The quality of medical laboratory practice in Trinidad and Tobago, West Indies

The introduction of automated chemical analyzers in the laboratory service has the potential of adversely affecting professionalism in laboratory practice. The present study assesses the quality of medical laboratory technicians in Trinidad and Tobago using structured questionnaires. Some of the critical questions included job status, years of experience, training, qualification(s) and knowledge of quality assurance and its application. About 82% of laboratory technicians responded to the study. The majority of technicians (62%) had diploma certificates while only one (1.2%) had a postgraduate degree. Although the majority (91.7%) of technicians knew about quality assurance, 36% learnt on the job and 59% knew they were not professionally trained. The results showed that there is paucity of highly trained laboratory technicians in Trinidad and Tobago and this has significant implications on the technical initiative and quality of medical laboratory practice in this country. We recommend the establishment of appropriate professional institutions for training medical laboratory technologists and regular expert inspection and accreditation of all medical laboratories in the country.

Pregnancy outcome of personnel in Swedish biomedical research laboratories

Possible hazardous effects of laboratory work on the reproduction outcomes of female laboratory personnel in Sweden from 1990 to 1994 were investigated in a questionnaire-based study (n = 1052) by comparison with personnel in non-laboratory departments. The individual woman constituted the primary sampling unit, with her pregnancies defined as the unit of analysis. Allowance for dependence between different pregnancies of the same woman was considered by applying random effect models. With regard to spontaneous abortions, no elevated odds ratio was found for laboratory work in general, but an odds ratio of 2.3 and a 95% confidence interval of 0.9 to 5.9 (n = 856) was connected to working with chloroform. The odds ratio for large for gestational age infants in association with the mother's laboratory work was 1.9 (confidence interval, 0.7 to 5.2). The result with regard to spontaneous abortion partly supports previously reported increased risks of miscarriage related to laboratory work with solvents.

Employee competence and performance-based assessment: A college of American pathologists Q-probes study of larboratory personnel in 522 institutions

OBJECTIVE

To survey employee competence assessment practices in departments of pathology and laboratory medicine and provide suggestions for improvement.

DESIGN

A 3-part study consisting of a questionnaire about current competence assessment practices, an evaluation of compliance with stated competence assessment practices using personnel records of 30 employees, and a written appraisal of competence of 5 specimen-processing staff members per institution.

SETTING

A total of 522 institutions participating in the College of American Pathologists 1996 Q-Probes program.

MAIN OUTCOME MEASURES

Institutional competence assessment practices, compliance of each institution with their own practices, and determination of competence of specimen-processing personnel.

RESULTS

Of the participating institutions, 89.8% had a written competence plan and 98.1% reported reviewing employee competence at least yearly. General competence was reviewed by direct observations (87.5%), review of test or quality control results (77.4%), review of instrument preventive maintenance (60.0%), written testing (52.2%), and/or other methods (20.8%). In 8.6% of institutions, employees who failed competence assessment were not allowed to continue their usual work. On review of records of 14 029 employees for adherence to the laboratory's general competence plan, adherence was 89.7% for direct observations, 85.8% for review of quality control and test results, 78.0% for review of instrument records, and 74.0% for written testing. Employee failure rate ranged from 0.9% to 6.4%, depending on the competence evaluated. Adherence to an institution's plan was 90.4% for new employees, 93.1% for computer skills, 95.8% for laboratory safety, and 92.1% for continuing education. When a written competence assessment was given to 2853 specimen-processing staff members, 90.0% responded satisfactorily.

CONCLUSIONS

Opportunities for improvement in employee competence assessment are numerous, and we provide several specific suggestions.

Cancer mortality in health and science technicians

BACKGROUND

Nearly one million U.S. women are employed as health or science technicians with various chemical and biological exposures, but few studies have looked at their health outcomes.

METHODS

Using 1984-1995 mortality data with coded occupation information, we calculated race- and age-adjusted proportionate cancer mortality ratios (PCMRs) and 95% confidence intervals for two age groups for black and white women with occupations of clinical laboratory (CLT), radiologic, and science technician.

RESULTS

For CLTs, the PCMRs for breast cancer were borderline significantly elevated. The PCMRs for leukemia were significantly elevated, particularly for myeloid leukemia. Radiologic technicians had no significantly elevated PCMRs. Science technicians had significantly elevated PCMRs for non-Hodgkin's lymphoma and multiple myeloma in the younger age group.

DISCUSSION

The elevated risks for lymphatic and hematopoietic neoplasms in CLTs and science technicians may be associated with occupational exposures.

