VIETNAM NATIONAL UNIVERSITY INTERNATIONAL UNIVERSITY

Report of Internship 2
at International Neurosurgery Hospital

Submitted to Dr. Pham Van Hung & Ms Bui Xuan Anh Dao in Partial Fulfillment of the Requirements for Internship II course Second Semester, 2010 - 2011

Student Name: Student ID: Date:

Nguyen Bao Ngoc BTIU08163

Page | 0 17th August, 2011

Table of Contents
Acknowledgement .......................................................................................................................... 2 I. II. 1. 2. III. Introduction and Overview of the International Neurosurgery Hospital ................................. 3 Internship ............................................................................................................................. 5 Internship Activities ............................................................................................................. 5 Instruments and Equippment ............................................................................................... 7 Personal judgment .............................................................................................................. 10

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ACKNOWLEDGEMENT
First of all, I would like to express my gratitude to The School of Biotechnology of International University for giving me a great chance to improve myself through the internship. I also would like to give my appreciation to the Board of Directors of International Neurosurgery Hospital for giving me an opportunity to have my internship at the laboratory of the hospital. I acknowledge with deep respect the help of Ms. Tran Thai Thanh and Ms. Nguyen Bach Hue, who have advised and taught me new knowledge and experiences during the internship. Last but not least, I am really grateful to Ms. Nguyen Bich Han for giving me her valuable help as well as being a great partner during this internship. Nguyen Bao Ngoc

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I. Introduction and Overview of the International Neurosurgery Hospital 1. Introduction and Overview: This is the report about the work during my internship in a clinical laboratory of the International Neurosurgery Hospital from 1st April to 31st May 2011. International Neurosurgery Hospital was established in 2009, which is the first hospital specialized for neurosurgery in Vietnam. From then till now, the hospital has been through many developments in human resources as well as material facilities to have high quality and effectiveness in diagnosis and treatment of neurotic diseases. International Neurosurgery Hospital belongs to the Can Gio Pharmaceutical Company and also is a satellite hospital of Cho Ray. Its organization structure is shown below:

Board of Directors

Emerfency and Outpatient Department

Department of Operating and Anesthesia

In-patient Department and Intensive Care Unit (ICU)

Department of Diagnostic Imaging

Laboratory

Deparment of Pharmacy

During the internship, I mostly worked in the clinical laboratory of the hospital. Its main function is to carry out several tests to examine and analyze blood or urine samples in order to detect the diseases, measure the amount of components in blood and urine, match blood transfusions and test for drug levels in the blood to show how a patient is responding to treatment. Also, after having the results, the clinical lab scientists have to analyze the results, apply them in the computer systems of the hospital and relay them to physicians who will decide based on the results to have suitable treatments for the patients.

2. Regulation for safety: Typically, the laboratory of the hospital often works on blood/urine samples which are highly risk of serious diseases. Therefore, in order to protect the staffs as well as the other

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people, it strictly requires individuals who work in the laboratory to follow the lab safety which is described below: Information about any hazards present in the lab must be provided by the chef at the time at the time initial the test and prior to any tests involving new potential chemical exposure situations. Also, all spills, accidents or potential exposures to infectious materials must be reported to the laboratory chef. A written record of such accidents and incidents should be maintained. Each clinical laboratory personnel must be adequately informed about the physical and health hazards present in the laboratory, the known risks, an what to do if an accident occurs. Each individual must be well equipped for personal protective such as laboratory blouse, glass, etc. at all times for work in the laboratory. Gloves are highly recommended to worn all procedures that may involve direct or accidental contact with blood, body fluids and other potentially infectious materials. After use, gloves should be removed aseptically and hands must then be washed. Open-toed footwear must not be worn in laboratories. Eating, drinking and smoking as well as storing human foods or drinks anywhere in the laboratory working areas are prohibited. For working area: the laboratory should be kept neat, clean and free of materials that are not pertinent to the work. Work surfaces must be decontaminated after any spill of potentially dangerous material and at the end of the working day. Non-infectious waste that can be reused or recycled or disposed of as general, household waste. All contaminated materials, specimens and cultures must be decontaminated before disposal or cleaning for reuse. Also, hypodermic needles, scalpels, knives and broken glass, disposable syringes, used alone or with needles, should be placed in sharps disposal containers and incinerated, with prior autoclaving if required.

