OSHA and Universal Precautions

• OSHA (Occupational Safety and Health Administration)
• Established by the US Congress in 1970
• Functioning as a federal agency
• Intended to assure every working person in the nation a safe and healthful working condition
• Laboratories must understand OSHA recommendations and watch for potential violations
• Works with other agencies to research and establish basic safety standards
• Violators pay fines and enact corrections
• CDC (Centers for Disease Control) established Universal Precautions and OSHA enforces them

Universal Precautions

• Treat all blood and other potentially infectious materials as if known to contain a pathogen
• No waivers or exceptions
• Bloodborne diseases can be deadly
• Protect yourself and others

Bloodborne Pathogens

• Microorganisms cause disease in humans
• Transmittal through contact with infectious body fluids
• Includes blood, semen, joint fluid, vaginal secretions, amniotic fluid, saliva in dental procedures
• Examples include:
• Hepatitis B and C
• HIV/AIDS
• Ebola virus
• Malaria
• Syphilis

Hepatitis B

• Symptoms present as jaundice, fatigue, abdominal pain, anorexia, or Nausea and vomiting
• Transmission occurs through contact with contaminated fluids, sharps injury, or splash to mucous membranes or non-intact skin
• Can be easily transmitted
• Carriers do not develop symptoms but can transmit the diseases

Hepatitis B Vaccination

• Free to at-risk employees
• Declination is possible upon signing, and can request later
• Prescreening titers cannot be required
• 87-95% effective
• Presents with a low-risk of side effects
• Comes in a series of 3 shots over 6 months
• Titer should be checked 1-2 months after the third shot for series begun after 02/14/2000
• A repeat is required if titer is low, and then titer again
• Medical evaluation needed, if titer is low after the 6th shot to determine if you are a carrier with immune deficiency
• Documentation must be kept confidential

Hepatitis C

• Symptoms include fatigue and abdominal pain
• Transmitted through contact with contaminated fluids, sharps injury, and splash to mucous membranes or non-intact skin
• Same as Hepatitis B/ HBV
• Leading cause of liver transplants
• Antiviral meds available
• No vaccine available yet

Human Immunodeficiency Virus (HIV)

• Symptoms include swollen lymph nodes, weight loss, night sweats, opportunistic infections, and skin lesions
• Transmitted through contact with contaminated body fluids
• Can be asymptomatic for many years
• Vaccine research ongoing
• Can eventually lead to AIDS

Risk of Exposure

• Collecting/handling body fluids, specimens, and biohazard wastes presents a risk
• Tending to wounds, removing sutures, and changing bandages can be risky
• Dental procedures, cleaning contaminated surfaces, instruments, or laundry all pose risks
• Aspirating fluids can cause exposure

Exposure Controls

• Engineering controls use safer sharps and sharps containers
• Work practices include no mouth pipetting, eating, drinking, or applying cosmetics in contaminated areas, hand-washing, avoiding passing of used instruments hand-to-hand, and using a one-handed technique to recap
• Personal protective equipment (PPE) recommended
• goggles, facemasks, gloves, and gowns

Post-Exposure Evaluation and Follow-Up

• Offered immediately
• Free of charge to the exposed employee
• Confidential
• Under supervision of a licensed healthcare professional
• According to current CDC guidelines
• Informed consent is required for testing
• Employees may decline testing or have blood collected and preserved for up to 90 days before making a decision
• A source individual's test results are given to employee, but confidentiality protects the source individual
• Sources are screened for HBV, HCV, and HIV
• Exposed employees are tested for the above, plus HBV antibodies
• Information shared about medical conditions that may result from exposure
• Determination of the necessity for subsequent testing / treatment of exposure individuals decided by healthcare professional

Safe Needle Regulations

• Intended to eliminate sharps injuries
• A new Bloodborne Pathogen Standard emerged in January 2001
• Most injuries occur between patient and sharps container
• Highest number of phlebotomy injuries occur with butterflies
• Up to 76% are preventable

Safer Sharps

• A part of exposure control plan
• Needleless systems and needles with engineered safety devices
• Capillary tubes that are self-sealing - lancets
• Safer devices need to:
• Provide a barrier between the hands and contaminated needles
• Require/allow hands to stay behind a contaminated needle
• Be easy to use and an integral part of device
• Not interfere with patient care

