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Organization and staffing ofdistrict laboratory services

Dr. Hafez AlsumairyDiagnostic & Molecular Microbiology

2014-2015

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Importance of laboratory practice in districthealth care• Surveillance, prevention, control, diagnosis and management of

diseases of greatest public health importance.Rural district health system consists of:1. Maternity centers, health centers and small urban clinics2. Referral system3. The district hospital (first referral hospital)4. Other government health related departments5. Non-government health sector organizations

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Why the laboratory is needed in districthealth care?• The laboratory has an important role in improving the:

● quality,● efficiency,● cost-effectiveness,● planning and management of district health care.

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What difference can the laboratory make tothe quality of district health care?1. Laboratory investigations increase the accuracy of disease diagnosis2. The laboratory has an essential role in screening

for ill health and assessing response to treatment3. The laboratory is needed to work with others in

reducing infection in the community and investigating epidemicsrapidly

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What difference can the laboratory make tothe quality of district health care?1. Laboratory investigations increase the accuracy of

disease diagnosisMisdiagnosis or late diagnosis can lead to:

• Incorrect treatment with misuse and waste of drugs.• Increased morbidity and mortality.• Hospitalization and need for specialist care.• Patient dissatisfaction leading to negative responses to future health interventions.• Underutilization of health facilities.• Lack of confidence and motivation of health personnel.• Increased risk to the community from inappropriate disease management and untreated

infectious disease.

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What difference can the laboratory make tothe quality of district health care?2. The laboratory has an essential role in screening for ill health and

assessing response to treatmentAt district level the laboratory is needed to:

• Assess a patient’s response to drug therapy.• Assist in monitoring the condition of a patient and to refer for

specialist care.• Screen pregnant women for anemia, proteinuria, and infections• Screen the contacts of persons with infectious diseases• Detect inherited abnormalities• Screen whole blood and blood products for transfusion transmitted

pathogens.20/10/2014 8

What difference can the laboratory make tothe quality of district health care?3. The laboratory is needed to work with others in reducing infection in

the community and investigating epidemics rapidlyThe public health functions of a district health laboratory service include:

• Detecting the source(s) of infection, identifying carriers, and contact tracing.• Participating in epidemiological surveys.• Assisting in disease surveillance and in the selection, application, and evaluation

of control methods.• Helping to control hospital acquired infections.• Participating in health education.• Examining designated community water supplies for indicators of fecal and

chemical pollution.• Responding rapidly when an epidemic occurs.

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In what ways can the laboratory contributeto achieving efficiency and cost effectivenessin district health care?1. The laboratory can help to reduce expenditure on drugs2. The laboratory can lower health care costs by identifying disease at

an early stage3. Significant savings can be made when the laboratory participates in

local disease surveillance and control

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1. The laboratory can help to reduceexpenditure on drugsa) Drugs can be used more selectively and only

when needed.b) Patterns of emerging drug resistance can be

identified more rapidly and monitored.

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In what ways can the laboratory contributeto achieving efficiency and cost effectivenessin district health care?

In what ways can the laboratory contributeto achieving efficiency and cost effectivenessin district health care?2. The laboratory can lower health care costs by

identifying disease at an early stagea) Reduce the number of times a patient may need

to seek medical care for the same illness.b) Prevent complications arising from advanced

untreated disease.c) Avoid hospitalization and further costly

investigations.

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3. Significant savings can be made when thelaboratory participates in local diseasesurveillance and control

• The spread of infectious disease can be containedmore rapidly.

• Disease control measures can be selected andtargeted more effectively.

• Sources of infection and disease carriers can beidentified.

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In what ways can the laboratory contributeto achieving efficiency and cost effectivenessin district health care?

What information can the laboratory provideto achieve rational health planning and goodhealth management?1. Reliable laboratory test results with relevant patient data, provide

information on the health status of a community, health patterns,and disease trends

2. Public health laboratory activities provide accurate epidemiologicalinformation for health planning

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What information can the laboratory provideto achieve rational health planning and goodhealth management?1. Reliable laboratory test results with relevant patient

data, provide information on the health status of acommunity, health patterns, and disease trends• Health care programs and location of health facilities.• Training of district health personnel and delivery of health

services.• Treatment schedules and changes in drug usage.• Financing of district health care programs.

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What information can the laboratory provideto achieve rational health planning and goodhealth management?2. Public health laboratory activities provide accurate

epidemiological information for health planning• Causes of ill health in the community and risk factors contributing

to the presence and spread of diseases.• Prevalence and incidence rates of important infectious diseases.• Effectiveness of health care programs, drug treatments, and

immunization programs.• Which methods have appropriate sensitivity and specificity to be

useful.

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Structuring of a district laboratory network

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Establishing a health center laboratory

• How will the results of tests be used?• Is the health center sufficiently well attended?• Is there a person trained to perform the required tests competently?• Is it to be visited regularly by the district laboratory coordinator?• Is it possible to organize a reliable supplying system?• Is the cost of running the laboratory affordable?• Can the health center provide adequate facilities for a laboratory to

operate effectively and safely?

