LESSON 2: DEFINING THE PRACTICE OF THE MEDICAL
TECHNOLOGY/ CLINICAL LAB SCIENCE PROFESSION
Definition and Nature of Medical Technology
Anne Fagelson – Branch of Medicine concerned with
the performance of laboratory
determinations and analysis used in the
diagnosis and treatment of diseases and
maintenance of health.
Ruth Heinemann – The application of principles of
natural, physical and biological sciences
to the performance of lab procedures
which aid in the diagnosis and treatment
of diseases.
Norma J Walters – The health profession concerned
with performing laboratory analysis in
view of obtaining information necessary
in the diagnosis and treatment of
disease as well as in the maintenance of
good health
Technology
- Physical artefact, machine, or instrument
- Activity or means to accomplish a goal
- As knowledge
• Improve the detection, diagnosis, treatment, and
monitoring of diseases. As such, it has linkages
with many other disciplines for specific
diagnostic or therapeutic purposes
• Testing plays a crucial role in the detection,
diagnosis, and treatment of diseases.
• Looks for the presences of bacteria, parasites,
and other microorganisms in the body,
abnormal cells, and presence of other fluids.
• Analysis of chemical contents in the specimen.
• Prepare specimens for examination and cell
count.
• Use of sophisticated and automated equipment
and computerized instruments.
• Analyze the results and relay them to
physicians
Medical Technology Practice Defined
RA5527 (Philippine Medical Technology Act of 1969)
Section 2 of the RA, as amended by R.A. 6132, P.D. 498,
and P.D. 1534 (Practice of Medical
Technology)
• Examination of tissues, secretions, and
excretions of the human body and body fluids by
various laboratory procedures and techniques.
• Blood banking procedures and techniques
• Clinical research involving human beings
requiring the use of and/or application of
medtech knowledge and procedure.
• Preparations and standardization of reagents,
standards, stains and others (exclusively for the
use of their lab).
• Lab quality control
• Collection and preservation of specimens
Medical Technology Code of Ethics (Revised by Rodolfo
Rabor)
Responsibility and Integrity
As I enter into the practice of Medical
Technology, I shall accept the responsibilities inherent
to being a professional; I shall uphold the law and shall
not engage in illegal work nor cooperate with anyone so
engaged; I shall avoid associating or being identified
with any enterprise of questionable character;
Objective and Teamwork
I shall work and act in a strict spirit of fairness
to employer, clients, contractors, employees and in a
spirit of personal helpfulness and fraternity toward
other members of the profession;
Respect
I shall use only honorable means of competition
for professional employment or services and shall
refrain form unfairly injuring, directly or indirectly, the
professional reputation, projects or business of a fellow
medical technologist;
Reliability, Accuracy, Fairness, and Honesty
I shall accept employment from more than one
employer only when there is no conflict of interest; I
shall perform professional work in a manner that merits
full confidence and trust carried out with absolute
reliability, accuracy, fairness and honesty; I shall review
the professional work of other medical technologists,
when requested, fairly and in confidence whether they
are subordinates or employees, authors of proposals for
grants or contracts, authors of technical papers or other
publications or involved in litigation;
Network
I shall advance the profession by exchanging
general information and experience with fellow medical
technologists and other professionals and by
contributing to the work of professional organizations;
Respect and Privacy
I shall restrict my praises, criticisms, views and
opinions within constructive limits and shall not use the
knowledge I know for selfish ends; I shall treat any
information I acquired about individuals in the course of
my work as strictly confidential, and may be divulged
only to authorized persons or entities or with consent of
the individual when necessary;
Law Abiding
I shall report any infractions of these principles
of professional conduct to the authorities responsible of
enforcement of applicable laws or regulations, or to the
Ethics Committee of the Philippine Association of
Medical Technologists as may be appropriate.
Professionalism
To these principles, I hereby subscribe and
pledge to conduct myself at all times in a manner
befitting the dignity of my profession.
Types of Clinical Laboratories (incomplete?)
1. Physician’s Office Laboratory (POL)
• Performs on-site diagnostic tests of specimen
from patients
• Ambulatory lab performing
• Low complexity Tests
2. Hospital Laboratory
• performing high volumes of routine tests
procedures
• May also serves as a reference lab for local
community
• STAT (Short Turn-Around Time)
• POINT-OF-CARE TESTING
- perform at the patient’s bedside using portable
instruments
- gives immediate results
3. Reference Laboratory
• Conduct specialized testing
• Specimens may be sent from all over the
country
• Usually contains complete sample analysis and
testing than POL
• Term is applied to any laboratory that does
additional analysis or testing of sample or
specimen
Why is Lab Testing Performed?
• Critical for Appropriate patient treatment
• Health care procedure to gain info that is not
found in the patient’s history
Reasons for Ordering Lab Testing
1. To assign a diagnosis
• For differentiate diagnosis test of the patient
• Confirm a clinical diagnosis
2. Prevention and early detection of diseases
• Routine keeping the patient healthy
3. Ongoing assessment of the patient’s
progress and treatment
• Monitoring the patient
• Req. frequent blood testing
• Verify the efficiency of the medical treatment
Phases of Lab Testing
1. Pre-Analytical Phase
• Proper specimen collection
• Specimen handling and identification
• Rigorous control measure to avoid errors
• Preparation of samples for testing
• Proper choice of test request
2. Analytical Phase
• Performance of the test that have been ordered
• Maintenance and calibration of lab equipment
and instruments
• Quality control of kits
3. Post-Analytical Phase
• Recording and reporting of lab results
• Storage and disposal of specimen after testing
• Patient notified of their results
Roles and Responsibilities of Medical Technology
Professionals
Perform Clinical Laboratory Testing
• Equipped with resources necessary for
performing procedures or any kind of
laboratory testing
• Performs from the basic to the most advanced
lab test.
Perform Special Procedures
• Special procedures in diagnosing diseases with
advanced diagnostic equipment.
Ensures Accuracy and Precision of Results
 • Impacts the interpretation of results by the
physician to provide proper medication for
treatment

Be Honest in Practice

Ensure Timely Delivery of Results

• Some request may require priority for

immediate release of results. Check notations
on STATS or Source of Request.

Demonstrate Professionalism

Uphold Confidentiality

Collaborate with Other Health Care Professionals

Conduct Research

• Assessing and revisiting knowledge

• For the development of skills, the field, and may be
used as future reference for patient care.

Involvement in Health Promotion Programs

Departments of Medical Technology (There are more)

1. Hematology (blood and blood forming tissues)

2. Clinical Chemistry (Chemistry of human health and
disease
3. Serology (immune serums, antigens or antibodies)
4. Immunology (structure and func of immune sys.)
5. Clinical Microscopy (Chemical and microscopic
analysis of specimen)
6. Histology (Tissues)
7. Pathology (Causes of diseases and the
modification in cell functions and changes)
8. Microbiology (microorganisms)
9. Parasitology (you know these people)
10. Cytology (Examination of the cells)

Practice of Other Laboratory Personnel

1. Pathologist (Clinical Lab Head)

2. Medical Lab Technicians (Assist medtech or
pathologist)
3. Phlebotomist (Draw blood)
4. Cytotechnologist (detects changes in body cells)
5. Histotechnologist (Preparation, processing, and
staining of biopsies and tissue specimen)
6. Nuclear Med Technologist
7. Toxicologist (Studies the effects of toxic
substances on the physiological func. of human
beings)
 LESSON 3: ETHICS 1. Direct (Baby in a serious condition)
2. Indirect
Human Problems (Daming Problema )
(Mother in a serious condition and need medical
• Logical (Reasoning)
treatment which requires the removal of the baby)
• Epistemological (Truth)
• Cosmological (Reasoning) 3. Induced (forced with the help of meds)
• Ethical (Morality) 4. Natural cases or Accidents
• Aesthetical (Art and Beauty)
Euthanasia
• Scientific Problems
1. Voluntary (with consent of the patient)
2. Non – Voluntary (unavailable consent of the
School of Ethics patient)
3. Involuntary (wants to live, but killed anyways)
Donal Harrington
Genetic Engineering
• Morality can be view as a law, inner conviction,
love, personal growth and social Genetic Screening
transformation.
• To Screen, choose, and select the genes for
James Gustafson proper detection of any genetic disease and
other chromosomal malfunctions.
Ethics Morality • Usually done for the early diagnosis of
Theoretical prescription/ Based on principles practiced
critiques by a particular community diseases.
• The nature of the food • Fundamental convictions of
• The nature of human human agent Genetic Interventions
person • Character of moral agent
• Criteria of judgement • Use of norms • Genetic control, therapy, and surgery
• Situational analysis • Intervene in the biological process and control
bad or defective genes
Ethical Relativism (Moral Relativism) Stem – Cell Therapy
• Morality is relative to the norms of a particular • Makes use of stem cells to treat or prevent
culture. diseases.
• Acknowledges societal diversity • Controversy due to the source of stem cells.
Ethical Pragmatism (Charles Sander Pierce) In Vitro Fertilization
• Further developed by William James • Deviation from natural process of fertilization
• Theory on knowledge, truth, and meaning rather
than morality.

