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Guidelines for Good Clinical Laboratory Practices (GCLP)to be followed by researchers while designing, conducting and reporting trials involvinghuman participants. Realizing the rapid pace, wide spectrum and potential for clinicalresearch in our country, the Indian Council of Medical Research (ICMR) launched theEthical Guidelines for Biomedical Research on Human Subjects in 2000 (revised in2006) and Central Drugs Standard Control Organisation (CDSCO) released the IndianGood Clinical Practices (GCP) guidelines in 2002 to guide biomedical research in thecountry. To harmonize practices and generate mutually acceptable data for non-clinicalhealth and environmental safety studies the Organization for Economic Cooperation and Development (OECD) evolved Good Laboratory Practice (GLP)guidelines. India is a signatory to OECD and National GLP Compliance MonitoringAuthority established in the year 2002 by the Department of Science & Technology,Government of India, provides GLP compliance certification to the test facilities involvedin conducting safety studies on chemicals (viz. industrial chemicals, pharmaceuticals,veterinary drugs, pesticides, cosmetic products, food products, feed additives, etc).To ensure reliability of data quality, WHO/TDR (Research and Training in TropicalDiseases) has developed good practice guidelines for laboratories involved in clinicaltrials. However, standards have not yet been developed in India for this purpose. Theproposed ICMR guidelines for Good Clinical Laboratory Practices (GCLP) aimto elucidate step wise procedures which should be followed by laboratories tostrengthen the quality of test results. These guidelines should be adopted by allICMR laboratories engaged in research as well as patient care. ICMR carriesout research activities through its own institutes as well as through approved researchcenters in the public and private health systems. It also provides financial support toprojects submitted by individual researchers and institutes. Adopting these guidelineswill lead to generation of uniformly acceptable and good quality laboratory data.Subsequently, a checklist will be prepared to monitor these laboratories forcompliance with these guidelines.2.0 SCOPEGood Clinical Laboratory Practices should be used by all laboratories where tests aredone on biological specimens for diagnosis, patient care, disease control and researchsuch as: 2Microbiology & SerologyHematology & Blood BankingMolecular Biology and Molecular PathologyClinical PathologyClinical BiochemistryImmunology (Immunohematology and Immunobiochemistry)Histopathology/Pathology and CytologyINDIAN COUNCIL OF MEDICAL RESEARCH

Guidelines for Good Clinical Laboratory Practices (GCLP)3.0 LEVELS OF LABORATORIESIn India, the laboratory services are integrated with the 3-tier public health system atthe primary, secondary and tertiary levels. Besides these, there are ReferenceLaboratories, Research Laboratories and Specific Disease Reference Laboratoriesto provide services for complex and special tests. The private sector provides laboratorysupport at all levels of health care both in rural and urban areas. Each laboratoryshould identify the scope, functions and the capacity of the services offered by it andappropriate infrastructure with requisite biosafety measures should be planned.Qualified and trained staff should be employed with periodic up-gradation of their skills.3.1 Primary LevelSimple laboratory tests such as haemoglobin estimation and urine examination foralbumin and sugar are carried out at Primary Health Centers (PHCs) and Urban HealthCenters (UHCs) by laboratory technicians. Most PHCs and UHCs also havemicroscopy facilities and trained technicians for examining blood smear for malarialparasite and sputum for acid-fast bacilli (AFB) and a cold chain system. The CommunityHealth Centers (CHCs) receive referrals from PHCs and the laboratory techniciansare trained and equipped to handle additional laboratory investigations for themanagement of medical and surgical emergencies and making etiological diagnosisof RTIs/STIs. Facilities for screening of G6PD deficiency, sickle cell anaemia andthalassemia are also available for vulnerable communities. Under IDSP, training willbe provided for diagnosis of typhoid using kits, detection of chlorination levels andfecal contamination in water samples.3.2 Secondary levelThe district hospitals have facilities and manpower for carrying out pathology, clinicalpathology, biochemistry, serology, and microbiological investigations. They also carryout tests of water quality and receive referrals from primary level facilities. The laboratorystaff includes pathologists, microbiologists, cytotechnicians, laboratory technicians,blood bank technicians and laboratory attendants.3.3 Tertiary levelThe medical college hospitals and non-teaching large hospitals are equipped withsophisticated diagnostic and investigative facilities to provide tertiary level health care.These hospitals receive referrals from the primary as well as the secondary levels.INDIAN COUNCIL OF MEDICAL RESEARCH3