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II. Internship: 1. Internship activities: My internship working time was on Thursday of every week, which often started at 8 oclock in the morning and finished after 5 oclock in the afternoon. At the very beginning of the work, I had to check if the machines worked well or not because most tests were automatically carried out by the machines; therefore, if there were some errors occurred, it could lead to a lot of false data. The process was performed by letting the instrument measure a standard sample that already has a standard result provided by the manufacturer. If the result given by the machine was within an acceptable range compared to the standard result, this means the instrument did not have any problems. This step is known as system calibration step or an end-to-end calibration step. As I have mentioned above, the clinical laboratory had a lot of tasks, however, I was mainly in charge of the task of measuring the amount of components in a blood/urine samples. Unfortunately, since most tests were performed by the machines in order to have accurate results quickly, all I had to do was prepared the samples before they ready to be submitted to the instruments. Although this is just a small step and seems to be easy to do, however, I could say that it is really an important step. There were different types of sample preparation. Some blood components such as glucose, the cholesterol group (LDL, HDL), hepatic enzymes (SGOT, SGPT), cardiac enzymes (CDK, CK), etc often enormously occur in blood plasma. By centrifuging the blood samples, I will have the blood plasma as well as the needed components gathered at the top of the test tube, which facilitates the submission and ensures the accuracy of the tests. In contrast, if the tests required to quantify the amounts of blood cells (red blood cells, white blood cells, etc), I should mix the samples well by gently inversing the test tube for 2-3 times to avoid breaking the blood cells. This manipulation was to ensure that the blood cells could be regularly distributed in the sample so that the final result would be more accurate. In addition, there were some machines that were semi-automatic, that is, I had
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to add an appropriate amount of reagent to the sample before submitting it to instruments. This required me to spend more practical skill and more concentration so that I could add right amount of sample as well as reagent. It also took me a lot of time since beside the blood samples, I also had to prepare the blank and the standard samples so that they would provide the standard results to compare with that of the blood samples.

Beside tests that were automatically carried out by machines, there were some tests that needed only a few seconds to perform and I was able to do. One of them was the blood type test, which was often used to determine the ABO blood group or Rh group. Although procedure was simple, it also had many requirements that I must apply. For example, the order in using the antibody reagents had been internationally stipulated in which anti-A (in blue container) was used first, followed by anti-B (yellow container), anti-A & anti-B (white container) and anti-D (white container). Furthermore, after adding the blood to the reagents, I had to make sure that they were mixed well for correct observation. By obeying the regulation, it would be easy for me to guess the blood type by comparing with the standard table as shown below. Another kind of test that I had performed was quick kit test. This test was carried out by simple tools that had strips precoated with monoclonal antibodies specific to antigens of a certain disease so that if the antigens were present, two lines would appear, showing a positive result. The procedure was really simple in which all I had to do was put a drop of serum or plasma on the kit and wait for a little while until a clearly result was drawn out. This kind of test was usually used to detect hepatitis, HIV, etc.

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Sometimes, I was also responsible for taking notes and entering the data into the computer system of the hospital. Interestingly, this work was carried out as carefully as the other jobs, from the very beginning to the end. For more details, blood samples after being collected from patients would be labeled with the patient name. As the samples were first delivered to the laboratory, I had to write down the sample date, the tests that would be carried out. During the process, I also had to enter the patient information to the instrument system for easy monitoring. Later, after having the results, I would enter the results to the computer system for saving and printing them to relay back to the physicians or the patients. For the truth, this work was truly crucial since it helped easily keep track of the work while the instruments were operating with many different samples, therefore, mistakes could be avoided. Besides, there were some patients that needed permanent treatment, thus, carefulness in taking note and saving data could help the physicians observe any changes in patient health during the treatment

2. Instruments and equippment: Instruments: There are some machines that I had worked with during the internship: o Biolis 24i which is used to quantify the amount of blood components

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o Erba is a semi-automatic instrument which means we have to prepare the reagents. Its function was similar to that of Biolis 24i

o Automatic machine (ABX Micros) is an instrument used to perform the quantity of blood cells, including red blood cells, white blood cells, platelets, etc.)