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Establishing a health center laboratory• Can the health center provide adequate facilities for a laboratory to

operate effectively and safely?• Structurally sound with secure door(s), and burglar proof, insect screened

windows that provide adequate light and ventilation.• Sufficiently large to be sub-divided into areas for working.• Provided with running water.• Provided with separate sinks for cleaning laboratory-ware and hand-

washing.• Fitted with facilities for the safe disposal of specimens.• Wired for mains electricity or an alternative source of power.• Fitted with appropriate washable working surfaces, seating for patients

and staff, secure storage cupboards, and shelving.

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Activities of a health center laboratory1. To investigate by referral or testing on site, important diseases and health problems affecting the local

community• Bacterial and viral infections• Parasitic diseases• Other causes of ill health

2. To assist the health worker3. To collect and refer specimens for testing to the district laboratory4. To notify the district hospital laboratory at an early stage of any result of public health

importance5. To screen pregnant women for anemia, proteinuria and malaria6. To promote health care and assist in community health education7. To keep careful records8. To keep an inventory of stock and order reagents and other supplies in good time9. To send an informative monthly report

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District hospital laboratory

Staff1. One experienced laboratory officer2. Two to four assistants3. Several aides

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District hospital laboratory

Activities of a district hospital laboratory1. To decide which laboratory tests are needed2. To manage effectively the district laboratory network3. To prepare and implement standard operating procedures for all district

laboratory activities4. To support the work of the outreach laboratories by:

• Testing specimens referred and returning test results speedily• Confirming a test result• supplying standardized reagents etc..• Checking the performance of equipment.• Implementing and monitoring safe working practices.• Visiting each outreach laboratory every three months• Training health center laboratory personnel• Organizing a district external quality assessment scheme

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District hospital laboratory

Activities of a district hospital laboratory5. To refer specimens to the regional laboratory6. To participate in external quality assurance programmes7. To keep accurate records and send a report every three months to the district

management

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District specimen collection and transportservice1. Improved treatment and follow-up care2. More reliable information on health trends and the causes of disease in

the district3. More rapid investigation and control of epidemics4. Opportunities for detecting the emergence of drug resistance and

monitoring its spread in the community

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Requirements of a specimen referral system

1. There is close communication between staff of the community-basedhealth facilities and the district hospital laboratory

2. Outreach laboratories are supplied with specimen containers andlaboratory request forms.

3. Community health workers and district laboratory personnel are trainedin the correct collection, preservation, and dispatch of specimens.

4. Correctly completed documentation accompanies all specimens, andcareful records are kept of referred specimens and test reports.

5. There is a reliable and secure means of transporting specimensthroughout the year and returning test results with the minimum ofdelay

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Training and continuing education of districtlaboratory personnel1. The need for more appropriately trained district laboratory staff2. The need for improved quality, safety, efficiency and management in

district laboratory practice3. The need for relevant, better planned, indigenous training programs with

educational objectives4. The need for continuing on-site training and education to retain

competency and motivation

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Indicators of poor training of laboratorypersonnel1. Increase in the number of wrong test results.2. Delays in issuing reports or loss of reports.3. Frequent and serious complaints from those requesting laboratory tests and an

increase in requests for repeat tests as confidence decreases.4. Increase in the damage to equipment.5. Increase in the contamination of reagents and materials and in the amounts of

reagents used.6. Greater incidence of laboratory-acquired infections and other laboratory

related accidents.7. Poorly motivated staff and job dissatisfaction.8. More time needed to supervise new staff.9. Increase in laboratory operating costs.20/10/2014 28

Code of professional conduct for medicallaboratory personnel• Be dedicated to the use of clinical laboratory science to benefit mankind.

• Place the well-being and service of patients above your own interests.

• Be accountable for the quality and integrity of clinical laboratory services.

• Exercise professional judgment, skill, and care while meeting established standards.

• Do not misuse your professional skills or knowledge for personal gain, and never take anything from your place of work that does not belong to you.

• Be at all times courteous, patient, and considerate to patients and their relatives. Safeguard the dignity and privacy of patients.

• Do not disclose to a patient or any unauthorized person the results of your investigations and treat with strict confidentiality any personal information that youmay learn about a patient.

• Respect and work in harmony with the other members of your hospital staff or health center team.

• Promote health care and the prevention and control of disease.

• Follow safe working practices and ensure patients and others are not put at risk. Know what to do should an accident or fire occur and how to apply emergencyFirst Aid.

• Do not consume alcohol or take un-prescribed drugs that could interfere with your work performance during laboratory working hours or when on emergencystand-by.

• Use equipment and laboratory-ware correctly and do not waste reagents or other laboratory supplies.

• Strive to improve professional skills and knowledge and adopt scientific advances that benefit the patient and improve the delivery of test results.

• Fulfill reliably and completely the terms and conditions of your employment

20/10/2014 29*Taken from the Code of Ethics of the International Association of Medical Laboratory Technologists.

National association of medical laboratorysciences• To discuss with health authorities the activities and requirements of

laboratories at district, regional, and central level.• To promote national legislation regarding the professional registration

of laboratory personnel and certification of laboratories to practice• To discuss with health authorities• To organize laboratory training and qualification• To establish links with laboratory associations

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Thank youAny question

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