Ethical Utilitarianism (Jeremy Bentham and John Professional Ethics

Stuart) • Covers the morality accepted behavior of
• Rightness or wrongness of actions is determined individuals in the workplace.
by their consequences. • The code of ethics of a particular profession
serves as the guiding principle in the ethical
Moral Issues practice of a profession
Abortion • Guide individuals in dealing with issues and
conflicts in the workplace in order for them to
(Article II Section 12) remain functional
Recognizes the sanctity of life and shall protect and
strengthen the family. It shall equally protect the life of
the mother and the life of the unborn

Types of Abortion
History of Medical Technology in a Global Context • Greatly contributed to the development of the
microscope
300BC – 180AD
• Simple-celled form: portists
Hippocrates (Father of Medicine) • Animalcules (Protozoa)

• Author of the Hippocratic Oath (oath of ethics Robert Hooke

taken by physicians)
• Seen the existence of cells through a
• Use of mind(logic) and senses as diagnostic
microscope
tools
• observing outward appearances MARCELLO MALPIGHI (Father of Histology)
• Taste urine and checks the color, and Listen to
• embryology of chicken
the lungs.
• Used and also contributed to development of FREDERIK DEKKERS
the Four Humors for Hippocratic Medicine
• urine contained protein; precipitate when boiled
Claudius Galenus of Pergamum with acetic acid
• Greek physician and philosopher THOMAS WILLIS
• fonder of experimental physiology
• Four Humors - measurement of body fluids in • best qualitative analysis of urine
relation to season • Diabetes Mellitus: “sweet urine”
1. blood: hot & mild/moist: Spring • Diabetes Insipidus: frequency of urination
2. phlegm: dry & mild/moist: Winter
3. yellow bile: hot & dry: Summer
4. black bile: cold & dry: Autumn
• diabetes = “diarrhea of urine”
• relationship between fluid intake and urine
volume

Medieval Times

• Medieval - “water casting” a.k.a. uroscopy

examination of urine and its varying color,
consistency, smell
• Physicians who failed to examine the urine
were subjected to public beatings

900AD

• 1st book detailing the characteristics of urine

(color, density, quality)

11th Century

• medical practitioners were not allowed to

conduct physical examination
• relied on patient’s description of symptoms and
their observations

15 - 16th Century

Hans and Zacharias Janssen

• Father and son invented the microscope
• Some say it is Hans Lippershey

17th Century

Antonie Van Leeuwenhoek

 MEDICAL TERMINOLOGIES AND ABBREVIATIONS -logist
-ac, -al, -ic, - Having a nature of, made of, caused
Order of the Parts of a Medical Term
ical by
Prefix – Root Words – Suffix -logic, -logical Study
-iatrics, iatry Medical Treatment
3 Basic Parts of a Medical Term
-logy Science of
Root Word

• Main Body of a word that denotes the meaning of List of Prefix

the word
• From Greek and Latin Words Mono 1 Epi/ Peri/ Around the
Circum object
Prefix Di 2 Endo/ Intra Inside/
interior/
• General modifier of the word
within
• Shows how meaning is assigned to the word.
Tri 3 Inter Between
Suffix Quad 4 Across Trans
Multi, Many Dia/per Through;
• It could be a procedure, condition, disease,
profession, study/science, part of speech Poly complete
• Focus on the suffix to know what the word is about Oligo Few Para Nearby
Nulli None Juxta Next to;
Rules of Combining Vowels beside;
adjacent
• Add a vowel after a root word if the first letter of a
suffix is a consonant Hyper Excess Tachy Rapid; fast
• Remove the last vowel of a root word if there is Hypo Under Brady/Brachy Slow
already a vowel in the first letter of a suffix Hemi, Half Ab Away
Semi
Example: Diplo Doube/ in Ad Toward
Enter/o + logy = Enterology pairs
Pan All Dis To separate
Enter/o + ic = Enteric (o is removed) Super, Above Leuko White
List of Root Words Ultra
Homeo Body Erytro Red
Cardi/o Heart Obstetr/o Preganancy Cephalo Head Cyano Blue
Crin/o To Secrete Onc/o Tumor Cerv Neck Chloro Green
Dermat/o Skin Opthalm/o Eyes Thoraco Chest Melan Black
Esthesi/o Sensation Orth/o Straighten Flav Yellow
Gastr/o Stomach Ped/o Child
Ger/o Old Age Ot/o Ear
Gynec/o Woman Laryng/o Larynx Singular and Plural Forms of Suffixes
Immun/o Immunity Path/o Disease Sing Plu Sing Plu Sing Plu
Enter/o Intestine Psych/o Mind is es ix ics on a
Geront/o Old Age Radi/o Radiation um a ax aces a ac
Ne/o New Pheumat/o Lungs us i ma s, nx nges
Nat/o birth Rhin/o Nose mata
Neur/o Nerve Ur/o Urine
List of Suffix
Medical Abreviations
-er, -ist
Specialist Ca Cancer
-iatricians
Dx Diagnosis
BP Blood Pressure ICU Intensive Care Unit
Spx Specimen
IV Intravenous
Lesson 5: Medical Technology/ Clinical Laboratory
HPF High-power Field
Science Education
LPF Low-Power Field
RBC Red Blood Cell Definition of Curriculum
WBC White Blood Cell • Learning standards, learning objectives, and
STI/STD Sexually Transmitted Infection/ Disease outcomes that should be achieved
NPO Nothing Per Orem • Knowledge and skills to learn
TAG Triglyceride • Means, materials, resources, and process
HDL High Density Lipoprotein • To process to gauge/measure student learning
ALT Alanin transaminase
ACP Acyl-carrier Protein Medical Technology Curriculum
• Commission on Higher Education (CHED) May 18,
ALP Alkaline Phosphatase
1994
NPN Non-protein nitrogen
o Republic Act no. 7722
BUA Blood Uric Acid
o Under the Office of the President of the
GTT Glucose Tolerance Test
PH
PCR Polymerase Chain Reaction
o Covers private and public college
ALL Acute Lymphoblastic Leukemia
institutions
AML Acute Myelogenous Leukemia
• Technical Committee for Medical Technology
NA Nutrient Agar
Education (TCMTE)
TB Tuberculosis
o Composed of leading academicians and
TCBS Thiosulfate-citrate-bile salts practitioners
MH Malignant Hyperthermia o Sets the standards among institutions offering
CBC Cell Blood Count BSMT/BSMLS and in monitoring and
MCV Mean Corpuscular Volume evaluating them.
MCH Mean Corpuscular Hemoglobin • BSMT/BSMLS
EEG Electroencephalograpgy o An allied health program
GS Gram Stain o 4-year program; 3 years of GE and prof courses
CNS Central Nervous System and 1 year of internship training
ABG Arterial Blood Gas • CHED Memorandum Order (CMO) No.13 of 2017
EDTA Ethylene Diamine Tetracetic Acid o A guide for institutions offering BSMT/BSMLS
CPD Citrate Phosphate Dextrose o Contains Goals, program outcomes,
ASAP As soon as Possible performance indicators, and the minimum
DOH Department of Health course offerings
CHED Commision on Higher Education o 1 unit = 1 hour, 3 units = 3h/week, 54h/sem = 18w
VDRL Venereal Disease Research Laboratories
AIDS Acquired Immunodeficiency Syndrome General Education (GE) Courses
AIDs Autoimmune disorders/diseases • Aim to develop humane individuals that have a
AMI Acute Mycardial Infarction deeper sense of self and acceptance of others.
BUN Blood Urea Nitrogen • Aim to develop foundational knowledge, skills,
STAT Short Term Around Time values, and habits necessary.
2PPBS 2 hours Postprandial Blood Sugar
AFS Acid Fast Stain Professional Courses
PCQACL Philippine Council for Quality Assurance in 1. Principles of Medical Laboratory Science 1
• Curriculum, practice of the profession, clinical
the Clinical Laboratories
lab, continuing professional education, biosafety
FBS Fasting Blood Sugar
practices, and waste management.
IU International Unit
2. Principles of Medical Laboratory Science 2 • The collection of specimen and the isolation and
• Phlebotomy deals with the basic concepts, identification of bacteria
principles, and application of the standard • Study of physiology and morphology of bacteria and
procedures in blood, collection, transport, and their role in infection and immunity
processing. • Antimicrobial susceptibility testing and development
• Study of pre-analytic, analytic, and post-analytic of resistance
variables. → Performing different → Characterization of
biochemical tests for colonies of bacteria
3. Community and Public Health for MT/MLS identification of growing in culture
• The promotion of community, public, and bacteria media
environmental health and the immersion and → Preparation of culture → Biosafety and waste
interaction of students media management
• Human ecology, demography, and epidemiology → Collection of specimen → Quality assurance and
quality control
4. Cytogenetics → Preparation of bacterial → Antimicrobial
• The analysis of nuclei Acids and their smear Staining of susceptibility testing
application to medical science smear
• Concepts and principles of hereditary and → Inoculation of specimen
inheritance (Genetic Phenomena, sex on culture media
determination and genetic defects rooted in
inheritance) 8. Clinical Parasitology
• Abnormalities and genetic disorder • Pathophysiology, epidemiology, life cycle, prevention
and control, and the identification of ova and/or
5. Human Histology adult worms and other forms seen in specimens
• Microscopic identification and differentiation of submitted for diagnostics purposes
cells • Study of animal parasites in human and their
• Study of fundamentals of cells, tissues, and medical significance
organs (Microscopic structures, characteristics, → Microscopic identification of diagnostic
differences, and functions) features of different groups of parasites
pathogenic to man
6. Histopathologic Techniques with Cytology → Different methods of preparing smear for
•Basic concepts and principles of disease microscopic examination
processes, etiology, and the development of
anatomic, microscopic structures, 9. Immunohematology and Blood Bank
characteristics, differences, and functions • Inheritance, characterization, and laboratory
• Preparation of tissue samples for macroscopic identification of red cells antigens and their
and microscopic examinations for diagnostic corresponding antibodies.
purposes • The app of these antigens and/or antibodies in
Performed for the lab by students: transfusion medicine and transfusion reactions
→ Tissue processing → Cutting of processed work-up
tissue Performed by students:
→ Mounting of → Performing biosafety → ABO and Rh typing → Coombs Test (direct
stained tissue and waste indirect)
for management → Blood donation → Transfusion reaction
microscopic process work-up
examination → Compatibility → Preparation of RBC
→ Staining testing suspension

