**Module 11: Use and Care of Equipment at the HIV Rapid Testing Site**

+----------------+-----------------------------------------------------+
| **Purpose**    | To help participants understand exactly what is     |
|                | expected of them concerning the care and use of     |
|                | equipment at the HIV rapid test site and to equip   |
|                | them with the necessary skills                      |
+----------------+-----------------------------------------------------+
| *              | -   Module 5: Assuring the Quality of HIV Rapid     |
| *Pre-requisite |     Testing                                         |
| Modules**      |                                                     |
+----------------+-----------------------------------------------------+
| **Module       | 55 minutes                                          |
| Time**         |                                                     |
+----------------+-----------------------------------------------------+
| **Learning     | At the end of this module, participants will be     |
| Objectives**   | able to:                                            |
|                |                                                     |
|                | -   Specify their responsibilities related to       |
|                |     equipment at the HIV rapid test site            |
|                |                                                     |
|                | -   Routinely monitor the temperatures of           |
|                |     refrigerators or freezers                       |
|                |                                                     |
|                | -   Confirm auto pipettes deliver specified volumes |
|                |                                                     |
|                | -   Properly use and maintain centrifuges           |
+----------------+-----------------------------------------------------+

**Module Overview**

+-----+-------+------------+---------------------------+--------------+
| **  | **T   | **         | **Content**               | **Resources\ |
| Ste | ime** | Activity/\ |                           | Needed**     |
| p** |       | Method**   |                           |              |
+-----+-------+------------+---------------------------+--------------+
| **  | 5 min | > Pr       | Module introduction       | > Slides 1-6 |
| 1** |       | esentation |                           |              |
|     |       |            |                           | Prepared     |
|     |       |            |                           | flipchart -- |
|     |       |            |                           | content      |
|     |       |            |                           | outline      |
+-----+-------+------------+---------------------------+--------------+
| **  | 5 min | > Pr       | Responsibilities          | Slides 7-8   |
| 2** |       | esentation | concerning equipment      |              |
|     |       | >          |                           |              |
|     |       | >          |                           |              |
|     |       | Discussion |                           |              |
+-----+-------+------------+---------------------------+--------------+
| **  | 25    | > Pr       | Refrigerator & freezer    | Slides 9-23  |
| 3** | min   | esentation |                           |              |
|     |       | >          | Pipettes                  | Pipettes     |
|     |       | > Activity |                           |              |
|     |       | >          | Centrifuge                | Centrifuge   |
|     |       | > Dem      |                           |              |
|     |       | onstration |                           |              |
+-----+-------+------------+---------------------------+--------------+
| **  | 15    | > Activity | Create a Maintenance      | Slide 24     |
| 4** | min   |            | Activity List             |              |
|     |       |            |                           | Flipcharts   |
+-----+-------+------------+---------------------------+--------------+
| **  | 5 min | > Q&A      | Summary                   | Slide 25     |
| 5** |       |            |                           |              |
+-----+-------+------------+---------------------------+--------------+

**Material/Equipment Checklists:**

-   PowerPoint slides or transparencies

-   Overhead projector or computer w/LCD projector

-   Flipchart for content outline and small-group activity

-   Handouts[: Daily Temperature Check Chart]{.underline}, [Generic
    Maintenance Form]{.underline}

