Lab Organization

Organization and Functions of Laboratories

The organization of laboratories in any country is usually a three or four tier system with various possible functional linkages between them. One possible way of networking of laboratories is shown in Fig 1.

     Peripheral laboratory services

Peripheral laboratories are located at the point of first contact of patients with the health care services. In most developing countries these are available only at primary health centre or community health centre (upgraded primary health centre) level. These laboratories provide technical support for preventive, curative and promotive services for the individual as well as the community.

     Staff

The staff in peripheral laboratories should include one technician and one laboratory assistant/attendant.

     Space

The space available in peripheral laboratories should include at least one laboratory-cum-office/record room (approx. 5 meters x 3 meters) and one store-room which can be used for other services also (approx. 5 meters x 3 meters).

     Other facilities

Other necessary facilities include

     supply of safe water

     reliable source of energy (battery, electricity, solar or kerosene)

     sterilization/disinfection facilities

     waste disposal facilities

There must also be transport and communication facilities between the peripheral and intermediate laboratories for referral of samples and patients, procurement of supplies and personal discussion.

     Equipment and supplies

Necessary equipment and supplies include good microscopes, centrifuges, autoclaves, refrigerators, balances, pH meters, incubators, water bath, transport media, glassware, sterile swabs, reagents for staining (eg. Gram, Albert, Ziehl Neelsen, Romanowsky), reagents for chemical examination of urine, kits and reagents for rapid diagnostic tests, sterilized syringes and needles, micropipettes and tips as well as sterile collection bottles for blood/serum and water analysis.

     Tests to be performed

Peripheral laboratories are expected to undertake tests of public health as well as clinical relevance. Among the tests of public health relevance, diseases of greater epidemiological importance should be accorded priority. Testing of environment samples (especially water) also falls into the priorities of public health relevance. Certain rapid serological tests may be of use in studying epidemiological patterns of important diseases and the same can also be performed at peripheral laboratories.

The tests to be performed by peripheral laboratories are subject to the availability of resources, manpower, technology and prevalence of various diseases in the area catered to by the laboratory. A suggested list is provided in Table 1.

Table 1: Suggested tests to be performed at peripheral laboratories

Procedure/Specimen	For detection/diagnosis of
Urine examination	Pus cells, RBCs Albumin Sugar
Stool examination	Ova and cysts
Stained smears Throat specimen Sputum CSF (pyogenic and tubercular) Peripheral blood smear	Diphtheria Tuberculosis Meningitis Malaria, filariasis
Diagnostic tests	HIV Hepatitis B surface Ag Syphilis Meningococcal disease

     Intermediate laboratory services

In most developing countries, intermediate laboratories are located at zonal or the regional headquarters and may act as clinical as well as public health laboratories. The following functions are expected to be performed by these laboratories:

1.      Laboratory support to clinical diagnosis/public health Quality assurance Logistic and technical support  Training of staff for peripheral laboratories

2.      Supervision and monitoring of peripheral laboratories

Intermediate laboratories help in the diagnosis and treatment of the individual patient and are also used as public health laboratories for epidemiological surveillance and control of diseases in the community. These laboratories also serve as links between peripheral laboratories and the state/central laboratory for the following:

     Collection, storage and analysis of data.

     Distribution of reagents, media, laboratory manuals.

     Purchase of equipment.

     Supervision of peripheral laboratories.

     To conduct external quality assessment scheme (EQAS) for peripheral laboratories.

     To take part in EQAS organized by the state/central laboratories.

     To send samples to higher/reference laboratories for characterization of isolate/confirmation of diagnosis.

          

     Staff

Qualified pathologist/ microbiologist
(Doctor of Medicine/diploma in clinical pathology)

BMLT:

Technicians –

CMLT (Certificate in medical laboratory technology) with experience
Laboratory Assistants
Laboratory attendants
Cleaner
Clerk-cum-storekeeper

Since it may not be possible to have a full-time epidemiologist, at least part time help of an epidemiologist should be available.

     Space

Microbiology/Serology laboratory  (approx.8 metersx5 meters)

Sterilization, disinfection and media preparation laboratory 

(approx. 6 metersx4 meters) 1

Store-room (approx.3 metersx5 meters)

Office (approx. 3 metersx5 meters)

     Equipment

Binocular microscope	2	Colorimeter	1
Dark-field microscope	1	Refrigerator	1
Inoculating chamber	2	Balances	2
Centrifuge	2	pH meter	1
Autoclave	2	Inspissator	1
Incubator	2	Distil water apparatus	1
Hot air oven	1	Micropipettes	as per workload
Water bath	2	Tips for pipettes	as per workload
VDRL shaker	1

This manual describes most of the tests that have been suggested to be performed at intermediate-level laboratories.