7. Clinical Bacteriology 10. Mycology and Virology

• Fungi viruses as agents of diseases with emphasis Formation, lab analysis, disease processes, and
•
on epidemiology, lab identification and clinical correlation of lab results
characterization, and prevention and control → Routine Urinalysis → Pregnancy tests
→ Special urine chem → Other bodily fluids
11. Laboratory Management exam exam
• Planning, organizing, staffing, directing, and → Stool specimen chemical examination
controlling as applied in clinical laboratory setting
• Process of solving problems, quality assurance and 16. Clinical Chemistry 1
quality control, preparation of policy and procedure • Concepts and principles of physiologically
manuals, and other activities necessary to maintain active soluble substances and waste materials
a well-functioning laboratory in the body fluids
• Formation, lab analysis, ref values and clinical
12. Medical Technology Laws and Bioethics correlation with pathologic conditions
• Various administrative orders, and other approved → Instrumentation → Renal func test
legal documents → Qual assurance and → Protein testing
• Study of ethics as applied to health and health care ctrl
delivery and to human life in general → Glucose → Biosafety and waste
determination mngt
13. Hematology 1 → Lipid Testing
• Concepts of blood as a tissue
• Formation of cells, lab assays, correlation with 17. Clinical Chemistry 2
pathologic conditions, special hematology evaluation • Concepts and principles of physiologically
are given emphasis active soluble substances and waste material
• Quality assurance and quality control in lab present in body fluids
• Bone marrow studies • Endocrine glands and hormones, and their
→ CBC → Erythrocyte indices formation, lab analyses, and clinical correlation.
→ Hematocrit blood test → Reticulocyte count • Therapeutic drug monitoring and laboratory
→ Platelet count → Instrumentation analyses of drugs and abused substances, also
→ Red cell morphology → Osmotic fragility test toxic substances
→ Fragility test → ESR → Bilirubin tests → Clinical
→ Biosafety and waste → Qual assurance & Enzymology
mngt control → Electrolyte testing → Hormone testing
→ Prep of blood smear and staining → Drug tests

14. Hematology 2 18. Seminars 1 and 2

• Concepts and principles of hemostasis, and • Goes with the internship training
abnormalities involving RBC, WBC, and platelets • About Current lab analyses in MT practices
• Lab identification of blood cell abnormalities,
quantitative measurement of coagulation 19. Molecular Biology and Diagnostics
factors, and disease correlation are emphasized • Nucleic acid and protein molecule interaction
→ Special stain → Coagulation factor test within the cell
techniques • The molecular mechanisms of DNA replication,
→ Instrumentation → Identification of repair, transcription, translation, protein
abnormal RBC and synthesis, and regulation
WBC • Application of diff molecular techniques as tools
in the diagnosis.
15. Clinical Microscopy • Polymerase Chain Reaction (PCR) sabi ni miss
• Study of urine and other body fluids (excluding eh
blood)
Research Course
• Research 1: Introduction to Laboratory Science o Chairpersons (PRC license holders)→ Licensed
Research pathologist → 2 RMT
o Basic concepts and principles of research Medical Technologist Licensure Examination
applied in MT/MLS • Exams on March and August/ September
o Ethical principles • List of licensure exam provisions included in
• Research 2: Research Paper Writing and Republic Act 5527
Presentation 1. Exam course weights
o Research Methodology Clinical Chemistry 20% Blood Banking, 20%
o Research paper writing format (prescribed by Immuno & Sero
the institution and international research Microbio and 20% Clinical 10%
agencies) Parasito Microscopy
o Finished and completed research presentation Hematology 20% Histopathologic 10%
in a formal forum Tchq
(MT Laws and Bioethics and Laboratory Management
Clinical Internship are now included in the board exam)
• 4th year students 2. Passing requirements
• Academic institution conduct orientation to interns • Gen ave 75% and above
regarding the policies and guidelines (Internship • No 50% in any major courses
Training Manual) • Pass in at least 60% of the courses computed
• Completed and passed all the academic and according to their relative weights
institutional requirements, and other 3. 21 and above will be given a certificate and PRC
requirements are qualified for internship card (MT license). Younger than 21 will be register
• Undergo physical and lab exams before internship professional after his/her 21th bday
• Aims to apply the theoretical aspects of the 4. After 3 failed attempts, the examinee should take a
profession into practice. refresher course before the 4th attempt
• 6-month or 1-year rotation in a clinical lab (CHED- 5. Gen ave of 70% -74% qualify for Med Lab
accredited). Technician
• Rotation in different clinical lab sections
• 32h/week duty, not exceeding a total of 1664h in 1 Program Goals and Learning Outcomes
year 1. Demonstrate knowledge and technical skills needed
Clinical Chemistry 300h to correctly perform laboratory testing and ensure
Clinical Microscopy and Parasitology 200h reliability of test results
Microbiology 250h 2. Be endowed with the professional attitude and
Hematology 300h values enabling them to work with their colleagues
Blood Banking 200h and other members of the health care delivery
Histopathologic techniques and Cytology 100h system
Immunology and Serology 220h 3. Demonstrate critical thinking and problem solving
Laboratory Management 40h skills when confronted with situations, problems,
Phlebotomy 54h and conflicts in the practice of their profession
4. Actively participate in self-directed life-long
Licensure Examination learning activities to be updated with the current
• To identify qualified MT trends in the profession
• Professional Regulation Commission (PRC) 5. Actively participate in research and community-
o Under the Presidential Office of the PH oriented activities
o Administer licensure exams to diff professionals 6. Be endowed with leadership skills
• Professional Regulatory Board (PRB) for MT/MLS 7. Demonstrate collaboration, teamwork, integrity, and
o Under the PRC respect when working in a multicultural
o Tasked to prepare and administer the written environment
licensure exam for qualified graduates
Assessment
 Functions of Assessment Techniques • Provide feedback to the learners regarding their
1. It provides feedback on the progress of students strengths and weaknesses
toward the achievement of learning outcomes.
2. It identifies the flaws in the psychomotor skills and Job Opportunities
deficiencies in the theoretical knowledge and • Clinical laboratory • Perfusionist
conceptual skills of the student. Janitor (Jk)
3. It serves as a diagnostic tool to determine the • MT/Clinical Laboratory • Molecular scientist
capabilities of a student so that the teacher can
Scientist
prepare additional exercises and activities to
• Histotechnologist in an • Diagnostic product
address his or her needs during the assessment.
anatomical laboratory specialist
4. It serves as a motivation to further improve a
student’ skill set in a particular area. • Researcher/research • Public health
5. It provides information on students' response to a scientist practitioner
particular learning strategy which serves as a basis • Member of the • Health care leader
for retaining or changing a strategy. academe
6. It provides information to the teacher if there is
need to improve teaching and learning strategies. A graduate may also practice in the following fields
7. It determines the demonstrable changes in the • Molecular Biology • Forensic Science
attitude and behavior of students • Public Health and • Nuclear
8. It determines whether learning has taken place Epidemiology Medicine/Science
Formative During instruction • Veterinary Laboratory • Health Facility
Summative End of instruction Science Administration and
Management
Diagnostics Prior to instruction
• Food and Industrial • Quality Management
Microbiology
Assessment Tools
• Veterinary Science
1. Teacher-made written tests
• Very popular and widely used
• Quizzes, long exams, term exams, and
comprehensive exams
2. Reflection papers
• Require excellence writing skills
• Ability to put ideas, facts, and opinions in writing
in an organize, direct, and understandable
manner
• Connection and relationship between theory and
practice
3. Portfolios
• Collection of outputs that show progress at the
end of the course program
4. Performance Tasks
• Usually given in a laboratory component of a
course
• Measures the attainment of psychomotor skills
necessary for the correct performance of
practical procedures in the laboratory.
5. Oral examination and presentations
• Competency through Oral Communication skills
6. Rubrics
• Evaluation tool based on a particular criterion
LESSON 6: BASIC CONCEPTS ON LABORATORY 1974 Classification of Etiological Agents on the
BIOSAFETY AND BIOSECURITY Basis of Hazards
SARS(Severe Acute Respiratory Syndrome) CoV Virus 1969 Richard Nixon terminated the US biological
Incident
weapons program
8,000 infected Came from the lab
800 killed Cross contamination with 1984 American Biological Safety Association
West Nile virus (ABSA)
Due to inappropriate lab Happened in Singapore, • Held the ABSA annual conferences
procedures Taiwan, China, and
Vietnam 1983 WHO’s Laboratory Biosafety Manual 1st ed
1984 CDC and NIH’s Biosafety in Microbiological
Brief History of Lab Biosafety (NOT SURE if this is even
and Biomedical Laboratories
included in the exams)
• Development of laboratory safety practice
1907- Arnold Wedum
• Model of biosafety containment levels
1908 • Use of mechanical pipettors to
with certain agents
prevent LAI
1986 NIH (National Institutes of Health) Guidelines
• Laboratory-Acquired Infections (LAI)
for Research Involving Recombinant DNA
Ventilated cabinets → Biological safety
Molecules
cabinets
• The microbiological practices, equipment,
1909 Ventilated cabinet to prevent infection from
and facility necessarily corresponding to
mycobacterium TB
4 ascending levels of physical
1943 Franklin Roosevelt ordered the US biological
containment
weapons program
• Guidelines laid the foundation for the intro
Ira L. Baldwin (Scientific Calculator of Camp
of a code of biosafety practice
Detrick) =)director
Arnold Wedum
• Established the biological weapons
• One the pioneers of that provided the
program for defensive purposes
foundation for evaluating the risk of
• To respond if attacked by such weapons
handling infectious microorganisms
After Newell A. Johnson
• Recognizing biological hazards and
WWII • Designed modifications for biosafety at
developing practices, equipment, and
Camp Derrick
facility safeguards for their control
• Developed Class III safety cabinets and
Biosafety was an inherent component of biological
laminar flow weapons development
1967 Smallpox Biosafety officers adopted the administrative role of
• Increasing mortality and morbidity ensuring that the proper equipment and facility
• WHO pursued the eradication of the virus controls are in place

