WHAT ARE THE MEDICAL LABORATORY TECHNIQUES IMPORTANCE IN PROMOTING QUALITY HEALTH, PEACE, AND ENTREPRENEURSHIP? THE CASE OF COVID-19

 

WHAT ARE THE MEDICAL LABORATORY TECHNIQUES IMPORTANCE IN PROMOTING QUALITY HEALTH, PEACE, AND ENTREPRENEURSHIP? THE CASE OF COVID-19

INTRODUCTION TO MEDICAL LABORATORY TECHNIQUES IMPORTANCE

By Benjamin Pulle Niriwa: July 2022; Last Updated on 13th December, 2022.

Summary

There is no valueless profession or job on earth, especially in the health sector, or science in general. No one wants to be disrespected for who he/she is or for what he/she does! Unfortunately, with the exception of Cuba and some few selected Western nations, Medical Laboratory Scientists are not given the dignifying recognition that they deserve for their profession. This article seeks to let people understand the importance of Medical Laboratory Techniques and what Medical Laboratory Scientists do to promote quality health, peace and entrepreneurship. This would help people accord them the needed recognition and respect that they deserve for their profession.

 

Background to the Article

Irrespective of how small a needle might be, never underrate what it can do. Anyone who pretends to value what a needle can do, can use it to prick himself/herself and see. There is no valueless profession or job on earth, especially in the health sector, or science in general. Unfortunately, with the exception of Cuba and some few selected Western nations, the Medical Laboratory Scientists (Biomedical Scientists, Laboratory Doctors, Medical Laboratory Technologists, Medical Laboratory Technicians, Medical Laboratory Assistants and Attendants) are not given the dignifying recognition that they deserve for their profession (Gohar & Nowrouzi-Kia, 2022; Oosterhuis & Zerah, 2015; Al-Enezi et al., 2008).

Evidence of this is how everyone working in the lab is mostly addressed as one gender “Man”. Though it is obvious that it is not only men who work at our Medical Laboratories worldwide. It is irritating and very insulting to refer to everyone working at the lab as a “Lab Man!” But if you ask anyone who is a health expert, he/she would tell you that the Medical Laboratory is one of the most import departments of every health facility. Any small mistake that the lab commits, affects trust issues of the whole health facility; unlike the other departments. This in most cases cannot be said about other departments. It is because most of them depend on the information provided by the lab.

Giving respect to others might not be valued by others as necessary, but respecting every human being for who he/she is or what he/she does is a magic that will only motivate him/her but encourages the person to give out the best. Having the feeling that what you are doing is valued and appreciated by others is itself an internal motivation and encouragement to do more. This article seeks to help people understand and appreciate what their Medical Laboratories do for them globally.

I have personally worked in the Medical Laboratory over seventeen (17) years. I myself on many occasions have been addressed as a lab man and I was not happy with it. Even when I am now a health tutor, some people who knew before this still call me lab man. It is not wrong to be called a lab man but it does not show respect! Why don't they call others by the name of the place they work? There are many colleagues within the profession who also complaint about the same issue (being called lab man), countless times. This alone pictures the emotional and psychological trauma that these professionals go through because some people undermine what they do and disrespect them; either out of ignorance or intentional.

No one wants to be disrespected for who he/she or for what he/she does! Even if someone is a prostitute, he/she still needs to be respected as a dignified human being. You might not appreciate his/her job but he/she might be helping others to manage their stresses, and thereby helping to prevent suicide (Mueller et al., 2021). The maxim of equity and the Golden Rule says: “Do unto others as you would have them do unto you” (Heeren, 2021; Editor., 2019; Nelson et al., 2016; Corazzini et al., 2005). When people understand the importance of the lab and medical techniques, it would help them to intern value what the lab is doing. It would also help them give those that are in-charge of what the lab does, the necessary recognition and respect that they need to continue carrying out their daily activities with different mindsets.

 

Introduction

If anyone still does not understands the important roles of the Medical Laboratory in helping to ensure quality health, peace, and entrepreneurship; he/she should cast his/her mind back to the activities of COVID-19 pandemic (Chen & Yu, 2020). Any time you sanitize your hands or anything, wear face mask, maintain a distance because of SARS-CoV-2 (Chen & Yu, 2020); they are indirectly reminding you of the importance of Medical Laboratory and the techniques that are used by the Medical Laboratory Scientists in identifying the pathogen. Preventing a disease or an infection without knowing the causative agent is like a military fighting a tough opponent that is not known to them (Figure 1.).

No one risks his/her life for humanity than a Medical Laboratory Scientist or Health Workers! This was made very clear at the peak of COVID-19 where some health workers even committed suicide because of their “traumatic experiences” of watching their colleague human beings passed on helplessly (Qiu et al., 2021; Billings et al., 2021; Steinbuch, 2020; Thakur & Jain, 2020). Some human beings were stigmatizing against suspected COVID-19 infected persons, those who were infected, and even their relatives or friends (Niriwa a, 2021; Peprah & Gyasi, 2020). But, most health workers were the hope of these people who were stigmatized and discriminated against because of SARS-CoV-2 infection. If these health workers did not give them hope and a reason to live, the stigma and discrimination alone could have killed them.

When one visits the wards of any health facility, he/she could attest that, really those who were saved and are now enjoying life were because of the sacrificial works of doctors and nurses at these wards. When it comes to the Medical Laboratory too; Biomedical Scientists/Medical Laboratory Scientists, Medical Laboratory Doctors, Medical Laboratory Technologists, Medical Laboratory Technicians, Medical Laboratory Assistants and Attendants were also playing important roles behind the scenes.

Whilst people are running away from COVID-19 infected persons, they are working on the infectious agent itself, SARS-CoV-2 up to now (Rasool et al., 2022; Tandara et al., 2022; Wolszczak-Biedrzycka* et al., 2022). There are also reports of some Medical Laboratory Scientists losing their lives as they try to sacrifice and save others (Wilson et al., 2022; Classfmonline.com., 2020; Fang & Meng, 2022). But, what helps the Medical Laboratory to be able to identify infectious agents or causes of diseases? They are able to do that using Medical Laboratory Techniques (MLTs) like the “Molecular, Serological and Biochemical” techniques (Rasool et al., 2022). To be able to get quality, representative and reliable results; some techniques are used in every Medical laboratory investigations.

Figure 1: Preventing a Disease without Knowing the Causative Agent Is Like Fighting an Unknown Enemy

 

In the outbreak of COVID-19, the prevention protocols that people are observing to prevent further spread were made possible with laboratory identification of the infectious agent, SARS-CoV-2 (Chen & Yu, 2020). When the microorganism/infectious agent responsible for causing a particular disease is known; it then normally informs the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) and all Health Experts on what to do next to prevent outbreak of an “epidemic” or “pandemic” from further spreading (Madhav et al., 2017).

A similar agent severe acute respiratory syndrome coronavirus, SARS-CoV, now SARS-CoV-1, is detected in China 2003 (Coleman & Frieman, 2014). The identification of SARS-CoV-2 using laboratory equipment is what has led to evidence-based treatment of the disease, COVID-19 for quality health care delivery (Carley et al., 2020). This would not have been possible without using Medical Laboratory Technique (MLTs). To help readers easily understand, this article is divided into five (5) learning objectives. At the end of the article, readers would be able to:   

1. Know what lab techniques are and how they contribute to safety
2. Give some examples of Medical Lab Techniques (MLTs)
3. Know the various lab units where these techniques are used
4. Know the techniques themselves that are used for each test at each lab unit, and their Standard Operating Procedures (SOPs.).
5. Know the importance of MLTs in promoting quality health, peace, and entrepreneurship.

 

What Are Medical Laboratory Techniques (MLTs)?