Report of survey: pregnancy outcomes in medical laboratory technologists

A survey was published and distributed in the CSLT Bulletin. Completed surveys were returned anonymously by mail. Of the surveys returned (n = 2002), 16 were not usable due to incomplete information. Spontaneous abortion (SA) occurred in 19.9% of the total responders' pregnancies. Technologists not employed during pregnancy had a lower rate of SA (13.2%) compared to those working full-time (19.9%) (p < 0.001). Including all types of early (< 28 wk) pregnancy terminations (except induced abortion) the non-employed group had a 17% incidence of fetal loss compared to 23% in the group employed full-time (p < 0.001). The differences in SA rate could not be accounted for by mother's age at pregnancy nor previous obstetric history. The incidence of cesarean section was higher in the full-time employed group (16%) compared to the non-employed group of technologists (9.9%) (p < 0.001). There were 141 reported birth defects representing an overall incidence in responders of 4.8%, comparable to literature values for the general population (6.0%). The incidence of specific birth defects was not different in the working group.

Mortality and cancer incidence in biomedical laboratory personnel in Sweden

BACKGROUND

The work in biomedical laboratories is associated with exposure to a mixture of known and potential chemical carcinogens, mutagens, and teratogens. Previous studies have suggested an excess of brain tumors and hematopoietic system malignancies as well as breast cancers in women.

METHODS

This retrospective cohort study investigated the standardized mortality ratio (SMR) and the standardized incidence ratio (SIR) for cancer in biomedical research laboratory personnel in Swedish universities 1970-1992. The cohort comprised 5,035 laboratory and, as an internal reference group, 2,923 nonlaboratory employees.

RESULTS

The overall death rate was lower in both groups than in the general population. The SIR for brain tumors among male laboratory workers was 1.69 (0.62-3.68) and among male laboratory scientists, after more than 10 years of work (4 cases), it was 3.11 (0.85-7.56). There was an elevated SIR for malignant melanoma among female scientists in laboratories (3.51, 0.96-8.98) and for male scientists in nonlaboratory departments (2.86, 1.05-6.22). The SIR for breast cancer among female laboratory scientists was 1.62 (0.78-2.98).

CONCLUSIONS

The present findings lend some support to an excess of brain tumors among male scientists and of breast cancer in female scientists in biomedical research laboratories.

MLO's national CLIA '88 survey, Part 2: Praise versus protest--views from both sides of the fence

While a recent survey shows that more laboratorians approve of CLIA now than in the past, a considerable enclave remain opposed to this law. Among the key issues that continue to dishearten and incite the clinical lab: the proposed exemption of POLs and diminished personnel standards.

Attitude of laboratory personnel towards accreditation

A multiple choice questionnaire was submitted to medical technologists in three medical laboratories, at varying times after obtaining an EN 45001 accreditation. A large majority (85-90 per cent) considered that their workload was increased by the accreditation process. In two laboratories, the technologists did not think that the accreditation process had improved the quality of the results. The major advantages were the fact that everything was traceable, that the technologists felt more sure about the procedures to follow, received more responsibilities and had a better knowledge of the tests they performed. The major disadvantages were the increased paperwork, discrepancies between the procedures and the reality, the fact that more attention is paid to the formalities than to the quality of the results and that the accreditation process decreased the adaptability. The number of advantages mentioned seemed to increase with the interval since the accreditation. A small majority of the technologists preferred working in an accredited laboratory than in a non accredited one.

Risk of occupational exposure to potentially infectious nonhuman primate materials and to simian immunodeficiency virus

Five hundred fifty persons who worked with nonhuman primates (NHP) or with NHP material in 13 North American research institutions were surveyed for potential occupational exposures and tested for antibodies to simian immunodeficiency virus (SIV). Needlesticks and mucocutaneous exposures were reported more frequently among persons who handled SIV-negative or SIV-status-unknown (SIV-N/U) animals (36% and 35%) or who worked with SIV-N/U material in the laboratory (18% and 17%) than among persons who handled SIV-positive NHP (SIV-P) (9% and 4%) or worked with SIV-P material (6% and 8%). The risk for needlesticks when working with both SIV-N/U and SIV-P animals and the risk for mucocutaneous exposures from SIV-N/U animals increased with the number of years working with NHP. Persons who performed invasive tasks (e.g., obtaining blood samples, performing surgery/autopsies) were more likely than others to sustain needlesticks (adjusted OR = 3.55, 95%CI = 1.40-9.02). Two (0.4%) of 550 persons had antibodies to SIV. One appears to be infected with SIV, as previously reported. These data suggest that persons who work with NHP or with NHP material are at risk for occupational exposure to potentially infectious materials including SIV. Prevention strategies are needed to reduce the risk for needlesticks and mucocutaneous exposures around all NHP, and safety guidelines should emphasize prevention options for invasive tasks performed with animals.

