count

c) Haemoglobin estimation

d) Haematocrit

e)

Mean corpuscular volumef) Mean cell haemoglobin

g) Mean cell haemoglobin concentration

h) Red cell counti) Platelets count

Perform the following tests4. Reticulocyte count

5. Pearl‟s stain

6. Staining for Red cell inclusion bodies such as Heinz bodies. HbH

7. Screening of Blood pictures8. Investigations for Haemoglobinopathies and Thalassaemias

a) Sickling

b) Hb Electrophoresis for variant Hb

c) Estimation of HbF (ADT), Kleihauer testd) Estimation of HbA2

e) Acid elution

9. Investigations of disorders of coagulation & Haemostasis



a) Bleeding Time

b) Clotting Timec) Prothrombin time

d) Activated Partial Thromboplastin Time

e) Thrombin timef) Clot retraction testg) Coagulation inhibitors detection

h) Coagulation factor correction studies

i) Factor assays j) Factor inhibitor studies

k) Dilute Russel‟s viper venom test

l) Estimation of D-Dimers

m) Protein C studiesn) Estimation of Anti Thrombin III

o) Protein S

p) Tissue thromboplastin inhibition testq) Platelet aggregation studies

10. Preparation of Bone marrow and Trephine touch films

11. Staining procedures (including special stains)

a. Leishman Stainb. Sudan black B

c. PAS

d. Neutrophil Alkaline phosphatase scoree. Nitroblue tetrazolium staining (NBT)

12. Methylene blue reduction for G6PD

13. Screening test for G6PD

14.

Hand‟s spectroscopy15. Detection & estimation of Methaemoglobin

16. Urine for Haemosiderin.

17. Detection of Auto immune antibodies Eg. ANA, ASMA18. Estimation of Complement, C3, C4

19. Estimation of Immunoglobulin, IgG, IgM, IgA

20. Osmotic fragility test21. Glycerolysis test

22. Ham‟s test

23. Heat stability test

24. Detection of warm & cold antibodies25. Detection of L.E. cells for SLE

26. E.S.R.

27. C-Reactive protein

28. Fibrinogen estimation29. RA factor

30. Immunological cell marker techniques

31. PCR techniques



32. Flow cytometry

33. Chromosomal studies

D. Histopathology

1. Receipt Numbering, Processing of Biopsy & Autopsy materials (fresh, fixed and frozen)for histopathological examinations.

2. Preparation of fixatives, decalcification reagent used in histopathological investigations

3. Arranging the specimen for dissection4. Assist dissections

5. Tissue processing, embedding, trimming, cutting and selection

6. Sharpening of microtome knives

7. Preparation of staining solutions and staining (routine and special)a. Haemotoxylene & Eosin stain

b. Vangieson stain for collagen fibres

c.

Massons trichrome stain for collagen fibresd. Mallorys Phophotungstic

e. Verhoffs technique for elastic fibres

f. Gorden and sweets technique for reticulin fibres

g. Zeil Neelson stain for Acid fast bacillih. Fites/Faraco stain for leprosy bacilli

i. Grocott‟s & Gomori stain for fungal studies

j. Pearl‟s stain for haemosiderink. Alcian blue stain for acid mucin

l. Mucicarmine for alkaline mucin

m. Congo red stain for amyloid

n.

Crystal violet technique for Amyloido. Periodic acid shift stain.

p. Silver stain.

q. Toludine blue for metachromatic granulesr. Buccal smear stain for Barbodies

s. Luxol fast stain for myelin

t. Gram stain for bacteria and any other special stains requested by theHistopathologist

8. Immunohistochemical and Immunoflorescent techniques eg. LCA, S100, GFAP

9. Preparation & staining of Cytological & Cytospin smears

10. Storage of Paraffin blocks, slides, specimens, request forms and records11. Staining of cervical smears by Papanicalaou techniques & screening and referral to the

Consultant Pathologist as per SOP.

12. Disposal of specimens by standard methods

13. Writing of reports and maintaining records.

E. Microbiology



Processing of specimens for microbiological investigations.

These include(a) Clinical samples

(b) Samples pertaining to Hospital acquired infections, activities of projects and public

health

Laboratory tests include

(a) Preparation, staining and examination of smears. Preparation and staining of

histopathological samples for fungi. Should be able to use different microscopesdepending on the test performed

(b) Processing of specimens, isolation and identification of different micro-organisms.

