Laboratory Safety Procedures PDF

BASIC ON LABORATORY PREPARED BY: PMLS-1 TEAM LEARNING OBJECTIVES: UNIVERSAL 01 PRECAUTION PERSONAL 02 PROTECTIVE EQUIPMENT (PPE) 03 HANDHYGIENE  LABORATORY SAFETY LABORATORY SAFET...

BASIC ON LABORATORY PREPARED BY: PMLS-1 TEAM LEARNING OBJECTIVES: UNIVERSAL 01 PRECAUTION PERSONAL 02 PROTECTIVE EQUIPMENT (PPE) 03 HANDHYGIENE  LABORATORY SAFETY LABORATORY SAFETY Not All Heroes Wear Capes, That's Us!  Not All Heroes Wear Capes, That's Us! LABORATORY SAFETY RULES ARE A MAJOR ASPECT OF EVERY CLINICAL LABORATORY. EACH STUDENT INCLINICAL LABORATORY MUST FOLLOW SPECIFIC SAFETY RULES AND PROCEDURES. INTRODUCTION SAFETY LABORATORY SAFETY  Not All Heroes Wear Capes, That's Us! WHYIS LABORATORY SAFETY IMPORTANT? SAFETY LABORATORY SAFETY  Not All Heroes Wear Capes, That's Us! LABORATORY SAFETY RULES AND SYMBOLS ARE NEEDED SO THAT STUDENTS AND OR WORKERS DONOT INJURE THEMSELVES OR THEIR CLASSMATES ORWORKERS. WHY IS LABORATORY SAFETY LABORATORY SAFETY SAFETY IMPORTANT  Not All Heroes Wear Capes, That's Us! MICROBIOLOGY LABORATORY SAFETY PRACTICES: 1913TEXTBOOK BY EYRE SAFETY LABORATORY SAFETY  Not All Heroes Wear Capes, That's Us! STERILIZATION IS A PROCESS WHEREBY ALL FORMS OF MICROBIAL LIFE, INCLUDING BACTERIAL SPORES, ARE KILLED. MAY BE ACCOMPLISHED BY PHYSICAL, OR CHEMICAL MEANS DISINFECTION IS A PROCESS WHEREBY PATHOGENIC ORGANISMS, BUT NOT NECESSARILY ALL MICROORGANISMS OR SPORES, ARE DESTROYED. ACCOMPLISHED BY PHYSICAL OR CHEMICAL METHODS. S TE RILIZ ATIONA N D SAFETY LABORATORY SAFETY D I S INFECTION LABORATORY SAFETY I. Physical Methods METHODS OF STERILIZATION 1. HEAT A. Moist Heat – Coagulate Proteins Autoclave =Most effective method of sterilization 121 C at 15 PSI for 15 minutes. =Infectious medical waste is often sterilized at 132 C for 30- 60 minutes Quality Control: Bacillus stearothermophilus Fractional =Alternative heating (Kills vegetativecells), incubation (Spores germinate), heating kills remaining vegetative cells a. Tyndallization – flowing steam 100 C for 30 minutes for 3 successive days. b. Inspissation – 75 – 80 C for 2 hours for 3 successive days. LABORATORY SAFETY B. Dry Heat – kills by oxidation a. Flame=To sterilizeinoculating loops and needles METHODS OF STERILIZATION b. Oven= 160-180 C for1 1⁄21/2 to 2 hours Quality Control: Bacillus subtilis var. niger c. Incineration= Most common method of treating infectious waste. Burned to ashes at 870-980 C. 2. FILTRATION Asbestos Filter Membrane Filter Method of Choice for antibiotics solutions, toxic chemicals, radioisotopes, vaccines and carbs which are all heat sensitive. Filtration of air is accomplished using HEPA (High Efficiency Particulate Air) filters designed to remove organisms larger than 0-3 um from isolation rooms, operating rooms, and biologic safety cabinets (BSCs). I. LABORATORY SAFETY 3. IONIZATION RADIATION Used in plastic syringe, catheter or gloves METHODS OF STERILIZATION Short wavelength, high energy gamma rays,ionizing gamma radiation Used for evacuated tubes II. Chemical Methods 1. Ethylene Oxide (ETO) –Most common sterilant -Quality Control: Bacillus subtilis 2. Formaldehyde vapor and vapor phase hydrogen peroxide -sterilize HEPA filters in BSCs 3. Glutaraldehyde -Sporocidal in 3-10 hours, is used in medical equipment -Cold sterilization LABORATORY SAFETY 4. PARACETIC ACID -used in surgical equipment METHODS OF STERILIZATION -Cold Sterilization LABORATORY SAFETY I. Physical Methods 1. Boiling =100 C for 15 minutes, which kills vegetative bacteria METHODS OF DISINFECTION 2. Pasteurization =Kills milk borne pathogens a. Batch Method: 63 C for 30 minutes b. Flash Method: 72 C for 15 minutes 3. Non-ionizing Radiation =Long wavelength and low energy =do not penetrate well,direct surface exposure such as working surface of BSC (Biological Safety Cabinet) II. Chemical Methods Disinfectant =Destroys vegetative forms of on inanimate objects =Phenol, QUATS,Chlorine, 2% glutaraldehyde =alcohols,aldehydes,halogens,heavy metals,quarternary ammonium compounds Antiseptic =Microbiostatic agents on living tissues =Alcohol, Iodine tincture (alcohol), Iodophor (Iodine +detergent) LABORATORY SAFETY Autoclave =Bacillus stearothermopihlus or Clostridium PA3679 B I OL OG I C A L I ND I C A TOR S Ionizing Radiation= Bacillus pumilus Dry Heat Oven= Bacillus subtilis variation niger Ethylene Oxide= Bacillus subtilis variation globijii LABORATORYSAFETY  LABORATORY SAFETY LABORATORY SAFETY RULES Not All Heroes Wear Capes, That's Us! LABORATORY SAFETY EQUIPMENT LABORATORY SAFETY EQUIPMENT BIOLOGICAL SAFETY CABINET LABORATORY SAFETY SYMBOLS A. UNIVERSAL PRECAUTION All patients are considered to be possible carriers of blood borne pathogens Wearing gloves when collecting and handling blood and body fluids contaminated with blood Wearing face shields when there is danger of blood splashing in mucous membranes and when disposing of all needles and sharp objects in puncture-resistant containers. The CDC (Centers for Disease Control and Prevention) excluded urine and body fluids not visibly contaminated by blood from UP BSI (Body Substance Isolation) guidelines are not limited to blood-borne pathogens; they consider all body fluids and moist body substances to be potentially infectious. According to BSI guidelines, personnel should wear gloves at all times when encountering moist body substances - They do not recommend handwashing after removing gloves unless visual contamination is present  HANDHYGIENE includes both hand washing and the use of alcohol-based antiseptic cleaners. STANDARD sanitize hands immediately after; 1. touching blood, body fluids, secretions, excretions, and PRECAUTION contaminated it whether or not gloves are worn. 2. gloves are removed, between patient contacts. sanitizing hands may be necessary between tasks and In 1996 the CDC and HIPAC procedures on the same patient to prevent cross contamination (Healthcare Infection GLOVES Control Practices Advisory wear gloves (clean, nonsterile gloves are adequate) when touching blood, body fluids, secretions, and contaminated Committee) combined the items major features of UP and BSI change gloves between tasks and procedures on the same guidelines patient after contacting materials with high concentration of microorganisms. remove gloves after use, before touching non-contaminated items and environmental surfaces, and between patients  MOUTH,NOSE AND EYE PROTECTION wear a mask and eye protection or face shield to protect mucous membranes of the eyes, nose, and mouth during STANDARD procedures and patient care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, or PRECAUTION excretions an N95 mask must be used during patient care activities related to suspected mycobacterium exposure In 1996 the CDC and HIPAC GOWN (Healthcare Infection wear a clean, nonsterile gown gown to protect skin and to Control Practices Advisory prevent soiling of clothing during procedures and activities that are likely to generate splashes or Committee) combined the sprays of blood, body fluids, secretions or excretions. major features of UP and BSI select a gown that is appropriate for the activity and the guidelines amount of fluid likely to be encountered remove soiled gown as promptly as possible sanitize hands to avoid transferring microorganisms to other patients or environments  PATIENT CARE EQUIPMENT handle used patient care equipment soiled with blood, body STANDARD fluids, secretions, and excretions in a manner that prevents skin and mucous membranes exposure, clothing contamination, and PRECAUTION transfer of microorganisms to other patients or environments ensure that; 1. reusable equipment is not used for the care of another patient In 1996 the CDC and