Clinical Chemistry Laboratory Safety PDF

Safety in the Clinical Chemistry Laboratory Chapter 2 Preamble PowerPoints are a general overview and are provided to help students take notes over the video lecture ONLY. PowerPoints DO NOT cover the details needed for the Unit exam Each student is responsible for READING the T...

Safety in the Clinical Chemistry Laboratory Chapter 2 Preamble PowerPoints are a general overview and are provided to help students take notes over the video lecture ONLY. PowerPoints DO NOT cover the details needed for the Unit exam Each student is responsible for READING the TEXTBOOK for details to answer the UNIT OBJECTIVES Unit Objectives are your study guide (not this PowerPoint) Test questions cover the details of UNIT OBJECTIVES found only in your Textbook! Laboratory Safety Occupational Safety and Health Administration (O S H A) Provides federally mandated policies and procedures to ensure safety in the workplace, including laboratories and health-care facilities Standards are found in the Code of Federal Regulations (C F R). Additional resources for safety information and guidelines Occupational Safety and Health Administration (O S H A) Four major O S H A standards have made a significant impact on the safety practices in clinical laboratories: Occupational Exposure to Hazardous Chemicals in Laboratories Hazard Communication Bloodborne Pathogens Bloodborne Pathogens Organizations Actively Involved in Providing Safety Standards, Guidelines, Education, and Procedures for Clinical Laboratories. AACC American Association for Clinical Chemistry ASCP American Society for Clinical Pathology CAP College of American Pathologists CDC Centers for Disease Control and Prevention CLSI Clinical and Laboratory Standards Institute DNV Det Norske Veritas (Hospital Accreditation Organization) EPA Environmental Protection Agency NFPA National Fire Protection Agency NIOSH National Institute for Occupational Safety and Health OSHA Occupational Safety and Health Administration TJC The Joint Commission (formerly JCAHO, Joint Commission on Accreditation of Healthcare Organizations) U.S. NRC United States Nuclear Regulatory Commission Chemical Safety Chemical hygiene plan O S H A mandated that each laboratory establish a chemical hygiene plan Specific Elements in the Chemical Hygiene Plan (B0x 2-1) include: Glossary of terms A description of standard operating procedures An inventory of all chemicals Safety data sheets (S D Ss) Proper labeling and storage of chemicals An inventory of personal protective equipment (P P E) A description of engineering controls Procedures for waste removal and disposal Requirements for employees’ physical and medical consultations Training requirements Procedures for proper record keeping Designation of a chemical hygiene officer and safety committee Chemical Safety Operating procedures Specific operating protocols should be developed for proper disposition of accidents in laboratories involving chemical spills. Laboratory staff should be properly trained to respond in a safe manner. Appropriate response to a chemical spill is dictated by the size of the spill. Before cleaning up the spill, remember to wear appropriate personal protective equipment (P P E). Response for a large chemical spill requires a higher level of expertise and coordination of departments. Policies for avoiding unnecessary chemical exposure must be defined. Safety data sheets (S D Ss) Documents that provide information about chemical substances Identification Composition Hazards First aid Firefighting concerns Safe handling Chemical Safety Identifying and labeling chemicals Actual labeling system used is adopted from the hazard identification system developed by the National Fire Protection Agency (N F P A). Nine classes of hazardous materials, as follows: Explosives Compressed gases Flammable liquids Flammable solids Oxidizer materials Toxic materials Radioactive materials Corrosive materials Miscellaneous materials not classified by any other means Chemical Safety Storing and inventorying chemicals During the inventory process, the technologist should pay particular attention to the following: Keep only the amount of chemicals that is needed. Less is better. If possible, purchase chemicals in plastic containers to avoid breaking glass. Rotate your chemical inventory and note expiration dates. Dispose of chemicals if not used within a year—especially peroxide-forming compounds. Make sure all secondary containers are properly labeled. If possible, relocate corrosive, flammable, and reactive chemi- cals to below eye level. Chemical Safety Examples of Poor Storage Chemicals are stored in random order or Chemicals are stored in alphabetical order Chemicals are stored by poorly chosen categories or stored in a hood while the hood is in use for other purposes Flammables are stored in domestic or