• Serious concerns about biosafety Brief History of Laboratory Biosecurity

practices were raised (Yup, wla pa cuz tinatamad at wla naman nagdiscuss si
• Virus stocked in CDC and in SRCVB miss)
VECTOR Local and International Guidelines on Laboratory
Biosafety and Biosecurity
(Same)
Different Organizations in the Field of Biosafety
1. American Biological Safety Association (ABSA) in
1984
• Promotes biosafety as a scientific discipline and
provides guidance to its members on the
regular regime
2. Asia-Pacific Biosafety Association (A-PBA) in 2005
• Acts as a professional society for biosafety
professionals
• Active members of the International Biosafety
Working Group are required to directly
contribute to the development of the best
biosafety practices
Singapore Brunei China
Indonesia Malaysia Thailand
Philippines Myanmar
3. European Biological Safety Association (EBSA) in
June 1996
• Aims to provide a forum for discussions and
debates on issues of concern and to represent
those working in the field of biosafety
4. Philippine Biosafety and Biosecurity Association
(PBBA) in….
• Multidisciplinary team with members
• Individuals from the executive, legislative, and
judicial branches of the gov’t
• National Laboratory Biosafety and Biosecurity
Action Plan Task Force (Sept 15, 2006) members
(steering committee and technical working
group) are included
o A long term goal of the association is to
assist the DA and DOH in their efforts to
create a national policy and implement
plan for lab biosafety and biosecurity
5. Biological Risk Association Philippines (BRAP) in….
• Works to serve the emergent concerns of
biological risk management in various
professional fields (health, agriculture, and
technology sectors)
• “Assess, Mitigate, Monitor”
Fundamental Concepts of Laboratory Biosafety and
Biosecurity
Biosafety
• Focuses on laboratory procedures and practices
necessary to prevent exposure to and acquisition of
infections
• To protect humans from germs
• “The containment principles, technologies, and
practices that are implemented to prevent
unintentional exposure to pathogens, and toxins, or
their accidental release” Laboratory Biosafety
Manual
Biosecurity
• The maintenance of secure procedures and
practices in handling biological materials and
sensitive information
• To protect germs from humans
• “the protection, control, and accountability for
valuable biological materials within laboratories, in
order to prevent their unauthorized access, loss,
theft, misuses, diversion, or intentional release”
- Biohazard symbol – by Charles Baldwin, an
engineer from Dow Chemical Company
Biosafety and Biosecurity Similarities
• Risk assessment and management methodologies
• Personnel expertise and responsibility
• Control and accountability for research materials
• Access control elements
• Material transfer documentations
• Training
• Emergency planning
• Program management among others
Classifications of Microorganisms According to Risk
Groups
Criteria of Risk Groups
• Pathogenicity • Mode of • Host range
transmission
• Availability of preventive measures & effective
treatment
 Pathogenicity Mode of Host range Availability BSL3 – Anteroom
transmission of
preventive
Agents corresponding to their BSL
measures
& BSL 1 – Bacillus subtilis, Naegleria gruberi, canine,
treatment hepatitis virus, and etc
1 Unlikely to Low individual Available
cause and BSL 2 – Hepatitis B virus, HIV, salmonellae, and
diseases community Toxoplasma species
risk
BSL3 – Mycobacterium TB, St Louis encephalitis virus,
2 Unlikely to Ingestion, Moderate Available
cause a through the individual risk Coxiella
significant skin, and via and limited BSL4 – Ebola Virus
risk facial community
mucous risk
membranes.
3 Serious and Same as Risk High individual Available
can be Group 2 plus risk and
lethal0 inhalation. limited to
moderate
community
risk
4 Life- Same with High individual Not LESSON 7: BIORISK MANAGEMENT
threatening group 3 and usually
or lethal community available Biorisk
risk • Biological toxins or infectious agents
• Unintentional exposure to unauthorized access,
accidental release or loss, theft, misuse, diversion,
or intentional unauthorized release of biohazards
Categories of Laboratory Biosafety According to Levels
Biorisk Management (BRM)
Biosafety level designations
• A system or process to control safety and security
Design features Equipment risks associated with the handling or storage and
Construction Practices disposal of biological agents and toxins in
Containment facilities Operational procedures laboratories and facilities
(agents) • Encompasses the identification, understanding, and
management aspects of a system in an interrelated
process

Components of AMP model

→ Risk Assessment → Mitigation → Performance
Procedures Evaluation

• The components are interdependent with one

another in supporting the biorisk management
system.
• Requires equal attention to each component
• Requires control measures be based on a robust
risk assessment, and a continuous evaluation of
effectiveness and suitability of the control
BSL 3 practices (additional)
measures.
• Laboratorians under medical surveillance and
receive immunizations for microbes Key Components of Biorisk Management
• Access to lab is always restricted and controlled Risk Assessment
Risk – The possibility that something bas or unpleasant
Facilities (Additional) will happen.
BSL1 – with doors to separate the work area - The likelihood that an adverse event involving a
BSL2 – Alternative methods of decontamination if specific hazard or threat will occur followed by
autoclave is not available consequences of that occurrence
Has self-closing doors Hazard – Anything in the environment (object, situation,
Sink and eye wash setting) that has the potential to cause harm
 RISK HAZARD work environment that can reduce or prevent
Risk refers to a situation Hazard is defined as exposure to hazards
which is exposed to something that can 4. Administrative controls
harm, danger or loss. cause harm, loss or - The policies, standards, and guidelines used to
danger. control risk
Potential of harm Potential source of harm - Proficiency and competency training for
Probability Physical object, situation laboratory staff
or setting - Biohazard or warning signage, markings, and
It can be expressed in It cannot be expressed in
labels, controlling visitor and worker access,
degrees. degrees.
and documenting written SOPs
- Standard operating procedures (SOPs)
Risk Assessment – identification of hazards and
5. PPE (Easiest to Implement and Least Effective)
characterization of risk that are possibly present in the
- Devices, equipment, and wearables worn to
laboratory
protect against chemicals, toxins, and
Process of Risk Assessment pathogenic hazards in the lab
1. Define the situation
- Identify the hazards and risk of the bio agents to Performance Evaluation
be handled. • A systematic process intended to achieve
- Identify the at-risk host inside and outside the organizational objectives and goals
lab • Ensures that the implemented mitigation measures
- Identify the work activities, procedures and are indeed reducing or eliminating risk
equipment, and lab environment • It is a continuous cycle of monitoring process
2. Define the risk • Provides direction to be able to come up with
- Review of how individuals inside and outside the reasonable and justifiable biosafety guidelines
lab may be exposed to the hazards Performance management – a reevaluation of the
- The manner of exposure overall mitigation strategy
3. Characterize the risk Performance Evaluation Procedure Cycle
- Compare the likelihood and the consequences 1. Identify the Key Issues of Concern
of infection-either qualitatively or quantitatively 2. Define OUTCOME Indicators and Metrics
4. Determine if risks are acceptable or not 3. Define ACTIVITIES Indicators and Metrics
- Process of evaluating the biorisk arising from a 4. Collect Data and Report Indicator Results
biohazard 5. Provide Findings from Performance Indicators
o Adequacy of any existing controls 6. Evaluate and Refine Performance Indicators
o Deciding whether or not the biorisk is
Note:
acceptable
The result of a robust risk assessment MUST be properly
Mitigation Procedures recorded, documented, and communicated to all
Mitigation – actions and control measures that are put stakeholders of the organization.
into place to reduce or eliminate the risks associated
Only through this final process (Performance
with biological agents and toxins
Evaluation) that findings could be decided upon, given
Hierarchy of Controls in Mitigation (According to appropriate action, to be able to provide and establish a
rank) clear manifestation of implementing the fundamental
1. Elimination (Most difficult and most effective) concept of biosafety and biosecurity in the laboratory
- Total decision not to work with a specific bio
Decontamination
agent or even not doing the intended work
• A process of cleansing an object/substance
2. Substitution
• Render an area, device, item or material safe to
- The replacement of the procedures or biological
handle
agent with a similar entity in order to reduce the
• Decontaminate equipment and work surface
risks
routinely
3. Engineering Controls
o With proper disinfectant for agents
- Physical changes in work stations, equipment,
o After spills or contamination
production facilities, or any other aspect of the
o Whenever work is done
 o Decontaminate equipment before removal Contaminated solids Animal tissue and cage
from lab waste
o Decontaminate potentially infectious
materials before disposal or reuse What Should not be Autoclaved
• Corrosives, flammable, toxic, and radioactive
Sterilization materials
• Act/process, physical or chemical, that
destroys/eliminates all forms of life, especially
microorganism
• It is absolute. How? Coagulation and denaturation of
enzymes