-   Precision and disposable pipettes -- have several sets to pass
    around

-   Centrifuge

**Teaching Guide**

+-----------------+-----------------------------------------------------+
| **Slide         | **Teaching Points**                                 |
| Number**        |                                                     |
+=================+=====================================================+
| ![](me          | Modify this module based on the equipment your      |
| dia/image1.wmf) | participants will be using at the test sites. For   |
| {width="0.49166 | example, consider:                                  |
| 666666666664in" |                                                     |
| heigh           | -   What type of pipettes will they be using        |
| t="0.4416666666 |                                                     |
| 6666665in"}***C | -   Whether a centrifuge will be available on site  |
| ustomization*** |                                                     |
|                 |                                                     |
| ***Notes***     |                                                     |
+-----------------+-----------------------------------------------------+
| ![](me          | Also modify this module based on participants' jobs |
| dia/image1.wmf) | and responsibilities.                               |
| {width="0.49166 |                                                     |
| 666666666664in" | -   For lab management or supervisors, put emphasis |
| heigh           |     on the oversight responsibilities.              |
| t="0.4416666666 |                                                     |
| 6666665in"}***C | -   For lab technicians or testers, put emphasis on |
| ustomization*** |     execution and following procedures.             |
|                 |                                                     |
| ***Notes***     |                                                     |
+-----------------+-----------------------------------------------------+
| **1**           | **[Module 11: Use and Care of                       |
|                 | Equipment]{.underline}**                            |
|                 |                                                     |
|                 | DISPLAY this slide before you begin the module.     |
|                 | Make sure participants are aware of the transition  |
|                 | into a new module.                                  |
+-----------------+-----------------------------------------------------+
| **2**           | **[The Lab Quality System]{.underline}**            |
|                 |                                                     |
|                 | REMIND participants that equipment is a component   |
|                 | of the Lab Quality System. This component           |
|                 | addresses:                                          |
|                 |                                                     |
|                 | -   Equipment selection                             |
|                 |                                                     |
|                 | -   Equipment acquisition                           |
|                 |                                                     |
|                 | -   Equipment installation and initial              |
|                 |     calibration/validation                          |
|                 |                                                     |
|                 | -   Maintenance service and repair                  |
|                 |                                                     |
|                 | -   Troubleshooting                                 |
|                 |                                                     |
|                 | -   Retiring equipment and disposition              |
+-----------------+-----------------------------------------------------+
| **3**           | **[Learning Objectives]{.underline}**               |
|                 |                                                     |
|                 | STATE the objectives on the slide.                  |
+-----------------+-----------------------------------------------------+
| **4**           | **[Content Overview]{.underline}**                  |
|                 |                                                     |
|                 | EXPLAIN the topics that will be covered in this     |
|                 | module.                                             |
+-----------------+-----------------------------------------------------+
| **F             | WRITE the content outline on a flipchart prior to   |
| lipchart**![](m | training.                                           |
| edia/image2.wmf |                                                     |
| ){width="0.8423 | REFER to it frequently to orient participants to    |
| 611111111111in" | where they are in the module.                       |
| height="0.84236 |                                                     |
| 11111111111in"} |                                                     |
+-----------------+-----------------------------------------------------+
| **5**           | **[Functioning Equipment is Vital to Quality        |
|                 | Service]{.underline}**                              |
|                 |                                                     |
|                 | EXPLAIN the rationale for properly maintaining      |
|                 | equipment.                                          |
|                 |                                                     |
|                 | -   Reliable results aid clinical diagnosis.        |
|                 |     Unreliable results may result in incorrect      |
|                 |     diagnosis and treatment of the patient.         |
|                 |                                                     |
|                 | -   If equipment is properly maintained, it is less |
|                 |     likely to breakdown before its next service and |
|                 |     is less likely to perform inadequately due to   |
|                 |     lack of maintenance.                            |
+-----------------+-----------------------------------------------------+
| **6**           | **[Equipment at HIV Rapid Testing                   |
|                 | Site]{.underline}**                                 |
|                 |                                                     |
|                 | STATE HIV Rapid Testing can be performed with       |
|                 | minimal equipment. At a minimum, there are 4 pieces |
|                 | of equipment that may be used at the rapid testing  |
|                 | site.                                               |
|                 |                                                     |
|                 | EXPLAIN the use of each type of equipment.          |
|                 |                                                     |
|                 | -   Refrigerators store reagents, kits, and quality |
|                 |     control materials requiring refrigerator        |
|                 |     storage (such as Capillus).                     |
|                 |                                                     |
|                 | -   Freezers store specimens collected for EQA      |
|                 |     purposes prior to transport to a reference      |
|                 |     laboratory. Quality control specimens may also  |
|                 |     be stored in a freezer.                         |
|                 |                                                     |
|                 | -   Pipettes collect or transfer specimen to test   |
|                 |     device.                                         |