Medical Laboratory Techniques (MLTs) refer to the professional skills, practices or processes used by a Biomedical Scientist to do laboratory tests using Medical Laboratory Equipment (Wood, 2021). So, routine laboratory techniques refer to the various diagnostic methods that are skillfully employed in daily lab investigations (Midzi et al., 2020; Nowakowski et al., 2001; McGowan Jr. & Georgia, 1991). All the maintenance trainings on how to maintain laboratory equipment like the microscope; to ensure quality, fast, and reliable results, all form part of MLTs.

Even how you handle medical laboratory equipment requires some technicalities in doing that. Example, the microscope is not just handled any how; whilst one hand is holding its limb, the other hand is placed at its base to provide support. The same technicalities are needed in the handling of laboratory glass wares, like; conical flasks or bottles.

When doing culture and sensitivity (C/s) too; some technicalities are mostly required to ensure quality and reliable results or to protect yourself and others. One of such techniques is how the inoculation of biological sample/inoculum onto the culture medium/media is/are done (Meade et al., 2021; Cheesbrough, 2009; Vandepitte et al., 1991). Example; when doing urine culture and sensitivity, the sample is not just poured unto the medium (CLED). Even before the sample is taken for inoculation, the inoculating loop is technically redly heated. For urine cultures, loop full of the sample is taken and inoculated at one end of the medium, then by using standard streaking techniques whilst turning the medium in the petri dish at an angel of 60℃ (Vandepitte et al., 1991).   

 

What Is the Difference between MLTs and standard operating procedures (SOPs)?

The techniques that are used in the medical laboratory are mostly in line with the “standard operating procedures” (SOPs) which are similar everywhere in the world. These techniques are mostly the same everywhere in the world too! Example, the same techniques required in conducting most laboratory investigations like urine or stool routine examination are similar in most parts of the world.

For urine R/E, irrespective of where it is done, pouring of the urine into the test tube is done in the same way. Macroscopic, chemical, and microscopic examinations for both urine and stool R/E are similar everywhere they are done globally (Tetteh-Quarcoo et al., 2022; Demeke et al., 2021; Milani & Jiala, 2021). The formol ether concentration technique for identifying intestinal parasites is the same everywhere global. One cannot decide to use distill water instead of the formol ether for the same test!

Another example is that, the technicality of flaming the inoculating loop/wire has an international standard. Irrespective of where a medical laboratory is located; the inoculating loop must be heated to become red-hot, and at an angle of thirty degrees Celsius (30℃) (Pakpour & Horgan, 2021; Rollins et al., 2000). One cannot decide not to heat it as recommended or not to heat it at all; it will help that Biomedical Scientist to get growth from a patient who might be having no bacterial infection. There are many SOPs for each test used for laboratory disease investigations; they are available to guide Medical Laboratory Scientists in doing medical laboratory diagnosis.

For every laboratory test, there is a written document that instructs the Biomedical Scientist/Medical Laboratory Scientist (BMS/MLS) or a Medical Laboratory Doctor (MLD) how to do it. That written document telling the Medical Laboratory Scientist what to do at each stage of the test is the SOPs of that test (Hollmann et al., 2020). But the technicalities that the Laboratory Scientist is using to do the test are the MLTs. Each SOPs can be made of two (2) or more MLTs like in the case of COVID-19 (Onigbinde et al., 2021; Shrestha & Pokharel, 2020).

Some of the laboratory tests that require the application of standard operation procedures are:

Biochemical tests, like; blood urea nitrogen (BUN), liver function tests (LFTs), lipid profile (LP), urine routine examination (Urine R/E or Urinalysis).

Electrolyte tests such as; Sodium (Na⁺), Potassium (K⁺), Chloride (Cl^-), Calcium (Ca²⁺), and Magnesium (Mg²⁺).

Routine Investigations for intestinal parasites like; Stool routine examination (Stool R/E), Kato-Katz technique, Stool concentration techniques like the Formol Ether Concentration Technique. 

Hematological tests, like; Full Blood Count (FBC), Sickling, Erythrocyte Sedimentation Rate (ESR), blood film for malaria parasite (Bf for MPs) or rapid diagnostic test for malaria parasites (RDT for MPs), blood film comment.

Culture and sensitivity (c/s) test, like; blood c/s, urine c/s, high vaginal swab (HVS) c/s, stool c/s.

Screening tests done for blood transfusion, like: Syphilis, Hepatitis (B and C), HIV, and so on.

These laboratory techniques are done in different departments of the Medical Laboratory. They are divided depending on the type of laboratory investigations each department does into: Microbiology (Fig. 2A.), Hematology, Biochemistry/Chemistry, and Blood Bank. Examples: Culture or sensitivity and routine investigations for intestinal parasites are done in the Microbiology Department; hematological tests such as FBC, ESR, and test for abnormal hemoglobin (hemoglobin S or sickling) are done in the Hematology Department; tests like electrolytes, LFTs, LP, and BUN/Cre are done in the Biochemistry/Chemistry Department; whilst Screening tests for blood transfusions are done in the Blood Bank.

Figure 2: Units of the Microbiology Department, What They Investigate (A) and Importance of Medical Laboratory Techniques (B)

 

Within each department too, it is further divided based on the specific tests that are done there into various units. Using the microbiology department as an example; it is further divided into bacteriology, parasitology, virology, mycology, and mycoplasmology (Fig. 2A.). The bacteriology unit deals with the investigations of bacterial diseases; the parasitology unit investigates parasites; the virology unit works on viruses, fungi are investigated in the mycology unit, whilst mycoplasmas are tested for under the mycoplasmology unit respectively (Fig. 2A.). Each of these investigations is done using different techniques or SOPs, but some techniques are the same irrespective of the department or unit.

Though there are SOPs for each laboratory investigation; there are also SOPs for group of tests that are similar. Example; though there are SOPs for doing LFTs, LP, BUN, CRE each; there are also SOPs for doing all clinical chemistries (Sameer, 2015).

Standard Operation Procedures (SOPs) are not only used in the Medical Laboratory! They are by all professions that want to render nothing but the best services to their customers. Disease Control Officers (DCO) use SOPs in providing and assessing most of their services; especially, when they are introducing a new intervention like the “New types of insecticide-treated nets” (Lissenden et al., 2021). At the “Palliative Care Units” (Lödel et al., 2020), “Emergency” rooms (E/R) or wards (Lucas et al., 2021), the Consulting rooms of health facilities (Deveugele et al., 2004), and so on; SOPs are for evaluating and assessing services provided for patients.

Standard Operation Procedures (SOPs) are used for specialized health care services like neurologic care (Jaiteh et al., 2017), cancer treatment (Danos, 2019) or nutritional advice (Petrigna, 2022), and so on. In the COVID-19 pandemic, SOPs were used throughout and are still being used (Afridi, 2021). Aside the many SOPs for COVID-19 (Who f., 2022; Ashok, 2021), there were other SOPs that were specifically for those involved in collecting sample for investigation of SARS-CoV-2 (Onigbinde, 2021; Shrestha, 2020). All the guidelines (Dos and don’ts) that were are used for wearing face masks or person protective equipment (PEP) in general are all SOPs (Niriwa et al., 2021; Ubaid et al., 2021; Elmhurst, 2020). But within each of these SOPs, there are some technicalities that are applied.

Specialized consultation services (Deveugele et al., 2004) on conditions associated with weak immunity body weight management are normally referred to the Nutrition Officer. If a Nutrition Officer is checking obesity using body mass index or whatever to check whether someone is obesed (too fat); he/she is doing “physical fitness assessment” (Petrigna, 2022) and that Officer needs SOPs. But with each SOPs like the SOPs for assessing physical fitness; calculating the body mass index, checking the weight of the person, measuring his/her height and so on, are all techniques. 