HIPAC until it has been cleaned and reprocessed appropriately 2. single-use items are discarded properly (Healthcare Infection Control Practices Advisory Committee) combined the ENVIRONMENTAL CONTROL ensure that the hospital has adequate procedures for the major features of UP and BSI routine care, cleaning, and disinfection of environmental guidelines surfaces, beds, bedrails, bedside equipment, and other frequently touched surfaces  LINEN HANDLE, TRANSPORT, AND PROCESS LINEN SOILED WITH BLOOD, BODY FLUIDS, SECRETIONS, AND EXCRETIONS IN A MANNER THAT PREVENTS SKIN AND MUCOUS STANDARD MEMBRANES EXPOSURES AND CLOTHING CONTAMINATION AND THAT AVOIDS THE TRANSFER OF PRECAUTION MICROORGANISMS TO OTHER PATIENTS AND ENVIRONMENT OCCUPATIONAL HEALTH AND BLOOD- BORNE PATHOGENS In 1996 the CDC and HIPAC never recap needles or otherwise manipulate them using both (Healthcare Infection hands or use any other equipment directing the point of a Control Practices Advisory needle toward any part of the body; rather, use self-sheathing Committee) combined the needles or a mechanical device to conceal the needle do not; major features of UP and BSI 1. remove used unsheathed needles from disposable syringes by guidelines hand 2. bend, break, or otherwise manipulate used needles by hand place used needles and other sharp items in appropriate puncture-resistant containers  PATIENT PLACEMENT place patient in a private room who contaminates the STANDARD environment or who does not (or cannot be expected to) assist in maintaining appropriate hygiene or environment control if a private room is unavailable, consult with infection control PRECAUTION professionals regarding patient hygiene placement or other alternatives In 1996 the CDC and HIPAC (Healthcare Infection RESPIRATORY HYGIENEORCOUGHETIQUETTE educate health-care personnel, patients, and Control Practices Advisory visitors to Committee) combined the contain respiratory secretions to prevent droplet major features of UP and BSI and fomite transmission of respiratory pathogens offer masks to coughing patients, distance guidelines symptomatic patients from others practice good hand hygiene  INFECTION CONTROL GUIDELINES USED IN HEALTHCARE SETTINGS TO MINIMIZE THE RISK OF SPREADING INFECTIOUS DISEASES UNIVERSAL PRECAUTION STANDARD PRECAUTION 1987 CDC PUBLISHED guidelines known as 1996 these safety recommendations became known as UP developed in response to the HIV Standard Precautions evolving from UP to include wider range of precautions for various infectious epidemic agents, expansion and modification of UP to reduce risk of HBV transmission in clinical laboratories and blood banks these precautions require that blood and body fluids prevent the transmission of bloodborne from every patient be treated as potentially infectious pathogens,primarily HIV main focus,treat all human blood and certain designed to reduce the risk of transmission of a human body fluids as infectious for broader range of infectious agents,including those bloodborne pathogens regardless of the transmitted by respiratory droplets or contact with perceived risk contaminated surfaces rigid and more focused on specific types of wider range of infection control: proper body fluids hygiene,PPE,safe injection practices,respiratory infection control: PPE (gloves,gowns,masks, hygiene,cough etiquette,safe handling of potentially and eye protection) contaminated equipment and surfaces, and strategies to prevent transmission of infectious agents in healthcare settings UNIVERSAL PRECAUTIONS WERE A FOUNDATIONAL CONCEPT THAT LAID THE GROUNDWORK FOR INFECTION CONTROLAND STANDARD PRECAUTIONS EXPANDED THESE PRACTICES TO BE MORE COMPREHENSIVE AND ADAPTABLE TOA WIDER RANGE OF INFECTIOUS DISEASES.THE TRANSITION FROM UNIVERSAL TO STANDARD PRECAUTIONS REFLECTS A MORE HOLISTIC APPROACH TO INFECTION PREVENTION IN HEALTHCARE SETTINGS.  