Yes

II.U CAPS DAILY CLEANING

Effective Date: 
Mon, 07/24/2017
Revised: 
Wed, 07/26/2017
Policy: 

This policy provides the guideline for the cleaning and disinfecting of the patient care areas in CAPS, as per the SHC's Infection Prevention and Control Program.

Procedure: 

The reception/waiting area and the counseling offices are subject to use by students, some of whom may be  ill or carriers of infectious/contagious conditions.  By nature of the patient traffic volume, fomite surfaces in these areas can be contaminated and become sources of infection to other patients and staff.

Basic cleaning is provided by the custodial staff from the Campus Facilities Department.  The cleaning contract specifies that the custodial staff will provide the following weekday services :

  • All restrooms are cleaned using approved cleaning agents/products
  • Floors are swept, mopped or vacuumed
  • Containers of non-hazardous trash are emptied
  • Less frequent cleaning, such as shampooing upholstery or cleaning window blinds is arranged by the SHC manager in conjunction with the Facilities staff

CAPS Reception staff are responsible for cleaning surface areas and equipment used in patient care. This cleaning is done daily, and as needed through out the day. Approved cleaning products are listed on the CAPS Cleaning Log and are in accordance with the SHC's Infection Contol Committee cleaning guidelines.

Daily cleaning includes but is not limited to: horizontal Reception surfaces (such as keyboard, mouse and desk), clipboards and pens, computer touch screens and touch pads, vital signs station equipment.

Private offices and other CAPS areas (such as kitchen, group room, scanning room, etc.) can be cleaned as needed, using the approved cleaning products listed on the log.

Key Points: 
  • In accordance with the SHC's Infection Prevention and Contol Program, daily cleaning in CAPS areas is done using approved cleaning products.
  • See Cleaning Log for details.
Attached File: 

APPENDIX J - LET'S TALK PROCEDURE

Effective Date: 
Mon, 06/01/2015
Policy: 

 

  Philosophy

 Let's Talk is an outreach program designed to engage students by providing informal walk-in consultations with CAPS counselors at sites across campus.

Let’s Talk is intended to reach students in distress who might be unlikely to seek traditional mental health services at CAPS. This service is called "informal consultation" and is different from formal counseling. One difference relates to its accessibility. There is no clinical paperwork to fill out, no formal intake, no appointments, and no fees. Students are encouraged to drop by and talk about whatever is important to them, much as they might talk with a TA, residence hall director, or academic advisor and students can choose to remain anonymous if they prefer.  Let’s Talk is advertised to students as a 10-15 minute consultation.  However, CAPS staff may use their clinical judgment to lengthen the time of meeting with the student if necessary.  When the meeting lasts much longer than 15 minutes, staff should let the student know that this is an exception, since Let’s Talk is understood to be a brief consultation.

The goal of a Let’s Talk consultation in general is engagement. The clinician listens, empathizes, problem-solves, provides mental health and general health information, conducts informal needs assessments, offers advocacy and referrals, and -- most importantly -- plants the seeds of a relationship to facilitate the student seeking additional help if necessary. It is akin to the kind of pre-counseling conversation one might have with a student after giving a stress management presentation on campus. As such, it is not considered a "clinical" service.

A number of students are served by a one-time consultation. Others benefit from intermittent, as-needed visits. Some are referred to CAPS for treatment following a brief assessment. Having made a positive, informal first contact with a clinician is usually sufficient to mitigate any lingering barriers to accessing mental health services at CAPS.

Though Let's Talk is designed to be a short-term intervention, occasionally a student may visit more than once or twice when barriers are robust. For example, some students need more help than one visit can provide but find accessing services at the health center very uncomfortable. They may need multiple visits at Let's Talk to be ready to accept a referral. However, Let's Talk is not a substitute for regular counseling and should not be treated as such.

Though the primary mission of Let's Talk is to reach students who do not conventionally seek mental health services, many other students come simply because of the convenience and immediacy. A Let's Talk consultation can often head off a crisis before it happens, facilitate a quick referral to CAPS, and, in many cases, prevent the unnecessary use of CAPS intakes for students who need a simple, brief intervention.

Sites:

Let’s Talk is held at different locations across campus, with emphasis on reaching student communities who may have difficulties accessing traditional mental health services or have a hard time accessing CAPS because of tight schedules or geographic location.  Examples of target of student communities include students of color, first-generation college students, and students in Science, Technology, Engineering, and Math.  Despite the emphasis on hosting Let’s Talk at sites convenient to particular communities, every site is open to all UCSC students. Indeed, many students access a site for other reasons, including fit with one's schedule and interest in talking with a particular counselor. Students find out about counselors by reading their biographies and seeing their pictures on the Let's Talk website.

For a complete list of current Let's Talk sites and times, refer to the CAPS web site: http: caps.ucsc.edu

Procedures

Material Necessary when Conducting Let’s Talk:

Telephone. Most sites provide one for you.
Clock or watch for monitoring time.
Emergency phone numbers: CAPS (9-2628 for the front desk) and UCSC police (9-2345 Emergency; 9-4856 Dispatch).
CAPS laptop with remote access Point and Click
"Let's Talk FAQ"
“Let’s Talk Sign-in Sheet
"Let's Talk Busy Notice"*
"Let's Talk Leaving Early Notice"*
Billboards pointing students to location
5150 procedures, Crisis assessment form, 5150 form, informed consent form to be used only in an emergency.
Site Contact Person for support and to hang notices on door PRN
Advertising Post Card or Brochure

Information to Obtain from Students at Let’s Talk:

Ask students for first and last name at beginning of consultation time, and inform them of option to meet anonymously if they prefer.
After consultation is complete, if counselor has a student’s full name and it seems clinically appropriate, may check the student’s PNC record to see if any other action is warranted.   (For example, it might be appropriate to notify other CAPS staff of the student’s consultation with Let’s Talk. ROI is not needed since let’s talk is part of the CAPS services).

