College Course Content/Curriculum

Written for a Medical Assisting college course with only two learning objectives provided. The goal is to create connections for students by providing casual language and relatable scenarios:

Learning Objectives:

• Discuss the importance of safety procedures and quality control when working with urine

• Identify personal safety precautions as established by the Occupational Safety and Health Administration (OSHA)

As far back as 6,000 years ago, physicians used urine as a primary diagnostic tool. In fact, urine was the first laboratory test and acted as a “liquid window” through which doctors could view the body’s inner workings. In 4000 BC, urine assessments were recorded on clay tablet, and by 100 BC, 20 types of urine were described. You might be surprised to learn that Hindu cultures realized some urine was sweet because it attracted black ants. We know now that this was a sign of diabetes. Hippocrates (460 to 355 BC) noted that urine with bubbles on top indicated kidney disease, an accurate diagnosis since proteinuria (excessive protein the urine) can result from kidney disease or urinary tract infections. By the Middle Ages (500 to 1500 AD), it was determined that different colors of urine had implications for an illness or disease. By the Renaissance (1450 to 1600 AD), many doctors were diagnosing conditions from urine alone.

Today, urinalysis offers a rich history of measuring health and offering evidence toward a clinical diagnosis. For such a small, simple, and inexpensive test, urinalysis provides a wealth of information. In fact, doctors have jokingly referred to it as a “poor man’s kidney biopsy” because of the information provided without an invasive procedure (Fareed, 2019). So, when your doctor asks you to “pee in a cup,” know the value in this small task!

Safety Procedures and Quality Control with Urinalysis

Urine specimens are often ordered by physicians for the following reasons:

• Annual exams: urinalysis is routinely done as part of an annual physical check-up.

• Pregnancy: urine specimens are collected at each prenatal visit to detect glucose, protein, and white blood cells.

• Back pain: patients with back pain may have a urinalysis performed to rule out a urinary tract infection since back pain is often a symptom of kidney or urinary tract problems.

• Diabetes: diabetic patients routinely have a urine test performed to check for glucose, which may signal a change needed in the patient’s diet or their insulin regimen. If a diabetic patient has glucose and ketones present in their urine, they could indicate a serious problem that needs to be addressed.

• Keto diet: a person on a Keto diet might also need a routine urinalysis since the Keto diet can be hard on a person’s kidneys and may result in kidney stones. If ketosis results in ketoacidosis, a patient’s kidney, liver, and even brain can be damaged, so this monitoring is important.

• Urinary symptoms: patients who experience burning with urination, frequent need to urinate, or get up more than once at night to urinate will need a urinalysis.

We’ve established that urinalysis is an important and frequently-ordered test. Now, let’s look at how safety standards and quality control protect you, your patients, and the accuracy of test results.

Quality Control

Following specific procedures are required by the Clinical Laboratory Improvement Amendments (CLIA) of 1988 and help ensure the safety of the lab personnel and the accuracy of the results. CLIA sets regulations for all sites that test human specimens to assess health through diagnosis, prevention, or treatment of disease.

The Centers for Disease Control and Prevention supports CLIA programs and laboratory quality through the following services:

• Providing research

• Giving technical assistance

• Conducting lab studies

• Developing standards and guidelines

• Monitoring practices

• Distributing professional information and resources

• Offering training through a free, on-demand eLearning course through the CDC

When it comes to laboratory tests, some are waived by CLIA because they are simple tests with a low risk for inaccurate results. While some testing sites only perform waived testing, they still may have to follow CLIA regulations. Other than waived tests, a test system will be moderate or high complexity, which determines what CLIA requirements are applicable. Typically, the more complicated a test is, the more stringent the testing requirements are under CLIA. Otherwise, the only difference between moderate and high complexity testing exists in the requirements for personnel. Now let’s look at OSHA’s requirements in relations to safety precautions in a lab.

Safety Precautions by OSHA

The Centers for Disease Control and Prevention, known as the CDC, and the Occupational Safety and Health Administration, known as OSHA, developed universal precautions meant to keep healthcare workers and patients safe. Unfortunately, by the time these guidelines were published in 1991, over 6 million healthcare workers had been exposed to Hepatitis B with almost 6,000 deaths.

As a result, the regulations mandated that when a healthcare worker has contact with any bodily fluid, they must treat the fluid as infectious--whether confirmed or not. Doing so offers the utmost protection for all involved because it reduces the transmission of disease. Let’s review universal and standard precautions here.

• Universal precautions treat all human blood and fluids as if they are infected with HIV, HBV, and other bloodborne pathogens. If exposure is anticipated, use the proper precautions like the following PPE: gloves, masks, and gowns. Healthcare workers should also use engineering and workplace controls to limit exposure: for example, sharps disposal containers, self-sheathing needles, or needleless systems.

• Standard precautions reduce the spread of microorganisms from both known and unknown sources. This effort includes handwashing and use of PPE when being exposure to bodily fluids.

In addition to these precautions, the CDC and OSHA require bloodborne pathogen training for anyone in the healthcare field. This includes workers in maintenance and housekeeping in a hospital, along with anyone who comes in contact with blood or bodily fluids. All laboratory personnel must also complete required training as required by CDC and OSHA.

Employers are also required to have a post-exposure plan to protect employees in the event of exposure to blood or bodily fluids. Even though treatments are now available for the three major diseases transmitted through blood and bodily fluids—Hepatitis B, Hepatitis C, and HIV—other diseases can be transmitted that put healthcare workers at risk.

Engineering protocols have been implemented in most organizations when there is potential for an employee to be exposed to provide an extra layer of protection. In addition, employers must also provide personal protective equipment to their workers.

As you can see, these precautions and regulations are designed to protect you, your coworkers, and your patients. But what are your responsibilities when it comes to common tests, like urinalysis?

The Job of a Medical Assistant

As a medical assistant, you will have many important responsibilities in a healthcare facility. For example, regarding urinalysis, you may need to analyze information that patients give you to anticipate what tests the doctor will order. In fact, you may work for a physician who leaves standing orders for you to order a urinalysis if needed based on patient symptoms.

Next, you will need to instruct patients on how to give a urine specimen. This task requires not only knowledge but also good communication, critical thinking, and professionalism. A common mistake is to assume that all patients know what to do because a urinalysis is a frequently-ordered test, but you will need to professionally communicate the requirements each time to ensure an appropriate sample. You will find that part of professionalism is the ability to communicate and analyze information that a patient provides.

Finally, you will likely keep supplies stocked in the restroom so the patients have what they need to give a specimen. While this may not feel very glamorous, it’s a vital service needed in every medical facility. Attention to this detail provides an important support to your patients and colleagues.

Overall, your knowledge about urine tests, why they are ordered, and safety precautions will be vital skills to add to your ever-growing toolkit of knowledge, further preparing you to an essential team member in your future career.

References

Fareed, W. (2019, September 11). Urinalysis (urine test). Medicine Net. Retrieved on April 27, 2020. https://www.medicinenet.com/urinalysis/article.htm

Sources of Information

Armstrong, J. (2007, March 1). Urinalysis in Western culture: A brief history. Science Direct. Retrieved on April 28, 2020. https://www.sciencedirect.com/science/article/pii/S0085253815523806

Clinical Laboratory Improvement Amendments (2020, April 28). Centers for Disease Control and Prevention. Retrieved on April 29, 2020. https://www.cdc.gov/clia/index.html