household-type refrigerators Food is stored beside chemicals in the refrigerator Chemicals are stored on shelves above eye level One bottle of a chemical is sitting on top of a second bottle of the chemical Shelves are overcrowded Shelving on which chemicals are stored is not strong enough to support chemicals Shelves are not securely fastened to a permanent structure Inventory control is poor or nonexistent There are containers with no labels or inappropriate labels Containers are stored on the floor Caps on containers are missing, not on properly, or badly deteriorated Chemical Safety Storing and inventorying chemicals Categorical storage of chemicals is a safe approach for separating potentially reactive chemicals. Flammable chemicals must be stored in an appropriate safety cabinet. Transferring chemicals from one container to another can result in an accident. Transporting chemicals throughout the laboratory can be hazardous. Problems Associated with Storing Chemicals Alphabetically Chemical Combination Problems Acetic acid + acetaldehyde Small amounts of acetic acid will cause the acetaldehyde to polymerize, releasing a large amount of heat Ammonium nitrate + acetic acid Mixture will ignite, especially if an acid is concentrated Hydrogen peroxide + ferrous sulfide Vigorous reaction, highly exothermic Lead perchlorate + methanol Explosive mixture if agitated Potassium cyanide + potassium nitrite Potentially explosive mixture if heated Chemical Safety NFPA 704-M Identification System of Warning Labels for Chemical Hazards (1 of 2) Color Codes Interpretations Color Codes Interpretations Interpretations Blue—Health Hazard 4—deadly Yellow—Reactivity 4—may detonate 4—may detonate 3—extreme danger 3—shock and heat 3—shock and heat 2—hazardous may detonate may detonate 1—slightly hazardous 2—violent chemical 2—violent chemical 0—normal material change change 1—unstable if heated 1—unstable if heated 0—stable 0—stable Red—Fire Hazard 4—below 73°F Flash Points 3—below 100°F White—Specific Oxidizer OXY 2—below 200°F Hazard Corrosive CO R 1—above 200°F Acid ACID 0—will not burn Alkali ALK Use no water Radiation Chemical Safety Potentially Explosive Compounds An explosive chemical Causes a sudden release of pressure, gas, or heat When subjected to shock, pressure, or high temperatures. Cryogenic Material Cryogenic liquids (cryogens) Liquefied gases kept in their liquid state at very low temperatures Have boiling points below - 150°C ( − 238°F) Gases at normal temperatures and pressures Classified as “compressed gases” according North American Industrial Classification System (N A I C S) 325120 Hazards associated with cryogens include the following: Fire or explosion Asphyxiation Pressure buildup Embrittlement of material Tissue damage Chemical Safety Formaldehyde Safety Cabinets Chemical Waste Colorless liquid O S H A defines the maximum Disposal of chemical waste is Characteristic pungent odor amount of flammable and the responsibility of individual Routinely used in laboratories combustible liquids that can laboratories. for tissue processing be stored in any laboratory Resource Conservation and with N F P A-approved Recovery Act (R C R A) flammable storage cabinets. “Cradle-to-grave” Regulations are defined by responsibility and liability the solvents’ classification. Provides for management of hazardous wastes from point of origin to point of final disposal. Promotes resource recovery and waste minimization. Chemical Safety Chemical Waste Any hazardous, corrosive, or flammable materials are prohibited from being disposed of by pouring down sink drains. Includes chemicals such as: Organic solvents with a boiling point of less than 50°C Hydrocarbons Halogenated hydrocarbons Nitrocompounds Mercaptan Freon Azides and peroxides Concentrated acids and bases Biohazards: Universal Precautions (1) Exposure-control plan Biological hazards Hand hygiene practices Needlestick regulations Personal protective equipment Biosafety levels Toxic substances Biohazards: Universal Precautions (2) Exposure-control plan Should include sections on the following: 1. Purpose 2. Scope 3. References 4. Definition of terms 5. Delineation of responsibilities 6. Detailed procedural steps Biohazards: Universal Precautions (3) Exposure-control plan O S H A guidelines for this plan require that the employer place each employee into one of three groups: Group I All employees face occupational exposure to blood or other potentially infectious materials. Group II Some employees face occupational exposure to blood or other potentially infectious materials. Group III Employees will not face any occupational exposure to blood or other potentially infectious materials. Biohazards: Universal Precautions (4) Biological hazards Examples of exposure sources include the following: Centrifuge accidents Needle punctures Spilling infectious material on bench