Contact

Daria Pašalić
Editor-in-Chief
Department of Medical Chemistry, Biochemistry and Clinical Chemistry
Zagreb University School of Medicine
Šalata ul 2.
10 000 Zagreb, Croatia
Phone +385 (1) 4590 205; +385 (1) 4566 940
E-mail: dariapasalic [at] gmail [dot] com

Useful links

S6-1

Laboratory staff safety: Prophylactic procedures after sharp injuries

Zorica Šumarac. Laboratory staff safety: Prophylactic procedures after sharp injuries. Biochemia Medica 2015;25(Suppl 1):S35-S37.

Centre for Medical Biochemistry, Clinical Centre of Serbia, Belgrade, Serbia

 

Health care workers compared to the general population, are at greater risk of exposure to infectious diseases that are transmitted through blood and other body fluids. Occupational exposure entails a risk of health workers contact with potentially infectious biological materials. Prevention of occupational blood-borne infections in health care workers, especially viral HBV, HCV and HIV includes the application of non-specific pre-exposure prophylaxis which involves the use of standard precautionary measures in daily work, specific pre-exposure prophylaxis by compulsory vaccination against acute viral hepatitis B and the application of post-exposure prophylaxis procedures. Given the importance of prevention of transmission of blood-borne pathogens, every health care institution should have a clearly defined procedure of post-exposure prophylaxis, which should have a categorization of the emergency procedure. Post-exposure prophylaxis includes a set of measures to reduce the chance of transmission of blood-borne pathogens by blood and body fluids in the persons who have been exposed to potentially infectious biological material. As part of the implementation of post-exposure prophylactic measures, the first step is to provide first aid to the exposed worker and treatment of the exposure site. The following procedure includes reporting of occupational exposure to the Department of Epidemiology in Health Institution or the nearest Public Health Institute, along with recording data on the vaccination status of the exposed worker, mode of occurrence and type of injury, the object that caused the exposure, the exposed part of the body, the type of potentially infectious biological material, circumstances which led to the exposure etc. Assessment of the risk of infection in addition to clinical and epidemiological evaluation includes serological testing of the patient-infection source and the exposed health care worker. For this purpose it is necessary in accordance with the Law on the patients’ rights to inform the patient-infection source and seek approval for the determination of their HBV, HCV and HIV status. If the source patient refuses testing or is not available, Department of Epidemiology obtains information relevant to risk assessment from the source patient’s medical records. If the source patient is unknown, the data relevant to the assessment of risk for HBV, HCV and HIV infection are obtained from the department in which the exposure occurred (incidence of HBV, HCV and HIV patients in the ward, incidence of patients who use drugs, etc.). After evaluation of the exposure incident, an epidemiologist evaluates the risk of transmission of the blood-borne infection and refers workers to immunization and/or viral diagnostics and medical examination by an infectious disease specialist. The process of post-exposure prophylaxis against hepatitis B depends on the vaccination status and immune response of the exposed worker. Based on the results of virological testing in blood samples of the exposed worker and the source patient (if applicable), an infectious disease specialist decides on the treatment and further implementation of post-exposure prophylaxis. Post-exposure prophylaxis for HBV infection includes application of HBV vaccination and specific hepatitis B immune globulin. At the moment, there is no specific prophylaxis available for HCV infection. Therefore, post-exposure prophylaxis includes only subsequent serologic testing of the exposed worker. For the prophylaxis after occupational exposure to HIV-positive blood, antiretroviral agents are recommended, based on the treatment guidelines developed by a team of infectious disease specialists. The Department of Epidemiology monitors and records the entire process of diagnosis and treatment, as well as the clinical condition of the exposed worker. The objectives of defining procedural actions for post-exposure prophylaxis in health care institutions are to enable timely protection of exposed workers, efficient management of the supervisory, monitoring, and reporting systems, establishment of an integrated approach for risk assessment and prevention of the impact of risk factors leading to exposure, improvement of safe working conditions and use of standard precautions, in order to reduce the incidence of exposure of health care workers to potentially infectious biological materials.

 

e-mail: zsumarac [at] gmail [dot] com

 

S6-2

Rationalization at the level of pre-preanalytical phase

Dunja Rogić. Rationalization at the level of pre-preanalytical phase.Biochemia Medica 2015;25(Suppl 1):S37-S39.

Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia

 

Pressure on health care systems to reduce expenses, with the same or improved quality of service and additional concurrent increase in the number of patients due to ever longer life expectancy, together make an apparently unsolvable paradox.