Culture and sensitivity is an investigation that is mostly done in the Microbiology Department using different SOPs and techniques for each type of culture. The word “culture” is itself a MLT that uses many other MLTs to arrive at the final identification of microorganism(s). Though there are general SOPs for all microbiological tests (Lam, 2014), each of the tests has a separate SOPs and techniques that are used. The preparation of media that are used for culture and sensitivity are done using different SOPs and techniques (Maxwell, 2018). In the SOPs for preparing culture media, more than five (5) MLTs are used:

A.    Dressing: Wearing the appropriate protective clothing (personal protective clothing) like gloves, face masks, lab coat and so on are advisable,

B.     Pouring: distilled is poured into measuring cylinder to measure the volume,

C.     Boiling: They are again poured into metal jars and boiled for them to melt for uniform mixture,

D.    Covering: There is a special technicality of covering the prepared media with corks of the cultures media bottles. After the media are boiled to melt, they are corked in such a way that they are not too tight or too lose.

E.     Sterilization: This is done before and after media preparation. Before preparation, all the things needed are sterilized. The media after preparation are poured into culture bottles and sterilized again.

F.      Cooling and Solidifying: The prepared media are dispensed into culture bowls and are allowed to cool and solidify (become solid or jelly-like).

G.    Storing: They are then stored at the required temperature (2-8℃) for daily use.

Some examples of medical laboratory techniques that are used in all the departments/units of the Medical Laboratory are: staining, disinfection, sterilization, stirring, pouring, microscopy, filtering, measuring and so on.

All these medical laboratory techniques emerged from the various discoveries initially made by Founding Fathers from various fields of health. Anthony Van Leuwenhoek out of his hobby of grinding lenses and molding microscope is the person who discovered the microscope and the microbial world, initially known as “Little Animalcules” (Aryal, 2019; Opal, 2009).

 

Importance of Medical Laboratory Techniques in the 21^st Century Health Care Delivery

Most researchers and writers mostly focus on getting results and using the right methods during laboratory diagnosis (Otsetov, 2020). They are not wrong but after getting the results, the Biomedical Scientist must be able to interpret them. So, the ability to interpret laboratory results cannot be left out in the importance of laboratory techniques. Laboratory techniques do not only ensure timely, reliable, representative, and quality results; but they also ensure safety of Laboratory staffs, patients, and visitors (Katz & Tobian, 2014).

But why is it important for any health worker like a Nutrition Officer to learn about Medical Laboratory Techniques? Laboratory investigations are very important when it comes to nutritional need assessment (Shrivastava et al., 2014). Nutrition Officers can easily assess and monitor macronutrient status using their normal medical investigations like checking the weight, body mass index, and muscle mass (Mercer-Smith et al., 2021). Though protein and fat are also macronutrients like carbohydrates, it might not be easy to just use these “Clinical examinations” or calculations to arrive at the right diagnosis.  

So, laboratory investigations like biochemical tests such as Urinalysis, Liver Function Tests (LFTs), Lipid Profile (LP); electrolytes assessment such as Na, K, Cl, Ca, Mg; or hematological tests like Full Blood Count (FBC), Blood film comment, Blood film for malaria parasites (Bf for MPs) tests and so on are needed (Mercer-Smith et al., 2021). All the laboratory investigations provide specific information to the Nutrition Officer or Consultant that serve as evidence-based treatment for their patients. They also help them in making the right/best decision.

Stool routine and urine examinations can also help provide a Nutrition Officer with vital information that can help him/her diagnose malnutrition (Tetteh-Quarcoo et al., 2022; Sumbele et al., 2021; Cheesbrough, 2009; Vandepitte et al., 1991). Though hematological examination can diagnose anemia (Pfeiffer & Looker, 2017); some of them which are caused by intestinal worms or parasites can still be missed (Dassah et al., 2022; Caldrer et al., 2022). Example, Hookworms (Ancylostoma duodenale, Necator americanus) are known causes of iron deficiency anemia (Cheesbrough, 2009; Vandepitte et al., 1991).

In the same way the Consultant can also miss parasites and bacteria from the urinary tract (Bono et al., 2022; WHO d., 2020; Medina & Castillo-Pino., 2019) like Schistosoma hematobium (SH) or Escherichia coli (E. coli) which can also help him/her knows the specific cause of an anemia. SH, like the hookworm, also causes iron deficiency anemia and malnutrition; mostly as a result of passage of blood in the urines of infected persons (Tetteh-Quarcoo et al., 2022; Sumbele et al., 2021; Marques et al., 2020).

The following eight (8) points are some of the reasons why a Health Professional, like the Nutrition Officer, Needs Medical Techniques.

Point One (1) – The ability to know the right samples for specific laboratory tests and be able to detect errors in laboratory results: Basic knowledge in medical laboratory techniques helps one to be able to know which sample is supposed to be used for a particular diagnosis (Fig. 2B, Number 1). Laboratory investigations are based on the principle of “Garbage in: garbage out” (Compton, 2018; O'Hurley et al., 2014; Anthonisen, 2010). What this means is that, whatever sample you put into the laboratory equipment (garbage in) will provide result(s) (garbage out), but such result(s) might not be reliable or a true reflection of the patient’s condition. The result(s) could be true representation of the sample used (the garbage that was put in) but not a true representation of the patient’s sickness.

The evidence that one provides to support treatment of a patient is directly dependent on the quality of the sample taken (Fig. 2B, 2). The Founding Fathers of Medical Laboratory like Anthony Van Leuwenhoek, Louis Pasteur, and Robert Koch (Aryal, 2019; Opal, 2009), would not have been able to make the right discoveries if the samples that they used were not true representations of what they discovered.

Even the right sample that has been rightly collected can still produce result(s) that is/are not reliable or of quality. Example, a blood sample that has been rightly collected from the right patient at the right time, from the right site and for right test; can still produce false or error ridden results, if it is not well processed before testing. Blood samples for the investigation of hemoglobin (Hgb) levels must always be uniformly mixed for that. If this is not done and it has been left in the rack for long and the test is done without proper mixing, the results could be falsely high or low depending on the portion of the sample used. The first point of saving a patient or getting everything right depends on the nature of the sample collected. Once that fails everything that follows irrespective of how good or experience one is, would be errors or wrong. 

So, one who understands MLTs would be able to detect if there is any error in reporting a patient’s result could be due to the nature of the sample. If a patient is looking very pale or anemic without any bleeding and the Hgb level is normal or high, that would be a call for curiosity. The likely cause could be because the blood sample has been left for long in the rack and the test was done by aspirating the packed red blood cells at the bottom. Without basic knowledge from Medical Laboratory Techniques, this could be very difficult to detect. But one who had this knowledge can easily identify most errors in the results before treating a patient. It would also help the person to trust the results that are produced by the laboratory.

Example, if one requests for blood film for malaria parasites (Bf for MPs); he/she would expect to see Plasmodium species if present, but not hookworm. He/she would be able to detect that as an error, because he/she understands that the sample to detect hookworm is stool but not blood. A health professional who has basic knowledge of MLTs would be able to know that though a pale looking and weak patient did not complaint of abdominal pains, there is the need to add stool or urine routine examination in the test. 

This is because one of the most common causes of weakness is anemia; but intestinal parasites (Caldrer et al., 2022; Chou & Austin, 2022) urinary tract infections (UTIs) are also known as some of the causes of anaemia (Caldrer et al., 2022; Dassah et al., 2022; Turner et al., 2022). Though the patient thinks because his/her abdomen is not paining you should stop the stool R/E, there are evidence of people who do not even show any sign of sickness but intestinal parasites were detected form them. There are also evidence of intestinal parasites like hookworms or E. histolytica detected as causing anaemia in asymptomatic people (Irisarri-Gutiérrez et al., 2022; Gujo & Kare, 2021).