Documentation:

No documentation is required for Let’s Talk consultation meetings with a student.  Remember that let’s talk is considered an informal consultation and not a formal counseling session.
If the Let’s Talk counselor receives information about a student from a third party who has contacted Let’s Talk that may be useful to document in PnC, encourage that person to call the CAPS Crisis Counselor to relay that information.  The CAPS Crisis Counselor can then document in PnC using the Third Party Consultation note.
Let’s Talk counselors do not provide written documentation or case management for students. If a student is requesting written documentation, they should be preferred to phone triage and a formal intake.
Let’s talk counselor collects demographic data about each individual scene for consultation (see demographic sheet) which is aggregated at end of year.

Transferring Care to CAPS:

Once students have engaged with you, they may be interested in becoming a regular client at CAPS.

From the Let’s Talk Meeting, the counselor can schedule the student for a Phone Triage appointment in PnC. In the phone triage block on PnC, please note the student was referred from Let’s Talk.
A student must not be referred directly to an Intake appointment from Let’s talk. They must complete a phone triage because risk questions are not asked during a Let’s Talk contact.
A student may be scheduled for an in-person phone triage (versus phone triage) with the Lets Talk counselor at their office (not at the Let’s Talk location).
If the Let’s Talk Counselor is unable to schedule the Phone Triage appointment (via PNC or by phone with the front office), the student can contact the Central Office to schedule a Phone Triage appointment.

Informed Consent:

Because we do not consider Let's Talk a clinical service, students are not required to sign a "consent for treatment" and "limitations of confidentiality" statement.  Let’s Talk counselors do not have formal conversations about confidentiality at the beginning of the Let’s Talk consultation, as Let's Talk is akin to a conversation one might have with a student after a stress management outreach presentation

Students coming into Let’s Talk are provided a Professional Disclosure statement which describes the service and guidelines for confidentiality, but the student is not asked to sign this form. 
Students are encouraged to read the "Frequently Asked Questions" section of the Let's Talk website, which explains the difference between Let's Talk and formal counseling and outlines the limits of confidentiality. Counselors are also provided with a paper copy of the "Let's Talk FAQ"* to give to students as necessary.
It may be necessary to discuss and clarify the limits of confidentiality with a student utilizing a Let’s Talk consultation in certain circumstances. For example, if a student was on the verge of disclosing something that might require breaking confidentiality, the clinician would stop the process to discuss the issue.

Repeated Visits:

On average, the yearly average of Let’s Talk visits is one-to consultations per year.  Occasionally, a student may be reluctant to accept a referral to more formal counseling.

If a student continues to use Let’s Talk repeatedly (more than 2x per year):

Gently discourage the student from using Let’s Talk as a substitute for counseling
If a period of more extensive engagement with Let’s Talk let’s talk may be warranted, please consult with a member of the Let’s Talk team or management.

Assessing Risk:

Students who utilize Let’s Talk are not asked directly about suicide unless clinical judgment indicates it is warranted. Let’s Talk is not a clinical service and its goal is to provide access to students who may be reluctant to seek traditional mental health services because of its associated stigma.
For students who voluntarily reveal imminent risk, the student is referred to the Central Office for assessment in same day Crisis Services and asked to walk to the Central office at that time (the Let’s Talk counselor should call ahead and alert the on-call CAPS clinician).
In rare cases, the Let’s Talk Counselor may need to walk the student over, or call the Central Office for a CAPS clinician to come to the Let’s Talk location to assist in an on-site assessment.  Calling the campus Police is also an option in urgent cases.

Emergencies:

If the student is psychotic, actively suicidal or homicidal, or might warrant emergency help for other reasons, the following options can be utilized:

If the student needs immediate counseling follow-up but does not need hospitalization. Make a short-term safety and coping plan with the student and schedule a Priority CAPS Intake.
If the student may need hospitalization. If you are concerned that the student needs to be hospitalized:

Call the CAPS Central Office for consultation with management
The Let’s Talk counselor may need to walk the student over to the CAPS Central Office of Campus Police can be contacted for transport
Call the Central Office for a CAPS clinician or management to come to the Let’s Talk location to assist in an on-site assessment and possible hospitalization. .

Unexpectedly Leaving Early from Let’s Talk:

If you have to leave the site early, either to facilitate a hospitalization or for any other reason, leave a copy of the "Let's Talk Leaving Early Notice" on the door.

Absences from Let’s Talk:

Planned absences:

Contact your site to inform them you will be absent and forward a copy of the "Let's Talk Absence Notice" *.  Please have your contact person post the notice on the door of your site during the scheduled Let’s Talk hours

Unplanned absences:

When you call the CAPS front desk to inform them you will be out for the day, please ask them to contact your Let's Talk site. The front desk has a list of all sites and contact names.

Front desk guidelines for unplanned absences:

In the event a Let's Talk clinician calls in sick, please call the person listed under "contact in the event of absence" on the "Let's Talk Master List"* and inform them that Let’s Talk” will not be offered that day.

Follow up with an e-mail with the "Let's Talk Absence Notice"* attached. The contact person should post this on the door.

Responsibilities of Campus Offices Which Host Sites:

Provide an office for the scheduled Let’s Talk time;
Provide a phone, unless arrangements have been made for you to use your own cell phone
Have someone nearby in case of an emergency.  It's occasionally helpful to remind site personnel of this need; we can be easily forgotten in our offices as people go home for the day.

Let's Talk Documents:

All documents are also located in the "Let's Talk Administration" folder on the K drive.  Since the K: drive is not accessible at Let’s Talk sites, it is important that you bring these materials with you to the site.

ENTERING RESULTS IN LIS (ORCHARD HARVEST)

Effective Date: 
Tue, 03/25/2014
Reviewed: 
Tue, 01/10/2017
Policy: 

Purpose and Scope:
To describe the steps for manually entering and approving lab results in the LIS (Orchard Harvest).
 