Areas of Microbiology

• Microbiology is the study of microorganisms
• Bacteriology deals with the identification, study, and cultivation of bacteria, and their applications in medicine, agriculture, industry, and biotechnology
• Mycology is the study of fungi
• Fungi break down dead organic material and continue the cycle of nutrients through ecosystems
• Virology is the study of biological viruses and their structure and classification
• Seeks, ways to infect, exploit cells to reproduce, and cause disease
• Techniques to isolate and culture them and identifies potential uses in research and therapy
• Serology and immunology studies antigens and antibodies in serum and immune process and immunity
• Immunology labs identify antibodies produced due to disease states from samples collected in red top tubes
• Tests are based on antigen-antibody reaction

Infection Control System

• Designed to break the chain of infection
• Utilizes natural barriers like skin, mucous membranes, GI tract, lymphoid, and blood systems
• Asepsis destroys organisms after they leave the body through handwashing and the use of disposable equipment and gloves
• Isolation procedures that protect the patient and HCW isolate pathogens and reduce their transfer

Types of Isolation

• Contact
• Airborne
• Droplet
• Reverse

General Lab Safety

• Must be used throughout lab to ensure safety and specimen integrity

Disaster Plans

• Medical facilities and labs must have a disaster plan with:
• A floor plan of the facility showing the nearest exit
• Locations of alarms and fire extinguishers
• How fire equipment is used
• Defined roles for each employee when disaster arises

Physical Hazards Inside Labs

• Include fire, electrical issues, radiation leaks, and mechanical issues

Fire Safety

• Fire needs heat, oxygen, and fuel to burn
• All present in labs.
• Fire Department must be notified of a fire, and patients and employees should be moved out of danger

Categories of Fires

• Class A fires involve paper, wood, cloth, and plastics
• Class B fires involve flammable solvents, gases, oils, paints, grease, and interaction with air and vapors
• Class C fires appear in or near electrical equipment
• Class D fires include combustible metals such as lithium and magnesium

Fire Extinguisher Classification

• Class A fire extinguishers contain soda and H₂O for use in ordinary combustible fires
• Class B fire extinguishers contain foam, dry chemicals, or CO2 for fires involving solvents and air-vapor mixtures
• Class C fire extinguishers contain dry chemicals and are used for electrical fires
• Class ABC fire extinguishers are multipurpose, avoiding confusion over which to use
• Class Halon fire extinguishers are designed for computer fires

Mnemonic R.A.C.E. in Event of Fire

• Remove the patients
• Activate the alarm and alert other staff
• Contain or confine fire by closing all doors
• Extinguish the fire if it is safe to do so

Mnemonic P.A.S.S. in Event of Fire

• Pull the pin
• Aim the nozzle at the base of the fire
• Squeeze the trigger of the extinguisher
• Sweep the nozzle over the fire

National Fire Protection Association Labels

• Labels are used to communicate hazards; refer to the guide

Electrical Safety

• Shock poses a major risk
• All equipment must be grounded with 3-pronged plugs
• Turn off main power source, and get medical attention if someone is being shocked; don't touch them or the equipment
• Avoid working with electric equipment on a wet floor, do not overload circuits
• Grasp plug to disconnect equipment by grasping the plug, not the cord
• Any device-related occurrence causing death, serious injury, or serious illness must be reported to risk management

Broken / Malfunctioning Equipment

• Turn it off, tag with a sticker: Defective – Do Not Use, call Plant Operations Department, and notify your supervisor

Radiation Safety

• Exposure has a cumulative effect
• Wear radiation badges and leave the room when x-rays are performed
• Those with radium implants should always go to the nursing station for instructions and draw blood as quickly as possible
• Observe, time, distance, and shielding

Mechanical Safety

• Equipment can cause injury if used improperly
• Equipment should not be put in use unless checked by the engineering department
• Improper loading centrifuges is of particular concern