Investigation of an excess of melanoma among employees of the Lawrence Livermore National Laboratory

As a follow-up to an observed fourfold excess of malignant melanoma among workers at Lawrence Livermore National Laboratory, Alameda County, California, the authors conducted a case-control interview study of 31 cases diagnosed during the period 1969-1980 and 110 individually matched controls. Respondents were queried regarding familial cancer history, health history, general health behaviors, socioeconomic status, sun-exposure history, skin sensitivity to sunlight, and detailed occupational and occupational exposure history. Measurements were taken of constitutional risk factors such as eye color and skin reflectance. The associations between nonoccupational risk factors and case status were consistent with those reported from population-based studies of malignant melanoma. Several occupational indicators of risk were strongly associated with case status. These included chemist duties (odds ratio (OR) = 8.0), as well as work around high explosives (OR = 3.0), volatile photographic chemicals (OR = 3.0), and sources of ionizing radiation (OR = 3.7). Multivariate analyses of these risk associations suggested each to have a reasonably independent relation to case status. After adjustment for constitutional and occupational risk factors of interest, the odds ratio associated with reported work around sources of ionizing radiation remained elevated (OR = 2.3, 95% confidence interval 1.0-7.6). The authors believe these results to be sufficiently suggestive to warrant additional studies of occupational factors and risk for malignant melanoma of the skin.

Observations on the 1996 clinical laboratory conferences

The author reviews five trends in the laboratory and diagnostic industries. The five trends are: consolidation of both the diagnostic companies and clinical laboratories (hospital and commercial); pressure to cut costs; robotics; implication of new technology; and the pressure to cut costs by transitioning certain tasks to nontechnical personnel while dealing with an abundant labor supply.

The Reference Laboratory's quality quest

The reference laboratory began development of a Quality Assurance Program in 1991. This program evolved into Total Quality Management supported by strategies, systems, policies, and procedures. We also developed powerful Vision and Value Statements. We are proud of our accomplishments and of the Special Recognition awarded from the clinical laboratory management association for our Human Resources Management and Client Service/Education Programs.

Work process redesign for blood banks and transfusion services

Blood banks and transfusion services generally have been slower than other clinical laboratory areas to look into redesigning their work processes. Work process redesign (WPR) provides a tool for facilities to critically review their current work processes for improvement opportunities. This article provides blood banks and transfusion services with a redesign road map and the experiences of a large, metropolitan transfusion service in undertaking a WPR project.

Integrating academic and community laboratory needs: developing a successful outreach program

Remarkably few large regional laboratory programs involving academic health centers exist in Canada. We present a model of a successful laboratory outreach program established by the Queen's University Department of Pathology (Kingston, Ontario) and its affiliated hospital laboratories. Community hospitals in small urban and semi-rural areas benefit from a diffusion of specialty expertise in laboratory medicine and technology, which enables them to increase their local testing capabilities and improve turn-around time. Testing and services of a more complex nature are referred to the academic hospitals. The result has been a steady improvement in the quality of laboratory services in the region with increased cost-effectiveness through shared services and focused economies of scale.

Surveying technologists: a novel method for establishing productivity standards in a clinical haematology laboratory

Personnel costs comprise the largest clinical laboratory expense. Yet standards to judge the productivity of personnel have not been established. A survey of the authors' own personnel was conducted to derive productivity standards in the Clinical Hematology Laboratory at the Massachusetts General Hospital, Boston, Massachusetts, USA. Technologists were asked how many white blood cell differentials they could perform in an eight-hour shift. Differential productivity was tracked before and after the survey. Of the respondents, 100 per cent failed to meet their own expectations of productivity. Nine technologists were tracked both before and after the survey was mailed and manifested a significant increase in productivity. These results suggest that technologists are objective in their assessment of their own productivity, that their opinions might be a resource for establishing productivity standards within the laboratory, and that such surveys may serve as motivational tools to augment productivity.

Medical technologist career commitment and satisfaction with job benefits

The purpose of this study was to determine the impact of career commitment on satisfaction with job-related benefits. A validated seven-point career commitment scale was used to measure career commitment. A 31-item benefits survey was used to collect data on satisfaction. In addition, salary information was collected. An analysis of variance was used to analyze the data. The high career commitment group was significantly more satisfied with 29 of the 31 benefits. There was no significant difference in salary among high, medium, and low career commitment groups. Low commitment individuals comprised only 11.5% of the respondents. The positive attitudes of the majority of medical technologists are a useful asset to the laboratory during this time of change in the practice of laboratory medicine.