surfaces Cuts and scratches from contaminated glassware Removing stoppers from blood drawing tubes Universal precautions Every clinical laboratory should treat all human blood and other potentially infectious materials as if they were known to contain infectious agents. Hands and other skin surfaces should be washed immediately and thoroughly if contaminated with blood or other body fluids. Biohazards: Universal Precautions (5) Hand hygiene practices Transmission of pathogens most often occurs via the contaminated hands of health-care workers. CDC recommends vigorous rubbing together of all lathered surfaces for at least 15 seconds. Hand hygiene is still necessary after gloves are removed. Gloves may become perforated. Bacteria can multiply rapidly on gloved hands. Hand Hygiene Procedure Hand wash procedure Comments Hand wash procedure Comments 1. Turn on water faucet to a cool Water that is too hot can affect skin 5. Rinse thoroughly under To reduce skin irritation from temperature. integrity. running water. soap residue. 2. Place hands under water To aid soap activation. 6. Pat hands dry with paper 3. Dispense one pump action Excessive volume of soap product towels, discarding the volume of soap. may cause drying of hands, and dry paper towels in a waste cracked hands may harbor bacteria, container. viruses, and fungi. 4. Rubbing briskly, wash all The focus of good hand washing 7. If using a handoperated All faucet handles are surfaces of hands, including technique is to initiate mechanical faucet, use a dry paper considered contaminated. between fingers, for at least 15 removal of dirt and microorganisms, towel to turn off the seconds. using friction and rinsing under faucet. running water. Biohazards: Universal Precautions (7) regulations Needlestick OSHA Needles used for withdrawing blood must have a “built-in safety feature or mechanism that effectively reduces the risk of an exposure incident." CDC Implementing measures might prevent needlestick injuries: Use safe and effective alternatives to needles. Participate in the selection and evaluation of needle safety devices. Use only devices equipped with safety mechanisms. Do not recap needles. Implement a plan that will ensure safe handling and disposal of needles. Immediately dispose of used needles in the proper sharps disposal containers. Communicate needlestick hazards to your employees. Participate in infection-control training. Biohazards: Universal Precautions (8) Personal protective equipment Specialized clothing or equipment worn by an employee for protection against a hazard General work clothes are not considered to be personal protective equipment. Personal protective equipment (PPE) includes: Gloves Eyewear Respirators Laboratory coats and footwear Engineered controls Glass versus plastic Biohazards: Universal Precautions (9) Personal protective equipment Gloves Routine use of gloves to protect laboratory staff against exposure to bloodborne pathogens was mandated by O S H A in 1991. N I O S H has recommended that employers provide gloves with reduced protein content. Gloves are also available to protect employees from expo- sure to chemicals. Eyewear Conventional or prescription eyeglasses are not impervious to chemicals Proper eyewear is recommended. Glasses or goggles that provide protection to sides of the face as well as the front. Face shield. Respirators Should contain high-efficiency particulate air (H E P A) filters if no other engineering controls are available. Filtration respirators will require the use of one or two cartridges. Biohazards: Universal Precautions (10) Personal protective equipment Laboratory coats and footwear Employers must provide proper laboratory coats to each employee. They must have cuffed sleeves and be full length. They should remain buttoned to avoid contaminating street clothes. The material should be resistant to liquids. The construction of lab coats resistant to liquids includes layers of polypropylene, spun bonded filaments, and meltblown polypropylene microfibers. Engineered controls Safety equipment that isolates or removes the bloodborne pathogen hazard from the workplace. Glass versus plastic Clinical laboratories should use products that reduce the risk of exposure to broken glass. Benefits of converting to plasticware Examples of Safety-Engineered Controls Splash shields Biosafety cabinets Secondary containers Impervious needle boxes Automatic pipettes Centrifuge caps Self-sheathing needles Biohazards: Universal Precautions (12) Biosafety levels CDC and National Institutes of Health (NIH) have developed criteria for handling infectious materials. BSL Agents BSL 1 Not known to consistently cause disease in healthy adults BSL 2 Associated with human disease, hazard by percutaneous injury, ingestion, mucous membrane exposure BSL 3 Indigenous or exotic agents with potential for aerosol