 

 

Procedure: 

Procedure

  1. Log on to Harvest Orchard by selecting your username from the drop down box. Enter your password in the appropriate space.
  2. Select the Work in Progress box from the Work Center menu. (Alternatively, Work in Progress can be selected from the drop down menu under Laboratory).
  3. Double click on the patient’s test that is to be resulted. Enter the appropriate numerical result in the Result column or select a text result by clicking the down arrow on the Text Result column.
  4. Click the Approve button on the top right of the screen. This will release results to the medical record.
  5. If results are present from an instrument interface, review results for accuracy, enter any additional results or comments and click the Approve button to release to the medical record.
Key Points: 

References

Orchard Harvest LIS Help Manual Version 8.5  Copyright 2009

HAZARDOUS MATERIALS/HAZARDOUS WASTE

Effective Date: 
Thu, 10/17/2013
Reviewed: 
Tue, 01/10/2017
Policy: 

The clinical laboratory generates materials that are considered hazardous and/or biohazardous waste. The handling of and storage of hazardous materials and hazardous waste will be monitored regularly according to University requirements.

The clinical laboratory completes and maintains a "Storage Area Self-Inspection Form" for Hazarous Materials/Hazardous Waste. The form is completed weekly. The form includes: Inspection date, Area free of spills or leaks, Proper secondary containment, Contaminant clean, Containers labeled, Incompatibles segregated, Waste tagged and dated, Waste within storage time, Emergency procedure posting, and Inspectors initials and Comments/Corrective Actions.

 

Procedure: 

Hazardous Waste

Wright stain and Gram Stain washings are considered hazardous waste. The washings are collected in e-tagged (UCSC online hazardous waste program WASTe) leakproof containers and stored until two thirds full or 90 days whichever comes first. They are subsequently picked up by UCSC EHS department.

Leftover reagents from the Beckman Coulter AcT analyzer are sprayed with Cavicide disinfectant to remove any possible biohazardous waste on the outside of the container, then e-tagged and subsequently picked up by UCSC EHS.

 

Biohazardous Waste

The biohazardous waste the lab generates consists of blood tubes and any visibly bloody tissues, papers or containers. Blood tubes are disposed of in sharps containers and then deposited in the biohazardous waste receptacle located in the lab storage closet. Bloody materials are put in the red bags lining the self closing waste cans under the counters in the lab. The red bags are then deposited in the biohazardous waste receptacle located in the closet.

 

QUALITY ASSESSMENT PLAN

Effective Date: 
Mon, 09/23/2013
Reviewed: 
Tue, 01/10/2017
Policy: 

Principal

The quality assurance plan outlines written policies, procedures and activities designed to monitor and evaluate the quality of testing processes (preanalytic,analytic and postanalytic). Policies and procedures insure accurate reliable and prompt reporting of test results, as well as help to meet standards from regulating agencies. Ongoing quality assurance activities can detect errors, procedural lapses or divergences from goals, while also suggesting changes need in procedures or training.

The plan includes policies and procedures that describe quality control, proficiency testing, personnel training and competencies, management of test results, handling of test specimens, and the verification of accuracy of instrumentation and methodologies.

The plan also includes activities to detect prompt result reporting, to detect mishandling of specimens and to monitor the proficiency of testing personnel.

Quality Control

Controls are used according to manufacturer’s recommendations or as required by accrediting agencies for each testing procedure performed. The medical director designates the lab supervisor to monitor and review all quality control data and/or charts on a timely basis. See the QUALITY CONTROL policy located in Section VI of the LAB MANUAL for specific descriptions of quality control materials and activities.

Proficiency

Proficiency samples are provided by the American Proficiency Institute (API) on a quarterly schedule. Proficiency samples are handled in the same manner as patient samples. All testing personnel participate in analyzing proficiency samples. The medical director reviews all results and corrective actions (if needed). See the PROFICIENCY TESTING policy located in Section VI of the LAB MANUAL for more details of proficiency testing activities and monitoring.

Training and Competency

All personnel are required to undergo an extensive training period before performing testing. Training checklists and performance reviews are reviewed by the lab supervisor. Performance reviews and competency checks are performed at 6 months for new staff, and annually thereafter. Moderate to highly complex testing is only performed by licensed clinical lab scientists, while waived testing is only performed by personnel that have successfully completed training. Phlebotomy is only performed by licensed phlebotomists or clinical lab scientists. See the LABORATORY STAFF ORIENTATION, TRAINING AND ASSESSMENT policy located in Section VI of the LAB MANUAL for more details.

Test Results

All test results performed in-house are reviewed and released by clinical laboratory scientists. Abnormal or unexpected results are verified as needed. Any results questioned by the clinician are repeated and verified if possible. Critical results are called to clinicians within 30 minutes of final result. Critical result phone calls follow the format of using two forms of patient identification and having the recipient read-back the result. Documentation of the call is included in the medical record with the result. Corrected test results are called to the clinician as soon as possible. Documentation of corrected result calls is included in the medical record with the results. See the REVIEW OF TEST RESULTS policy located in Section VI of the LAB MANUAL for more details.

Lab Specimens

All lab specimens are labeled with Point and Click (MIS) labels. Hand labeled specimens may be acceptable but must have at least two forms of identification. Unlabeled or inadequately labeled specimens are rejected. Compromised specimens (clotted or hemolyzed) may be recollected if possible.  All specimens with lab orders are accessioned into Point and Click (MIS) which sends them to Orchard Harvest (LIS) system. See procedures BLOOD COLLECTION, GENERAL SPECIMEN COLLECTION AND HANDLING, QUEST LABORATORY SPECIMEN COLLECTION PROCEDURES, REJECTION OF SPECIMENS and TEST AND SPECIMEN REQUIREMENTS CHART in Section I of the Laboratory Manual for further information.

