Laboratory Medicine

Precision Testing for Accurate Diagnosis

Overview & Quality Policy

The Clinical Laboratory in Nazareth Hospital started in a very small way in the year 1965. It provided very basic laboratory services to begin with and graduallyevolved &expanded to its present size and scope. Located in a dedicated floor covering an area of 2700 sq. ft.,it provides comprehensive services to patients 24×7, using state of the art equipment and stringent Quality Control. The Mycobacteriology laboratory is the State reference centre for testing multi-drug resistant strains of tuberculosis. Our vision is to introduce high-end testing in the future, which will enable patients to access these facilities within the city itself at an affordable cost. We constantly endeavour to serve our fellow human beings following our hospital motto……“to love, to serve, to heal”.

Quality Policy

Nazareth Hospital Clinical Laboratory is committed to producing reliable patient test results in a manner necessary to ensure appropriate and timely patient care.
The laboratory will strive to produce reliable patient test results by combining procedures that promote efficiency with technology appropriate to the laboratory mission and operated by staff that is both trained and competent to perform the work.
Lastly the Laboratory will try its utmost to provide investigations commensurate with the level of clinical services provided in Nazareth Hospital.

Pathology

The Clinical Laboratory actually started services as a Pathology laboratory and included all the departments (including Biochemistry & Microbiology) under its umbrella. Gradually due to increase in size and complexity , they separated and Pathology evolved into a standalone department with two sections, Haematology & Clinical Pathology and Histopathology & Cytopathology. These sections currently serve the hospital.

Haematology & Clinical Pathology

Haematology is a branch of Medicine concerned with the diagnosis, treatment, and prevention of diseases of the blood and bone marrow as well as of the immunologic, haemostatic (blood clotting) and vascular systems. Because of the nature of blood, the science of hematology profoundly affects the understanding of many diseases and changes that are seen in the blood of a patient, providing clues to the diagnosis and treatment of various clinical conditions(adapted from http://www.medicinenet.com/script/main/art.asp?articlekey=22594).

Tests performed

Complete blood counts : Hb Haematocrit TRBC MCV MCH MCHC Platelet count TLC Reticulocyte count
Haemorrhagic disorders : Prothrombin time (PTT) activated partial Thromboplastin time (APTT)
High Precision Liquid Chromatography : Glycosylated hemoglobin (HBA1C) hemoglobin variants
Bone marrow examination : Manual bone marrow study for various hematological disorders
Urine Stool & Body fluid examination

Histopathology & Cytopathology

This section of the Pathology department started functioning from the year 2003. The department performs Histopathological examination of all specimens obtained from biopsies. In addition fine needle aspiration studies along with Papinicolau smear (PAP smears) and cytology for malignancy from various body samples are carried out. The section is also actively involved with the National Cancer Registry Atlas currently being carried out in the country.

Clinical Microbiology & Immunology

Clinical Microbiology is the branch of medicine concerned with the prevention, diagnosis, and treatment of infections and communicable diseases.This is the youngest of the departments functioning in the Clinical Laboratory. It was established full time from 2008 onwards to the present. Since its inception, it has increased in scope & size by leaps and bounds. A number of new equipment have been introduced in it in which we were the first in the state to do so and in fact for the Vitek MS (MALDITOF), we were the third in the country and the first in Eastern India to achieve this distinction. In addition, our Mycobacteriology laboratory is a RNTCP certified laboratory for Line Probe Assay (LPA) and is the referral C & DST (Culture & Drug Susceptibility Testing) laboratory for the state of Meghalaya using LPA. The department is heavily involved in Infection Control and education on the safe and rational use of antimicrobials in the hospital.

Bacteriology & Mycology

This section forms the backbone of the Clinical Microbiology department. It is concerned with the growth, identification and antimicrobial susceptibility testing of various bacterial and fungal pathogens isolated from patient samples. This susceptibility data is subsequently analysed for meaningful information which is used in the creation of hospital policies and in the treatment of patients.

The Vitek 2 and Vitek 2 Compact are instruments capable of identifying and performing susceptibility testing for bacteria and yeasts (which are a type of fungi that can cause infections in humans). This greatly aids in the treatment of patients.

The Vitek MS is a mass spectrometer which analyses the protein profile of an organism and based on its protein composition, identification is made.