Avoiding Injury From Mechanical Devices

• Follow manufacturers' instructions when operating the analyzer
• Centrifuges pose special caution
• Load needs to be properly balanced
• Lid needs to be properly closed
• Bring to complete stop before opening (aerosols)
• Do not leave centrifuge until max speed is reached
• Speed (RPM) is measured by tachometer

Chemical Hazards

• Common chemicals include hydrochloric acid and sodium hydroxide
• Most are highly caustic and can cause severe burns
• Always consult the labels
• Clean all spills with a spill cleanup kit that includes absorbents and neutralizers
• Post chemical hazards signs

Chemical Exposure

• Treat all chemicals that come into contact with the skin or eyes immediately
• Wash in eyewash stations and seek medical treatment

Material Safety Data Sheets (MSDS)

• Required for all hazardous materials and drugs. Must be available.
• They provide info on identity, characteristics, physical hazards, and handling. Includes information on Reactivity and dangerous reactions, health hazards
• Provide Handling precautions/control measures required

Chemical Hygiene Plan (CHP)

• Labs with chemicals must have a CHP
• Required by OSHA
• Designed to protect workers, patients, and visitors from exposure to hazardous chemicals
• Chemical labels must be linked to the CHP

Chemical Labeling

• Both the manufacturer and "in-house labels."
• Labels must be legible and prominently displayed in English, with additional languages to address any needs

Chemical Hygiene Plan

• Should cover employees use of protective equipment and functioning hoods
• Includes procedures for how to handle disposal and spills
• Describes employee medical exams and orientation

Method of Detection

• Odors, skin and respiratory irritation, nausea/ vomiting, coughing/ sneezing
• Observation

Common Healthcare Chemicals

• Include alcohol, cytotoxic drugs. nitrous oxide, formalin
• Includes bleach (Sodium hypochlorite), Betadine and mercury
• Also gluteraldehyde and white out
• Must have hazard labels present referring to flammability, irritants, carcinogens and tumors

Chemical Hazard Controls

• Engineering controls for ventilation
• Well designed and enforced working practices as well as wearing proper protective equipment

Spill Clean-Up Procedures

• Isolate and contain spill
• Retrieve spill kit and MSDS
• Follow PPE protocol
• Apply absorbent, and then sweep up absorbed chemicals
• Dispose according to MSDS and then clean with soap and water

Radioactive Waste

• Increased due to advances in nuclear medicine
• Includes waste containing or contaminated by radioactive material, such as iodine 123, iodine 131, and thallium 201
• Radioactive waste is not generated by x-rays
• Must be clearly labeled
• Must never be placed in incinerators, down to drains, or in public
• Removed by waste disposal company

Infectious Waste

• Any material with the potential of carrying disease
• Only 10-15% of all medical waste is infectious
• Includes lab cultures, blood products from blood, the bank, OR, ER, doctor/ dentist offices, and autopsy and patient rooms

Health Hazards

• Acute health effects are nausea, vomitting, diarrhea, rashes, headaches and fainting
• Chronic effects are organ damage, cancer, fertility and genetic problems

Housekeeping

• Disinfect work surfaces that may become contaminated and clean up at the end of every shift
• Use an EPA-approved tuberculocidal disinfectant
• Include a written schedule for cleaning and inspect waste containers, and address when needed
• Housekeeping staff has exposure

Methods for Treating Infectious Waste

• Steam sterilization, incineration, and thermal inactivation
• Gas or vapor sterilization, irradiation sterilization, and chemical disinfectant
• Steam and incineration are the most commonly recommended

Guidelines for Handling Biological Specimens

• Wear gloves and other protective clothing when handling or processing
• Use a biological safety hood or protective cabinet when opening tubes to filter aerosols away
• All specimens must be handled as infectious and autoclaved before disposal
• Disinfect workstations: a 1:10 bleach solution is appropriate

Body Mechanics

• Proper body mechanics maintain posture when lifting, bending, standing, or sitting
• Safe and correct body mechanics keep back in alignment and balanced
• Back injuries are the most common, serious, and costly work-related injuries
• Assess the situation to get help before, and lift with your body or your mind
• Keep straight to align your eat, shoulder, and hip with the load close to your body
• Utilize abdominal muscles, the natural curve of back, and lift with the leg muscles
• Never twist when lifting with feet, only take steps when need to turn