Accuracy of Instruments and Methods

All instruments and methodologies are validated before being adopted into use for routine patient testing. The validation consists of precision testing, correlation with a previously verified method and verification of linearity (if quantitative results are involved). Established instruments and methods are verified to be accurate through the use of Interlaboratory Quality Assurance Programs (IQAP) when available, quarterly proficiency testing and biannual calibration verification (where applicable). See procedures, EVALUATION OF AUTOMATED TEST METHODS, LINEARITY TESTING (REPORTABLE RANGE) CALIBRATION VERIFICATION, PROFICIENCY TESTING and QUALITY CONTROL AND ASSESSMENT in section VI of the Laboratory Manual for further information.

 

QUALITY ASSURANCE ACTIVITIES

Quality assurance activities are the ongoing studies or monitoring of lab processes in order to measure the performance or effectiveness of protocols in relation to goals set. These activities may be ongoing or may change periodically to meet the needs and the goals of lab management.

Turn around times

Turn around times or TAT is usually perceived as the time it takes once a specimen is received in the lab to the time a final result is generated. It is desirable to decrease the TAT for testing that is needed urgently (STAT) so as to expedite patient care. Monitoring TAT can help facilitate corrective actions where the TAT does not meet goals and can lead to overall changes in procedures and personnel in order to maximize efficiencies. The lab will monitor STAT in-house CBCs and STAT urine dipsticks for TAT during the current year.

Unlabeled or mislabeled specimens

Mislabeled specimens (specimens labeled with the wrong patient’s name and/or identification) can lead to serious errors in patient care. Unlabeled specimens causes delays in specimen processing and can lead to mislabeled specimens. The lab will monitor and investigate each instance of mislabeled or unlabeled specimens. The goal will be to decrease the number of incidents to zero.

Accuracy of Test Results

Inaccurate or erroneous lab results can lead to serious errors in patient care. Erroneous lab results can be caused by typographical errors, mislabeled specimens and/or instrument malfunction. All erroneous lab results must be corrected and the clinician notified promptly. Such errors are documented in the problem log.

Quality Improvement

Projects are to be undertaken to assess the quality of certain processes and procedures during the course of the year. The projects will ascertain to measure the quality of the process in terms of sensitivity, specificity or timeliness. It will also be assessed as to whether the process can be improved by implementing various changes or having staff focus on the issue. Examples of such past QI projects are the Wet Mount vs Trichomonas Culture project (improve sensitivity) or the  Urine Leukocyte Esterase vs Manual WBC Count project (improve accuracy, sensitivity and utilization).

COMPLETE BLOOD COUNT (CBC)

Effective Date: 
Fri, 08/16/2013
Reviewed: 
Tue, 01/10/2017
Revised: 
Fri, 08/16/2013
Policy: 

 

Principle

The Coulter AcT2 Hematology Analyzer performs a Complete Blood Count (CBC),
Platelet Count, and a Three-Part Differential. Whole blood is aspirated, diluted, and then divided into two samples. One sample is used to analyze the red blood cells and platelets while the second sample is used to analyze the white blood cells
and hemoglobin.

Electrical impedance is used to count the white blood cells, red blood cells, and platelets as they pass through an aperture. As each cell is drawn through the aperture, a change in electrical resistance occurs generating a voltage pulse. The number of pulses during a cycle corresponds to the number of cells counted. The amplitude of each pulse is directly proportional to the cell volume.

Lyse reagent is added to the diluted sample and used to count the white blood cells. After the white blood cells have been counted and sized, the remainder of the lysed dilution is transferred to the Hgb Flow Cell to measure Hemoglobin concentration.

The AcT2 uses electronic sizing to determine a three part automated differential. The percentage and absolute counts are determined for lymphocytes, neutrophil, and mid-size population of monocytes, basophils, eosinophils, blasts, and other immature cells.

The AcT diff2 analyzer has two operating modes: Open Vial Whole Blood and Closed Vial Whole Blood.  Whole blood samples can be analyzed in either mode.  Prediluted samples can be analyzed at the Open Vial Station.

Specimen Collection and Handling

HANDLE BLOOD AS A POTENTIAL BIOHAZARD CAPABLE OF TRANSMITTING INFECTION. ALWAYS WEAR PROTECTIVE GLOVES AND LAB COAT WHEN PROCESSING SPECIMENS.

Draw specimen in into a lavender-top Vacutainer tube containing K2EDTA. Thoroughly mix blood with EDTA anticoagulant. If hemolysis or small clots are observed, discard specimen.
Mix venous blood sample at least 8 times by hand inversion. Gently turn capped sample upside down then back straight up. Alternatively, use a mechanical mixer for at least 5 minutes.  Do not test samples that are incorrectly filled or that are clotted. If hemolysis or small clots are observed, discard specimen.

Analyze venous blood samples within 24 hours of collection. Do not refrigerate samples for platelet and differential counts. If platelet or differential results are not required, store anticoagulated whole blood specimens at 2- 8 C. Warm samples to room temperature (16-35 C or 61-95 F) before testing.
 

Equipment and Materials

Equipment Performance Parameters
The AcT diff2 Analyzer operates at ambient temperature (16- 35 C or 61- 95 F) at humidity no higher than 85% without condensation.

Materials, Reagents 
COULTER diff AcT Tainer reagent pack or diff AcT Pak™, both of which contain diluent (Reagent 1) and lytic reagent (Reagent 2).  The diff AcT Tainer reagent pack also contains AcT Rinse™ Shutdown Diluent (Reagent 3).

Reagent 1 is an isotonic electrolyte solution that dilutes whole blood samples, stabilizes cell membranes for accurate counting and sizing, conducts aperture current, rinses instrument components between analyses, and prevents duplicative cell counts by using the sweep-flow process.

Reagent 2 is a lytic reagent that lyses red blood cells for white blood cell count and hemoglobin measurement.  Caution: Eye irritant.  Avoid contact with skin and eyes.  Avoid breathing gas.  Contact with acid liberates poisonous gas.