But, this patient is not only anaemic but is complaining of body weakness which can be caused by anaemia. Full blood count, FBC, would help you to know the exact level of the Hgb; whilst any positive result of the Bf MPs, stool or urine R/E can help you know the cause of the anaemia. Knowing the exact cause would prevent try and error treatment which is not helpful for the patient, putting his/her safety at risk; because every antimicrobial has its side effect.

Point Two (2) - Evidence-based treatment: The 21^st Century’s world endorses “Evidence-based therapy” or treatment as the Gold Standard (Selva, 2021; Lesser, 2021; Li et al., 2019). Evidence-based medicine in health started with Anthony Van Leuwenhoek’s (1632-1723) discovery (Bio.libretexts.org., 2021; Aryal, 2019; Opal, 2009).  His initial crucial discoveries were what triggered massive interests in the scientific investigations of infectious pathogens by Scientists like Robert Hooke (1635-1703) who “confirmed some of Leuwenhoek’s discoveries” (Gest, 2009; Gest a., 2004). Evidence-based medicine is now the gold standard (Lobitz, 2019).

But the Scientist who specifically talked about evidence-based treatment and control of diseases was Frederick Griffith (1879-1941), a bacteriologist from England. He was specifically referring to evidence-based health care delivery in his believed that: “Progress in the epidemiology and control of infectious diseases would come only with more precise knowledge of the identity of the causative microorganisms” (Méthot, 2016). Learning about Medical Laboratory Techniques would help a health professional to appreciate or understand how the results that he/she uses for treating patients are obtained (Fig. 2B., 2).

Evidence is a mirage if the one using the result(s) cannot interpret it/them. With respect to evidence-based treatment, a health professional would be able to know the exact infectious agent(s); like hookworms or Schistosoma species that causes anemia.

Point Three (3) – Right Interpretation of Laboratory Results: Every lab result means differently and is interpreted differently. The interpretations of Liver Function Tests (LFTs) or Lipid Profile ‘LP’ (Burke, 2002; Clinic, 2021; Zhao et al., 2021) are different from the interpretation of Urea or Creatinine (Urea/Cre) but they are all biochemistry tests (Gounden et al., 2022; Fig. 2B., 3).

Even the individual parameters of the same test, like LFTs, are interpreted differently! Any elevated LFTs result is an indication of “autoimmune hepatitis”, “a chronic disease” that normally shows characteristics hepatic cells continuously inflaming, looking necrotic and have the possibility of making the liver inflamed (Lala et al., 2022). The aminotransferases of LFTs – AST (aspartate aminotransferase) and ALT (alanine aminotransferase) are also indicative of trauma/injury of liver cells. When the same AST and ALT are high or above their normal ranges, they confirm “hepatic steatosis and nonalcoholic steatohepatitis” and they also indicate that the patient is a drunkard (Lala et al., 2022; Burke, 2002).

Albumin and total protein which are parameters of the same LFTs, mean completely different from that of AST and ALT when they are low or high. They are normally telling the consultant about “protein synthesis” (Lala et al., 2022; Burke, 2002) unlike AST and ALT.

Though most of the results are accompanied with reference ranges, they normally only indicate whether result(s) is/are normal or abnormal. It all forms part of interpreting the results, but true interpretation of the result(s) is your ability to know what it means if a result is below or above the reference range. Just knowing that a result is normal or abnormal is not enough! But what does it really means if a result is normal or abnormal?

Example, knowing that a patient is anemic is not enough! It simply means that the patient’s hemoglobin (Hb.) level is below the normal reference range. But, your ability to tell exactly why the patient is anemic is the best interpretation of laboratory results. It could be caused by iron or foliate deficiency, parasitic infections like hookworms or Schistosomiasis, injury or bleeding, underlined chronic disease(s) and so on.

To be able to know this; it is always advisable to accompany test requested for suspected anemia with other tests like Bf for MPs/MPs (RDTs), stool/urine R/E and blood film comment. If bleeding is suspected, the following tests; peripheral blood film, prothrombin time (PT) and partial thromboplastin time (PTT) should added (Khan & Mandiga, 2022; Neutze & Rogue, 2016).

No matter how excellent the evidence provide by the Medical Laboratory might be; it is your ability to understand and rightly interpret the result(s) is what will make it/them useful. In the same way, a lab result could be full of errors but your inability to understand what goes into carrying out the test that produces it would make you fail to notice that error. The inability to rightly interpret the results can also lead to unnecessary argument between the Biomedical Scientist and the Consultant. This can also delay patients waiting time, since the time that both workers are supposed to use for working has being wasted debating or unnecessarily arguing.

Example, there can be blood in the chemistry test of urinalysis but no red blood cells (RBCs) in the microscopy. This is because the blood in the urine that has been detected by chemistry test is a hemolyzed one. This could be as a result of infection with infectious agents like Clostridium perfringens, Escherichia coli (Ristow et al., 2016; Orf & Cunnington, 2015), Plasmodium specie (Orf & Cunnington, 2015), Streptococcus pneumoniae (Orf, 2015), Salmonella species (Orf & Cunnington, 2015), Bartonella bacilliformis (Orf & Cunnington, 2015) and so on. This hemolysis causes anemia and malnutrition in infected persons, especially amongst the children. The commonest Gram-negative bacterium, Escherichia coli (E. coli), is known for causing hemolytic urinary tract infections (UTIs).

Point Four (4) - Making Inform Decision(s) on treating patients: Making an informed decision is dependent on one’s ability to know the exact cause of a patient condition, but not by using try and error. The emphasis on treating a patient with a confirmed evidence of what causes the sickness (Selva, 2021; Lesser, 2021; Li et al., 2019) is because it aids in making the best or an informed decision about his/her treatment. If a patient complaints of abdominal pains, you just don’t jump into treating him/her for intestinal parasites; whilst even malaria can also make a patient present with the same complaint. Properly diagnosing this patient with the right laboratory investigation is what would help you identify the exact cause of his/her sickness. 

Applying the knowledge gotten from Medical Laboratory Techniques would help one to be able to make the best decision(s) on the treatment(s) that patients need. He/she would be able to know how to use some laboratory investigations like urinalysis or Complete blood count (CBC) to diagnose anemia. How a health professional would treat a patient whose urinalysis has yeast cells, without any knowledge of Medical Laboratory Techniques, is different from using this knowledge.

Making the best or an informed decision always goes with your ability to understand and correctly interpret a patient’s result(s) (Graber, 2020; Lobitz et al., 2019). This ability to understand, detect errors, tell what an abnormal result means, and making good decision(s) based on how you understand the result is called interpretation of results (Graber, 2020; Kopanitsa, 2020; Charney & Dourmashkin, 2019). You can do this by comparing the results with their reference ranges, “positive or negative test, and contextual” (Charney & Dourmashkin, 2019); accompanied by effectively communicate with the patient.

Example, abnormal “serum urea/BUN concentrations” could be caused by highly rich protein meals or if the patient is given medication of “corticosteroids” that he/she is taking orally. The same urea/BUN results are also normally high in both “acute and chronic renal disease” (Gounden et al., 2022). For such a situation, the best way that you can rightly confirm if the abnormal urea/BUN values are raised as a result of the patient orally taking corticosteroids’ treatment is by asking him/her.

To get the right answers, mixed yes/no questions with those that demand the patient to explain or describe; but not yes/no alone. Examples are: Please are you given any drugs or treatment anywhere? If the answer is “Yes!” follow up with questions like, when were you given that medication? How do the drug(s) look(s) like? How were you instructed to take it?

Another example; using this knowledge, he/she would better understand that; seeing yeast cells is not only an indication that the patient has Candidiasis. It is also an indication of immunosuppression, especially if the patient is a male. So, during treatment he/she would advise the patient on eating nutritious foods or adding some food supplements to help boost his/her immune system (Fig. 2B., 4).