Equippment: o Test tube: The different colors of the test tube caps show different ways as well as purposes of using the collected sample. For instant: the red tube contains silica beads which act as clot activators so that both serum and red blood cells may be collected. The sample contained in this tube was often used to measure the amount of glucose, cholesterol,
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enzymes or utilized in quick kit tests. In contrast, a whole blood contained in the blue one will be used to perform the blood group determination, blood composition, ect since the tube insists of EDTA which plays a role of an anticoagulant o Blood group determination reagents:

o Pipettes o Microscopes

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III. Personal judgment: 1. The use of knowledge and technique skills learnt from school during the internship: As I have mentioned above, during the internship, I worked in the clinical laboratory where I mainly worked with several tests on blood and urine samples, which frequently related to the detection of diseases, the measurement of components in patient blood/urine for further treatments, etc... Therefore, the knowledge and technique I had used during the internship were mostly from these three courses: analytical chemistry, immunology and biochemistry. Usually, the goal for testing blood/urine samples was to measure the amount of their components such as glucose, cholesterol, ions: Na+, K+, Ca2, etcBy studying analytical chemistry as well as biochemistry, I could know the principle of sample analysis, that is, how the sample could be analyzed by using appropriate chemicals in order to determine or quantify its components and for that reason, even though I did not directly worked on the blood/urine samples since they were automatically tested by machines, I could understand how those tests were progressed and what techniques were used. Besides, the knowledge obtained from the course helped me recognize if there were errors occurred when reading the results. It also reminded me that small carelessness in manipulation could bring incorrect results; hence, I always had to strictly follow the procedures required for sample preparation and submission. Similarly, studying immunology course provide me a lot of necessary knowledge in detecting disease or giving out a comment when reading the results. For example, in hepatitis testing, if the result shows us a negative, this means the patient is not infected and vice versa. However, the positive result sometimes can be a fake positive result, that is, the patient actually is not infected. It is because the patient has been healed from hepatitis before and now he may still have hepatitis antigens which act as detector for hepatitis and when doing the test; it shows a positive result. There are also cases that a negative result for patient considered to be infected due to the absence of antigens in blood samples. To get an accurate result, therefore, we should use more complicated tests for these special cases. This is how I apply my knowledge that I have learnt from school during the internship. However, unfortunately, because most of tests were automatically carried out by machines so I did not have many chances on using practical skills learnt from school. In fact, I

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was only able to practice to improve skill of using pipettes, pumps, the microscopes and the hemocytometer counting chamber in order to use them properly and skillfully. 2. Personal strength and weakness: One of my strength is the solid knowledge and skills English. They are very critical when most of the procedures or the instructions for utilizing the equipment as well as the chemicals were written in English. This strength can be reflected by my capacity of following the manuals to manipulate some clinical tests. Independency can be considered as the other one of my strength. Independent working ability involves some important skills such as problem resolving skills and researching skills. For instant, during the internship, I had met some problems in controlling the machine and reading the results. To overcome them, I did searches through the internet to find possible and effective solutions. After did several experimental tests according to the researches, I finally found the proper solution and solved the problems. Although these strength helped me did good work during the internship, however, I realized that I had quite many weak points which revealed and reduced my effectiveness when I was in a real working environment. First of all, I really lacked the soft skills, that is, I did not do many communications to the other staffs in the hospital since I was timid and worried about what to say. This is so regrettable since from everyone, I could study and obtain more knowledge as well as experiences that may be necessary for my future study. Second, besides the knowledge that I have achieved from school, there are still some vacancies that need to be filled. This means that there are things that I just remember but do not know or understand them thoroughly. As a result, I cannot use them properly without reviewing them from the materials. I think I should have more focus on studying like spending more time for reading books, looking for more information on the internet, etc Besides, my practical skill was not really good when I first joined the internship. Fortunately, they had become better when the internship completed. The final weakness that I have is my insufficient initiative of doing the job, that is, I often wait for the tasks to be assigned by my supervisor rather than actively asking for jobs to do. Initially, I performed like this because I did not want to bother my supervisors and disturb their work when they were busy. Long time past, it became my working style. I think I should invest more enthusiasm and motivation onto my job and be more initiative to contribute my team in the future.
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3. Personal judgment about the internship: It is hard to say any new skills are developed during the 8 weeks internship; however, as some people say all work is education, there are so many other things that I have obtained. That is, first of all, I know how the real working environment is. Is is a place where we have to work with serious attitude and do our best for good results since it can give huge affect to other people. Second, the internship has provided some experiences for me. For instant, it is really essential to know how to organize the job effectively in order to complete them in enough time or to take note carefully some important information since they can be useful in future. In conclusion, I think the internship it is a valuable step in the transition from education to professional life or in other words, to transfer from studying environment to a working environment. I think the internship should be encouraged and be provided for more conditions so that the students will have more chances in choosing the place for internship which may be more relevant to their future majors.

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