Reagent 3, AcT Rinse Shutdown Diluent, prevents protein buildup that occurs in and around the apertures.  Caution:  Avoid eye and skin contact.  Do not ingest.

Reagent Preparation
No reagent preparation is required. Appropriate safety precautions for handling reagents are contained on the respective Material Safety Data Sheets located in the laboratory’s MSDS/ HAZARDS binder.

Reagent Storage
Store reagents at ambient room temperature (2-25 C).  Keep containers closed. Discard reagents at the expiration date. Replace reagents when the screen prompt appears or when the reagent container is empty.

Reagent Tracking
When opening new reagents, log on the Reagent Log indicating date opened, lot number, and expiration date.
 

Quality Control Procedures

QC Frequency
Test 3 levels of QC samples once per day of testing using Coulter 4C PLUS cell controls.

QC Procedure Using COULTER 4C PLUS Cell Control

  1. Be sure the 4C PLUS cell control information and values have been correctly entered from the TABLE OF EXPECTED RESULTS listed on the package insert.  For information on how to enter the values, see "Entering 4C PLUS Cell Control Information" in chapter 2 of the AcT diff2 Operator’s Guide.
  2. Ensure that 4C PLUS cell control is not past its expiration date and that it is at the correct storage temperature.
  3. Allow refrigerated controls/calibrators to sit 10-15 minutes at room temperature before use . Mix by rolling slowly between the palms of the hands 8 times then invert and roll 8 times. Gently invert the tube 8 times. Inspect the tube contents to determine if all cells have been uniformly distributed. Repeat above steps if tube contents have not been uniformly distributed Inspect the tube contents to ensure that all cells are uniformly distributed; if not, repeat this step.
  4. At the Main screen, touch the QA icon.
  5. At the QA screen, touch the 4C PLUS Run icon.
  6. Select the correct control level:

   L   Low

       N   Normal

                                                            H   High                                                   

  1. The square darkens next to your selection. Make sure that the level of control you are testing matches the one selected (L, N or H).
  2. Invert the tube once or twice prior to cycling.

IMPORTANT:  Risk of misleading results if Cap Pierce Station door is opened before the sample analysis is completed.  Do not open the door.  The door will open automatically.

  1. Place the well-mixed sample in the tube holder at the Cap Pierce Station and close the door.
  2. When the tube holder door opens, remove the vial and return it to the refrigerator.
  3. Results appear on the screen.  Unless non-numeric results occur for one or more parameters, the control results are automatically stored:
  4. If Autoprint is off you can manually print results by touching the Print icon.
  5. To manually reject these results, touch the Trash icon.
  6. If results are not within the expected range, rerun the control starting at step 6. If results are still out of range, see the Special Procedures and Troubleshooting Section of the AcT diff2 Operator's Guide.
  7. Repeat steps 6 through 10 for each required control level.
  8. If the results are within the expected range, you are finished running controls.  If you do all of the above steps and the results still do not meet your performance expectations, call your Beckman Coulter Representative.
  9. First try re-running the control with the same vial of control.
  10. If QC is still not in range, open a new vial of QC material and re-run.
  11. Refer to troubleshooting procedures in the Coulter Operator’s Guide section 6.8.

       Do not report patient test results until control values are acceptable.
 

Critical Values

Critical/Alert Values are those results demonstrating such variance from normal as torepresent a pathophysiological state with potential of being life threatening unless action is taken quickly. These results must be immediately reported to the care provider and be documented in the test record as to who was contacted, the time of contact, the person making contact, and that the results were read back.

WBCs K/mm3 <3.0 or >15.0
HGB g/dl <8.0 or > 20.0
HCT % <25 or >60
Platelets  K/mm3 <100 or >600

 

Procedure: 

Sample Analysis  - Closed Vial Whole Blood Mode

  1. At the Main screen, select Closed Vial Whole Blood mode.
  2. At the Main screen, touch the Sample Results Screen icon.

NOTE:  If the door is inadvertently closed after it has opened automatically, or if it is closed at a screen where samples are not run, you can open the door by touching the Main Menu icon and then the Sample Results icon.

  1. Touch the Patient Range icon until the desired range (1, 2 or 3) appears.
  2. Verify that the sample ID is correct.  If autosequencing is on, the 9-digit sample ID number automatically increments by 1.  If autosequencing is off, manually enter the sample ID and touch the Save icon.  Be careful not to duplicate an existing sample ID number that may have been used previously. Unique sample accession numbers will be automatically assigned to specimens by the Orchard Harvest LIS.
  3. Mix the sample on the mechanical rocker prior to sampling.
  4. Be sure you are in the Closed Vial Whole Blood mode.
  5. Check the sample for clots by tilting the tube back forth and observing for clots.
  6. Place the well-mixed sample in the tube holder at the Cap Pierce Station and close the door.
  7. When the tube holder door opens, remove the tube.
  8. Sample results are automatically saved by the instrument, and the results appear on the screen.
  9. Print the results:
  • If Autoprint is on, the results print automatically.
  • If Autoprint is off, touch the Print icon.
  • If Autosequence is on, the instrument is ready to run the next sample.
  • If Autosequence is off, you must manually enter an ID number before the probe  descends for the next sample.
  • If flags appear, see the Special Procedures and Troubleshooting   Section of the AcT diff 2 Operator's Manual.