Guidelines for Good Clinical Laboratory Practices (GCLP)3.4 Reference Laboratories, Research Laboratories and Specific DiseaseReference LaboratoriesThe Reference Laboratories, Research Laboratories and Specific Disease ReferenceLaboratories provide services in a specialized field or area of importance. These maybe located in a medical college, research institution or a private institution. They setand should maintain high standards of quality in one or more particular area andtherefore receive referrals specific to that field. They also offer consultancy, standardizediagnostic tests and carry out training pertaining to that specific area.4.0 INFRASTRUCTUREInfrastructure of laboratories should be planned according to the services provided bythe laboratory. The basic infrastructure facilities include: Reception room/area where requisition forms are received and reportsdisbursedSpecimen collection room/area, toilets, privacy for special purposes eg. semencollection, facilities for disabled persons, toilet for staffQuality water supply for analytical purposeUninterrupted power supplyAnalytical work areaSpecimen/Sample/slide storage facility including cold storage where applicableRecord room/areaFacility for cleaning of glassware, sterilization /disinfectionWaste disposal facility including biomedical wastesFire-safety equipmentVentilation, climate control and lighting arrangementsSeparate room/area for meetings/administrative workSeparate facilities/area for staff for hand washing, eating and storing food,drinks etc.Communication facility with referral centersTransport of specimen/samples to referral centersAdditional infrastructure facilities may be added for special tasks as and whenneeded.5.0 PERSONNEL, TRAINING AND DEVELOPMENT 4Each laboratory should designate a Head of the laboratory who should beoverall in-charge of the daily functioning of the laboratory includingadministration. A Quality Manager should be designated for monitoring andmaintaining of day-to-day quality management system.INDIAN COUNCIL OF MEDICAL RESEARCH

Guidelines for Good Clinical Laboratory Practices (GCLP) The qualifications and experience of the staff outlined in NABL document 112(2007) should be followed unless specified by the health care providers. The strength of staff employed should be appropriate to the level of facility andthe workload. The roles and responsibilities of the staff should be clearly outlined. The staffshould also understand the nature of work assigned to them and must becapable of performing the tasks independently beyond routine working hours ifthe need arises. A programme for technical training and updating of skills on a regular basisshould be in place. The laboratory management should be committed forproviding continuing professional development and training opportunities tostaff. Action plan for improvement in the laboratory should be determined andrevised according to the feedback received from previous trainings andexperiences. Laboratory should organize or conduct periodic staff evaluation, preferablyonce a year; frequency and method of evaluation should be decided by thelaboratory. The laboratory should maintain a personal file of all the technical and nontechnical staff employed. Personal file should contain all information on:Personal bio-data including educational qualification and experienceCopy of degree/diploma and registration with state authority if applicableCopy of appointment letterDuly verified health information (physical fitness including color blindness,immunizations received etc.) prepared at the time of employment and itsregular updatesPerformance appraisalTraining certificates, awards/recognition receivedDisciplinary action if any taken by the managementReference letter from previous employer if applicable6.0 EQUIPMENT Each laboratory should prepare an exhaustive list of equipment andconsumables required and available for general functioning of the laboratoryand specialized equipment for special tests. Laboratory equipment should be of adequate capacity to meet work loadrequirement.INDIAN COUNCIL OF MEDICAL RESEARCH5