Myla is a dedicated software which helps with reporting of results, collection of data, detecting hospital associated infections and helps in making all the data generated make sense. It, when fully implemented will radically change the way the department functions in the sense that it will improve quality of reports, turnaround times and trouble shooting. The software enables access to the instruments from anywhere around the world at anytime, this in turn improves monitoring of the functions in the laboratory.

Serology

This section deals with the detection of antigens and antibodies in serum. This helps and confirms presence of infections in the body. It also helps with the diagnosis of auto-immune diseases.

Tests performed on the Vidas

HBsAg Screening & Confirmatory
Anti-HCV
HAV IgM
Procalcitonin (PCT)
Anti-thyroglobulin antibodies anti-TG
Thyroid peroxidase antibodies (TPA)

Other tests performed

Widal test
Weil Felix
Syphilis rapid test
Rapid Plasma Reagin (RPR)
Anti-thyroglobulin antibodies anti-TG
Scrub typhus rapid test
Typhidot Rapid
Stool Rota-adeno virus rapid test
Japanese encephalitis rapid test

Integrated Counseling & Testing Centre

The Hospital Surveillance &Infection Control Program supervised by an Infection Control Committee was started in 2011. An Infection Control Team (ICT) comprising of an Infection Control Officer (ICO) and two trained Infection Control Nurses (ICN) monitors and documents all events related to the control of Nosocomial Infections (NI) such as proper hand hygiene, use of Personal Protective Equipment (PPE), proper methods for insertion and maintenance of intravenous lines and catheters, proper cleaning and maintenance of the hospital environment, active and passive surveillance for nosocomial infections such as Ventilator Associated Pneumonia (VAP), Catheter Associated Urinary Tract Infections (CA UTI), Skin and Soft Tissue Infections (SSTI) and Catheter Associated Blood Stream Infections (CA BSI). Surveillance of kitchen staff and food handlers and Central Sterilization Supply Department (CSSD) and Laundry is also carried out.Active surveillance is in the form of daily rounds by the ICN with active intervention and the calculation of various parameters ranging from hand hygiene compliance rates to Indicator nosocomial infection rates, such as, ICU VAP rates, CA UTI rates, etc.A yearly antibiogram is published and circulated to the various departments, thus keeping track of changing susceptibility patterns of organisms with regard to type of infection and wards.

Accreditation / Certification

Licensed Blood Bank Licence No.: 3/DL/MFG
RNTCP certified Line Probe Assay (LPA) laboratory: Certification No.: 33 /RNTCP/ 2013
NABH Pre-Accreditation Entry Level Hospital Requirements Achieved Certificate No. : PEH-2016-0125
NABL Certification Achieved

Clinical Biochemistry

Clinical Biochemistry is a branch of medicine concerned with developing and carrying out clinical analyses of body fluids and other biological material for the diagnosis, therapy and prophylaxis of diseases (after Richterich & Colombo 1981). Evidence based medicine is being increasingly practiced by clinicians world-wide, it therefore becomes imperative that the results which are released by the laboratory are accurate and reproducible. Our Biochemistry laboratory is well staffed and equipped with the latest instruments to achieve this goal. In addition the department participates in Internal as well as External Quality Assurance (EQAS). EQAS is performed with BioRad Laboratories.

System wise parameters tested

Liver Function Test: Serum bilirubin with fractions AST (SGOT) and ALT (SGPT) alkaline phosphatase serum protein with fractions
Kidney Function tests: Serum urea serum creatinine
Pancreatic function: Serum amylase serum lipase
Lipid profile: Total cholesterol triglycerides LDL HDL VLDL
Anaemia: Serum iron serum ferritin Total iron Binding Capacity (TIBC)
Vitamins: Vitamin D vitamin B12
Hormones: TSH T3 T4 Free T3 Free T4 beta-HCG
Serum electrolytes Na+ K+& Cl–
Body fluids (CSF pleural peritoneal etc.): Glucose protein adenosine de-aminase (ADA)