WHAT ARE THESE? N95 CAN YOU IDENTIFY THESE ITEMS WORN?  PERSONAL PROTECTIVE N95 EQUIPMENT disposable gloves surgical masks/respirators/N95 goggles/eye visors faceshields shoe covers bouffant cap/hairnet lab gown/labsuit/isolation gown PERSONAL N95 PROTECTIVE EQUIPMENT OSHA regulation Healthcare facilities provide employees with all PPE necessary to protect themselves from hazards encountered during the course of work.  B. PERSONAL PROTECTIVE EQUIPMENT (PPE) - PPE used in the laboratory includes gloves, fluid-resistant gowns, eye and face shield, and plexiglas countertop shield. - When specimens are collected, gloves must be changed between patients every patient. - A variety of glove types are available (sterile and nonsterile, powdered and unpowdered, and latex and nonlatex). - Allergy on latex is increasing among health workers. - Reactions to latex include irritant contact dermatitis, which produces patches of dry, itchy irritation on the hands; delayed hypersensitivity reactions resembling poison ivy that appear 24-48 hours after exposure; and true, immediate hypersensitivity reactions often characterized by facial flushing and breathing difficulties. - Replacing latex gloves with nitrile or vinyl gloves provides an alternative. - Fluid resistant laboratory coats with wrist cuffs are worn to protect clothing and skin from exposure to patient’s body substances. - Disposable coats are placed in containers for biohazardous waste, and nondisposable coats are placed in designated laundry receptacles. - Shoes must be closes-toed and cover the entire foot. - A variety of protective equipment available, including masks and goggles, full-face plastic shields that cover the front and the sides of the face, mask with attached shield, and Plexiglas countertop shields. DONNING OF PPE 1.PERFORM HAND HYGIENE 2. Put on gown 3. Put on surgical mask or P2 or N95 respirator 4. Put on protective eyewear or face shield 5. Put on gloves CLICK HERE FOR THE YOUTUBE LINK DOFFING OF PPE 1.REMOVE GLOVES 2. Perform hand hygiene 3. Remove gown 4. Perform hand hygiene 5. Remove goggles or face shield 6. Perform hand hygiene 7. Remove mask or respirator 8. Immediately perform hand hygiene CLICK HERE FOR THE YOUTUBE LINK C. HAND HYGIENE Hand contact is the primary method of infection transmission. Laboratory personnel must always sanitize hands before patient contact, after gloves are removed, been leaving the work area, at any time when hands have been knowingly contaminated. Hand Hygiene includes both hand washing and using alcohol-based antiseptic cleaners. Alcohol-based cleaners can be used when hands are not visibly soiled; hand washing when hands are visibly soiled. Hand washing is the best way to break the chain of infection. CHAINOF INFECTION CLICK THIS LINK TO VIEW THE YOUTUBE VIDEO GROUP DISCUSSION Infection control measures you can apply and share your thoughts for your choosen scenarios. Instructor will ask one representative from the group: (15 mins) workplace/office hotel/resort school visiting sick person public transportation canteen/restaurant pandemic public gathering hospital supermarket home (bathrooms,playpens,bedrooms etc) GROUP DISCUSSION: REAL-LIFE APPLICATION Infection control measures apply not only in healthcare but also in various settings: workplace/office hotel/resort school visiting sick person public transportation canteen/restaurant pandemic public gathering hospital supermarket home (bathrooms,playpens,bedrooms etc) Murphy’s Law: Application to disaster management … Did you unplug your clothes iron? HISTORY OF MURPHY’S LAW The author of the law, Edward Murphy, was an engineer in the US air force. He was involved in a project called Gee whiz where they would assess on what will happen to a person when decelerated rapidly in a certain g-force. The project used a chimpanzee as a