OSPE exercise

You are about to perform phlebotomy for serological testing. Demonstrate hand hygiene,
donning and doffing of hand gloves.

Answer :
It involves hand rub, donning of gloves, perform phlebotomy procedure, doffing of
gloves, hand wash respectively.
Steps of hand rub include :
1. Remove all hand accessories and apply sufficient amount of hand rub.
2. Rub palm to palm.
3. Rub back of palm on both sides.
4. Rub fingers by interlacing in between web spaces.
5. Rub back of fingers on palm on both sides.
6. Rotational rubbing of thumb on both sides.
7. Scrub nails on palms on both sides.

Steps of gloves donning include :

1. Donning of the first glove : Wear by touching and pulling only the edge of the
cuff.
2. Donning of the second glove : Avoid touching the forearm skin by pulling
external surface of second glove by the finger of gloved hand.

Steps of gloves doffing include :

1. Remove first glove by using the other gloved hand. Grasp the palm area of the
first glove and peel it off.
2. Hold the removed glove in the other gloved hand. Slide fingers of the ungloved
hand under the other glove at wrist and peel off second glove over first glove.
3. Dispose gloves in red bin.
4. Perform hand wash.
Steps of hand wash include 1 – 7 of hand rub followed by :
8. Rinse hands with water.
9. Dry hands with a single use paper towel. Close tap with same paper towel.
10. Dispose paper towel in yellow bin.
 OSPE exercise

Segregate the given biomedical waste as per BMW 20216 rules.

N95 mask. Syringe. IV set. Nasogastric tube. Nitrile gloves. Central venous
catheter. Blood bag. Syringe with fixed needle. Needle. Scalpel. Microscopy slide.
Metallic implant. Broken glass ampoule. Stained cloth. Stained cotton. Expired
medicines. Urine bag.General waste.

Answer :

Perform Hand rub. Wear appropriate PPE.

1. Yellow bag : N95 mask. Blood bag. Stained cloth. Stained cotton. Expired
medicines.
2. Red bag : Nitrile gloves. Central venous catheter. Syringe. IV set.
Nasogastric tube. Urine bag.
3. White box : Syringe with fixed needle. Needle. Scalpel.
4. Blue box : microscopy slide. Metallic implant. Broken glass ampoule.
5. Black bag : General waste.

Remove PPE. Perform Hand wash.

 OSPE exercise

Collect Nasopharyngeal swab from a patient with symptoms suggestive of

COVID 19

Answer :

1. Introduce yourself to the patient. Confirm patient identity. Explain the

procedure to the patient and the purpose of taking the swab. Make the
patient comfortable. Obtain verbal consent from the patient.
2. Perform Hand rub. Wear appropriate PPE like gloves, N95 respirator, gown,
apron, face shield, head cap, shoe cover. Check the label and test request
form for accuracy.
3. Use a synthetic fiber swab with a thin and flexible plastic shaft.
4. Tilt patient’s head back 70 degrees. Gently and slowly insert the swab
through the nostril parallel to the palate until resistance is encountered.
Gently rub and roll the swab. Leave swab in place for several seconds to
absorb secretions. Slowly remove swab while rotating it. Place swab, tip
first, into the viral transport medium tube provided and send it to the
molecular laboratory in a triple pack maintained in a cold chain.
5. Remove PPE and discard them in a dedicated COVID 19 waste bags for
BMW management. Perform Hand wash.
 OSPE exercise

Collect peripheral venous blood for culture

Answer :

1. Introduce yourself to the patient. Confirm patient identity. Explain the

procedure to the patient and the purpose of phlebotomy. Make the patient
comfortable. Obtain verbal consent from the patient.
2. Perform hand rub. Wear sterile gloves. Check the label and test request
form for accuracy.
3. Prepare 2 separate venepuncture sites for blood collection. Skin at the sites
is disinfected by 2 step procedure. First, it is cleaned with 70% alcohol and
allowed to dry for 30 seconds. Then, it is cleaned with povidone iodine and
allowed to dry for 1 minute.
4. 2 blood culture sets [ each set consists of 2 blood culture bottles: 1 for
aerobe culture and the other for anaerobe culture ]are taken.
5. Tourniquet is applied just above the venepuncture site. Blood is drawn
using a sterile syringe and needle. 8 ml of blood is injected into each bottle.
The blood is mixed gently with the broth in the bottle and then transported
immediately to the microbiology laboratory.
6. Recap the needle. Discard in white bin.
7. Remove gloves. Perform hand wash.
 OSPE exercise

Instruct urine collection procedure to a 25 year old male patient who presented
with UTI to the OPD.

Answer :

1. Introduce yourself to the patient. Confirm patient identity. Explain the

importance of the test. Make the patient comfortable. Obtain verbal
consent from the patient.
2. Provide a labeled [ with patient identity ], wide mouth screw capped sterile
container to the patient.
3. Tell him to wash hands, urethral meatus and glans with water and soap
before micturition. Then open the lid of the container. Urinate a small
amount into the toilet bowl, and then stop the flow of the urine. Then
collect a clean, sample of midstream urine into the container, until it is half
full.
4. Then close the container with the screw cap and send it to the microbiology
laboratory immediately.
5. Then, wash hands thoroughly.
 AETCOM exercise

Instruct a ward boy to manage a large blood spill.

