Saturday, August 2, 2008

Week 6 SIP


Week 6 of SIP. I will share my SIP experience chronologically. I am still at histopathology department.

Week 2
There was a talk on how to handle spillage. It was briefed to all staff. Training staff on how to handle chemical spills is important because some chemicals are potentially harzardous or flammable. The key point to remember from the talk is MSDS. Material Safety Data Sheet. It contains all the necessary information regarding the chemical.

Next there was a briefing during emergencies, particularly an outbreak of fire. We were taught on fire safety procedures and evacuation route. After these 2 briefings, there was a small quiz for all staff, which was required by JCI. I scored 12/14.

Week 2 was about the same as the first week. I heated slides to melt the wax, labelled casettes and sorted slides. We also had a rough idea on our major project. To find out the minimum processing time.

Week 3
I labelled chemical bottles in the cabinet. We have to check the expirary date, date of opening and batch number. I was assigned to do this because there is a JCI inspection next week. We have to ensure all chemicals and materials are accounted for and not expired.

Apart from checking chemicals, I did slide sorting for the whole week. A recap: we have to sort according the the biopsy number eg. 08-12345, then followed by the block number eg. A3, then by the number of levels being cut. eg. VL 2.

For example, this is how we arrange it.
(A1 vl 1/3 08-19000)
(A1 vl 2/3 08-19000)
(A1 vl 3/3 08-19000)
(A2 08-19000)
(B1 08-19000)
(A1 08-19001)
(A2 vl 1/2 08-19001)
(A2 vl 2/2 08-19001)
(A1 08-19005)

Notice that some blocks do not have "vl" because the block is only cut once. Meaning only one layer is cut. vl stands for variable level. The 08 in the biopsy number 08-xxxxx, stands for the year, 2008.

Apart from sorting, I rearranged boxes of blocks in the store room. We have to keep blocks for at least 5 years. Just in case the doctors requires a re-examination when a patient suffers a relapse or the doctor made a mistake 5 years ago.

Week 4
JCI inspection week. We didn't do much work this week because the auditors from JCI may come any day. JCI inspection occurs once every 2 years. I heard from one of the staff that there are 3 standards in JCI acceditation, a basic level, silver and gold. Currently, my lab is at the silver standard. After this inspection, it may become gold.

We also managed to collect some tissues this week for our project. But unfortunately for JCI, we weren't able to use it. Furthermore, our machine temporarily malfunctioned on friday.

Week 5
Besides heating and sorting slides, I have started shaving blocks. There are about 500-700 blocks in a day and it is rather tiring to shave all of them. It is fun because I can finally get to use the microtome. Oh and I accidentally cut my finger, fortunately only the skin peeled off, no bleeding. The blade is very very sharp.

Shaving is done at 20 um instead of the usual 4 um that we use for sectioning.

I was on MC one of the days. Apparently, there is a flu bug going around the lab where more than 5 staff have gotten sick, including ying chee. And on Friday, we went back to school for campus discussion. So this week I wasn't around much.

Week 6
Shaving of blocks, fishing, sorting slides, heating. We have started processing our tissues that we collected for our project. it was rather sucessful. One of the staff briefly verified our slides and commented that it was acceptable. We have successfully shortened the time!

I have growned to like shaving very much. Eventhough it requires speed and muscle, my job is very important and we have to be alert, so as not to cut too much or too little.

I have also observed how embedding is performed. It is quite easy for standard tissues but for postate and equally tiny tissues, it is rather difficult. Imagine a short hair. We have to use a forcep to carefully pick it up and put it in molten wax. In addition, we have to press it down using a screw-driver like instument. The trouble is, every time after we press it down, we have to remove the instrument, and the tissue always move away.

Thank you


THE CODEC 5 said...

Hi Ernest,

So what happen when the JCI auditors came to the lab? What did they do? I guess its more interesting to see it in action rather than on paper right?

And, so how do you solve the problem when the tissue move away everytime you remove the instrument?

Xin Yi

~immortals~ said...

Hi Ernest!!

How will handle if there is a chemical spillage in your lab? What are the usual types of tissues that come to your lab?


~immortals~ said...

hey earnest

u seem to be getting comfortable with ur attachment place

anyway, i've got a few questions for you:

1)What is the difference between shaving and sectioning?