Point Five (5) – Quality health care delivery: The quality of care and treatment that is given to a patient is directly dependent on making the right decision using the right diagnosis with right sample. Even with the right diagnosis, if the decision taken is not in line with that diagnosis; quality would be missing in whatever services that would be offered for the patient. The World Health Organization (WHO) emphasis is also on quality health care delivery (WHO b, 2021; WHO a., 2020; WHO b., 2020). Poor quality equipment or poorly maintained equipment can be a barrier to quality laboratory results and quality patient’s management. So, medical laboratory techniques help one to know how the equipment used for producing the results work; and how these equipment or the whole laboratory can be maintained (WHO c., 2020).

This cannot be realized using the old fashion try and error treatment methods. Quality would be questionable if the health professional does not know the exact infectious agent that he/she treats. Clinical laboratory equipment is/are needed with professional or experienced Medical Lab Scientists who know how to use and maintain those (Fonjungo et al., 2012). So, getting this knowledge as a health professional can help one to appreciate the processes that are used to confirm diseases like anemia. The person would be equipped with basic knowledge on what is supposed to be done to prevent errors (pre-analytical, analytical, and post-analytical) and get quality and reliable results.

Point Five (6) – Patients Safety Is Guaranteed: The “safety” of every patient is more protected (WHO b, 2021; WHO a., 2020; WHO b., 2020) using the knowledge that a health professional gets from Medical Laboratory Techniques. A health professional like a Nutrition Officer can be able to properly practice evidence-based treatment, or make informed decision(s) for quality and timely treatment of patients. The old fashion try and error treatment puts the patient at risk (Fig. 2B, 6).

This is because the diagnosis and treatment could be wrong, leading to drug resistance and complications from the disease. This could make the patient be risking his/her life to visit the health facility and spend more money (financial risk). But once the specific cause (evidence of the disease causing agent) is known, it would provide informed decision on the exact treatment that the patient needs.

Example, evidence revealed that patients who have “diabetes mellitus” are thirty (30) times at a higher risk of undergoing amputation than those who do not have it (Molina & Faulk, 2022). This risk of undergoing an amputation and the psychological trauma that a patient would go through (Molina & Faulk, 2022; Sahu et al., 2016), could be reduced or eliminated by doing medical laboratory test to detect diabetes early for early interventions. When that happened the patient is safe from progressing to complicated diabetes or the possible risk of amputation with its associated emotional and psychological trauma.   

Point Six (7) – Peace: Experiences in life are evidence that quality health care delivery, safety, peace, and entrepreneurship are like biological identical “quadruplets” (Christine, 2022; Lama et al., 2020; Rathod et al., 2015)! Where ever any of them is present; the remaining triplets are there too, and vice versa. But all these are also built from the first six (6) points above. Collecting the right sample(s) from the right patient would provide reliable and quality results which are true reflections of a patient’s health status (Fig. 2B, 7).

This finding from the diagnosis would serve as an evidence to help the health professional like a Nutrition Officer to make an informed decision. But the ability of the professional to make an informed decision is based on how best he/she can interpret (Charney & Dourmashkin, 2019) whatever results that are produced by the Medical Laboratory. The decision that he/she makes would not only help in giving the patient the best of treatment or management (quality health care delivery); it would leads to speedy recovery of the patient too. It would reduce the risks that the patient would have gone through; visiting the same facility with the same condition – financial risk, accident, and the side effects of using wrong medication form a try and error treatment.

The excruciating pains alone that one goes through when he/she is sick or has an accident are enough to justify why one needs to be healthy in order to be peaceful or have peace. Guessing to treat a patient is an obstacle of peace that could lead to treatment failure which could also result in an additional “emotional stress” (Duberg et al., 2020) of the patient visiting the health facility with the same sickness. If the specific cause is identified using medical laboratory techniques, like in the case of diabetes the patient would be put on the right medication(s). This would facilitate speedy recovery of the patient for him/her to have a peaceful mind. The patient’s safety is guaranteed since he/she would spend less and has reduced risk of visiting the hospital with the same condition that could even resulted into an accident on his/her way to seek healing.

So, this therefore makes every health professional a peace ambassador; because for one to have a peaceful mind he or she needs to be healthy. To be able to work for raising capital to take care of his/her family needs, and also contributes to economic development the person needs to be healthy. Example, tests on inherited diseases, like sickle cell disease and diabetes (Molina & Faulk, 2022; Otsetov, 2020), can be prevented if marriage couples do Medical Laboratory investigations before marriage. A health professional who is able to interpret the results, can use it give them “genetic counseling” (Marzulla et al., 2021; Kashmola-Perez et al., 2021) before marriage.

This will help save them from the financial risk of making the hospital their home because they have given birth to a sickle cell disease (SCD) child. Even with improved diagnosis and treatment where gene editing is said to help solve such problem, it would be an added financial burden to couples. Patients with diabetes alone in the United States of America (USA) is said to cost the nation above “$4.3 billion each year (Molina & Faulk, 2022). This indirectly revealed the financial burden that diabetes alone puts on each family.

Point Seven (8) – Entrepreneurship/Improved Economic Activities: The popular sayings that your “health is wealth” and your “wealth is health”; are indirectly telling people the relationship between health, wealth, and entrepreneurship/economic activities (Niriwa, 2022; Carlson, 2016; Phrasisombath et al., 2013). It is obvious that it takes a healthy person to work and contribute to economic development, but not a sick person (Niriwa B. P., 2022). Health problems are normally associated with inevitable stresses that a patient has to manage. But research findings have also indicated that “stress” negatively affect how the body functions (Yaribeygi et al., 2017).

A person with amputated limbs (legs or hands) cannot successfully work like those who have everything intact (Molina & Faulk, 2022; Sahu et al., 2016; Ajibade et al., 2013). It is obvious that patients who are sick and are admitted at the hospital cannot carry out their daily economic activities like they used to do when they were healthy. But after they are successfully treated and discharged, they can start whatever daily economic activities they used to do again (Fig. 2B, 8). This would help them get financial reward for their pockets and also contribute toward the common good of their societies.

Your ability to request the right laboratory investigation(s), using the right sample for the right test is what would determine whether the evidence before you to be used for treating your patient is reliable or of quality. Even if the result is a reliable one and you could not be able to interpret it, you will not be able to make an informed decision. That decision is very important for ensuring that your patient gets the best of service(s) from you; thus, quality health care delivery which would lead to the speedy recovery of your patient. Once the patient is cured, he/she can now do whatever was previously not possible because of the sickness. So, you are contributing to successful economic development or helping Entrepreneurs to carry out their entrepreneurial role efficiently and effectively.

For details, read my book: “UNDERSTANDING THE 21^ST CENTURY MEDICAL LABORATORY TECHNIQUES AND THEIR ROLES IN HEALTH CARE DELIVERY” which is now at chapter twelve.

 

Conclusion

There is clear evidence that the Medical Laboratory Professionals have not being given the necessary recognition and respect that they deserve for their job. For so many years these scientists who are offering essential health care services to the masses have been complaining of lack of job satisfaction (Al-Enezi, 2008). This is once again exposed by the COVID-19 pandemic where these essential health workers who are the ones working with SARS-CoV-2 itself have been struggling to be counted as frontline workers (Gohar & Nowrouzi-Kia, 2022). The question now becomes, who is a COVID-19 frontline worker than those who have been having direct contact with the virus itself?

 

 Suggestions and Recommendations

Ø  The Medical Laboratory Profession itself in most nations or health facilities is full of inherent internal sabotage. Before they begin to get the necessary recognitions that they deserve, they must first of all clean their internal sabotaging mesh.