Other tests

Troponin I
Serum phosphorous
Serum magnesium
Anti-streptolysin O (ASO)
Rheumatoid factor (RA)
C-reactive protein (CRP)
Hormones: TSH T3 T4 Free T3 Free T4 beta-HCG
Serum electrolytes Na+ K+& Cl–
Gamma glutamyl transferase (GGT)
Serum uric acid
Serum calcium
Serum glucose (GTT RBS FBS PPBS)
24 hour urine protein estimation

Mycobacteriology

This section deals with the growing and testing of bacteria that cause tuberculosis (Mycobacterium tuberculosis) and other diseases caused by organisms similar to Mycobacterium tuberculosis called atypical mycobacteria. The differentiation is important as the treatments of the two types of conditions are different. The Mycobacteriology Laboratory performs rapid liquid culture on all kinds of samples to check for growth of Mycobacterium tuberculosis and /or atypical mycobacteria. Positive growth is followed by testing to ascertain whether the strains are multi-drug resistant or not. Again the treatments for sensitive and resistant strains of Mycobacterium tuberculosis are different. The method used is called Line Probe Assay (LPA). This method uses Polymerase chain reaction (PCR) to amplify the DNA of Mycobacterium tuberculosis which must first be extracted. The amplified DNA is then made to react with probes specific for genetic mutations associated with resistance to Isoniazid & Rifampicin. The reaction is performed on a strip of special paper and the results interpreted as per the readings obtained. The LPA laboratory is the first such laboratory in the north east, established in 2011 and was subsequently accredited by RNTCP/ Central TB Department, New Delhi to function as the state referral laboratory. To this date, it is functioning as such. Plans are on the anvil to upgrade the facility for 1st Line Liquid Drug Sensitivity Testing (1st Line DST) and subsequently 2nd Line testing too.

Equipment

Yorco Class 2 Bio-safety cabinet
Yorco Laminar flow
Fume hood
Procalcitonin (PCT)
AB Systems Thermal Cycler for PCR
HAIN Lifescience Twincubator
Hettich Refrigerated centrifuge
Dynamica Minifuge
Yorco Vortexer
bioMerieux BacTAlert 3D 120
Walk in cold room

Designated Microscopy Centre (DMC)

The DMC was set up in 2009 and has since then provided exemplary services to the people of this city. It was awarded the best performing DMC from the NGO sector in the year 2012. It screens just under 6000 slides every year. It functions in conjunction with the Public Health Department, the hospital DOTS centre and the Mycobacteriology section of the Clinical Microbiology department. It has two trained full time technologists looking after its functioning under the supervision of the doctor in charge.

Integrated Counseling & Testing Centre

The ICTC Nazareth Hospital was started in the year 2009 under Meghalaya AIDS Control Society (MACS). It is one of the busiest ICTCs in the state catering to both the indoor and outdoor patients of the hospital. It has a full time Counselor who provides both pre- and post-counseling services.There is also a doctor in-charge to oversee its overall operations. All patients undergoing ante-natal checkup, surgeries or any other procedure requiring screening for HIV are mandatorily referred for counseling and voluntary testing. Unregistered, previously untested delivery cases are offered bedside emergency HIV testing. The ICTC is provided with prophylactic Nevirapine tablets and syrup for HIV positive women at the time of delivery and their infants respectively.
The ICTC is linked to the RNTCP (Revised National Tuberculosis Control Programme), whereby all patients suspected to be suffering from tuberculosis are referred via the Public Health Department and vice-versa. It is also linked to the Anti-retroviral Treatment (ART) Centre and the Sexually transmitted diseases (STD) Clinic, Civil Hospital, Shillong. Newly diagnosed patients are linked to the ART Centre for monitoring of CD4 counts and to avail definitive therapy. The ICTC also provides appropriate counseling &post-exposure prophylaxis to all patients/staff suspected of having infection or who are deemed at risk of having contracted HIV accidentally.
In the future, there is hope to scale up the services of the ICTC with the addition of a CD4 counter and PCR for molecular diagnosis and viral load testing.
The Nazareth Hospital Blood Bank was established in the year1993, when it was granted its license (License No.: 3/DL/MGF). It caters to the needs of the residents of the city as well as to the needs of the surrounding districts too. Standards in the techniques used and quality control are rigourously maintained as laid down in the Drugs and Cosmetic Act, of the Regulatory Authority, Director Drugs Controller (India), Ministry of Health & Family Welfare, Government of India.