|                 |                                                     |
|                 | -   Centrifuges separate cells from serum/plasma    |
|                 |                                                     |
|                 | EMPHASIZE all equipment used at the testing site    |
|                 | must be properly maintained. Using equipment that   |
|                 | has not been properly maintained may compromise the |
|                 | quality of test results.                            |
+-----------------+-----------------------------------------------------+
| **7**           | **[Management Responsibilities: Ensure Test Site    |
|                 | Readiness]{.underline}**                            |
|                 |                                                     |
|                 | EXPLAIN lab management is responsible for making    |
|                 | sure the test site is ready to receive and install  |
|                 | a new piece of equipment. This includes:            |
|                 |                                                     |
|                 | -   Assigning responsibilities -- this includes     |
|                 |     oversight of all lab equipment and individual   |
|                 |     responsibilities.                               |
|                 |                                                     |
|                 | ```{=html}                                          |
|                 | <!-- -->                                            |
|                 | ```                                                 |
|                 | -   Establishing inventory record -- Each piece of  |
|                 |     equipment must have an inventory record. This   |
|                 |     record contains pertinent information such as   |
|                 |     make and model, maintenance and service record, |
|                 |     and manufacturer contact information.           |
|                 |                                                     |
|                 | ```{=html}                                          |
|                 | <!-- -->                                            |
|                 | ```                                                 |
|                 | -   Training the operators -- Everyone using any    |
|                 |     piece of laboratory equipment must be properly  |
|                 |     trained. Training must include troubleshooting. |
+-----------------+-----------------------------------------------------+
| **8**           | **[Your Responsibilities: Execute at Test           |
|                 | Site]{.underline}**                                 |
|                 |                                                     |
|                 | EXPLAIN the responsibilities of the test site       |
|                 | staff.                                              |
|                 |                                                     |
|                 | DISCUSS the reason against using malfunctioning     |
|                 | equipment.                                          |
+-----------------+-----------------------------------------------------+
| **9**           | [**Function** **Checks Verify that Equipment is     |
|                 | Working Properly**]{.underline}                     |
|                 |                                                     |
|                 | EXPLAIN function checks -- they are activities      |
|                 | performed periodically to ensure that:              |
|                 |                                                     |
|                 | -   Equipment is working properly before use        |
|                 |                                                     |
|                 | -   Equipment is properly maintained for peek       |
|                 |     performance                                     |
|                 |                                                     |
|                 | PROVIDE examples of function checks at the HIV      |
|                 | rapid test site.                                    |
+-----------------+-----------------------------------------------------+
| **10**          | **[Refrigerator and Freezer: Use and                |
|                 | Care]{.underline}**                                 |
|                 |                                                     |
|                 | EXPLAIN the points on the slide.                    |
+-----------------+-----------------------------------------------------+
| **11**          | **[Refrigerator & Freezer: Temperature              |
|                 | Checks]{.underline}**                               |
|                 |                                                     |
|                 | EXPLAIN this photo illustrates routine monitoring   |
|                 | of temperatures of this refrigerator.               |
|                 |                                                     |
|                 | -   It is good practice to attach the form for      |
|                 |     recording temps directly on the front of the    |
|                 |     refrigerator for easy access.                   |
|                 |                                                     |
|                 | -   Inserting it into a protector page will guard   |
|                 |     against tearing of paper.                       |
+-----------------+-----------------------------------------------------+
| **12**          | **[Refrigerator & Freezer: Temperature              |
|                 | Log]{.underline}**                                  |
|                 |                                                     |
|                 | EXPLAIN this form is an example of what should be   |
|                 | used to record and monitor refrigerator/freezer     |
|                 | temps.                                              |
|                 |                                                     |
|                 | REFER participants to a sample temperature log in   |
|                 | the participant manual.                             |
+-----------------+-----------------------------------------------------+
| **13**          | **[Types of Pipettes]{.underline}**                 |
|                 |                                                     |
|                 | EXPLAIN the difference between the two types of     |
|                 | pipettes.                                           |
|                 |                                                     |
|                 | EMPHASIZE never re-use disposable items. Doing so   |
|                 | will cause cross contamination.                     |
+-----------------+-----------------------------------------------------+
| **Activity**    | PASS around a few sets of precision and disposable  |
|                 | pipettes for everyone to see and touch.             |
| **3 minutes**   |                                                     |
+-----------------+-----------------------------------------------------+
| **14**          | **[Pipette: Use and Care]{.underline}**             |
|                 |                                                     |
|                 | EXPLAIN the points on the slide.                    |
|                 |                                                     |
|                 | EXPAND the first bullet: Select a pipette with      |
|                 | delivery range close to the volume required. For    |
|                 | example, if 50 micro liters (ul) of specimen is     |
|                 | required, use a 100 ul pipette.                     |