Ø  There is also an open secret of inherent sabotage among the various health professionals that must be stop. Taking Ghana for example; until recently, Medical Doctors and Medical Laboratory Scientists were all in the same union or welfare. But the MLS broke away from the doctors because their concerns in most cases were left unaddressed.

Ø  Health workers would sell their profession better if they unite as one for a common purpose.

Note: This article is currently available on two sites only; here and HubPages where I first published it on this link,13.12.2022: https://hubpages.com/education/UNDERSTANDING-THE-IMPORTANCE-OF-MEDICAL-LABORATORY-TECHNIQUES-IN-PROMOTING-QUALITY-HEALTH-PEACE-AND-ENTREPRENEURSHIP.

References

Afridi, M., I., Dars, J., A., Junejo, J., Tunio, K., A., Shahani, M., Y., & Katariya, C., L. (2021). Perception of Medical and Paramedical Staff in Regard of Standard Operating Procedure (SOP) of Covid-19. Medical Forum Monthly, 32(1): 81-85. ID: covidwho-1197803. Retrieved from https://pesquisa.bvsalud.org/global-literature-on-novel-coronavirus-2019-ncov/resource/pt/covidwho-1197803 on 07.11.2022 at 4:12 AM.

Al-Enezi, N., Shah, M., A., Chowdhury, R., I., & Ahmad, A. (2008). Medical Laboratory Sciences Graduates: Are They Satisfied At Work? Educ Health (Abingdon, England), 21(2):100. Epub.

Aryal, S. (2019). History of Microbiology. Basic Microbiology. Retrieved from https://microbenotes.com/history-of-microbiology/ on 24.01.2022 at 4:41AM.

Ashok, K., Shailesh, G., Ashish, G., Nameksh, B., & Neha, M. (2021). Outcomes of Standard Operating Procedures Instituted for Non-COVID Outpatient Department During COVID-19 Pandemic in Rural India. J Fam Med Prim Care, 11(7): 3801-3807. Doi: 10.4103/jfmpc.jfmpc_292_21.

Billings, J., Ching, B., C., F., Gkofa, V., Greene, T., & Bloomfield, M. (2021). Experience of Frontline Healthcare Workers and Their Views about Support During COVID-19 and Previous Pandemics: A Systematic Review and Qualitative Meta-Synthesis. BMC Health Serv Res, 21:923. Doi: 10.1186/s12913-021-06917-z.

Bio.libretexts.org. (2021). History of Microbiology - Hooke, van Leeuwenhoek, and Cohn. (Last Updated: 2021, January 3). In Bio.libretexts.org., Book: Microbiology (Boundless) (p. https://bio.libretexts.org/@go/page/8765). California: Retrieved from https://bio.libretexts.org/@go/page/8711 on 24.01.2022 at 5:09AM.

Carley, S., Horner, D., Body, R., & Mackway-Jones, K. (2020). Evidence-Based Medicine and COVID-19: What to Believe and When to Change. Emerg Med J, 37: 572-575. Doi: 10.1136/emermed-2020-210098.

Charney, A., N., & Dourmashkin, J., T. (2019). Interpreting Clinical and Laboratory Tests: Importance and Implications of Context. Diagnosis (Berlin, Germany), dx-2019-0009. Adv online pub, Doi: 10.1515/dx-2019-0009.

Cheesbrough, M. (2009). Laboratory Practice in Tropical Countries, Part 1. 2nd Edition. Cambridge, New York, Melbourne: Cambridge University Press.

Chen, X., & Yu, B. (2020). First Two Months of the 2019 Coronavirus Disease (COVID-19) Epidemic in China: Real-Time Surveillance and Evaluation with a Second Derivative Model. Global Health Res & Policy, 5:7. Doi: 10.1186/s41256-020-00137-4.

Coleman, C., M., & Frieman, M., B. (2014). Pathogens, Coronaviruses: Important Emerging Human . American Soc Microbiol, 88(10): 5209-5212. Doi: 10.1128/JVI.03488-13.

Corazzini, K., N., Lekan-Rutledge, D., Utley-Smith, Q., Piven, M., L., Colón-Emeric, C., S., Bailey, D., Ammarell, N., & Anderson, R., A. (2005). “The Golden Rule”: Only a Starting Point for Quality Care. Director, 14(1): 255–293.

Classfmonline.com. (2020). Lab Scientist Involved in COVID-19 Sample Collection Dies of the Disease . News, Shobiwz, Retrieved from https://mobile.classfmonline.com/news/health/Lab-scientist-involved-in-COVID-19-sample-collection-dies-of-the-disease-15361 on 07.12.2022 at 12:17 PM.

Danos, A., M., Krysiak, K., Barnell, E., K., Coffman, A., C., McMichael, J., F., Kiwala, S., Spies, N., C., Sheta, L., M., Pema, S. P., Kujan, L., Clark, K., A., Wollam, A., Z., Rao, S., Ritter, D., I., Sonkin, D., Raca, G., Lin, W., H., Grisdale, C., J., Kim, R., H., Wagner, A., H., Madhavan, S., Griffith, M., & Griffith, O., L. (2019). Standard Operating Procedure for Curation and Clinical Interpretation of Variants in Cancer. Genome Med, 11(1): 76. Doi: 10.1186/s13073-019-0687-x. PubMed.

Demeke, G., Fenta, A., Dilnessa, T. (2021). Evaluation of Wet Mount and Concentration Techniques of Stool Examination for Intestinal Parasites Identification at Debre Markos Comprehensive Specialized Hospital, Ethiopia . Infect Drug Resist, 14:1357-1362. Doi: 10.2147/IDR.S307683. PubMed

Deveugele, M., Derese, A., De Bacquer, D., van den Brink-Muinen, A., Bensing, J., & De Maeseneer, J. (2004). Consultation in General Practice: A Standard Operating Procedure? Patient Educ Couns, 54(2): 227–233. Doi: 10.1016/S0738-3991(03)00239-8. PubMed.

Editor. (2019). Faith in Focus: The Golden Rule in All Faiths. Faith, Retrieved from https://naijaavenue.com/faith-in-focus-the-golden-rule-in-all-faiths/ on 15.01.2021 at 6:34PM.

Elmhurst, E. (2020). Dos and Don’ts of Wearing Face Masks in Public. Healthy Driven Life, Retrieved on 07.11.2022 at 4:37 AM from https://www.eehealth.org/blog/2020/05/dos-and-donts-face-coverings/#:~:text=DON'T%20push%20your%20mask,distortions%20in%20shape%20or%20form.

Fang, B., & Meng, Q. H. (2022). The Laboratory's Role in Combating COVID-19. Critic Rev Clin Lab Sci, 57(6): 400–414. Doi: 10.1080/10408363.2020.1776675.

Gest a., H. (2004). The discovery of microorganisms by Robert Hooke and Antoni Van Leeuwenhoek, Fellows of the Royal Society. Notes Rec R Soc Lond, 58(2): 187–201. Doi: 10.1098/rsnr.2004.0055. PubMed.

Gest, H. (2009). Homage to Robert Hooke (1635-1703): New Insights from the Recently Discovered Hooke Folio. Perspect Biol Med, 52(3): 392–399. Doi: 10.1353/pbm.0.0096. PubMed.

Gohar, B., & Nowrouzi-Kia, B. (2022). The Forgotten (Invisible) Healthcare Heroes: Experiences of Canadian Medical Laboratory Employees Working During the Pandemic. Front. Psychiatry, 13:854507. Doi: 10.3389/fpsyt.2022.854507.

Graber, M. (2020). Progress Understanding Diagnosis and Diagnostic Errors: Thoughts at Year 10. Diagnosis, 7(3): 151-159. Doi: 10.1515/dx-2020-0055.