Disinfection

• Generally, a less lethal process than sterilization

• It is the elimination of nearly all recognized
pathogenic microorganisms
• But not necessarily all microbial forms

Levels of Disinfection

High level (Sporocides)

• Kills all microorganisms except high numbers of
bacterial spores Steps of not really sure ano to na steps hehe
• 5 - 10 minutes’ exposure → Define the Situation
• Ex aldehydes, hydrogen peroxide, peracetic acid → Identify the hazards
→ Consider host
Intermediate level (Tuberculocides)
→ Define work activities and lab environment
• Kills M TB var Bovis and all vegetative bacteria,
fungi, and most viruses → Define the risk
• Minimum 20 minutes’ exposure Inside lab Outside lab Animals Exposure
• Ex: phenolics iodophores chlorides alcohols route
→ Characterization of the risk
Low Level (Hospital Germicides used for - Likelihood - Consequences
Housekeeping) → Mitigation measures (hierarchy of controls)
• Kills most vegetative bacteria and some fungi, but
not M TB var Bovis IDK what these are but extra info =)
• Minimum 20 minutes’ exposure • BSL 1 Contaminated Petri dish →decontaminate
• Ex quaternary ammonium compounds with 10% bleach for 2hrs if no autoclave is available
Autoclave • Solution used to decontaminate (IDK)
• Strong, pressurized and steam-heated vessels • Isolation of unknown microbes from the
• 121 C (250F) at least 15 psi for 15 minutes (Time and environment
temp varies depending on what is being autoclaved) • Plating and sealing in BSL 1
• Most dependable system available for • Sub-culturing BSL 2
decontamination • Autoclave book keeping is practiced

Autoclave Hazards Summary

• Explosive breakage of glass vessels during • No disinfectant is ideal
opening and unloading • There are number of factors that determines how
• Burns arising from careless handling of vessels effective a particular disinfectant is
containing boiling liquids • Microorganisms have various innate resistance to
• Burns from physical contact disinfectants
• Autoclaves use wet heat at appropriate
What can be autoclaved temperature, time, and pressure
Pathogenic plant matters rDNA • Wet heat is more effective than dry heath in
Culture and stocks of Discarded live and disinfecting
infectious agent attenuated vaccines • Validation of equipment is necessary
 1. Institution-based

LESSON 8: NATURE OF THE CLINICAL LABORATORY Operates with the premises or part of an institution
(Hospitals, schools, med clinic, medical facilities)
Clinical Laboratory
• The place where specimens collected from 2. Free-standing

individuals are processed, analyzed, preserved, Not part of an established institution

and properly disposed Free-standing out-patient clinical lab is a common

• Main task is to provide accurate and reliable example

information to medical doctors for the

diagnosis, prognosis, treatment, and According to Ownership
management of diseases 1. Government-owned
• 70% of all decisions performed by MD are based Clinical labs are owned, wholly, or partially, by national
on laboratory test results or local government units
• Actively involved in research, community
Laboratories of DOH-run gov’t hospitals
outreach programs, surveillance, infection
San Lazaro Hospital, Jose R. Reyes Memorial Medical
control in the hospital and community settings,
Center, UP-PGH
information dissemination, and evaluation of the
applicability of current and innovative diagnostic Local gov’t-run hospital-based clinical Labs of
technologies Ospital ng Maynila Medical center, Sta. Ana Hospital,
and Bulacan Medical Center
Factors that Can Affect the Activities Done in the
2. Privately-owned
Lab
Owned, established, and operated by an individual,
1. Shifting demographics
corporation, institution, association, or organization.
2. Emergence of new and re-emergence of
infectious and non-infectious diseases, According to Service Capability
3. Demand for a more efficient and effective Primary Secondary Tertiary Category
workflow Category 10sqm Category 20sqm 60sqm

4. New government institutional policies Routine Primary lab tests All test of sec
urinalysis BGC category
Classifications of Clinical Laboratories
Routine stool BUN Immunology and

According to Function exam BUA serology

Routine Blood creatinine Microbiology
1. Clinical Pathology
hematology Cholesterol Bacteriology
Concerned with the diagnosis and treatment of
Complete blood determination Mycology
diseases performed through lab testing of blood and
count Quali platelet Special clin
other body fluids
WBC differential count chemistry

2. Anatomic Pathology count Gram stain Special hematology

Concerned with the diagnosis of diseases through Qualitative KOH mount Immunohematology
platelet count Crossmatching and blood banking
microscopic examination of tissues and organs
Blood typing
According to Institutional Characteristics
 Gram staining 6. Inspection (every 2 yrs. or as necessary)
7. Monitoring
National Reference Laboratory 8. Issuance of License (License is non-
A laboratory in a gov’t hospital designated by the DOH transferable)
9. Terms and Conditions of License
to provide special diagnostic functions and service for
Section 8: Violation
certain diseases
• Operation of a clinical lab w/o a certified
Laws on the Operation, Maintenance, and Registration pathologist or w/o a RMT
• Changes of ownership, location, head of laboratory
of Clinical Laboratories in the Philippines (I SUGGEST
or personnel w/o informing the BHFS and/ or the
YOU READ THE BOOK ABOUT THIS SECTION) CHD
• Refusal of BHFS inspection of clinical lab during
Republic Act No. 4688 (Clinical Laboratory Law June 18 reasonable hours by authorized person(s)
1966) • Gross negligence
• Any act or omission detrimental to the public
Administrative Order No. 59 s. 2001 (New ver. Revised • Provincial, City and Municipal Health Officers are
AO 2007-0027) I WOULD ADVISE READING THE BOOK authorized to report to the CHD and BHFS
ABOUT THIS PART Section 9: Investigation of Charges or Complaints
Violating RA 4688 or any of suspend, cancel, or revoke
Section 1: Title these rules and regulation for a determined period of
time the license
Section 2: Authority Any person w/o proper Imprisonment 1mo ≤ X ≤ a
BHFS – Exercise the regulatory functions under these license who still operates a year OR a fine 1,000≤ X ≤
rules and regulation clinical laboratory 5000 OR Both
Any clinical lab operating Closed upon order issued
Section 3: Purpose w/o a valid licensed or a by the BHFS/CHD (Hindi
revoked/cancelled early close ha)
To protect the health of the people and in compliance
with quality standards
Section 10: Modification and Revocation of License
Section 4: Scope
Section 11: Repealing Clause
Section 5: Classification of Laboratories Rules and regulation shall supersede all other previous
official issuances
Section 6: Policies
Section 12: Publication and List of Licensed Clinical
Section 7: Requirements and Procedures for Laboratories
A list of licensed clinical laboratories is published
Application of Permit to Construct and License to
annually (every 1 year)
Operate
Section 13: Effectivity
1. Application for permit to Construct Rules and regulations take affect 15 days after its
publication
2. Application for New License
3. Application for renewal of license ANNEX A
• Certificate from EQAS is required for renewal that I. STAFFING
states “satisfactory” • Managed by a licensed physician certified by the
• 90 days before the expiry date of the license PBP or a pathologist
• Physician who undergo 3 months of training
4. Permit and License Fee
certified by BHFS
5. Penalties
• Qualified and adequately train personnel
1000 pesos penalty for late renewal + 100 for
each month of delay
• Sufficient number of RMT proportional to the • Deals with the enumeration of cells in the blood and
workload and shall be available at all times other body fluids
• At least 1 MT per shift
• Coagulation studies focus on blood testing for the
• Staff development and education program
determination of various coagulation factors
II.
PHYSICAL FACILITIES
• Bone marrow examination
• Well-ventilated, adequately lighted, clean and safe
• Sufficient working space Clinical Microscopy
• Adequate water supply
1st area: routine and other special examinations of urine
• 10 sqm • 20sqm • 60sqm
Primary Secondary or urinalysis
Tertiary
2nd area: the examination of stool or routine fecalysis
III. EQUIPMENT/INSTRUMENTS
Blood Bank/Immunohematology
IV. GLASSWARES/REAGENTS/SUPPLIES • Main Activities: Blood Typing and Compatibility
V. WASTE MANAGEMENT testing
Guidelines of the DOH and the local government for
• Screening for all antibodies and identification of
adequate and efficient disposal
antibodies and blood components used for
VI. QUALITY CONTROL PROGRAM
Internal and External Quality Control Program transfusion
• Most critical section in the clinical laboratory
VII. REPORTING (name and signature of RMT and
Pathologist, except emergency cases) Immunology and Serology
VIII. RECORDING • Analysis of serum antibodies in certain infectious
All laboratory records shall be kept on file for atleast agents
1yr except anatomic and forensic pathology records are
kept forever (may forever) Anatomic Pathology
IX. LABORATORY FEES Histopathology/Cytology
• Tissue processing, cutting into sections, staining,
Sections of the Clinical Laboratory and preparation for microscopic examination by a