Sample Analysis  - Open Vial Whole Blood Mode

  1. At the Main screen, select Open Vial Whole Blood mode.
  2. At the Main screen, touch the Sample Results Screen icon.
  3. Touch the Patient Range icon until the desired range (1, 2 or 3) appears.
  4. Verify that the sample ID is correct.  If autosequencing is on, the 9-digit sample ID number automatically increments by 1.  If autosequencing is off, manually enter the sample ID and touch the Save icon.  Be careful not to duplicate an existing sample ID number that may have been used previously.
  5. Mix the sample thoroughly on the mechanical rocker.
  6. Be sure you are in the Open Vial Whole Blood mode.
  7. Present the well-mixed sample to the probe so that the tip is well into the tube, and press the aspirate switch.
  8. When you hear the beep, remove the sample, and put the cap back on the tube.
  9. The analyzer displays the sample results on the screen and automatically saves them.
  10. Print the results:
  • If Autoprint is on, the results print automatically.
  • If Autoprint is off, touch the Print icon.
  • If Autosequence is on, the instrument is ready to run the next sample.
  • If Autosequence is off, you must manually enter an ID number before the probe descends for the next sample.
  • If flags appear, see the Special Procedures and Troubleshooting Section of the AcT diff2 Operator’s Manual.

Test Results

WBC - White Blood Cell or leukocyte count
              LY#          Lymphocyte number
              LY%         Lymphocyte percent (or ratio)
              MO#         Mononuclear cell number
              MO%        Mononuclear cell percent (or ratio)
              GR#          Granulocyte number
              GR%         Granulocyte percent (or ratio)
RBC - Red Blood Cell or erythrocyte count
Hgb - Hemoglobin concentration
Hct - Hematocrit (relative volume of erythrocytes)
MCV - Mean Corpuscular (erythrocyte) Volume
MCH - Mean Corpuscular (erythrocyte) Hemoglobin
MCHC - Mean Corpuscular (erythrocyte) Hemoglobin Concentration
Plt - Platelet or thrombocyte count
RDW - Red Cell (erythrocyte volume) Distribution Width
MPV - Mean Platelet (thrombocyte) Volume

Flagged Results

Parameter
Range
Action

WBC, RBC, HGB, PLT

Exceeds linearity

Dilute and re-run

WBC

<4.0 or  >15,000

Slide review

PLT

<100,000  or >500,000

Slide review

MCV

<75 or >105 fl

Slide review

MCHC

> 36

Check for cold agglutinin by placing in 37C incubator for intervals of 15 min; check for lipemia, hemolysis.

RDW

>22%

Slide review

No diff or incomplete diff

 

Manual differential

Neut #

<1.0 or >8.0

Slide review

                   Neut %

>85%

Slide rev. for bands

Bands,Metas,Myelos,Blasts,nRBCs

>5%  on slide rev.

Manual differential

Eosinophils >10% on slide rev. Manual differential
Basophils >5% on slide rev. Manual differential

Lymph%

> 50.0

Slide review

Mono#

>1.5

Slide review

-----

Total voteout

Thoroughly mix and repeat specimen, zap apertures if persists

+++++

Results over range for Plt, WBC, RBC, HGB, HCT GRAN, LYM

Check bath shield; make a dilution with normal saline

MCV +++++

<50 or >130

Use spun crit or slide rev to verify

XXXXX

Aperture alert

Check sample for clots; if persists, repeat with known sample; if persists, zap apertures.

…..

Incomplete calculation

Address voteout (above)

Reportable Ranges
The operating range listed below is the range of results over which the AcT diff2 Series AnalyzerSeries instruments display, print and transmit results.  The linear (reportable) range is also listed below. Linearity limits apply only to directly measured parameters. The AcT diff2 Series Analyzer flags values between the linear range and the operating range.

Parameter

Operating Range

Linearity Limit/

Reportable Range

Units

WBC

0.0 ‑ 150

0-99.9

x 103 cells/ mL

RBC

0.00 ‑ 8.00

0-7.0

x 106 cells/m L

        Hgb

00.0 ‑ 30.0

0-25.0

g/dL

MCV

50.0 ‑ 130.0

 

fL

        Plt

000 ‑ 3000

0-999.0

x 103 cells/ mL

LY%

0 ‑ 100

 

%

MO%

0 - 100

 

%

GR%

0 - 100

 

%

        LY#

0 - 99.9

 

x 103 cells/ mL

MO#

0 - 99.9

 

x 103 cells/ mL

        GR#

0 - 99.9

 

x 103 cells/ mL

 Reference Ranges

 

Parameter

Units

Our Reference Ranges

WBC

x103 cells/ uL

<21 yrs 4.5-13.2

>21 yrs 3.4-10.0

RBC

x106 cells/ uL

Males 4.4-5.9

Females 4.0-5.2

HGB

g/dL

Males 13.5-17.5

Females 12.0-15.5

HCT

ratio

Males 41-53.0

Females 36-46.0

MCV

fL

80.0-100.0

MCH

pg

26.0-34.0

MCHC

g/dL

31.0-36.0

PLT

x103 cells/ uL

140-450

LY

#

<21 yrs 1.0-6.1

>21 yrs 1.0-3.4

MO

#

<21 yrs 0-1.4

>21 yrs 0-0.8

GR

#

<21 yrs 1.8-8.0

>21 yrs 1.8-6.8

Limitations of the Procedure

 K2EDTA is the recommended anticoagulant. K3EDTA and Na2EDTA are also acceptable. Use of other anticoagulants can yield misleading results.

 

Interfering Substances

These can also yield misleading results for the parameters listed below:

  • WBC: Certain unusual RBC abnormalities that resist lysing, nucleated RBCs, fragmented WBCs, any unlysed particles greater than 35 fL, very large or aggregated platelets as when anticoagulated with oxalate or heparin.
  • RBC: Very high WBC count, high concentration of very large platelets, agglutinated RBCs and RBCs smaller than 36 fL.
  • Hgb: Very high WBC count, severe lipemia, certain unusual RBC abnormalities that resist lysing, anything that increases the turbidity of the sample such as elevated levels of triglycerides.
  • MCV: Very high WBC count, high concentration of very large platelets, agglutinated RBCs, RBC fragments that fall below the 36‑fL threshold, rigid RBCs.
  • Plt: Very small red blood cells near the upper threshold, cell fragments, clumped platelets as with oxalate or heparin, platelet fragments or cellular debris near the lower platelet threshold.
  • Hct: Known factors that interfere with the parameters used for its computation, RBC and MCV.
  • MCH: Known factors that interfere with the parameters used for its computation, Hgb and RBC.
  • MCHC: Known factors that interfere with the parameters used for its computation, Hgb, RBC and MCV.
  • LY,MO,GR: Known factors that affect the WBC count as listed above, such as high triglycerides, that can affect lysing.