Heeren, J. (2021). What Does "Do Unto Others" (The Golden Rule) Mean in the Bible? Topical Studies, Retrieved from https://www.biblestudytools.com/bible-study/topical-studies/what-does-do-unto-others-mean.html on 11.12.2022 at 12:42 PM.

Hollmann, S., Frohme, M., Endrullat, C., Kremer, A., D'Elia, D., Regierer, B., Nechyporenko, A., & Cost Action CA15110. (2020). Ten Simple Rules on How to Write a Standard Operating Procedure. PLoS Comput Biol, 16(9): e1008095. Doi: 10.1371/journal.pcbi.1008095. PubMed.

Jaiteh, L., Helwig, S. A., Jagne, A., Ragoschke-Schumm, A., Sarr, C., Walter, S., Lesmeister, M., Manitz, M., Blaß, S., Weis, S., Schlund, V., Bah, N., Kauffmann, J., Fousse, M., Kangankan, S., Ramos Cabrera, A., Kronfeld, K., Ruckes, C., Liu, Y., Nyan, O., & Fassbender, K. (2017). Standard Operating Procedures Improve Acute Neurologic Care in a Sub-Saharan African Setting. Neurology, 89(2): 144–152. Doi: 10.1212/WNL.0000000000004080. PubMed.

Katz, L., M., & Tobian, A., A. (2014). Ebola Virus Disease, Transmission Risk to Laboratory Personnel, and Pretransfusion Testing. Transfusion, 54(12): 3247–3251. Doi: 10.1111/trf.12913.

Kopanitsa, G. (2020). Automatic Interpretation of Laboratory Tests and Its Influence on Follow-up. Stud Health Technol Inform, 270: 916–920. Doi: 10.3233/SHTI200295.

Lam, K. (2014). Microbiology Clinical Laboratory SOPs. Articles, Retrieved from https://globalhealthlaboratories.tghn.org/articles/microbiology-clinical-laboratory-sops on 07.11.2022 at 7:31 AM.

Lissenden, N., Armistead, J. S., Gleave, K., Irish, S. R., Martin, J. L., Messenger, L. A., Moore, S. J., Ngufor, C., Protopopoff, N., Oxborough, R., Spiers, A., & Lees, R. S. (2021). Developing Consensus Standard Operating Procedures (SOPs) to Evaluate N. Developing Consensus Standard Operating Procedures (SOPs) to Evaluate New Types of Insecticide-Treated Nets. Insects, 13(1): 7. Doi: 10.3390/insects13010007. PubMed.

Lobitz, G., Armstrong, K., Concato, J., Singer, B., H., & Horwitz, R., I. (2019). The Biological and Biographical Basis of Precision Medicine. Psychother Psychosom, 1-8. Doi: 10.1159/000502486.

Lödel, S., Ostgathe, C., Heckel, M., Oechsle, K., & Gahr, S. (2020). Standard Operating Procedures (SOPs) for Palliative Care in German Comprehensive Cancer Centers - An Evaluation of the Implementation Status. BMC Palliat Care, 19(1): 62. Doi: 10.1186/s12904-020-00565-6. PubMed.

Lucas, B., Schirrmeister, W., Pliske, G., Leenen, M., Walcher, F., & Kopschina, C. (2021). Existence and Role of Standard Operating Procedures in the Emergency Department: A National Online Survey, Vorliegen und Rolle von Standard Operating Procedures in der Notaufnahme: Eine nationale Onlineumfrage. Medizinische Klinik, Intensivmedizin und Not. Med Klin Intensivmed Notfmed, 116(1): 50–55. Doi: 10.1007/s00063-019-00642-6. PubMed.

Madhav, N., Oppenheim, B., Gallivan, M., Mulembakani, P., Rubin, E., & Wolfe, N. (2017). Pandemics: Risks, Impacts, and Mitigation. In D. T. Jamison, Disease Control Priorities: Improving Health and Reducing Poverty (pp. 3rd ed. Chapter 17. Doi: 10.1596/978-1-4648-0527-1_ch17). Washington (DC): The Intern Bank for Reconstruction & Dev/The World Bank.

Maxwell, A. (2018). Five Tips for Culture Media Preparation Success. Blog Post, Food, Retrieved on 07.11.2022 at 7:38 AM from https://www.thermofisher.com/blog/food/five-tips-for-culture-media-preparation-success.

McGowan Jr., J., E., & Georgia, A. (1991). New Laboratory Techniques for Hospital Infection Control. Am J Med, 91(3B): 245S-251S.

Meade, E., Slattery, M., A., & Garvey, M. (2021). Biocidal Resistance in Clinically Relevant Microbial Species: A Major Public Health Risk. Pathogens, 10:598. Doi: 10.3390/pathogens10050598.

Méthot, P., O. (2016). Bacterial Transformation and the Origins of Epidemics in the Interwar Period: The Epidemiological Significance of Fred Griffith's "Transforming Experiment". J Hist Biol, 49(2): 311–358. Doi: 10.1007/s10739-015-9415-6. PubMed.

Midzi, N.,Bärenbold, O., Manangazira, P., Phiri, I., Mutsaka-Makuvaza, J., Mhlanga, G., Utzinger, J., & Vounatsou, P. (2020). Accuracy of Different Diagnostic Techniques for Schistosoma haematobium to Estimate Treatment Neeed in Zimbabwe: Application of A Hierachical Bayesian Egg Count Model. PLoS Negl Trop Dis, 14(8): e0008451. Doi: 10.1371/journal.pntd.0008451.

Milani, Q., D., A., & Jialal, I. (2021). Urinalysis. Treasure Island (FL): StatPearls’ Publishing.

Mueller, A., S., Abrutyn, S., Pescosolido, B., & Diefendorf, S. (2021). The Social Roots of Suicide: Theorizing How the External Social World Matters to Suicide and Suicide Prevention. Front. Psychol, https://doi.org/10.3389/fpsyg.2021.621569.

Nelson, S., K., Layous, K., Cole, S., W., & Lyubomirsky, S. (2016). Do Unto Others Or Treat Yourself? The Effects of Prosocial and Self-Focused Behavior on Psychological Flourishing. Emotion (Washington, D.C.), 16(6): 850–861. Doi: 10.1037/emo0000178.

Niriwa a, B., P. (2021). Assessing the Role of Religion in Preventing Discrimination and Stigma, Like in COVID-19, to Promote Peace: Stop Discrimination and Stigma with Your Faith. IOSR-JHSS, 26(2): 32-48. Doi: 10.9790/0837-2602013248.

Niriwa, B., P., Azongo, M., A., & Asafo, M., K. (2021). Prevention of 21st Century Emerging Pandemics, Covid-19: Using Face Masks. TheIJHSS, 9(3): 46-65. Doi: 10.24940/theijhss/2021/v9/i3/H2103-019.

Niriwa, B., P. (2022). Identifying the 5Ps of Life for Global Peace, Health and Entrepreneurship: Prayers, Preparation, Patience, Praises, and PEACE. IOSR-JHSS, 27(1) Series 6: 56-72. Doi: 10.9790/0837-2701065672.

Nowakowski, J., Schwartz, I., Liveris, D., Wang, G., Aguero-Rosenfeld, M., E., Girao, G., McKenna, D., Nadelman, R., B., Cavaliere, L., F., Wormser, G., P., & LDSG, (Lime Disease Study Group). (2001). Laboratory Diagnostic Techniques for Patients with Early Lyme Disease Asspciated with Erythema Migrans: A Comparison of Differnt Techniques. Diag Tech Lyme Dis, 33: 2023-2027. .

Onigbinde, O., A., Ajagbe, A., O., Oyeniran, O., I., & Chia, T. (2021). Post-COVID-19 Pandemic: Standard Operating Procedures for Gross Anatomy Laboratory in the New Standard. Morphologie: bulletin de l'Association des anatomistes, 105(350): 196–203. Doi: 10.1016/j.morpho.2020.10.004.