Guidelines for Good Clinical Laboratory Practices (GCLP) Equipment should be suitably located in the laboratory so as to allowaccessibility and sequential utilization thus minimizing the need for frequentmovement of specimens or reagents. All equipment should be in good working condition at all times. Periodicinspection, cleaning, maintenance of equipment should be done. An equipmentlog book should be maintained for all major equipment. Laboratories shouldmaintain necessary instructions for operation and maintenance of equipmentin the form of Standard Operating Procedures (SOPs). A copy of SOP shouldbe readily available. Maintenance contracts including warranty cards, telephone numbers of staffto be contacted in case of equipment malfunction should be kept safely. Usermanual should be available readily for reference. The staff should be aware oftrouble shooting measures to be adopted for preventing equipment malfunction.A format of the equipment log book provided in Annexure 1 can be used. New equipment should be calibrated and validated before routine use. AMR(Analytical Measurement range) should be verified, manufacturer can beconsulted for verification and selection of range. Periodic performance check/calibration check for all equipment should be doneusing reference standard/reference material. The frequency of performancecheck should be based on the day-to-day performance of the equipment. Equipment performance should be verified from Internal Quality Control resultsand External Quality Assessment results. Outlier parameter trend analysisrecord should be maintained in respect of its effect on the equipment. All analytical equipment should be calibrated and calibration certificate providedby equipment company. Non-analytical equipment such as pipette,thermometer, weighing balance and centrifuge should be calibrated byaccredited calibration laboratory or done in-house with traceability to NationalPhysical Laboratory (NPL). For in-house calibration, laboratories should use :Calibrated tachometer - for centrifugeCalibrated digital temperature sensor - for checking temperature ofrefrigerator, incubator etc.Calibrated glass thermometer- for temperature checking of oven, waterbath etc.Calibrated weights - for balance6INDIAN COUNCIL OF MEDICAL RESEARCH

Guidelines for Good Clinical Laboratory Practices (GCLP)National Institute of Science and Technology (NIST) buffer - for pH meter.Standard buffer solutions bought from reputed manufacturers withcertifiable traceability can be used as alternative. Equipment measuring pressure, temperature, humidity etc. should be checkedby using suitable reference standards.7.0 REAGENTS AND MATERIALS Standard reagents of certified quality must be used for the purpose of analysis.The batch number of reagents must be recorded. The quality of the reagentviz. Analar grade, HPLC grade, etc. to be used for in-house procedures shouldbe defined in SOP The reagents, chemicals and consumables should be stored under appropriateenvironmental conditions. Quality of newly purchased reagents should be validated against suitablecontrol/reference material prior to use. Validation data should be properlydocumented. In-house prepared reagents should also be checked periodicallyfor stability and a record of the same should be maintained. Reagent label should contain name of reagent, concentration, date ofpreparation/opening, date of expiry, storage conditions and warnings eg. 'donot use if solution is turbid' where applicable. When individual bottles are small,this information can be recorded in a goods received ledger. Microbiology laboratories should check activity/potency of each lot of antibioticsensitivity discs before using and at least weekly thereafter with referencestrains. Other microbiological consumables such as strips etc. used foridentification should be checked against reference strains. Laboratories testingmicrobiology specimens should check the quality of media by using appropriatereference strain and pH of the media. All batches of culture containers should be checked for sterility before issuingto patients for collection of specimen. Water quality should be checked for its grade and presence of interferenceelements. Reagent grade water according to IS1070 : 1992 of Bureau of IndianStandards (BIS) should be used for testing.INDIAN COUNCIL OF MEDICAL RESEARCH7

Guidelines for Good Clinical Laboratory Practices (GCLP)8.0 SPECIMEN COLLECTION Specimen collection is the first phase of interaction between the patient andthe laboratory. Appropriate counselling should be done before specimencollection and consent taken whenever needed. Attention should be paid topatient's sensibilities during the entire process. Any error in specimen collectioncan lead to erroneous results. It is therefore considered an important step ofgood clinical laboratory practice and is referred to as "preanalytic control". Specimen collection can be done at the patient's bedside, in the laboratory orin the field. Trained manpower/phlebotomist should be employed for specimen collection.Other staff such as doctors, nurses and others who are involved in specimencollection should also be trained periodically. Laboratory should have a "primary specimen collection manual", containinginformation on patient preparation before specimen collection (if any), exactmethodology of specimen collection, labelling, handling, transportation andstorage of the specimens. In addition, the laboratory should provide adequateand appropriate information/instructions to patients wherever necessary. Allpreanalytical factors that may influence the test results should be identified.The manual should include guidelines on specimen collection includingpreservation for histopathological examination. These manuals should beavailable for reference and should be used for training of staff engaged inspecimen collection. Specimen should be secured properly so that there is no leakage, spillage orcontamination. A Biohazard symbol should be used on the containers duringtransportation. Appropriate specimen transportation kit (such as use of dryice, etc.) to be used wherever required. Specimen should be sent to thelaboratory along with the requisition form.9.0 REQUISITION FORM8 The requisition form should be completed by the doctor requesting the testsand sent along with the specimen/patient to the laboratory. It should contain the patient's identity, age, location, date of specimen collectionand the investigations requested. The referring doctor should be encouragedto mention the provisional or working diagnosis and relevant clinical andtreatment history in the space provided (Annexure 2).INDIAN COUNCIL OF MEDICAL RESEARCH