 

Key Points: 

 

Use the Operator's Guide for:

                               Getting started and running the instrument day‑to‑day

Reviewing unusual results (how to read a result report and what flags mean)

Performing special procedures such as cleaning, replacing, or adjusting a component of the instrument

Troubleshooting problems with your instrument.

 

Use the Reference Manual for:

What the instrument does and methods it uses

Instrument specifications and requirements

How to interface your analyzer to your laboratory's host computer

How to safely use the instrument.

 

Use the Installation and Training Guide for:

Initially setting up the instrument and printer

Powering up the instrument

Customizing the software.

 

Use the Operating Summary for:

Running your instrument using a quick reference set of procedures

Verifying screen icon

 

References

Coulter AcT diff2 Analyzer Operator's Guide PN 4237495B (June 2003) Copyright Beckman Coulter 1999,2003

 

 

 

 

BACITRACIN TEST (A DISK)

Effective Date: 
Mon, 08/12/2013
Reviewed: 
Tue, 01/10/2017
Policy: 

 

Purpose and Scope:

The bacitracin susceptibility test is used to distinguish Group A streptococci, from other streptococci. When grown on blood agar, Group A streptococci are sensitive to (killed by) the antibiotic bacitracin. A sterile disk impregnated with bacitracin (also known as “Taxo A disk”) is placed on the first sector of an isolation plate before incubation. A zone of inhibition (area with no growth) will be seen around the disk after incubation if the organism is a Group A beta-hemolytic Streptococcus. Other beta-hemolytic streptococci are resistant to (not killed by) bacitracin. Their colonies will thus grow right up to the disk of bacitracin.

 

Reagents and Supplies:

  • BBL Taxo A disks (0.04 IU Bacitracin)
  • 5% Sheep Blood  w/TSA plates
  • Sterile inoculating loops
  • 37 C Incubator

 

Reagent Storage

  • On receipt, store at -20 to +8°C. After use, store vial or cartridge to protect product integrity at 2 to 8°C.
  • Use oldest discs first and discard expired discs. Allow containers to come to room temperature before opening.
  • Return unused discs to the refrigerator when application of discs has been completed.
  • Vials and cartridges from which discs have been frequently removed during one week and discs left out overnight in the laboratory should be discarded, or the discs should be tested for performance with control organisms prior to continued use.

 Quality Control:

 QC is performed weekly by inoculating one half of a blood agar plate with S pyogenes ATCC 19615 and the other half with S agalactiae ATCC 12386. After 24 hr incubation the S pyogenes should show a distinct zone of inhibition while the S agalactiae should not.

Record result in Bacitracin test QC log.

 

 Procedure

  1. With a sterile inoculating loop, obtain a portion of an isolated colony of the strepcococci being tested.
  2. Streak the plate for isolation.
  3. With sterile forceps, obtain a bacitracin disk and place inon the inoculated agar at the intersection of the primary and secondary streaks. Tap the disk with forceps to ensure adherence to the agar surface.
  4. Incubate the blood agar plate in ambient air at 35°C for 18 to 24 hours.
  5. After the incubation period, examine the blood agar for a zone of growth inhibition around the bacitracin disk.

 

Interpretation:     Susceptible= any zone of growth inhibition

                             Resistant=no zone of growth inhibition               

 

REFERENCES

BD BBL Taxo Discs for Differentiation of Group A Streptococci Package Insert 8800671JAA(01) Ver. 02/2012

Levinson, M.L and P.F. Frank 1955 Differentiation of Group A from other beta-hemolytic streptococci with bacitracin. J. Bacteriol. 69:284-287

NOVOBIOCIN TEST

Effective Date: 
Fri, 08/09/2013
Reviewed: 
Tue, 01/10/2017
Policy: 

 

Purpose and Scope:

The HardyDisk™ Novobiocin Differentiation Disks are useful in presumptively distinguishing S. saprophyticus from other CoNS. Other human staphylococcal species that are novobiocin-resistant (S. cohnii, S. xylosus, S. pulvereri) are rarely isolated from patients.

Coagulase-negative staphylococci (CoNS) are among those organisms that have traditionally been considered skin contaminants, and their recovery from cultures doesn't always indicate presence of disease. Therefore, little attention had been paid to the pathogenic potential of this group of bacteria until recently. By the mid-1970's, microbiologists were becoming aware that CoNS could indeed be pathogenic, especially in compromised hosts.

 Today, S. saprophyticus has proven to be an important uropathogen. It is second only to E. coli as the most common cause of cystitis and acute urinary tract infection (UTI) in healthy, young adult women. S. saprophyticus tends to adhere to uroepithelial cells more often and more successfully than other staphylococcal species, this is believed to partially explain the organism's frequent role in urinary tract infections.

 

Reagents and Supplies:

  • HardyDisk™ Novobiocin Differentiation Disks 5ug
  • Mueller Hinton plates
  • BD  BBL Prompt Inoculation System

 

Reagent Storage

  • Upon receipt store at -20 to +8 degrees C. away from direct light.
  • The disks should not be used if there are any signs of deterioration, discoloration, or if the expiration date has passed.
  • Protect from light, excessive heat, and moisture.
  • The expiration date applies to the product in its intact packaging when stored as directed.

 

Quality Control:

 

QC is performed on each day the test is performed. Use procedure with stock culture of Staph saprophyticus ATCC 15305  (Novobiocin resistant) and Staph epidermidis ATCC 12228  (Novobiocin sensitive).

