LABORATORY SKILLS MODULE

BLOCK : Tropical Medicine system

TOPIC : The taking of skin specimens for the examination of skin infections in tropical medicine

I. GENERAL OBJECTIVE
After completing this skill practice, the students will be able to take skin specimens for the examination of
skin infections in tropical medicine.

II. SPECIFIC OBJECTIVE

At the end of skill practice, the student will be able to:
1. Conduct skin smears for the examination of leprosy
2. Conduct skin scraping for the examination of scabies
3. Conduct skin scraping for the examination of cutaneous mycosis

III. METHOD
1. Presentation
2. Demonstration
3. Coaching

IV. GENERAL
After using the scalpel please pass through the flame but don’t become not red.

V. EQUIPMENT
1. Presentation:
- Audiovisual aids
2. Demonstration:
- Video film
3. Coaching:
a. Skin smears for leprosy:
- anatomical model - bunsen burner or alcohol lamp
- matches - 70% alcohol
- cotton wool - wooden plate
- forceps - scalpel holder
- scalpel blade - glass slides
- gloves - steril gauze
- adhesive tape
b. Skin scraping for scabies:
- anatomical model - 70% alcohol
- cotton wool - scalpel blade
- Imerse oil - glass slides
- cover slips - vaselin album
- tooth pick/cotton buds - pipette
- gloves

c. Skin scraping for cutaneous mycosis

- anatomical model
- bunsen burner or alcohol lamp
- 70% alcohol
- cotton wool
 - scalpel blade
- adhessive tape + dispenser
- 10% KOH or 20% KOH + Blue-black ink Parker aa
- glass slides
- cover slips
- forceps
- pipette
- gloves

3. LEARNING GUIDE:

SKIN SMEARS FOR LEPROSY, SKIN SCRAPING FOR SCABIES, DAN SKIN SCRAPING FOR CUTANEOUS MYCOSIS

PERFORMANCE SCALE
No. STEP 1 2 3 4

SKIN SMEARS FOR LEPROSY

Client assessment
1. Greet the patient respectfully and with kindness
Ask the patient to sit down.
2. Give an adequate explanation about the test that will be carried out, and
explain the goals or the expected result of the test.
Ask the patient to sign the informed consent form, and then sign it yourself.

Preparation
3. Check the appropriate equipment.
4. Select the smear sites:
3 sites routine for taking smears are:
- The right earlobe
- The left earlobe
- The lesion
If there is no lesion, please take the third smear from the upper knee or the
back of the hand.
Skin lesions can be very different:
a. A well defined lesion: take the smear from the edge
b. In ill defined lesion : take the smear from the centre
c. A raised lesion : take the smear from the centre.
5. Prepare glass slides:
Clean the slide with cotton wool soaked in 70% alcohol.
Thereafter, avoid to touch the glass slide with your fingers.
Put the clean glass slide on the table where it is easy to reach, with its marked
side upwards
6. Light the alcohol lamp/Bunsen burner.
Clean the scalpel blade by wiping it with a piece of cotton wool soaked in 70%
alcohol.
Pass the scalpel blade trough the flame, but do not let it become red hot.
Allow the scalpel blade to cool in such a way that it does not touch anything.
7. Wash your hands thoroughly using antiseptic hand soap.
Put on gloves on your both hands.
8. Soak a piece of cotton wool with 70% alcohol and clean the site before
making the smear. Allow the site to dry before making the cut.
9. Pinch the skin into a fold with your forefinger and thumb, or with artery
clamp.
Apply enough pressure to minimize bleeding.
Wait for a view seconds before making the cut.
10. Make a cut of approximately 5 mm long and at least 2 mm deep.
Make the cut into the infiltrated layer of the dermis.
11. After the cut, turn the blade 90othrough a right angle and scrape to get tissue
material from the edge and the bottom of the cut.
Pinch firmly during the whole procedure.
12. Transfer material to the one third first partof the glass slide and spread it
evenly in a circular manner. The smear should be 5-7mm in diameter.
If this is done carefully the reading of the smear will be easier.
The material should appear colorless to pink.
If the cut bleeds, apply a dry piece of cotton wool and press for a few
minutes.
13. Repeat the cleaning of the scalpel blade before making the second cut.
14. Perform the same procedure on the left earlobe and the lesion, and place the
material on the same glass slide.
Specimen from the left earlobe is placed on the middle one third of glass
slide, and specimen from the lesion is placed on the one third last of glass
slide.
15. Leave the slide to dry in a plate, for at least five minutes, but not more than a
few hours.
After drying, the smear is ready to be fixed.
16. Pass the slide three times through the flame.
Hold it either with your fingers or with a forceps.
The slide is now ready to be stained
17. Fill out the request form, send the specimen and request form to a laboratory
for identifying Mycobacterium leprae and count bacterial index (BI) and
Morphological index (MI)
 PERFORMANCE SCALE
No. 1 2 3 4
STEP