tribute for better results after multiples trials with a humanoid. Everything was ready until one of his assistant accidentally switched the instruments and installed the wrong way resulting to no data collected. Murphy stated that “if there are two ways to do things and one of those ways result in a disaster then he will do it that way” Hence, if anything can go wrong, will go wrong…at the worst possible moment. POSTULATES OF MURPHY’S LAW Anything that can go wrong, will go wrong You will always find something in the last place you look. No matter how long or hard you shop for an item, after you’ve bought it, it will be on sale somewhere cheaper The other line moves faster If it jams, force it. If it breaks, it needs replacing anyway. Build a system that even a fool can use, and only a fool will use it.  MURPHY’S LAW AND DISASTER MANAGEMENT After the tragedy of the Gee Whiz, Col. Stapp, told his subordinates to prepare every project with Murphy’s law in mind, because anything can go wrong. Entire months of practices were destroyed in a few minutes of testing and they cannot do anything about it but pivot by doing the project and recover all materials that they can use again. Bad things do happen, even to good people. Preparation for disaster is the key. As the saying goes, “an ounce of prevention is worth a pound of cure”.  MURPHY’S LAW AND DISASTER MANAGEMENT Murphy’s 1st law reminds us of the importance of risk assessment and the value of investment of risk prevention However hard organizations try and however much they invest in risk prevention, they never completely identify and eliminate all risk. The rules of mathematics are clear; regardless of how small the probability of risk occurrence, given enough time it is certain to happen  MURPHY’S LAW AND DISASTER MANAGEMENT Murphy’s law aware us that always install the fail-safes Fail-safes are referred to as “idiot-proofs”. Murphy’s law still has the tendency to strike even the care (idiot-proof) has been taken against the failure. So this leads us to compare murphy’s law with one more law called “Grave’s Law”. Which states that: “if you make something idiot-proof, the world will create a better idiot.” SYSTEMIC AND DEPLOYABLE EVACUATION PLAN CLASS OF FIRES AND TYPES OF EXTINGUISHER USED MSDS SAFETY DIAMOND/NFPA RATING OF HAZARDOUS MATERIALS HOW TO HANDWASH? WASH HANDS WHEN VISIBLY SOILED! OTHERWISE, USE HANDRUB Duration of the entire procedure: 40-60 seconds 0 1 2 Wet hands with water; Apply enough soap to cover Rub hands palm to palm; all hand surfaces; 3 4 5 Right palm over left dorsum with Palm to palm with fingers interlaced; Backs of fingers to opposing palms interlaced fingers and vice versa; with fingers interlocked; 6 7 8 Rotational rubbing of left thumb Rotational rubbing, backwards and Rinse hands with water; clasped in right palm and vice versa; forwards with clasped fingers of right hand in left palm and vice versa; 9 10 11 Dry hands thoroughly Use towel to turn off faucet; Your hands are now safe. with a single use towel; All reasonable precautions have been taken by the World Health Organization to verify the information contained in this document. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members of the Infection Control Programme, for their active participation in developing this material. May 2009  THANK YOU AND STAY SAFE! Questions?Too shy to ask? You canreach me through email:[email protected]  1. MCPHERSON,R.A. & PINCUS,M.R. (2012) HENRY’S CLINICAL DIAGNOSIS AND MANAGEMENT BY REFERENCES: LABORATORY METHEDS (22ND ED.) PHILADELPHIA: ELSEVIER INC. 2. STRASINGER, S.K. & DI LORENZO, M.S. (2014) URINALYSIS AND BODY FLUIDS (6TH ED.) F.A. DAVIS COMPANY, PHILADELPHIA, PENNYSLVANIA 3. LECTURE HANDBOOK IN PMLS 037 (INTRODUCTION TO MEDICAL TECHNOLOGY 1 WITH SCIENCE TECHNOLOGY AND SOCIETY) BY MERLYN A. BARACLAN-ORAIS,MSCPI,RMT,RN