Dr. N.G.P.

ARTS AND SCIENCE COLLEGE

(An Autonomous Institution, Affiliated to Bharathiar University, Coimbatore)
Approved by Government of Tamil Nadu & Accredited by NAAC with A++Grade (3rd Cycle- 3.64 CGPA)
Dr. N.G.P.-Kalapatti Road, Coimbatore-641 048, Tamil Nadu, India.
Website: www.drngpasc.ac.in | Email: info@drngpasc.ac.in. | Phone: +91-422-2369100

Faculty of Bio Sciences

KMCH INTERNSHIP
MANUAL

Name…………………………………

Class…………………………………
 DISCIPLINE COMMITTEE
Patrons
Dr. Nalla G PalaniswamiM.D., A.B. (USA)
Chairman
Dr. Thavamani D. Palaniswami M.D., A.B. (USA)
Secretary
Dr. O.T.BuvaneswaranM.A.,M.Phil.,Ph.D.
Chief Executive Officer

Chief Editor
Prof. Dr. V. RajendranM.Tech.(Nanotech), Ph.D., D.Sc., FInstP.(UK), FASCh.
Professor and Principal

Editors
Dr. Meera Raman M.Sc., B. Ed., Ph.D., UGC-NET.
Dean – Basic and Bioscience
Dr. J. Rengaramanujam
Professor and Head of Microbiology

Associate Editors
Mrs. S. Dhivyapriya
Assistant Professor in Biochemistry
Dr. K. Anbalagan
Assistant Professor in Clinical Laboratory Technology
Dr. S. Saranya
Assistant Professor in Biotechnology
Ms. M. Nivethitha
Assistant Professor in Microbiology
 CONTENTS

S.No. Particulars Page No.

Preface
i i

Summary
ii ii

Introduction
1.1 Goals
1 5-7
1.2 Objective
1.3 Vision
Guidelines
2.1 Scheduling
2 8-10
2.2 Safety Procedures

Proceedings
3.1 Reception
3.2 Phlebotomy
3.3 Blood Bank
3 3.4 Biochemistry 11-16
3.5 Microbiology
3.6 Histopathology
3.7 Clinical Pathology
3.8 Molecular Biology

4 Observation 17
 PREFACE
Medical Laboratory Internship is an experiential learning phase spanning 36 hrs
where the graduate of the Bio Sciences is trained in the clinical diagnostic laboratory to acquire the
knowledge, skill, and competencies required to acquire a job or to function as an independent
Medical Laboratory Technologist. This internship period is mandatory for all Bio Science graduates
of Dr. N.G.P. Arts and Science College.

This internship manual is prepared with the intention to provide orientation

about various tasks to be performed in different disciplines at the hospital. The main goal of the
internship is to acquire necessary practical skills in performing various laboratory tests in different
disciplines at laboratory medicine department in hospitals that will contribute directly to efficient
laboratory diagnosis and improve health care services. The beginning of the booklet entails the
description of Laboratory Medicine program stating its mission, goals and objectives. Following this,
particulars of internship and general laboratory safety procedures are stated which each intern has to
follow in addition to the instructions issued by the training site. The main contents of this booklet are
the tasks list for each discipline which interns are expected to either perform or observe during the
training.

They need to fill tasks list in each discipline during their training at each
rotation. It is essential to evaluate intern’s professional behavior and technical competencies that are
expected to achieve on completion of his/her internship. Internship builds experience as part of
education or find career-building opportunities after graduation. It provides opportunity to learn how
a job at Labcorp provides many possibilities for launching early career of our graduates.
 SUMMARY
The College shall constitute a “KMCH Internship Committee” in the Chairmanship of the
Principal at the beginning of every academic year. It shall comprise of Dean Biosciences, Heads and
Faculty members as nominated by the Principal from bioscience departments. This Committee shall
be fully responsible to ensure the scheduling of KMCH internship and creating awareness among the
students about the significance of internship in getting a job in clinical segment. The students are
also educated about the prerequisites to be followed during internship and its impact on intern,
patient and laboratory quality index sequentially to the society also. The intern by students will assist
the recruiting labs in attaining the maximum efficiency during the diagnostic period where an edge
will be with the students of Dr. N.G.P. Arts and Science College with KMCH internship certificates.
 1. INTRODUCTION
1.1. Goals
To understand the competency required for laboratory specialists who should have
acquired necessary knowledge, skills, training and proficiency in the laboratory diagnosis of
various diseases

1.2. Objective
Upon completion of internship the graduate will understand the

 Need for in-depth knowledge of the relationships between laboratory data and pathologic
processes, and how laboratory data relate to health and disease.