In this respect, laboratory medicine is not an exception but very often the field where attempts at significant cost-cutting are made in spite of an average annual 5-10% growth in requested tests at global level. At this point, it is necessary to emphasize that laboratory medicine participates in total health care expenses with very low percentage (in most countries below 5%) and that all interventions to economize are relatively limited at the level of the entire system, yet in no manner unachievable or pointless. There are two possible mutually complementary approaches to economize in laboratory medicine. The first is economical - at the level of achieving the most favorite procurement price for necessary reagents and instruments, which is attained only through transparent open tenders and high quality specifications. The second approach is related to modification of the availability of laboratory tests in line with applicable guidelines and data provided by evidence-based medicine. Actually, the use of laboratory tests by clinicians could undoubtedly be additionally optimized and rationalized not only with a view of reducing costs but also to achieve more effective clinical care in terms of rational diagnostics and adequate therapy monitoring. It is crucial to state that optimization does not always mean reduction in the number of requested tests, but may also involve orientation to those lab tests that have high predictive value within a certain clinical context. The role of laboratory professionals in this process is irreplaceable. Above all, education and dialogue between laboratory and clinics should be encouraged in all manners possible as this is a requisite but not sufficient precondition for changes. If these changes are really to occur, it is necessary to act also at administrative level and modify the interface used to request laboratory tests. This should be done because the process of ordering lab tests is not so infrequently performed rather routinely and is part od nurses’ job description. However, it is not simple to introduce changes in availability of lab tests without being familiar with clinical situation; we should therefore equally rely on both literature data and opinion of relevant clinical specialists and be by all means ready to encounter significant disagreements, with attempts to solve them using valid arguments. Possible issues about clinical benefit of an individual test can be explained by direct communication while complete test panel can and should still remain available: the only change introduced is the need for minimum conscious effort in lab test ordering. Although the costs of individual tests are low, considerable cost savings are achieved in this way during a prolonged time period. In addition to the type of lab tests, it is possible to intervene in terms of their frequency, which is optimally performed at pre-preanalytical level to prevent unnecessary sampling. Initiative for such interventions should be continuously arising from laboratory, without expecting somebody else to demand them, as they reduce unneeded costs, useless labor and futile consumption of laboratory services, and at the same time make room for introduction of new laboratory tests that are relevant for clinical care.        

    

e-mail: dunjarogic [at] hotmail [dot] com

 

S6-3

24-hour urinesamples: are they properly collected?

Željko Debeljak. 24-hour urinesamples: are they properly collected? Biochemia Medica 2015;25(Suppl 1):S39-S40.

Department of Clinical Laboratory Diagnostics, Clinical Hospital Center Osijek, Osijek, Hrvatska

 

Collection of 24-hour urine samples is still indispensible part of numerous diagnostic procedures like Wilson›s disease, Addison›s disease and carcinoid diagnostic work up. In most instances it is done by patients without the supervision of educated personnel. Therefore most laboratories provide patients with written instructions for 24-hour urine collection. However, suggested collection procedures are tedious and require high degree of patients› compliance which reflects in unreliable daily urine collection.

Different factors may compromise the integrity of 24-hour urine samples. Even in situations when patients strictly adhere to written instructions factors like containers, preservatives, existence of unknown interfering substances etc may compromise integrity of 24-hour urine samples. But the central issue in 24-hour urine sample collection is completeness/accuracy of collection which implies collection of all and complete portions of urine throughout the 24-hour period.

Different quality indicators of 24-hour urine collection accuracy have been proposed. Indicators that rely solely upon forms filled by patients during the collection have been disputed due to the unrealistically low fraction of inadequate samples which give rise to diagnostic errors. Numerical sampling quality indicators that are less prone to subjective judgment like urinary creatinine excretion and para-aminobenzoic acid (PABA) recovery have been used for some time. But even with numerical sampling quality indicators some degree of patient compliance is still required. In case of urinary creatinine excretion this mostly refers to physical activity, pharmacotherapy and meat intake during the sampling period. Besides, urinary creatinine excretion depends on age and muscle mass which requires reference interval and/or calculation adjustments. Reliability of PABA recovery based approaches implies oral ingestion of PABA tablets in adequate time intervals. Besides that, different drugs interfere with the urinary PABA determination and its elimination also depends on age.

All these issues raise question about the necessity of 24-hour urine collection. Analytes which daily fluctuations correlate with urinary creatinine fluctuations do not require 24-hour urine collection. Overview of these analytes will be given in the presentation. Different quality indicators of 24-hour urine sample collection needed for reliable determination of all other urinary diagnostic parameters will be described and compared. This will be followed by a brief summary of other factors that may affect 24-hour urine sample quality. Presentation will be concluded with the recommendations for 24-hour urine collection harmonized with the contemporary scientific evidence.

 

e-mail: zeljko [dot] debeljak [at] gmail [dot] com