Guidelines for Good Clinical Laboratory Practices (GCLP)10.0 ACCESSION LIST Accession list is a record of all the specimens received by the laboratory foranalysis and is prepared by the laboratory at the time of specimen receipt(Annexure 3). It records the patient's identity including name, age, sex, location in the hospital/medical facility, name of referring physician, investigations requested, dateand time of receipt of specimen and condition of the specimen at receipt. Thelaboratory assigns a unique laboratory number to register each specimenreceived, which can be used to trace the specimen in the laboratory. The testresults and remarks if any are also entered in the accession list. In laboratories handling a very large number of specimens, the accession listmay be computer generated and the condition of specimen at receipt may notbe recorded unless it has been rejected.11.0 WORKSHEET Worksheet is essentially a form provided to the analyst along with the specimen(Annexure 4). The following details should be recorded on the worksheet:Date of analysisCondition of the specimen before starting analysis (should be entered inthe laboratory notes)Findings and resultName and signature of the analyst (In case of electronically generated andmaintained worksheets, appropriate control, validation and accessprocedures should be built in the system) Laboratory number assigned to the specimen should be mentioned in theworksheet before sending the specimen to the analyst. The specimen should be analyzed according to the plan mentioned in theSOP. Any deviations from the analysis plan should be mentioned giving reasons.Wherever applicable the laboratories can use requisition form cum worksheet(Annexure 5) instead of two separate forms. However, laboratories usingelectronic transmission of patients' details and test results may not requireindividual worksheets.INDIAN COUNCIL OF MEDICAL RESEARCH9

Guidelines for Good Clinical Laboratory Practices (GCLP)12.0 REPORTING TEST RESULTS Test results approved and signed by the designated authority should be madeavailable to authorized person(s) only. Results should be reported clearly, without any errors, specifying measurementprocedure where appropriate and units of measurement as recommended byprofessional societies such as International Council for Standardization inHaematology, International Society of Haematology & International Federationof Clinical Chemistry and Laboratory Medicine. A format for reporting results isgiven in Annexure 6.13.0 SPECIMEN REJECTION RECORD Laboratories should maintain a record of specimens which were rejected priorto analysis. Rejection statistics (eg. number of hemolyzed specimen etc.)along with reason for rejection and person responsible for rejection should bemaintained (Annexure 7). Specimen rejection statistics can be used by laboratories to identify the needand areas for staff training. For example, if specimen contamination is detected,the containers should be checked for sterility prior to collection as well asspecimen handling procedure. This information should be shared with themedical, nursing and other staff engaged in specimen collection andtransportation.14.0 DATA MANAGEMENT10 Laboratory data management includes recording details of the patient, findingsof analysis, reporting of results and archiving the data for future reference.Recording data allows smooth functioning of the internal quality controlmeasures, internal audit and external quality assessment. From the point ofview of management, absence of record implies that the work was neverdone. The format of recording and reporting results should be described in theStandard Operating Procedures (SOPs). Data entry should begin as soon as registration number is assigned to thespecimen. Further entries should be made in the accession list and worksheet.The final report should be recorded after approval/signature of the designatedauthority. All auto analyzers should be connected with printer and uninterrupted powersupply (UPS). If printing option is not available or semi auto analyzers areINDIAN COUNCIL OF MEDICAL RESEARCH

Guidelines for Good Clinical Laboratory Practices (GCLP)used, laboratory should maintain manual raw test data counter-checked bytwo persons. The laboratory should maintain raw test data preferably for one month in noneditable format or signed printed copy. Procedure for adequate data protection and security including data editingand deleting s

Annexure 1. Equipment Log Book 25 Annexure 2. Requisition Form 26 Annexure 3. Accession List 27 Annexure 4. Worksheet 28 Annexure 5. Requisition Form cum Worksheet 29 Annexure 6. Reporting Format 30 Annexure 7. Specimen Rejection Record 31 Annexure 8. Steps to Initiate IQC in Laboratories 32 Annexure 9. Calculation of Mean, Standard Deviation .