Urine Processing

Hello People.

This is Jordan Wong Wei Jie reporting for his entry for SIP Post.

First thing when we arrived into the clinical laboratory, we were greeted by our lab manager and deputy lab manager. Our deputy lab manager then brought us around the clinical laboratory and introduces us to several things we need to take note in the lab of the Hospital, such as the Mission and Vision of the Hospital as well as the 4 codes of emergency. Of course the most important of all, our deputy lab manager also emphasized was the hand wash and hand rub in the clinical lab, especially H1N1 is still around. He taught us the procedures of hand wash and hand rub with the specific type of reagent (Desmanol & MicroShield respectively).



This is a picture of Desmanol that we used for Handrub.

Desmanol® is a rapid acting alcohol based handrub for hygienic and surgical hand disinfection. It helps prevent the skin from drying out.

"Desmanol® has a broad spectrum of activity and is effective against MRSA and VRE, bacteria ( inlc. TB bacilli), fungi, viruses (polio, vaccina, adeno, herpes, herpes simplex viruses, HAV, HBV, HCV, HIV)"

This picture and information is taken from http://www.demkasakti.com/products/medical/schuelke/desmanol.html on 22 June 2009

After which we were separated into 4 different departments. I chose to be in haematology department currently. I was introduced to my supervisor. My supervisor then allocate me into a section dealing with urine samples, doing tests like Dip stick test, Drug test and Urine culture etc. Of course, there were several senior colleagues who have guided me through out, one of which was our senior in TP BMT.

Laboratory Information System

First of all, I was taught how to access to the Laboratory Information System (LIS). This lesson is very important because we will have to retrieve information on which patient wants to carry out a certain tests and what type of tests a particular patient wants. All of these data were actually being registered into the LIS by our admin staffs. After which our individual department can check which patient wants to do urine FEME test or urine culture test by typing in a code number that represents a certain test. For example, urine FEME test has a code number of 472100 and urine culture’s code number will be 457262.

Then, we will print a worksheet out with the information of the patients such as their name, their ID number and the type of test we are going to performed. ID number will be something like 090622-00XX. 090622 will refer to the date/month/year the test is performed and 00XX refers to the number of this patient doing the test. There are other functions of the LIS too such as registering patient samples into the LIS and approving the results of a certain patient so it can be sent to the doctor for diagnosis. LIS is definitely a very convenient system for all of us, it’s so accessible!

Urine FEME

I was then taught on how to process dip stick strips with urine samples using machines. Usually in school, after dipping the dip stick strip into the urine, we check by comparing with the colour chart manually. However, with the use of machines, there is not a need to perform this manual checking of one square at a time on the strip. The machine can help us to check all the squares in the strip and tell us the results for each component (Specific Gravity, pH, Ketone, Glucose, Nitrites, Blood, Bilirubin, Urobilinogen, Protein and Leucocytes) The old machine used was called Miditron Junior II and now there is a newer machine used called Cobas u 411 (Roche).

The process goes like this:

Firstly, we will get the list of patients who wants to have Urine FEME test from the LIS.

Next, we will scan their ID number from the sticker label noted on the urine sample into the machines, Miditron Junior II or Cobas u 411 (Roche). After we scan all their ID number into the machine, we can then press start.

Thirdly, we will need to dip the strip into the urine sample (ensure it is the correct ID number from the machine and urine sample we are using) and then place it into the machine. The machine will then bring the dip stick strip and perform its necessary function (screening of the strip).

A few seconds later, a slip of results containing all 10 components will be shown (Performing a 10 test dip stick method). Of course this is not the end; we will need to load a small amount (15.0ul) of urine sample into a combination cover-slip microscope slide for the medical technologist to view on microscope. This is for microscopic examination, which is also used to verify the results produced from the machine. This combination cover-slip microscope slide also called as Glasstic® Slide 10 with grid chambers by KOVA® is something new, I have not seen in the school lab.



The diagram above is the LIS Window for Urine FEME. The Code nuumber used is 472100 and to print out the worksheet of patients who wants this test (Urine FEME), click report and print. This is a diagram that i drew during the lab.



The picture above is the New Analyzer Machine that we are using for Urine FEME

This picture is taken from
http://labsystems.roche.com/content/products/cobas_u_411/introduction.html on 22 June 2009



The picture above is the Older Analyzer Machine that was used before for Urine FEME

This picture is taken from http://labsystems.roche.com/content/products/miditron/introduction.html on 22 June 2009

This combination cover-slip microscope slide has 10 different semi circle columns, with each having grid chambers. This slide can hold up to 10 different patient’s urine sample. The medical technologist will then view and read the 10 different patient’s urine sample on the 10 grid chambers. Compared to the use of normal glass slide, this combination cover-slip microscope slide save resources as a combination cover-slip microscope is equal to the usage of 10 glass slides.



This is the Glasstic® Slide 10.

This Picture is taken from http://www.cenmed.com/productDetail.asp?productid=17291&catID=&category=5617&mainCat=LNS&cat=5305 on 10th July 2009



This is also Glasstic® Slide 10 but a close up that i drew during the lab.

Urine Culture

The next thing I learnt was to perform urine culture from urine sample. We will have to use two different agar plates, called the TSA (Blood agar) and CLED. First we will have to log in into LIS to check job descriptions of patients requiring for urine culture test. Next, we use a disposable inoculating loop (plastic) to retrieve urine from sample, and then inoculate onto the TSA and then CLED agar plate. Then, incubate the agar plate into the incubator at 37°C.

Open Sample and Distribution to Department

Opening of sample is one of the most important processes in clinical lab. Without helping of opening samples in the admin department, there wouldn’t be any samples to be processed. Also due to the lack of manpower, we have to help out a little. Helping in opening sample is not a very difficult task. It goes like this.

1. Nurse and People delivering/dispatching samples, which usually comes in bulk and packages will go to the admin counter

2. One of our staff will then get the samples and a checklist from them

3. The staff will check against the checklist the amount of samples (how many EDTA tubes how many plain tubes how many urine bottles etc)

4. After ensure checklist is completed (all samples have arrived), some of us will take the bulk of samples and separate them accordingly.

5. We separate the packages by 4 different sites. They are HIV Test, Malaria Parasite Test, VDRL Test and Those that can be open right away.

6. HIV test comes in a single plain tube, Malaria Parasite test comes in 1 Plain and 1 EDTA tube, VDRL comes in 1 plain tube. And usually these are the ones that come in a huge bulk. So they are the last to open

7. The remaining samples can be open right away, like those testing for full blood count or urine test.

8. After which we will send it to the admin people to register, once they register into LIS, print out the label, stick on the sample, they’ll placed it into a basket for us to distribute to the other department for testing

9. Plain Tubes will be sent to Biochemistry department, EDTA tubes will be sent to Haematology department, Stool Bottles or Swab will be sent to Microbiology department and last will be the Urine bottles which will be sent to Urine section, a sub-section of Haematology department.

After the samples are being sent to their individual departments, they will be able to start their test/processing.

This will be the end of my post for now. I will explain more about Urine Drug Test Kits, Microscopic Examination and other related Experiments on my further posts. Do stay tune! =)

This is Jordan Wong Wei Jie (TG02)