2)Why is shaving important?

3)You mentioned that the blocks are kept for 5 years, is it possible for the tissues to deteriorate after the long period of time?



tg01 group 2 said...

Hi xinyi

JCI inspectors will inspect the cleaniness of the area, the quality control and the integrity of the equipments. They also asked several questions to the staff there. For example, "What do you do during a fire?" The answer is to call the company's emergency hotline (sorry I cannot disclose the number) and to evacuate if the fire is too big.

To prevent the tissue from moving away, we can cool down the molten wax first to make it partially solid, that way the tissue is "stuck" in place and cannot move.

Thank you

tg01 group 2 said...

Hi Amir

There is a spill kit located inside every lab. Inside the spill kit contains the necessary PPE required to clean it up. For example, face mask with air filter, rubber gloves etc.

For a minor or moderate spill, the first step after wearing PPE is to cordon off the area to prevent people from entering and to prevent the liquid from spreading. We also use a hotdog-shaped sponge to surround the liquid. Then use the super-absorbant 3M cloth to soak it up. All these materials can be found in the spill kit. As I have mentioned in my post, it is necessary to read the MSDS before cleaning up the spill. This is because some chemicals may be corrosive and hazardous.

After cleaning it up, place all used materials in a biohazard bag and dispose of it appropriately. There are proper procedures to clean up special chemicals such as mercury but we were not taught how to do so (because there is no mercury in histopathology)

The usual types of tissues/organs are liver, kidney, fibriods, uterus, endometrium, ovary, prostate, lung, cornea,skin, breast, bone, pancreas, colon, fatty tissue and many more.

Thank you

tg01 group 2 said...

Hi Rusy

1)Shaving is getting rid of the intial layer of wax and to expose the tissue as much as possible. It is done at 20um. The microtome blade does not need to be extremely sharp for this

Sectioning is to cut the blocks at 4um and place it on the slides. This has to be very carefully done as the slides will be used for diagnosis. The microtome blade must be as sharp as possible.

2)Shaving and sectioning is done by separate people. It is important because otherwise, alot of time is wasted to shave then section for each block. So why not shave all 600 blocks then later section 600 blocks?

If shaving is not done, it is tedious to remove the first layer of unwanted wax and difficult to expose the tissue

3)This amazes me too. Apparantly, just like formalin, if the tissue is fully processed and kept in wax, it can be kept for more than 100 years.

For example, theoratically speaking, if the tissue is kept in pure 10% neutral buffered formalin, it can be kept forever! I believe this is the same for wax.

One of the staff mentioned that the ideal length to keep the blocks is not 5 years but within the patient's life time. So if the patient lives for another 60 years, we must keep the block for 60 years.

Thank you

tg01 group 2 said...

what does the JCI check for? like for example what kind of things are the JCI ppl looking for, the criteria for gold...

From Ivan(TG01)

De Incredibles said...

Hi ernest,

How are the blocks stored in the boxes? Are there different compartments in the box? or just a normal box?

Have u retrieve any tissue block for cases that happen years ago? Would it be difficult to find that one block since so many blocks are kept?

Jean Leong

tg01 group 2 said...

Hi Ivan

The lab staff told me that each time JCI inspects the lab, your lab rank will go up.

For example in year one, your lab gets inspected, if you pass you get bronze or a "pass". Then in year 3, you will get silver upon passing the inspection. And finally in year 5, you will get gold.

The criteria is all the same for every inspection, just that they will update accordingly every year. They will mainly check for quality control, turnaround time and staff and equipment management.

Thank you
Ernest TG01

From Ivan(TG01)

tg01 group 2 said...

Hi Jean

The box is just a normal cardboard box. Roughly 5cm (height) 25cm (width) 40cm (length).

Before the blocks are stored, the exposed tissues will be coated with wax. This is to protect the tissues. Prevent exposure to atmosphere.

I didn't retrieve any blocks but i did went to the storeroom to label them. They are arranged according to year, then batch number.

Imagine the library, the first shelf is for year 2006.
The top row is for blocks 06-1000 to 06-1080. Second row is for blocks 06-1081 to 06-1155.
Then the next shelf is for 2007 etc. (Remember the first 2 digits represents the year)

This is roughly how we arrange it, so it is easy to find.

Thank you
Ernest tg01