Record QC results on Novobiocin Test QC Log.

 

Procedure

  1. Allow disks to equilibrate to room temperature.
  2. Using a pure 18-24 hour culture, prepare a suspension using the Prompt inoculation system. (See Kirby Bauer Sensitivities Procedure SOP Micro-06 for instructions on using Prompt Inoculation system.)
  3. Inoculate Mueller Hinton Agar  plate with a sterile swab to obtain confluent growth. (See Kirby Bauer Sensitivities Procedure SOP Micro-06 for instructions on inoculating Mueller Hinton agar.)
  4. Aseptically apply one novobiocin disk onto the inoculated agar surface and lightly press down to ensure full contact with the medium.
  5. Incubate aerobically for 18-24 hours at 35-37 degrees C.
  6. Measure (in millimeters) the diameter of the zone of inhibition around the novobiocin disk, and record as susceptible or resistant.

Sensitive - A zone of inhibition greater than 16mm.
Resistant - A zone of inhibition less than or equal to 16mm.

 

Limitations

It is recommended that biochemical and/or serological tests be performed on colonies from pure culture for complete identification.

The novobiocin disk is not helpful and can give misleading results if it is performed on isolates other that those from urinary specimens.

Occasional human isolates that are not S. saprophyticus, S. cohnii subsp., or S. xylosis may also be resistant to novobiocin.

 

 

 

 

 

 

REFERENCES

HardyDisk™ Novobiocin Differentiation Disks Package Insert Copyright 2013

Murray, P.R., et al. 2003. Manual of Clinical Microbiology, 8th ed. American Society for Microbiology, Washington, D.C.

NOVOBIOCIN TEST

Effective Date: 
Fri, 08/09/2013
Policy: 

 

Purpose and Scope:

The HardyDisk™ Novobiocin Differentiation Disks are useful in presumptively distinguishing S. saprophyticus from other CoNS. Other human staphylococcal species that are novobiocin-resistant (S. cohnii, S. xylosus, S. pulvereri) are rarely isolated from patients.

Coagulase-negative staphylococci (CoNS) are among those organisms that have traditionally been considered skin contaminants, and their recovery from cultures doesn't always indicate presence of disease. Therefore, little attention had been paid to the pathogenic potential of this group of bacteria until recently. By the mid-1970's, microbiologists were becoming aware that CoNS could indeed be pathogenic, especially in compromised hosts.

 Today, S. saprophyticus has proven to be an important uropathogen. It is second only to E. coli as the most common cause of cystitis and acute urinary tract infection (UTI) in healthy, young adult women. S. saprophyticus tends to adhere to uroepithelial cells more often and more successfully than other staphylococcal species, this is believed to partially explain the organism's frequent role in urinary tract infections.

 

Reagents and Supplies:

  • HardyDisk™ Novobiocin Differentiation Disks 5ug
  • Mueller Hinton plates
  • BD  BBL Prompt Inoculation System

 

Reagent Storage

  • Upon receipt store at -20 to +8 degrees C. away from direct light.
  • The disks should not be used if there are any signs of deterioration, discoloration, or if the expiration date has passed.
  • Protect from light, excessive heat, and moisture.
  • The expiration date applies to the product in its intact packaging when stored as directed.

 Quality Control:

 QC is performed on each day the test is performed. Use procedure with stock culture of Staph saprophyticus ATCC 15305  (Novobiocin resistant) and Staph epidermidis ATCC 12228  (Novobiocin sensitive).

Record QC results on Novobiocin Test QC Log.

 

Procedure

  1. Allow disks to equilibrate to room temperature.
  2. Using a pure 18-24 hour culture, prepare a suspension using the Prompt inoculation system. (See Kirby Bauer Sensitivities Procedure SOP Micro-06 for instructions on using Prompt Inoculation system.)
  3. Inoculate Mueller Hinton Agar  plate with a sterile swab to obtain confluent growth. (See Kirby Bauer Sensitivities Procedure SOP Micro-06 for instructions on inoculating Mueller Hinton agar.)
  4. Aseptically apply one novobiocin disk onto the inoculated agar surface and lightly press down to ensure full contact with the medium.
  5. Incubate aerobically for 18-24 hours at 35-37 degrees C.
  6. Measure (in millimeters) the diameter of the zone of inhibition around the novobiocin disk, and record as susceptible or resistant.

Sensitive - A zone of inhibition greater than 16mm.
Resistant - A zone of inhibition less than or equal to 16mm.

 

Limitations

It is recommended that biochemical and/or serological tests be performed on colonies from pure culture for complete identification.

The novobiocin disk is not helpful and can give misleading results if it is performed on isolates other that those from urinary specimens.

Occasional human isolates that are not S. saprophyticus, S. cohnii subsp., or S. xylosis may also be resistant to novobiocin.

  

REFERENCES

HardyDisk™ Novobiocin Differentiation Disks Package Insert Copyright 2013

Murray, P.R., et al. 2003. Manual of Clinical Microbiology, 8th ed. American Society for Microbiology, Washington, D.C.

MEDICAL BILLING HANDLING OF RECHARGES

Effective Date: 
Sun, 08/21/2011
Reviewed: 
Sun, 08/21/2011
Revised: 
Sun, 08/28/2011
Policy: 

Medical services performed at the Student Health Center for UCSC departments such as TAPS, EPC, OCEAN SCIENCES, OPERS etc.. are reimbursement via inter-department transfer called “Recharge”.

A recharge document is either sent out in advance of services being performed or shortly after a request has been made from the Student Health Center. 

Procedure: 

SEE PDF for additional images accompanying text procedure.

The recharge form must be filled out in advance by the “requesting” department.  Medical billing will complete the form by filling in data such as; totals, FOAPAL for the Student Health Center, and the descriptive data relating to the services in need of reimbursement.  

Attached File: 
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