 Experience required for trouble-shooting and resolving typical problems in the clinical
laboratory and are familiar with laboratory quality assurance, laboratory safety,
laboratories regulations, information systems, management, research design and
educational methodology

 Capability to demonstrate an attitude of professionalism when working with colleagues

with all other health professional staff working in the hospital.

1.3. Vision

To understand and perform all routine techniques and analysis as applicable in every section of the
department as follows.

 Receives or obtains specimens for laboratory analysis and does order entry.
 Labels bottles, containers, tubes, sample cups.
 Perform various bio-chemical, microscopic and bacteriologic tests to
obtain data for usein diagnosis and treatment of disease.

 Maintains departmental equipment and carry out the daily routine

maintenance requiredas per the guidelines of each equipment.
 Records lab tests results and may assist in research and technical activities.
 Transcribing materials, filing and maintain all pathology and clinical laboratory files.
 Prepare written documentation and file as required by the profession.
 Keys in lab test results.
 Print all laboratory reports if required.
 Prepare requisition forms and record of specimen to be sent to reference laboratory.
 Prints/prepares daily reports on work load details.
 Co-ordinates with mother transfusion medicine for blood and blood components
supply.
 Prepare and send samples to reference laboratory for tests that are not
performed in thelaboratory.
 2. GUIDELINES

2.1 Scheduling

i) Twenty four students (Blended from all departments including UG and PG) from the bioscience
departments will be part of first cycle (36 hrs) of internship for three days (12 hours/day)

ii) The 24 students of first cycle will be segregated into eight batches (3 students per batch) where
every batch will be positioned in different departments (Reception, Phlebotomy, Blood bank,
Biochemistry, Microbiology, Histopathology, Clinical Pathology and Molecular Biology)
simultaneously for 4.5 hrs in the rotation basis for three days (Refer Sample Schedule).

iii) The students will be reporting in the KMCH by 6.50 am to the in charge staff allocated for the
first cycle and will leave the hospital by 7.00 pm with marking of attendance.

iv) The staff in charge will be taking care of rotation of students to different lab points as per the
schedule.

v) A day Before the start of internship the staff in charge will have a presentation to the concern
students on the objective, do’s and don’ts, principles, collection of samples, labeling, storage,
disposal, turnaround time, critical values, post analytical interpretations, adverse reactions, rejection
of clinical specimen and guidelines to be followed during the internship.

vi) The same method of scheduling, orientation and rotation will be followed for the next cycle of
internship. The no of cycle will depend on the total no of final UG and PG students of Biosciences.

v) After the completion of internship the student should have understood the work flow of different
clinical lab departments.

vi) The significance of quality assurance in different phases like preanalytical, analytical, post
analytical, verification, validation, surveillance and calibration of instruments will be dealt during
the orientation by staff in charge.

2.2 Safety Procedures

A. General laboratory safety

 Always wear laboratory coat or apron while working. After work, leave the lab coat in an
assigned cabinet or area.
  Must wear personal protective equipment (gown, gloves, masks, face shield or glasses etc.)
when working with hazardous or toxic materials and change when contaminated.
 Shoes should be fluid impermeable material and cover the entire foot.
 The application of cosmetics within the laboratory is strictly prohibited.
 Contact lenses should not be worn while working in the laboratory.
 Always cover any cut, insect bite or open wound with water-proof adhesive dressing.
 Gloves should be removed (unless stated to wear) before handling telephones, computer
keyboards, laboratory equipments, doorknobs, etc.
 Eating, drinking, smoking and chewing gum are prohibited in the laboratory.
 Storage of food or drink is not allowed in laboratory refrigerators.
 Mouth pipetting must not be done.
 Laboratory working surfaces shall be decontaminated with a disinfecting solution after the
spill of blood or body fluid.
 Needles should not be recapped or removed from a disposable syringe.
 Discard used syringes, needles and other sharps (glass slides, glass pipettes, knives, etc.) in
specified containers.
 If equipment shows any problem while being used, report immediately to your supervisor.
Never try to fix the problem yourself.
 Follow the standard safety precautions when using a centrifuge.
 Hands should be washed with soap and water after handling hazardous and infectious
materials.
 Biological safety cabinets (Class I or II) should be used to avoid aerosolization or droplets.
 Equipment contaminated with blood or other body fluids should be decontaminated and
cleaned before use.
 All waste and contaminated materials (clinical specimens, bacterial cultures) should be
disposed in appropriate containers.
 Inform your supervisor about any accidents, spills or potential hazard.