Clinical Chemistry pathologist

• For the testing of blood and other body fluids to Specialized Sections of the Laboratory
quantify essential soluble chemicals including Immunohistochemistry
waste products useful for diagnosis of certain • Combines anatomical, clinical, and biochemical

diseases techniques where antibodies bounded to enzymes

and fluorescent dyes are used to detect presence of
Microbiology (Bacterio, mycobacterio, myco, &
antigens in tissue
virology)
• Useful in the diagnosis of some types of cancers
• More focused on the identification of bacteria and
fungi on specimens received. Molecular Biology and Biotechnology
• Primarily using different enzymes and other
• Specimens usually submitted are blood and other
reagents, DNA and RNA are identified and
body fluids, stool, tissues, and swab
sequenced to detect any pathologic
Hematology and Coagulation Studies conditions/disease processes
• Uses Polymerase chain reaction (PCR)
 Laboratory Testing Cycle National Kidney Hematology and Coagulation
Pre-analytical Phase and Transplant
1. The receipt of the lab 3. Specimen collection Institute (NKTI)
request Research Institute Microbiology and Parasitology
2. Patient preparation 4. Proper transport and of Tropical
processing of Medicine (RITM)
specimen to the Lung Center of the Clinical Chemistry
clinical lab Philippines (LCP)
East Avenue Drugs of abuse
Analytical Phase
Medical Center
• Actual testing of the submitted/collected specimen
(EAMC)
Post-Analytical Phase San Lazaro Infectious immunology
• Transmission of test results to the medical doctor
Hospital STD-AIDS hepatitis B surface antigen,
for interpretation
Cooperative Center HIV, and hepatitis C virus
• Turnaround time (TAT)
Laboratory
• Application of doctor’s recommendations
(SACCL)
• Diagnosis and treatment are based on the
generated Data TAT Turnaround Time
DOH Department of Health
EQAP External Quality Assurance Programs
BHFS Bureau of Health Facilities and Services
Quality Assurance in the Clinical Laboratory QC Quality Control
FBS Fasting blood sugar
Quality Assurance HbA1c Glycosylated hemoglobin for the dxg of
diabetes
• Ensure reliability of test results HDL and LDL High- and Low- density liproproteins
TAG Triglycerides
• Organized, systematic, well-planned, and regularly BUA Blood uric acid
BUN Blood Urea Nitrogen
done with the results properly documented and TP Total protein
TSH Thyroid-stimulating hormone
consistently reviewed. T3 Triodothyronine
T4 thyroxine
IQA Internal Quality Assurance
Internal Quality Assurance System (IQAS) CQA Continuous Quality Improvement
• Includes day-to-day activities that are undertaken NEQAP National External Quality Assurance
Program
in order to control factors or variables that may CBC Complete blood count
PCR Polymerase Chain Reaction
affect test results QA Quality Assurance
EQAS External Quality Assurance System
NRL National Reference Laboratories
External Quality Assurance System (EQAS) NKTI National Kidney and Transplant Institute
RITM Research Institute of Tropical Medicine
• Is a system for checking performance among LCP Lung Center of the Philippines
EAMC East Avenue Medical Center
clinical labs and is facilitated by designed external SACCL San Lazaro Hospital STD-AIDS Cooperative
Center Laboratory
agencies. HBsAg Infectious immunology hepatitis B surface
antigen
• NRL is the DOH- designated EQAS HIV human immunodeficiency virus
HCV Hepatitis C virus
• Unknown sample with known test results is
regularly sent to a clinical lab for testing
NRL-EQAS
 LESSON 9: PROFESSIONAL ORGANIZATIONS
Professional Organization
• Assemblages of professionals within a
specialization or professional field
• For the purpose of collaboration, networking, and
professional development or advancement
• Opportunities for professional growth and
continuing education
• Pay membership fees and monthly or yearly dues
to avail or access the benefits and services
• Membership to an APO or AIPO is a requirement for
hiring, retention, and sometimes for the renewal of
professional licenses.
• APO or AIPO is accredited by the PRC and PRB
Benefits of Membership in Professional Organization
Professionalism
• Adhering to the set of rules or code of ethics
prescribed by the professional society
• Adherence to prescribed rules shapes the conduct
of a professional
Profile
• Build the career portfolio of a professional
• Provide opportunities for speaking engagements,
career specialization, publication in research
journals, and even scholarship and training
programs abroad
Perks
• Monetary discounts on registration fees for
activities
• Discounts offered exclusively for members only
Network
• Provide opportunities for building networks in the
field
• Creating long-term linkages and connections with
other professionals in the field
Education
• CPD activities for their members through
conventions, seminars, for a, workshops, and other
activities of similar nature
• Publish research journals serve as avenues for
improving the body of knowledge
Recognition
• Awards are given to the outstanding members and
leaders in the practice and special fields (such as
research, public service, and community
engagement)
Types of Professional Organization
1. Accrediting Organization
• Curricular programs in educational institutions
• Education institution applying for accreditation will
be visited by a technical committee of experts from
the accrediting agency to verify its compliance to
the standards of quality education such as PAASCU
and PACUCOA
2. Crediting/Certifying Organization
• Provide certification exams for professionals
• Required to renew their licenses within a specified
duration
• Not common in the PH due to the presence of a
government professional regulatory body, the PRC
• Examples of international Credentialing/certifying
agencies for MT: AMT, ASCP, ISCLT, and NCA
3. Professional Societies
• Contribute to the continued development of a
specific group of professionals.
• Membership in a national society follows
membership in its local affiliate/chapter
Examples of Local Professional Societies for MT:
PAMET, PASMETH, BRAP, PBCC, PCQACL, PSM,
PhBBA
Examples of International Professional Societies
for MT: ASCP, AMT, AACLS, AAMLT, ASCLS, IAMLT,
IFBLS, and ISCLT.
Professional Journals
• Publications containing scholarly studies on
specific professional fields.
• Can also serve as a forum for new articles
• Prepared by professionals in the field and are peer-
reviewed by experts
• Help disseminate such work to other practitioners
in the field
• Publishing research studies also contribute to the
credibility of an individual
PAMET (September 15,1963)
• The national professional organization of RMT in the
PH. It is a non-stock, non-profit organization
• Crisanto G. Almario – the “Father of PAMET”
• FOUNDED at the Public Health Laboratory in
Quiricada St., Sta. Cruz, Manila
• Sept 15, 1963 -1st Organizational meeting of PAMET
in Public Health Laboratory 11 representatives from
allied medical professions and 9 from 5 schools
offering MT
CEU UPIPH UST FEU PUC
 • Dr. Narciso Albarracin (secretary of the DepEd)
• Sept 20, 1964 - 1 national convention and election
st
designated Dr. Serafin Juliano and Dr. Gustavo U.
of officers at FEU Reyes to organize an association of deans/heads of
• Charlemagne T. Tamondong – 1st president schools of MT and public health
• Incorporated and registered at the SEC on Oct 14, • 1st member schools were UST, FEU, CEU, SJDEFI,
1969 by Nardito D Moraleta PWU, and MMC
• Registration No. 39570 • Registered at SEC on Oct 6, 1985
• 57 Chapters in total • The founding organization of ASIAN Association of
Affiliation with Local Professional Organization Schools Medical Technology (AASMT)
COPHA, PFPA, CHAP, PCQACL, and AAHON • Dean Bernard U. Ebuen - Current PASMETH
Affiliation with International Level Organization president
AACLS, AAMLS. IFBLS, APFCB, IFCC
President Dr. Gustavo Reyes
VP Dr. Serafin Juliano
Secretary/treasurer Dr. Velia Trinidad
Press Relations Officer Dr. Faustino Sunico
PAMET Insignia
1. Circle – the continuous involvement where practice PASMETH Seal
and education must always be integrated 1. Circle – the continuity of learning and the never-
2. Triangle – The trilogy of love, respect, and integrity ending quest for excellence in the academic field
3. Microscope and Snake – the science of MT 2. Diamond – 4 corners represent the 4 objectives of
profession the association
4. Green – the color of health 3. Microscope – Represents the field of MT and Public
5. 1964 – the year the 1st PAMET Board was elected Health
PAMET Core Values 4. 1970 – The year the association was founded
• Integrity • Commitment • Unity
PASMETH Objectives
• Professionalism • Excellence
• to encourage a thorough study of the needs and
Roster of PAMET Presidents problems of Medical Technology and Public Health
Charlemagne T. Carmencita P. Romeo Joseph J education and to offer solutions to them
Tamondong (1st) Acedera Ignacio • to work for the continuous development of Medical
Emergence of the Image Building Golden Celebration
profession
Technology and Public Health education in order that
Nardito D. Moraleta Marilyn R. Atienza Ronaldo E. Puno the profession will be of maximum service to the
Professional Proactivism (present) country
Recognition Empowerment
Felix E. Asprer Norma N. Chang • to take a united stand on matters which affect the
Legislative agenda International interests of Medical Technology and Public Health
Leadership
education
Bernardo T. Agnes B. Medenilla
Tabaosares Organizational • to seek the advice, aid, and assistance from any
Celebration of the Dynamism government or private entity for the fulfilment of the
Profession
association's aims and purposes.
Angelina R. Jose Shirley F. Cruzada
Career Advocacy Interdisciplinary
Networking PHISMETS
Venerable C. V. Oca Leila M. Florento • the national organization of all medical
Educational Global Perspectives
Enhancement
technology/medical laboratory Science students
• 1st organized in 2002 by the Dr. Zenaida C. Cajucom
PASMETH (1970) • 1st PHISMETS advisers were Prof. Marilyn Bala,
• Is the national organization of recognized schools Prof. Nova Aida C. Cajucom and Prof. Zennie B.
of medical technology and public health in the PH. Aceron
• Hopes of maintaining the highest standards of • Reorganized on Nov 25, 2006 by Dir. Magdalena
MT/public health education and fostering closer Natividad and Dean Bernard Ebuan
relations among MT/Public Health schools
• 1st MT Students Congress at Our Lady Fatima PAASCU Philippine Accrediting Association of
University in Valenzuela City Schools, Colleges, and Universities
• Every May - Annual Medical Technology Student PACUCOA Philippine Association of Colleges and
Leadership Training and Strategic Planning Universities Commission on
Accreditation
• 1st Leadership Training Seminar was held at ATI-
CAR Benguet State University in La Trinidad, AMT American Medical Technologist
Benguet on May 13, 2010 ASCP American Association of Clinical
• A Council of Student Advisers (COSA) is designated Pathology
yearly during the leadership to help facilitate and ISCLT International Society for Clinical
oversee the PHISMETS national organization and its Laboratory Technology
local chapters NCA National Certifying Agency for Medical
Laboratory Personnel
PHISMETS Seal
1. 3 Circles – Continuous active involvement of the 3 PAMET Philippine Association of Medical
provinces in the national transforming venue of Technologist, Inc
MLS students PASMETH Philippine Association of Schools of
Medical Technology and Public Health,
2. Laurel – Nature and the continuation of life every
Inc
year PHISMETS Philippine Society of Medical Technology
3. Green Letters – Represent the color of health Students
4. 5 Bubbles from a Test Tube – the 5 objectives BRAP Biorisk Association of the Philippines
embodied in the constitution of the organization PBCC Philippine Blood Coordinating Council
5. 15 Interconnected Molecules Outside a Test Tube – PCQACL Philippine Council for Quality Assurance
the unity of the 15 board schools exploring various in Clinical Laboratories
possibilities and aiming towards the integral PSM Philippine Society of Microbiologist
PhBBA Philippine Biorisk and Biosecurity
growth and holistic development of MLS students
Association
6. Microscope – represents MLS