|                 |                                                     |
|                 | EMPHASIZE [never lay the pipette on its side when   |
|                 | liquid is in the tip]{.underline} -- doing so will  |
|                 | cause the specimen to flow into to the pipette      |
|                 | shaft and damage the pipette.                       |
+-----------------+-----------------------------------------------------+
| **15**          | **[Pipette: Use and Care (Cont'd)]{.underline}**    |
|                 |                                                     |
|                 | EXPLAIN the points on the slide.                    |
|                 |                                                     |
|                 | EXPAND the third bullet: Air bubbles in the tip can |
|                 | greatly reduce pipetting accuracy. If an air bubble |
|                 | is trapped within the tip during intake, do the     |
|                 | following:                                          |
|                 |                                                     |
|                 | -   Dispense the sample into the original vessel    |
|                 |                                                     |
|                 | -   Check the tip immersion depth                   |
|                 |                                                     |
|                 | -   Pipette more slowly                             |
|                 |                                                     |
|                 | -   If an air bubble appears a second time, discard |
|                 |     the tip and use a new one.                      |
|                 |                                                     |
|                 | EMPHASIZE the following safety practices. (REMIND   |
|                 | participants of the safety module)                  |
|                 |                                                     |
|                 | -   Care should be taken to discard pipette tips in |
|                 |     the appropriate container. Used pipette tips    |
|                 |     should not be found on the floor, as this poses |
|                 |     a safety hazard.                                |
|                 |                                                     |
|                 | -   Never re-use a pipette tip, which causes cross  |
|                 |     contamination and will compromise patient       |
|                 |     results. A fresh tip should be used for each    |
|                 |     sample.                                         |
+-----------------+-----------------------------------------------------+
| ![](me          | If precision pipettes are used at test sites,       |
| dia/image1.wmf) | provide hands-on practice.                          |
| {width="0.49166 |                                                     |
| 666666666664in" |                                                     |
| heigh           |                                                     |
| t="0.4416666666 |                                                     |
| 6666665in"}***C |                                                     |
| ustomization*** |                                                     |
|                 |                                                     |
| ***Notes***     |                                                     |
|                 |                                                     |
| **16-17**       |                                                     |
+-----------------+-----------------------------------------------------+
| **16**          | **[Precision Pipettes Require Performance           |
|                 | Checks]{.underline}**                               |
|                 |                                                     |
|                 | The analytical balance should have a scale of 0.1   |
|                 | to 0.0001 mg                                        |
+-----------------+-----------------------------------------------------+
| **17**          | **[Pipette: Steps for Checking                      |
|                 | Reproducibility]{.underline}**                      |
|                 |                                                     |
|                 | EMPHASIZE performance checks include                |
|                 | reproducibility and calibration.                    |
|                 |                                                     |
|                 | EXPLAIN the procedures for checking                 |
|                 | reproducibility.                                    |
+-----------------+-----------------------------------------------------+
| **18**          | **[Pipette: Troubleshooting]{.underline}**          |
|                 |                                                     |
|                 | EXPLAIN the points on the slide.                    |
+-----------------+-----------------------------------------------------+
| ![](me          | For participants without a lab background, or who   |
| dia/image1.wmf) | have never seen a centrifuge, add the following     |
| {width="0.49166 | steps before showing the next few slides:           |
| 666666666664in" |                                                     |
| heigh           | > SHOW a centrifuge.                                |
| t="0.4416666666 | >                                                   |
| 6666665in"}***C | > DEMONSTRATE how it works.                         |
| ustomization*** | >                                                   |
|                 | > NAME all parts that will be mentioned in the      |
| ***Notes***     | > following slides.                                 |
|                 |                                                     |
| **19**          |                                                     |
+-----------------+-----------------------------------------------------+
| **19**          | **[Centrifuge: Use and Care]{.underline}**          |
|                 |                                                     |
|                 | EXPLAIN the bullets on the slide.                   |
|                 |                                                     |
|                 | -   Always operate with the lids closed --          |
|                 |     Operating a centrifuge without the lid closed   |
|                 |     poses an unnecessary safety hazard.             |
|                 |                                                     |
|                 | ```{=html}                                          |
|                 | <!-- -->                                            |
|                 | ```                                                 |
|                 | -   Balance contents before turning on. -- For      |
|                 |     example, if there is only one sample to be      |
|                 |     centrifuged, a tube identical in size and       |
|                 |     volume must be placed in the rotor opposite the |
|                 |     tube. Note: The rotor is the part of the        |
|                 |     centrifuge that holds the tubes and rotates     |
|                 |     during operation.                               |
|                 |                                                     |
|                 | -   Check for vibration -- There may be several     |
|                 |     reasons why a centrifuge vibrates. When         |
|                 |     vibration occurs, you'll need to:               |
|                 |                                                     |
|                 |     -   Stop operation of the centrifuge.           |
|                 |                                                     |