Answer :

1. Explain the importance of the procedure.

2. Attend immediately. Mark the spill area. Place a wet floor signage.
3. Wear appropriate PPE like gloves and gown.
4. Confine the spill area and wipe immediately with an absorbent towel,
which is spread over the spill to solidify the blood. Then it is disposed as an
infectious waste into the yellow bag.
5. Clean the area with freshly prepared 1:10 dilution of 5% hypochlorite
solution. Allow it to remain wet on the surface for a contact time of 15
minutes.
6. Rinse the area with clean water.
7. Remove PPE. Wash hands thoroughly.
 AETCOM exercise

A 25 old male patient with a mild influenza like illness has come to the screening
OPD. He had exposure to a confirmed COVID 19 case 5 days back. He is anxious
and he wants to get tested and treated. However, he does not want to be
quarantined and discriminated, and has a fear of social stigma and losing the
job. He is also the only care taker of old parents at home.

Answer :

1. Assure the patient that the test result shall be maintained confidential.
Explain to him that it is part of the professional secrecy and shall not be
shared with others, including close relatives and employers, without his
consent. Tell him that he has the right to privacy, and the right to exercise
informed consent in all decisions about his disclosure of the test result
except in circumstances when disclosure to another person is required by
law or ethical or health considerations.
2. Counsel the patient that he will be identified with an alphanumeric code
instead of the name. Details of the test result will be released in the media
by the Government authorities with the code and not by his name. A label
will be put on the patient house to identify and alert other people.
3. Take informed consent from the patient.
 AETCOM exercise

A medical intern comes to the infection control division with a history of NSI 1
hour back. The source patient’s sample is collected and tested for HIV, hepatitis
B and C. The intern is waiting in the reception of the infection control division to
know about the test result of source sample. The test result shows that source
patient is reactive to HIV but negative for hepatitis B and C.

Answer :

1. Assure the intern not to panic. Give first dose of PEP for HIV immediately
and continue as per NACO guidelines.
2. Disclose the source patient’s test results to the intern.
3. Document and record the exposure. Test the intern for BBVs to determine
baseline status.
4. Refer the intern to ICTC for HIV testing. Counsellor interacts with the intern
in privacy. Pretest counseling is done with the purpose of understanding
the risk of HIV infection, to help cope with the stress and to make personal
decisions related to HIV/AIDS. Then written informed consent is taken
before sample collection and testing. Test report will not have the intern
name written, instead will have identification marks like moles, age, gender
for identification. Irrespective of the test result, the counselor does the post
test counseling and hands over the report directly to the intern. Thus
confidentiality regarding the intern identity and HIV infection status is
maintained throughout.
5. Follow up HIV testing is done at 6 weeks, 3 months, 6 months. Meanwhile
the intern is advised to follow precautions like 1. Not donate
blood/organ/semen. 2. Abstinence from sexual intercourse. 3. Seek medical
evaluation if any febrile illness develops.
 AETCOM exercise

In the midnight, the microbiology laboratory receives 3 specimens [ urine,

sputum, CSF ] from a patient for culture. The technician was already processing
a huge load of investigations, therefore he informed the clinical team that these
clinical specimens can only be processed on the next day.

Answer :

1. The technician should be made aware of prioritizing the specimen for

processing as relevant to the clinical situation.
2. Certain precious specimens like CSF, sterile body fluids, ocular specimens,
tissue specimens, suprapubic aspirate, bone specimen should be processed
immediately as soon as received, not more than 15 minutes delay. Blood
culture bottles should be immediately incubated upon receipt.
3. Ethical and medicolegal issues that involve following delay in processing the
precious specimens need to be discussed with the technician.
4. In this clinical situation CSF should be immediately processed for
microscopy and culture. Urine and sputum samples can be stored in
refrigerator at 40C and processed later in the morning.
 AETCOM exercise

Microbiology laboratory rejects a bunch of specimens because one or the other

relevant informations were missing in those specimens such as patient name,
age, gender, ward number, hospital ID, sample type, provisional diagnosis,
treatment history. The clinical team screams at the laboratory that they could
have called the ward or the patient’s attendant and verified the details instead
of rejecting.

Answer :

1. The laboratory personnel and the clinical team need to be made aware of
the judicious application of the sample rejection criteria in the best interest
of patient care.
2. Microbiology samples that do not meet the required sample and test
request requirements need to be rejected, so as to prevent inaccurate data
and to ensure the safety of the patients and laboratory personnel.
3. Reasons for sample rejection may include the following:
a. Improperly labelled or unlabelled sample.
b. Incomplete specimen related or clinical information on the sample
and/or on the requisition.
c. Sub optimal sample with any leak or insufficient quantity or improper
collection.
d. Inappropriate sample for test request.
e. Duplicate microbiology samples like multiple sputum or sputum samples
received on the same day.
f. Sample delayed in transit more than the accepted limit.
g. Sample not collected in sterile container.
h. Sample not collected in appropriate transport medium.
i. Mismatch of patient’s name written on sample container with that of
name written on requisition form.