Foreign Professional Societies ASCP American Society for Clinical pathology

AMT American Medical Technologist
• Foreign and local societies have the same goals
ASCLS American Society for Clinical Laboratory
which is to elevate the practice of MT/MLS and
Science
safeguard the welfare of their members IAMLT International Association of Medical
• But each professional society has roles and Laboratory Technologist
functions unique to itself IFBLS International Federation of Biomedical
CSMLS Laboratory Sciences
Canadian Society for Medical Laboratory ISCLT International Society for Clinical
Science Laboratory Technology
JAMT Japanese Association of Medical AACLS ASEAN Association for Clinical
Laboratory Sciences
Technologist
AAMLT ASEAN Association for Medical
SAMLS Singaporean Association for Medical Laboratory Technologists
Laboratory Sciences AAMLS Asia Association of Medical Laboratory
ASCLS American Society for Clinical Laboratory Scientist
Science
SEC Securities and Exchange Commission

Acronyms COPHA Council of Professional Health

Associations
APO Accredited Professional Organization PFPA Philippine Federation of Professional
AIPO Accredited Integrated Professional Association
Organization CHAP Council of Health Agencies of the
PRC Professional Regulation Commission Philippines
PRB Professional Regulatory Board PCQACL Philippine Council for Quality Assurance
in Clinical Laboratories
AAHON Alliance of All Health Organizations of
the Nation

AACLS ASEAN Association of Clinical

Laboratory Sciences
AAMLS Asia Association of Medical Laboratory
Science
IFBLS International Federation of Biomedical
Laboratory Scientists
APFB Asia-Pacific Federation of Clinical
Biochemistry
IFCC International Federation of Clinical
Chemistry
 CONTINUING PROFESSIONAL - Implements after 1 year on March 15, 2017 upon
the effectivity of the PRC Resolution No. 1032 or
DEVELOPMENT Implementing Rules and Regulations of R.A.
10912
- Competency • Lifelong learning
- Main goal: - Activities undertaken for the development of
➢ Maintenance competencies and qualifications of the
➢ Enhancement professional
➢ Extension of knowledge • CPD
- Effective way of maintaining and improving the - Inculcation of advanced knowledge, skills, and
competencies of health professionals ethical values in a post-licensure specialization
- Mandatory
CPD AIMS TO:
1. Continuously improve the quality of the
country’s reservoir of registered professionals
THE BENEFITS OF CPD
2. Provide support to lifelong learning in the
Benefits to the individual Benefits to the enhancement of competencies of Filipino
organization
towards delivery of quality and ethical services
Confidence and Maximizes staff potential
3. Deliver quality CPD activities aligned with the
credibility
Philippine Qualifications Framework (PQF) for
Showcases Helps employees to set
achievements SMART objectives national and global comparability and
Career goals Staff development competitiveness
Updating knowledge and Helps staff to apply
CPD PROCESS
skills learning to the
organization’s • CPD council
development - Chair: member of PRB
Improves productivity Helps employees focus - First member: president or officer of an
and efficiency their achievements Accredited Professional Organization (APO)
• President of PAMET
- Second member: president or organization or
CPD VS. CPE deans or department chairpersons of
CPD – development of one’s knowledge, skills, and universities
attitude relevant to profession • President of PASMETH
• CPD providers must apply for at least 45 days
CPE
prior to the conduct of CPD activity
- Linear and formal training • CPD Council will designate the number of units
- Learning particular skill or set of skills • CPD is mandatory requirement in the renewal of
PRC ID
JULY 25, 1995, EXECUTIVE ORDER N. 266 • Required: 45 minutes or 15 units per year
- President Fidel V. Ramos • Update/Provision: lessened to 15 units every 3
- “Institutionalization of the (CPE) Programs of years
the Various Professional Regulatory Boards
(PRBs) under the Supervision of the (PRC).” CPD DRAWBACKS
- Anticipate the stiff global competition - Difficulty of access for professionals assigned
- Took effect on November 13, 1995 to remote areas of the country
- Lack of time to attend programs
JULY 21, 2016, REPUBLIC ACT 10912 - DOH was encouraged by the government to
- Took effect on August 16, 2016 provide CPD programs
- Strengthens CPD programs for all regulated
professions and the creation of CPD Councils
for each profession
- Aims to improve the competence of
professionals in accordance with international
standards of practice
 LESSON 11 HEALTH CARE WASTE Anatomical Waste – a subgroup of pathological waste
that refers to recognizable body parts from amputation
MANAGEMENT procedures
DEFINING HEALTH CARE WASTES Bin: Strong leak-proof bin with label and biohazard
Waste from Health Care Activities symbol
According to WHO
Liner: Yellow plastic(can withstand autoclaving), with
Non-hazardous Hazardous label and tag (source, weight, collection data)
75-90% 10-25%
Philippines Sharps
69.63% 30.37% • Refers to waste items that can cause cuts, pricks, or
puncture wounds
• Most dangerous waste → can cause injury and
Health Care Waste Generators infection
• All Health care facilities, institutions, business
Syringe needles in Blood lancets
establishments, and other spaces where health care phlebotomy
services are offered with activities or work Surgical knives Broken glassware
processes that generate wastes
Chemical Waste
Mortuary and Clinics and Health care • Discarded chemicals generated during disinfection
autopsy center other health centers and and sterilization procedures
care facilities dispensaries • Wastes with high content of heavy metals and their
Hospitals and Drug Laboratory and derivatives
Medical manufacturers research Bin: liquid chemical in disposable amber-colored bottle
Centers facilities with min. 4l cap, strong chemical-resistant, and leak
Birthing Homes Infirmaries Institution proof

Liner: Yellow with black band w/ label (source, weight,

CATEGORIES OF HEALTH CARE WASTES and collection date)

Infectious Waste Laboratory X-Ray Film dev Disinfectants &

• All waste suspected to contain pathogens or toxins reagents sol soaking
in sufficient concentration that may cause disease to solution
a susceptible host Used batteries Conc ammonia Conc H
sol peroxide
Bin: Strong leak-proof and labelled with biohazard Chlorine Mercury
symbol

Liner: Yellow plastic (can withstand autoclaving), with Toxic Corrosive Flammable Reactive
label and tag (source, weight, collection data)

Bodily fluid Sputum Cups Urine Pharmaceutical Waste

wastes Containers • Expired, spilt, and contaminated pharmaceutical
Dressings Discarded Food wastes products, drugs, and vaccines
microbial from patients
cultures Bin: Strong leak-proof, “pharmaceutical Waste” label for
Blood bags expired drugs and drug containers and “Cytotoxic
Pathological and Anatomical Waste Waste” for cytotoxic genotoxic, and antineoplastic
• Refers to tissue sections and body fluids or organs waste
derived from biopsies, autopsies, or surgical Liner: yellow with black band and labelled (source,
procedures weight, and date)
Organs Tissue used for histopathological Empty drug vials Medicine bottles
examinations Cytotoxic drugs Materials used for
preparation and
administration
Radioactive Waste returned to the manufacturer/supplier.
• Refer to wastes exposed to radionuclides including Pharmaceuticals shall be kept in their original
radioactive diagnostic materials or radiotherapeutic packaging for proper identification and prevention of
materials possible reaction with other chemicals.
6. Radioactive waste has to be decayed to background
Bin: Radiation proof repositories; leak-proof, and lead-
lined container, radionuclide label, radioactive symbol, radiation levels. If it has reached the background
and date of deposition radiation level and is not mixed with infectious or
chemical waste. the radioactive waste is considered
Liner: Orange plastic and labeled “radioactive”, as regular non-infectious waste.
radionuclide tag, data of deposition 7. All waste bins must be properly covered to prevent
Cobalt Technetium Iodine cross contamination.
Iridium Irritated blood Contaminated 8. Aerosol containers can be collected with the
waste general waste.
Patient’s All materials used that are exoised
excretion within 48h
General Waste Hazard symbols
• Waste that have not been in contact with
communicable or infectious agents, hazardous
chemicals, or radioactive substances, and do not
pose a hazard