(c) Performance of antibiotic sensitivities by different methods. Eg. disk diffusion, broth

dilution and performing antifungal sensitivities(d) Preparation and sterilization of laboratory media and reagents

(e) Quality control of media and reagents

(f)

Maintenance of stock cultures of microorganisms(g) Testing of disinfectants for their efficacy

(h) Processing of food and water samples

(i) Processing of specimens pertaining to hospital acquired infections

(j) Performance of serological tests(k) Maintenance of test systems for viruses/. Eg. cell cultures, laboratory animals

embryonated eggs

(l) Propagation and maintenance of viruses (isolates, prototypes etc)(m) Preparation and quality testing of antigens and antisera

(n) Performance of molecular diagnostic methods

(o) Performance of various parasitological techniques

(p)

Permanent mounting of specimens and maintenance(q) Preparation and quality testing of vaccines

(r) Performance of laboratory investigations of animal house

(s) Preparation of mineral mixtures to be used in animal feeds(t) Supervision of disinfection and sterilization of equipment, areas and materials in the

animal centre

(u) Maintenance of mosquito colonies(v) Identification of vector mosquito larvae

(w) Testing of mosquito coils, mats and liquid repellents for biological efficacy

** MLTT in NBTS

Transfusion Laboratory Procedures

1. Preparation of washed cell suspensions for blood grouping2. Quality control of Antisera

3. ABO and Rh (D) grouping

4. Compatibility testing (cross matching)



5. Blood group ABO subtyping

6. Direct Antiglobulin Technique (DAT)7. Indirect Antiglobulin Technique (DAT)

8. Screening of unexpected Antibodies

9.

Identification of unexpected Antiboidies10. Antibody Titration11. Rare blood groups phenotype

12. Rhesus Genotyping

13. ISO – Haemagglutinin titre14. Haemolysin test and titre

15. Cold Agglutinin Test

16. Antibody Elutions Tests

17. Auto absorption (warm and cold auto antibody)18. Further investigations following blood transfusion reaction

19. Pre & post purchase evaluation of Antisera Diagnostic kits etc.

20.

Preparation of Red blood cells (Antibody Screening) panels21. Preparation of A-Lectin Antisera form Dolichos Diflorus seeds

22. Preparation of reagents & buffers etc.

23. (Human Lymphocytes Antigen) HLA – ABC/Class I Typing prior to Organ

Transplantation24. HLA Class I & II cross matching

25. HLA-DRDQ/Class 2 Typing prior to Organ Transplantation

26. HLA – B 27 and other specific markers Typing27. Screening of donor blood for HBs Ag (Hep. B Virus) by ELISA

28. Screening of donor blood for HBs Ag by Simple and Rapid Assay methods

29. Screening of donor blood for HCV antibodies Hep. C virus by ELISA method

30.

Screening of donor blood for HIV – 1 and 2 antibodies (Human Immunodeficiencyvirus) by ELISA

31. Screening of donor blood for HIV – 1 and 2 antibodies by Simple and Rapid Assay

Methods32. Screening and confirmation of donor blood for VDRL antibodies (Treponema

Pallidium) by VDRL antigen test and by VDRL carbon antigen test and TPPA.

33. Preparation of Cryo Precipitates – Blood components34. Preparation of Platelet concentrate

35. Preparation of Buffy Coats

36. Preparation of packed red cells

37. Preparation of FFP (Fresh Frozen Plasma)38. Preparation of washed red blood cells

39. Quality control checks on prepared blood components such as pH, blood counts –

WBD, RBC, platelet count, Factor VII assay etc.

40. Assisting & setting up of practicals relevant to training aspects.41. Operation, calibration & routine maintenance of all laboratory equipment

42. Document & Record keeping

43. Disposal of laboratory wastes



44. Laboratory procedures related to special Blood Transfusion Service Programme

organized by NBTS





My No: D/LS/NLP/Let/2010

Ministry of Health

“Suwasiripaya”

385,Baddegama Wimalawansa Mawatha,

Colombo 10,23.07.2010

To all-

Provincial directors and regional directors of health services

Directors of Teaching Hospitals and and Provincial General Hospitals

MSS of District general and Base Hospitals

Rational use of laboratory investigations in government hospitals

It has been brought to my notice by the committee appointed to Reorganize and Strengthen

Laboratory services in the country , that the existing laboratory services in governmenthospitals are not being properly used by the specialists, and other medical officers including

house officers, mainly due to inadequate communication of information between the Ward /OPD

staff and the laboratory staff. To overcome this situation the committee proposes to have

1. Monthly Committee meeting of the laboratory Medicine department of the hospital

The head of the institution must make sure that the meeting is held regularly on monthly basis

with the participation of the consultants in charge of units and any errors detected pertaining to

lab investigations are brought to the notice of the consultant in-charge and/or the chief MLT of the laboratory at this forum.A copy of the minutes of the meeting should be directed to the

DDG/LS for reference.

Arrangements should be made to enroll all newly appointed medical officers including interns tobe briefed on this topic by the laboratory consultants or the chief MLT at the orientation

program.