SKIN SCRAPING FOR SCABIES

Client assessment
1. Greet the patient respectfully and with kindness
Give an adequate explanation about the test that will be carried out
2. Ask the patient to sign the informed concent form, and then sign it yourself.

Preparation
3. Check the apropriate equipment.
The scraping is performed with a No 21 blunt scalpel
4. Determine the papular eruption or tiny vesicles at the finger web spaces
5. Clean the papular eruption or tiny vesicles gently with –
70% alcohol, being careful to leave the papular eruption
or tiny vesicles intact.
Wash your hands thoroughly using antiseptic hand soap Put on gloves on both
hands

Taking specimen
6. Drop KOH 10% to the papulareruption or tiny vesicle
7. Scraped off the skin gentle with a No 21 blunt scalpel.
8. Place the material on a glass slide, cover it with a cover slip.
9. Seal the edge of the cover slip with vaselin album.
10. Fill out the request form, send the specimen and request form to a
laboratory.
The presence of mites, eggs, larvae, nymphae, fragments
of egg shells or and scibala confirms the diagnosis.
 PERFORMANCE SCALE
No. 1 2 3 4
STEP

SKIN SCRAPING FOR CUTANEOUS MYCOSIS

Client assessment
1. Greet the patient respectfully and with kindness
Give an adequate explanation about the test to be carried out
2. Explain the goals or the expected result of the test.
Ask the patient to sign the informed consent form, and then sign it
yourself.

Preparation
3. Check the appropriate equipment.
4. Determine the skin lesions to be examined: Choose a skin lession with
an active border and which is characterized by erythematous papules
or plaque with scales, mainly at the border of the lesions.
5. Clean the skin lesions with 70% alcohol to remove surface contaminants
such as dirt, crusts or airbone micro-organisms so as to facilitate
reading of direct preparations.
6. Light the alcohol lamp / the Bunsen burner
Clean a slide with cotton wool or clean cloth soaked in 70% alcohol.
Thereafter, avoid to touch the glass slide with your fingers.
Put the clean glass slide, marked side upward, on the table where it is
easy to reach
7. Wash your hands thoroughly using antiseptic hand soap
Put on gloves on both hands

Taking specimen - Method 1.

8. Put the glass near (the lesion inferior edge)
9. Scrape off carefully the scales from the center part of the lesion to the
edge with a blunt scalpel or a sharp curette. The scales are best taken
from the leading edge of the rash.
10. Give the specimen to the laboratory staff
11. Fill out the request form, and send the specimen slides and request
form to a laboratory.
The presence of hyphae and spores confirm the diagnosis.
The preparation should be examined initially at low magnification to
obtain a general impression.
If this reveals hyphae, increase the magnification to x100-400.

Taking specimen -Method 2

10 a Strip off the skin with adhesive tape,
11 a Fill out the request form, and send the specimen slides and request
 form to a laboratory.
11 b Long the stop to the laboratory staff

VI. SCHEDULE

No.
Subject Allocatedtime Tutor
1. - Introduction 20 minutes
4 persons
- Demonstration 15 minutes

2. - Coaching 145 minutes 4 persons

VII. EVALUATION
1. Self practice on anatomical model and actual patients
2. OSCE

VIII. CRITERIA OF PERSONAL PERFORMANCE EVALUATION

SCALE PERSONAL ACHIEVEMENT

0 If students are not doing this step
1 If student doing this step, but not efficiently
2 If students are doing this step very well