Bin: Optional recycle symbol for recyclable non-

hazardous wastes

Liner: Black or colorless plastic for non-bio and green

for bio

SEGREGATION, COLLECTION, STORAGE, AND

TRANSPORT OF HEALTH CARE WASTES
Waste Management Color-Coding Segregation
Practices
1. Highly infectious waste must be disinfected at
source.
2. Anatomical waste including recognizable body
parts, placenta waste, and organs should be
disposed through safe burial or cremation.
3. Pathological waste must be refrigerated if not
collected or treated within 24 hours.
4. Sharps must be shredded or crushed before they
are transported to the landfill.
5. Chemical and pharmaceutical wastes shall be
segregated and collected separately. Wastes with
high content of heavy metals, except mercury,
should be collected separately and sent to the waste
treatment facility. Waste containing mercury must
be collected separately. Hazardous chemical waste
shall never be mixed or disposed down the drain but IMPACTS OF HEALTH CARE WASTE
shall be stored in strong chemical resistant leak- HEALTH CARE WASTE MANAGEMENT SYSTEM
proof containers or amber disposal bottles. Expired Health Care Waste Management Hierarchy
and discolored pharmaceuticals should be returned Green Procurement Policy
to the pharmacy for temporary storage to be
• an approach that is used by waste minimization; the
most important step in the proper management of
health care wastes
Prevent (Waste Prevention) – avail of services that are
the least harmful to the environment and to purchase
less polluting products
Reduce (Waste Reduction) – from the source is
implemented by encouraging proper waste segregation
to determine the nature and volume of generated wastes
1. Resource Development
• collective term for reusing, recycling, and recovering
waste
Reuse – refers to either finding a new application for a
used material or using the same product for the same
application repeatedly
Recycle – refers to the processing of used materials into
new products
Recover – energy recovery or used to encompass three
subset of waste recovery: recycling, composting, and
energy recovery
2. End of Pipe
• Implemented for waste that cannot be safely reused,
recycled or recovered.
Treat (Waste Treatment) – the process of changing the
biological or chemical characteristics of waste to
minimize its potential to cause harm
Dispose (Waste Disposal) – refers to discharging,
depositing, placing, or releasing any health care waste
into air, land, or water
• Not all types of wastes require treatment
• Health care waste must undergo sewage
treatment prior to its release to the
environment
TREATMENT AND DISPOSAL OF HEALTH CARE WASTE
1. Pyrolysis
• Thermal decomposition of health care waste in the
absence of supplied molecular oxygen
• Can handle the full range of health care waste
• Waste residues (greasy aggregates or slugs,
recoverable metals, or carbon black) are disposed
in a landfill
2. Autoclave
• Use of steam sterilization to render waste
harmless and is an efficient wet thermal
disinfection process
• Pressure (15psi) and heat (121°C temp may vary) for
15 to 30 minutes
3. Microwave
• Waste are exposed to microwaves that raise the
temperature to 100°C (237.6°F) with moist heat for
at least 30 minutes
• Microorganisms are destroyed by moist heat
4. Chemical Disinfection
• Chemicals are added to health care wastes to kill
or inactivate present pathogens
• 5 % Sodium hypochlorite, hydrogen peroxide,
peroxyacetic acid and heated alkali
• Generates chemical wastes from the used chemical
disinfectants
5. Biological Process
• Uses an enzyme mixture to decontaminate health
care waste
• Suited for large applications and is also being
developed for possible use in the agricultural
sector
6. Encapsulation
• Filling containers with waste, adding and
immobilizing material, and sealing the containers
• Containers are filled with up with a medium such as
plastic foam, bituminous sand, and cement mortar
7. Inertization
• Suitable for pharmaceutical waste that involves the
• mixing of waste with cement and other substances
before disposal
• Wastes are mixed with water, lime, and cement
Landfill
• An engineered site designed to keep waste isolated
from the environment
• The site must secure proper permits from DENR
before accepting waste
• Health care waste are properly treated before
mixing with general waste
• Health care facilities who have no access to
landfills ,disposal is usually through safe
burial(waste must be properly treated before
disposal)
 LABORATORY SAFETY 7. Protozoa (Complex single cell)
• Most are nonpathogenic
INFECTION CONTROL Ex: Amoeba (usually contact from food)
• Process of protecting health care workers and
patients from infectious agents GROWTH REQUIREMENT AND SURVIVAL OF
• Hazards, Laws, safety equipment MICROORGANISM
BIOLOGICAL AGENTS Elements for Microorganism Survival
Temperature – 98.6°F/37°C (body Temp)
Microorganism
• Too small =microscopic; bacteria, viruses, fungi, pH level – Neutral pH 7
protozoa and parasites
Environment – Dark and moist
Pathogens – Disease-causing organism
Nutrition – food source
Infection – Invasion by pathogens that cause disease
Oxygen availability – Aerobic (need O) & Anerobic (little
and symptoms
or no O)
Contagious/transmissible – can be spread to other
Chain Infection
people
Infectious
Types of Microorganism agents
3. Bacteria – single-celled organisms with cell wall Susceptibility Reservoir
Host
• 4% are pathogens
CHAIN OF
• Antibiotics – medications to kill bacteria
INFECTION
Basic Shapes of Bacteria Portal of Entry Portal of exit
Mode of
a) Cocci (Round)
Transmission
Staphylococci Streptococci - Diplococci -
8. Infectious Agents
grape-like chains pairs
cluster • Pathogens
Ex: Sore throat, Pneumonia, food poisoning • Yeast Infection
• Developed from antibiotic overuse
b) Bacilli (Long slender rod-shaped) • Opportunistic pathogen
• Spores – Dormant form, resistant to changes in
heat, moisture and disinfectants 9. Reservoir Host
Ex: Botulism, tetanus, TB, Salmonella food poisoning • Provide ideal environment for growth of
pathogens
c) Spirilla (Curved, spiral-shaped) • Infected/carrying the disease
• Less frequently isolated in the body
Ex: Treponema Pallidum - causative agent of syphilis 10. Portal of Exit
• Means by which the pathogens leave the body
4. Viruses – Smallest infectious agent • External Cavity and wounds
• RNA/DNA with protein capsules
• View by electron microscope 11. Mode of Transmission
• Measles, mumps, chicken pox, HIV • Transfer of pathogens
• HIV causative agent of AIDS, a retro virus • Air, direct contact, vectors(living organism)
• Vectors – living organism that take in
5. Fungi – Plant-like pathogens, allow it to live and multiply without
• Prefer dark and damp places becoming ill
• Mycotic infections – caused by yeast • Dirty hands – most common mode
Ex: Athlete’s foot, ring worms
12. Portal of Entry
6. Parasite (Take nourishment from host) • Same with Portal of Exit
• Larger multicellular organisms
• Malaria - attacks RBC 13. Susceptibility
• Not protected from the pathogens as it enters
the body of the host
• Age and illness are factors
 TYPES OF DISINFECTION ➢ Food must never be stored in the same
refrigerator with specimens or medications,
Sanitization
regardless of how it is packaged
- Reduces number of microorganisms
- Heat/chemical CHEMICAL SAFETY
Disinfection • Occupational Safety and Health Administration
- Chemical used to kill pathogens (OSHA)
- Skin disinfection: 70% isopropyl alcohol and - Created the Hazard communication
Povidone-Iodine solution Standard
- Work surface/equipment: 10% bleach - Potential hazards associated with the
solution chemicals in the work place

Asepsis Material Safety Data Sheet (MSDS)

- Without infection - Document provided by manufacturer with
- 2 types: details about chemical
- A. Surgical • Standard information required:
➢ All pathogens destroyed before 1. Identification
entering the body 2. Composition of ingredients
➢ Ex: venipuncture, injections, urinary 3. Physical and chemical properties
catheterization 4. Fire and explosion data
- B. Medical 5. Health hazards
➢ Procedure/environment that allows 6. Emergency first aid procedures
a patient to be treated without 7. Precautions for safe handling and use of the
exposure to pathogens chemical
8. Control measures
PRECAUTIONS
Physical Safety
Universal precautions - Fire, electrical emergency, personal injuries
• Everyone is potentially infectious for blood - Need to be aware of all hazards and how to
borne pathogens and that same care should be respond to emergencies appropriately
used to treat every specimen
• “Treat all specimens as potentially infectious” 14. Fire Safety
• Stop, Drop and Roll
Personal Protective Equipment - In case clothing caught in fire
Gloves • Rescue
• Most important PPE in medical laboratory • Alarm
• Prevent pathogen from entering body • Confinement
• Extinguish
Mask ➢ Types of Fire:
• To protect from droplets (coughing and sneezing) • Class A
Respirators • Class B
• For TB and other airborne disease • Class C
• Class D
Gowns ➢ Pull the pin
• For isolation areas, nursery with newborns ➢ Aim the nozzle
➢ Squeeze the lever
Lab coats ➢ Sweep side to side
• Used when there is a potential for splashing or
soiling clothes 15. Electrical Safety
• Fluid resistant - Minimize hazards by appropriate
• Note: maintenance and service of equipment and
➢ Laboratory professionals should NEVER APPLY electrical outlets
MAKE UP, EAT or DRINK when working with - Avoid extension cards and overloading or
blood or other specimens outlets
16. Body Mechanics
• Procedures that require bending over, lifting
equipment, etc.
• Avoid sitting for prolonged periods without
break