B. Chemical safety
 Know the color coding and numerical rating of chemicals or materials for health hazard, fire
hazard, reactivity hazard and specific hazard (reactivity with water) (NFPA label).
 Use volatile and flammable compounds only in a fume hood.
 Never return unused chemicals to their
original container.
  Dispose of chemical waste in proper containers according to manufacturer’s instructions.
C. Emergency response
 Read safety and fire alarm posters and follow the instructions during an emergency.
 Know the location of fire extinguisher, fire exits, and first aid kit and eyewash solution in
your lab and know how to use them.
 Know the building evacuation procedure in an emergency.
 3. PROCEEDINGS
3.1 Reception
 Patients typically have a limited understanding of how their medical bills get generated. They
need to be educated on the purpose of test
 Inaccurate coding is among the most prevalent problems that come up during medical billing
processes. It has to be ensured orally before accepting the request.
 To start registering the samples a proper sample register must be made. This register must
record all the relevant patient information and results of laboratory testing. This enables the
possibility to verify the results and perform other quality controls. Include at least the
following details:
 Patient name + unique identifier (e.g. social security number (if applicable)/date and place of
birth/etc.)
 Patient laboratory ID
 Contact details of the requester
 Type of primary sample
 Date of sample collection
 Date of sample reception
 Date of sample acceptance
 Examination(s) requested
 Results of examinations + name of the laboratory technologists performing the examinations
 Date of reporting
 Identification of person sending the report

3.2 Phlebotomy
Interns need to acquire practical skills of proper phlebotomy techniques during the internship period.
1. To disinfect the blood collection site with appropriate disinfectant.
2. To know how to apply a tourniquet and for desirable time.
3. To detect the preferred venous access sites.
4. To insert the needle properly for blood withdrawal.
5. To take care of the patient to avoid complications during and after blood collection process.
 Work flow

Receive patient in Phlebotomy area

Lab technician
fills the
requisition form

Requisition available?

Yes

No
Check whether fasting is
required

Yes No
Instruct to
come fasting
Is Patient fasting

Yes

Label the containers and

draw the blood No Apply band aid and explain

post phlebotomy problems
and care and time at which
Is Patient giddy? they can collect report

Yes
Take the Patient to
the treatment room

Specimen collection is the first phase of interaction between the patient and the
laboratory. Any error in specimen collection can lead to erroneous results. It is therefore
considered an important step of good clinical laboratory practice and is referred to as
"preanalytic control". The hospital has a policy to collect th samples in an appropriate
manner.
Blood Collection

 The Patient will be received in the sample collection area.

 Requisition form filled by the consultant/ duty doctor/ nurse is taken
from the patient &scrutinized.
 The lab technician assesses precautions required for the test.
 The containers are labeled and blood is drown.
 After blood is drown band aid is applied to the injected area after applying
pressure for 3-4 minutes finally it shell be confirmed that the patient is
stable.

Urine sample

Non Ambulant patient:

Check Doctors orders-Gather equipments-Greet patient by name-Explain procedure

to patient-Screen bed to provide privacy-Expose patient only where is necessary-Wash hands and
tray-Wear gloves-Clean patients genitalia with cotton swabs soaked in sterile water-Instruct patients
to void-Place sterile container and collect midstream urine-Pour specimen in to sterile bottle-Dry
patient-Remove glove and discord-Place patient in comfortable position and tidy bed-Clear items
used-Label specimen with patient details and date-Dispatch specimen and form to laboratory-
Document in nursing notes.