|                 |     -   Determine the cause of the noise or         |
|                 |         vibration.                                  |
|                 |                                                     |
|                 |     -   Correct immediately to prevent severe       |
|                 |         damage to the centrifuge or injury to the   |
|                 |         worker. Refer to the owner's manual for     |
|                 |         possible causes aside from improper         |
|                 |         balancing                                   |
|                 |                                                     |
|                 | -   Do not open until the lid until the rotor has   |
|                 |     come to a complete stop                         |
|                 |                                                     |
|                 | -   Keep lids on tubes when spinning -- Do not take |
|                 |     the tops off the tubes before spinning. Doing   |
|                 |     so will cause splashing and creating of         |
|                 |     aerosols from potentially infectious material   |
+-----------------+-----------------------------------------------------+
| **20**          | **[Centrifuges: Function Checks]{.underline}**      |
|                 |                                                     |
|                 | EXPLAIN separation activity is a function of both   |
|                 | centrifugal force and timing. Proper balance,       |
|                 | lubrication and rotor function are essential for    |
|                 | proper centrifugation to occur.                     |
+-----------------+-----------------------------------------------------+
| **21**          | **[Centrifuge: Routine Maintenance]{.underline}**   |
|                 |                                                     |
|                 | EXPLAIN how to clean the centrifuge:                |
|                 |                                                     |
|                 | -   Clean interior daily with soap and water, wipe  |
|                 |     with a disinfectant                             |
|                 |                                                     |
|                 | -   Wipe spills using 10% bleach solution           |
|                 |                                                     |
|                 | -   After cleaning, run the centrifuge at varying   |
|                 |     RPMs to check the braking mechanism and ensure  |
|                 |     a smooth gradual stop                           |
|                 |                                                     |
|                 | EXPLAIN what to do when noticing unusual noises:    |
|                 |                                                     |
|                 | -   Stop operation of the centrifuge                |
|                 |                                                     |
|                 | -   Follow manufacturer's recommendation on         |
|                 |     activation and release of brakes                |
|                 |                                                     |
|                 | -   Correct immediately to prevent severe damage to |
|                 |     the centrifuge or injury to the worker          |
|                 |                                                     |
|                 | MENTION brushes need to be inspected every 3-6      |
|                 | months and replaced according to manufacturer       |
|                 | specifications.                                     |
+-----------------+-----------------------------------------------------+
| **22**          | **[Centrifuge Safety]{.underline}**                 |
|                 |                                                     |
|                 | STATE the bullets on the slide.                     |
|                 |                                                     |
|                 | STATE simply turning the power off does not remove  |
|                 | power to the centrifuge.                            |
+-----------------+-----------------------------------------------------+
| **23**          | **[Keep a Log for All Maintenance                   |
|                 | Activities]{.underline}**                           |
|                 |                                                     |
|                 | MENTION the need for documenting problems,          |
|                 | corrective action, preventive maintenance,          |
|                 | cleaning, and inspections.                          |
|                 |                                                     |
|                 | REFER participants to a sample, generic maintenance |
|                 | log in the participant manual.                      |
+-----------------+-----------------------------------------------------+
| **24**          | **[Exercise: Create a Maintenance Activity          |
|                 | Log]{.underline}**                                  |
| **Activity**    |                                                     |
|                 | FOLLOW the procedure below when conducting the      |
| **15 minutes**  | activity:                                           |
|                 |                                                     |
|                 | > INFORM participants of the activity.              |
|                 | >                                                   |
|                 | > READ the instructions on the slide.               |
|                 | >                                                   |
|                 | > PROVIDE a flipchart for each work group.          |
|                 | >                                                   |
|                 | > ALLOW 10 minutes for the small group to work.     |
|                 | >                                                   |
|                 | > DEBRIEF by asking volunteers to present their     |
|                 | > lists and solicit comments from other             |
|                 | > participants.                                     |
+-----------------+-----------------------------------------------------+
| ![](me          | Alternative way to conduct this activity:           |
| dia/image1.wmf) |                                                     |
| {width="0.49166 | If all the participants come from the same test     |
| 666666666664in" | site, or if you have time constraint, you may       |
| heigh           | modify this activity by facilitating a large group  |
| t="0.4416666666 | discussion (instead of having small work groups) to |
| 6666665in"}***C | create the activity list.                           |
| ustomization*** |                                                     |
|                 |                                                     |
| ***Notes***     |                                                     |
|                 |                                                     |
| **24**          |                                                     |
+-----------------+-----------------------------------------------------+
| **25**          | **[Summary]{.underline}**                           |
|                 |                                                     |
|                 | ASK participants to answer the questions on the     |
|                 | slide.                                              |
|                 |                                                     |
|                 | ANSWER any questions participants may have.         |
+-----------------+-----------------------------------------------------+