Oosterhuis, W., & Zerah, S. (2015). Laboratory Medicine in the European Union. J Clin Chem Lab Med (CCLM), 53(1): 5-14. Doi: 10.1515/cclm-2014-0407.

Opal, S. M. (2009). A Brief History of Microbiology. Vaccines: A Biography, 31-56. Doi: 10.1007/978-1-4419-1108-7_3.

Orf, K., & Cunnington, A. (2015). Infection-Related Hemolysis and Susceptibility to Gram-Negative Bacterial Co-Infection. Front. Microbiol, 6:666. Doi: 10.3389/fmicb.2015.00666. PubMed.

Otsetov, A., G. (2020). Importance of Laboratory Techniques. J Clin Chem Lab Med, 3(2):146. Doi: 10.35248/clinical-chemistry-laboratorymedicine.20.3.146.

Pakpour, N., & Horgan, S. (2021). Lab 2: Aseptic Technique. Lab 1 Worksheet, Lab 2 Worksheet, Retrieved on 20.10.2022 at 9:24 AM from https://bio.libretexts.org/Learning_Objects/Laboratory_Experiments/Microbiology_Labs/Book%3A_General_Microbiology_Lab_Manual_(Pakpour_and_Horgan)/Lab_02%3A_Aseptic_Technique.

Peprah, P., & Gyasi, R., M. (2020). Stigma and COVID-19 Crisis: A Wake-Uo Call. Int J Health Plann Mgmt, 1-4. Doi: 10.1002/hpm.3065.

Petrigna, L., Pajaujiene, S., Delextrat, A., Gómez-López, M., Paoli, A., Palma, A., & Bianco, A. (2022). The Importance of Standard Operating Procedures in Physical Fitness Assessment: A Brief Review. Sport Sci Health, 18: 21–26. Doi: 10.1007/s11332-021-00849-1. PubMed.

Qiu, D., Li, Y., Li, L., He, J., Ouyang, F., & Xiao, S. (2021). Infectious Disease Outbreak and Post-Traumatic Stress Symptoms: A Systematic Review and Meta-Analysis. Front Psychol, 12:668784. Doi: 10.3389/fpsyg.2021.668784.

Rasool, G., Riaz, M., Abbas, M., Fatima, H., Qamar, M., M., Zafar, F., & Mahmood, Z. (2022). COVID-19: Clinical Laboratory Diagnosis and Monitoring of Novel Coronavirus Infected Patients Using Molecular, Serological and Biochemical Markers: A Review. Int J Immunopathol Pharmacol, 36: 03946320221115316. Doi: 10.1177/03946320221115316.

Rollins, D., M., & Joseph, S., W. (2000). BSCI 424 – Pathogenic Microbiology – Fall 2000 . Aseptic Techniques, Retrieved from https://science.umd.edu/classroom/bsci424/LabMaterialsMethods/AsepticTechnique.htm on 20.10.2022 at 9:40 AM.

Sameer, A., -E., I. (2015). Standard Operating Procedures for Clinical Chemistry. Publication, Medical University of Vienna, Retrieved from https://www.researchgate.net/publication/277709909_Standard_Operating_Procedures_For_Clinical_Chemistry on 29.10.2022 at 5:02 AM.

Shrestha, L., B., & Pokharel, K. (2020). Standard Operating Procedure for Specimen Collection, Packaging and Transport for Diagnosis of SARS-COV-2. JNMA J Nepal Med Assoc, 58(228): 627–629. Doi: 10.31729/jnma.5260.

Steinbuch, Y. (2020). Italian nurse with coronavirus kills herself over fear of infecting others. . News. , Retrieved from https://nypost.com/2020/03/25/italian-nurse-with-coronavirus-kills-herself-amid-fears-of-infecting-others/ on 04.04.2020 at 3:37PM.

Tandara, L., Filipi, P., Supe Domic, D., Kresic, B., Ivcic, I., Stojanovic Stipic, S., Rubic, Z., & Tandara, M. (2022). Laboratory Medicine in Pandemic of COVID-19. Biochemia Medica, 32(2):020501. Doi: 10.11613/BM.2022.020501.

Tetteh-Quarcoo, P., B., Ampong, A., Dayie, N., Ahenkorah, J., Udofia, E., A., Afutu, E., Aryee, R., Niriwa, B. P., Kotey, F., Donkor, E., S., & Ayeh-Kumi, P., F. (2022). Dynamics in Morbidity Markers and Cytological Observations Made in Urine of Schistosoma haematobium-Infected Children: Pre- and Post-Praziquantel Treatment in an Endemic Setting. Med Sci (Basel), 10(1): 14. Doi: 10.3390/medsci10010014.

Thakur, V., & Jain, A. (2020). COVID 2019 -Suicides: A Global Psychological Pandemic. Brain Behav Immun, Doi: https://doi.org/10.1016/j.bbi.2020.04.062.

Ubaid, M., T., Khan, M., Z., Rumaan, M., Arshed, M., A., Khan, M., U., G., & Darboe, A. (2021). "COVID-19 SOP’s Violations Detection in Terms of Face Mask Using Deep Learning,". 2021 International Conference on Innovative Computing (ICIC). Conferences, 1-8, Doi: 10.1109/ICIC53490.2021.9692999.

Vandepitte, J., Engbaek, K., Piot, P., & Heuck, C., C. (1991). Basic Laboratory Procedures in Clinical Bacteriology. Geneva: WHO.

WHO a., World Health Organization. (2020). Global Patient Safety Action Plan: Final draft Global Patient Safety Action Plan 2021-2030. Patient safety, Policy 2020, Retrieved from https://www.who.int/teams/integrated-health-services/patient-safety/policy/global-patient-safety-action-plan on 07.07.2020 at 8:41AM.

WHO b, World Health Organization. (2021). The Third Draft of the Global Patient Safety Action Plan 2021-2030: Towards Eliminating Avoidable Harm in Health Care. Featured Meeting Report, Retrieved from https://www.who.int/publications/m/item/the-third-draft-of-the-global-patient-safety-action-plan on 07.07.2021 at 8:50AM.

WHO b., World Health Organization. (2020). Standards for Improving Quality of Care for Small and Sick Newborns in Health Facilities. Geneva: WHO, Licence: CC BY-NC-SA 3.0 IGO.

WHO c., World Health Organization. (2020). Laboratory Designs and Maintenance: Laboratory Biosafety Manual Fourth Edition and Associated Mongraphs. Geneva, Switzerland: WHO.

Who f., World Health Organization. (2022). Clinical Management of COVID-19: Living Guideline. Geneva: WHO. WHO/2019-nCoV/Clinical/2022.2. Retrieved from https://creativecommons.org/licenses/by-nc-sa/3.0/igo on 07.11.2022 at 1:47 AM.

Wood, D. (2021). Basic Laboratory Techniques. Science, Academy Lesson, Retrieved from https://study.com/academy/lesson/basic-laboratory-techniques.html on 10.07.2022 at 5:01 PM.

 Wilson, K., S., Ntlebi, V., Made, F., Sanabria, N., Vetten, M., Joseph, J., Chin, G., Jones, D., & Tlotleng, N. (2022). COVID-19 Cases among Medical Laboratory Services Staff in South Africa, 2020–2021: A Cohort Study. Galdiero, M. (Ed.). PLoS ONE, 17(6): e0268998. Doi:10.1371/journal.pone.0268998.

Wolszczak-Biedrzycka*, B., Bieńkowska, A., & Maksymowicz, S. (2022). Adaptation of Medical Laboratory Scientists to Workplace Hazards – Experiences from the COVID-19 Pandemic. Front. Pub Health, 10:997049. Doi: 10.3389/fpubh.2022.997049.