Ambulant patient:

Instruct patient to wash with water Instruct patient to collect mid stream urine by voiding a
little urine into toilet bowl and then voiding into sterile specimen bottle and voiding last part of urine
in to the toilet bowl.
3.3 Blood Bank

Interns need to acquire practical skills of standard blood bank techniques during the internship period
 To develop technical accuracy and self-confidence by experiencing routine functions of
Blood Bank.
 To recognize and resolve discrepancies for blood grouping.
  To exhibit knowledge of standard techniques used for ABO and Rh typing, compatibility
testing, antibody identification, antigen typing, and preparation of blood components.
 To acquaint with the procedures of donor selection and issuing of blood and blood products
for transfusion.
Critical values

S.No Analyte Age range Critical Value

1 Hb Any age Less than 7.0 Gm%
2 WBC Any age Below 200 and above 80,000 cells per
cumm
3 Platelet count Any age Less than 20,000 cells per cumm
4 Peripheral Smear Any age Blast cells

3.4 Biochemistry

Possess knowledge of the normal range of values of the chemical content of body fluids, significance
of the altered values and its interpretation.
Possess knowledge of the principles of following specialized organ function tests and the relative
utility and limitations of each and significance of the altered values.
(i) Renal function tests 10
(ii) Liver function tests
(iii) Pancreatic function tests
(iv) Endocrine function tests
(v) Tests for malabsorption
Know the principles, advantages and disadvantages, scope and limitation of automation in the
laboratory.
Know the principles and methodology of quality control in the laboratory.
Critical Values in Biochemistry

S.No Analyte Age range Critical Value

1 Serum glucose Any age <40 or >500 Mg%
2 Total Billirubin < I Day > 8 Mg %
> 1 Day < 2 Days > /= 13 Mg %
> 2 Day < 30 Days > /= 15 Mg %
3 Serum Urea Any age > 100Mg %
 4 Serum Creatinine Any age > 8 Mg %
5 Serum Sodium Any age < 125 Mg %
6 Serum pottassium Any age <2.8 or > 6.5 Mg%
7 Serum magnesium Any age <1 or > 3.5 Mg%
8 Serum Calcium Any age <6.5 or >13 Mg%
9 PTT Any age >100 sec
10 PT INR Any age

3.5 Microbiology
Interns need to acquire practical skills of standard microbiological examinations during the
internship period.
 To select appropriate media for various clinical specimens.
 To process specimens for isolation of pathogenic microorganisms.
 To identify microorganisms encountered in the clinical laboratory.
 To exhibit knowledge of environmental influences on microbial growth.
 To differentiate between normal flora and pathogens.
 To interpret antimicrobial sensitivity patterns.

S.No Test Name Turnaround time

1 Routine culture sensitivity 48-72 hrs
2 Blood culture sensitivity 2 days to 5 days
3 TB Culture 6 weeks
4 HIV ELISA, HBsAg and ELISA 24 hrs
5 HCV ELISA 24 hrs
6 Dengue ELISA 24 hrs
7 ANA ELISA 24 hrs
8 ANA profile
9 PCR 3 days to 5 days
 To apply methods of sterile techniques in the laboratory at all times.
Turnaround time

3.6 Histopathology
Interns need to acquire practical skills of histo-and cytopathological procedures during the internship
 To recognize appropriateness of specimen type, size, and quality.
  To preserve and handle specimens for the requested tests.
 To exhibit knowledge of different stains and staining protocols includingimmuno-histo/cyto-
chemical staining.
Turn around time

S.No Test Name Turn around time

1 Small Sample 48-72 hrs
2 Medium Sample 72 hrs
3 Large Sample 96 hrs

3.7 Clinical Pathology

Independently prepare and stain good quality smears for cytopathologic examination.
Be conversant with the techniques for concentration of specimens: i.e.various filters, centrifuge and
cytocentrifuge.
Independently be able to perform fine needle aspiration of all lumps in patients; make good quality
smears, and be able to decide on the types of staining in a given case.
Given the relevant clinical data, he/she should be able to independently and correctly:
(i) Diagnose at least 75% of the cases received in a routine laboratory and categorize them into
negative, inconclusive and positive.
(ii) Demonstrate ability in the technique of screening and dotting the slides for suspicious cells.
(iii) Indicate correctly the type of tumour, if present
(iv) Identify with reasonable accuracy the presence of organisms, fungi and parasites

3.8 Molecular Biology

Interns need to acquire standard practical skills in molecular diagnostics.

 To identify types of specimens received for molecular diagnosis.

 To understand the importance of contamination hazard in molecular diagnosis.
 To perform the required tests in an appropriate way.
 To know the significance of accuracy in molecular testing procedures.
 To understand the appropriate interpretation of molecular results.
OBSERVATION