2. Avoidance of Duplication of investigations

Duplication of investigations occur when the same investigation is being requested from the

hospital lab as well as from the private lab,

incurring additional expenditure to the poor patient. The hospital has to bear an additional cost in

providing reagents, bottles and test tubes to collect samples for private labs, in addition to thetime spent on these procedures by the hospital staff in collecting samples.



A list of currently performed laboratory investigations by the hospital should be circulated

among all the medical officers regularly so that sending samples to private labs forinvestigations could be prevented.

3.

Increased vigilance by consultants in requesting for laboratory investigations.

The consultants in charge of units must exert vigilance on the following matters with regard to

ordering of investigations, and recording of reports in the BHT and diagnosis card .

a) The signature of the consultant is obtained in case of an expensive investigation for

in-ward patients.

b) The Medical officers carry out proper filling of investigation forms for routine

and “URGENT” investigations. Urgent request forms are signed by them indicating theWard number, date & time of ordering.

c) The Medical officers enter all investigation reports in the diagnosis card at the time

of discharge of patient.All heads of institutions are requested to circulate copies of this letter among the consultants of

the hospital. Your cooperation in this regard is very much appreciated.

Singed

Dr. H.R. U. Indrasiri Dr. U. A. Mendis Act. DDG (LS) DGHS

It would be mandatory for the directors/MSS of hospitals to conduct monthly meetings in theirrespective laboratories with the participation of all consultants. This would provide the

opportunity for consultants to have a closer relationship with the laboratory staff and to

clarifying their doubts.



My No: D/LS/NLP/2010

Ministry of Health

“Suwasiripaya”


Colombo 10,14.01.2011To all

Provincial Directors and Regional Directors of Health Services

Directors of Teaching and Provincial General HospitalsMSS of District General and Base hospitals

Increase Cost on Laboratory Tests

It has been brought to the notice of the Committee to Strengthen and Reorganize the

laboratory services that expenditure incurred by hospitals as well as by patients on laboratory

tests has increased due to various reasons and a few of them are indicated here for promptpreventive action.

Not ordering only the necessary investigations and not specifying the tests when

ordering.

Medical officers attached to hospitals routinely order full blood analysis which include allbiochemical parameters and also full blood counts at the same time. This kind of routine requests

arriving at the hospital laboratory has increased the workload of the laboratory staff in addition

to incurring unnecessary additional expenditure on laboratory consumables such as reagents andtest tubes.

In this regard you are hereby requested to get the Consultants in-charge of the units to instruct

the medical officers to order tests only when necessary and at the same time to specify the test.For example one can request for Blood urea without ordering for full blood analysis.

Lack of updated information to medical staff on currently available

investigations in the hospital laboratory.Duplication of investigations frequently results when the same test is requested both from

hospital and private sector laboratory.

It is the responsibility of the head of the institution to keep all categories of Medical officersupdated regularly on the currently performed investigations in the hospital and instruct the staff

attached to individual wards/units to maintain a separate register for investigations ordered from

private sector.

You may take up this as an important issue in your agenda at the Monthly laboratory meetingsand regularly assess the progress towards reducing the cost of laboratory tests on patients as well

as on government.

Your corporation in this regard is very much appreciated.Sgd.

Dr. V. S. P. Pannila Dr. U. A. Mendis

Director (LS) Director General of Health Services



My No: D/LS/14/04

Ministry of Health

“Suwasiripaya”


Colombo 10,17.08.2010

General Circular letter No. 02-11/2011

To All Provincial & Regional Directors of Health Services

Heads of Specialized campaigns

Directors of Teaching & Provincial General Hospitals

MSS of District General Hospitals & Base Hospitals

DMOO / MOIC of Divisional Hospitals

Notification of Newly Diagnosed Dengue Patients in Hospitals

Prompt notification of newly diagnosed dengue fever patients to epidemiology unit is of vital

importance in assessing the island wide dengue situation on a regular basis.

Medical officers attached to wards should make sure that the notification forms are filled

immediately after diagnosing a new Dengue patients and handed over to the nurse in charge of the ward.

Sister in- charge or the Nursing officer in- charge of the ward should ensure that these reports are

duly handed over to SGNO daily, after entering in the notification register maintained by theward.

The head of the institution must ensure that there is an established surveillance and notificationsystem available in the hospital to detect and report such patients to the epidemiology unit on

daily basis.

Infection control unit of the hospital may be entrusted with this duty if there are enough nursing

officers attached to that unit, but it is important to note that the primary duty of the infection

control nursing officer is to plan, organize and implement activities in the hospital in combating

infections.

All heads of institutions are requested to exert vigilance on the reporting system so that

epidemiology unit would be receiving information on a daily basis on the current situation of Dengue fever Island wide.

Dr. U. A. MendisDirector General of Health Services

Documents

Laboratory Service Important Circulars