transmission; disease may have serious or lethal consequence BSL 4 Dangerous/exotic agents, which pose high risk of life- threatening disease; aerosol-transmitted lab infections; or related agents with unknown risk of transmission Biohazards: Universal Precautions (13) Xenobiotic Toxic Pose a potentially significant and long-lasting A substance that is foreign to a living organism and is usually harmful A xenobiotic substance that results in the production of a cancer-producing tumor is substances Once a xenobiotic enters the body, risk. it circulates until a suitable cellular termed a carcinogen. receptor is located. Substance that acts Organogenesis preferentially on an embryo Describes 15th to 60th days of fetal at precise stages of its development, in which the embryo Teratogens development Thereby leading to possible is most sensitive to the action of a teratogenic substan anomalies and malformations Fire Safety (1 of 2) Laboratories should have the means available to extinguish small fires in a room, confine a fire, and extinguish clothing that has caught on fire. Fire safety devices include: Fire blankets Safety showers Fire extinguishers Fire extinguishers are designed to suppress and extinguish different classes of fires. Classes of fires: A B C D List of Classes of Fires, Associated Hazards, and Proper Types of Extinguisher to Use Fire Class Hazard Extinguisher Type A Ordinary combustible material Water or dry chemical (e.g., paper, wood, cloth, and some rubber and plastic material) B Flammable combustible liquids, Dry chemical or gases, grease, and similar carbon dioxide materials C Energized electrical equipment Carbon dioxide, dry chemical or Halotron® (Halon) D Combustible metals such as Specific for the type of magnesium, titanium, sodium, metal in question and potassium RACE and PASS for Fire-Related Emergencies In case of fire: RACE Rescue Activate alarm call (phone number) Contain fire Evacuate area How to use a fire extinguisher properly: PASS Pull the pin Aim extinguisher Squeeze handle Spray back and forth Compressed Gases (1 of 2) Department of Transportation (D O T) regulates the labeling of gas cylinders that are transported by interstate carriers. Gases may be: Flammable or combustible Corrosive Explosive Poisonous Inert A combination of the aforementioned hazards Staff should know: Dangers, if any, associated with the gas(es) they are using Proper procedure for securing gas cylinders Contents of cylinders must be clearly identified. Signs should be posted conspicuously in area where flammable gases are used. Electrical Safety CLS are often exposed to electrical hazards. Handling “live” or charged electrical devices requires users to be completely focused on the task and aware of possible hazards. Electrical Safety Recommendations Use properly grounded electrical circuits and devices. Electrical wires and cords should have no frayed edges, cuts, or exposed wiring. Use of extension cords should be discouraged. Multiplug adapters and “cheater” plugs (two-prong to three-prong adapters) should not be used. Use only Underwriter Laboratories (UL)-approved, fuse-protected, multiple-socket surge protectors. Use ground fault interrupters (GFIs) in areas where there is a source of water (e.g., sink faucets and water filtration systems). Keep heat sources and liquids away from outlets. Do not handle any electrical devices with damp or wet hands. Train employees in how to handle shock injuries. Electrical panels should be clear of obstacles for easy access (allow at least 3 feet from the panel). Never work on exposed electrical devices alone. All shocks should be reported immediately, including small “tingles.” Do not work on or attempt to repair any instrument while the power is still on. Unplug the equipment. Radiation Safety Clinical laboratory personnel may Protective measures usually include be exposed to two types of radia- some type of shielding and/or tion sources: containment devices that will Nonionizing protect the user from direct Emit electromagnetic radiation ranging exposure. from extremely low frequency (E L F) to Eyes are the most vulnerable to radiation higher frequency ultraviolet (U V) exposure Ionizing Workplace Safety Issues (1) Ergonomics Cumulative trauma disorders Noise and hearing conservation Laboratory hoods (ventilation)/biosafety cabinets Waste management issues Staff responsibilities Safety manual Training Institutional alerts Emergency codes Emergency management Workplace Safety Issues (3 of 16) Ergonomics Applied science that focuses on designing and arranging objects people use so people and objects interact most efficiently and safely. Serious complications can develop from performing challenging tasks and may render the staff member nonfunctional. Cumulative trauma disorders Also called “cumulative trauma syndrome,” “repetitive motion disorder,” and “overuse syndrome” Refer to disorders associated with overloading particular muscle groups from repeated use or maintaining a constrained posture Typically develop over weeks, months, or years May involve tendons, nerve entrapment, muscles, or blood vessels. List of Cumulative Trauma Disorder (CTD) Risk Factors (1) Repetitive and prolonged activity Forceful exertions, usually with the hands Prolonged static postures Awkward postures of the upper body (e.g., reaching above the shoulders or behind the back) Continued physical contact with work surfaces, such as contact with edges Excessive vibration from equipment Working in cold temperatures List of Cumulative Trauma Disorder (CTD) Risk Factors (2) Lack of adjustable chairs, footrest, body supports, and work surfaces at workstation Slippery footing Noise (low-level noise 785 decibels/8 hours can result Ain fatigue, irritability, and headaches) Lifting Repetitive stress issues Standing for long periods of time Workplace Safety Issues (5 of 16) Low-level noise or “white noise” can result in fatigue, irritation, and headaches. Noise and hearing O S H A allows a time-weighted average (T W A) of 785 decibels/8 hours. conservation A hearing conservation program is designed to provide an employee with proper equipment to reduce exposure to high levels of noise. Laboratory hoods (ventilation)/biosafety cabinets Also called fume hoods Laboratory hoods Used to ventilate unwanted fumes from chemical reagents Each hood should have a continuous monitoring device. Three Classes of Biosafety Cabinets and Associated Descriptors Type Description Class I Face velocity, 75 feet per minute Open front, exhaust only through HEPA filter Class II Face velocity, 100 feet per minute Recirculation through HEPA filters and exhaust via HEPA filter Class III Supply air inlets and exhaust through two HEPA filters Note: HEPA = high@efficiency particulate air Copyright © 2018, 2011 Pearson Education, Inc. All Rights Reserved Workplace Safety Issues (7 of 16) Waste management issues Three types of waste generated in most laboratories include: Chemical Radioactive Biohazardous Some issues to consider include: Create a recycling program. Dispose of the waste according to guidelines provided by federal, state, and local authorities. Create a waste management plan. Instruct employees on the types of liquids that can be discharged into sewers. Workplace Safety Issues (10 of 13) The following issues represent good safety practices: Do not use personal electronic devices in areas where infectious exposure is likely. Do not wear P P E or laboratory coats outside of the laboratory. Use splash barriers when capping/uncapping tubes, pipetting or dispensing, mixing with a vortex mixer, and making dilutions. Staff Do not eat or drink in the laboratory. Do not apply cosmetics in the work area. responsibilities Secure hair back and off the shoulders. Do not wear jewelry that can become caught in equipment or come into contact with biological fluids or chemical testing materials. Do have the hepatitis B vaccination. Do not store personal belongings such as purses, coats, coffee mugs, and other personal items in the technical areas. Workplace Safety Issues (13 of 16) Safety manual Should be written, reviewed, and made available to all laboratory staff Should present defined policies, procedures, and job responsibilities for each member of the laboratory staff May also serve as a training document Schedules should be developed for each safety topic that requires action. Recommended Topics for Inclusion in a Clinical Laboratory Safety Manual Institutional Emergency Codes Fire Safety Emergency Phone Numbers Electrical Safety Biosafety Levels 1-4 Criteria Compressed Gases Standard Operating Procedures (S O P) Signs and Labels Personal Protective Equipment (P P E) Medical Considerations Chemical Handling and Inventory Emergency Procedures and Cleanup Safety Data Sheets (S D S) Waste Disposal Bloodborne Pathogens Record Keeping and Training Workplace Safety Issues (14 of 16) Training Should be considered an ongoing event Needs to be part of: New employee orientation Laboratory staff continuing education Should be conducted in accordance with local, state, and federal regulations Institutional alerts Emergency codes Represent a means for health-care facilities to alert their employees that an adverse event is occurring somewhere in or near the facility Codes were developed using several different designations (e.g., colors, numbers, and names) and these codes are commonly initiated. Workplace Safety Issues (16 of 16) Every institution should create an emergency management plan (E M P). Adoption of the National Incident Management Emergency Systems (N I M S) is typically recommended. Management of a disaster is effectively mitigated management using the incident command system. Incident command system (I C S) is a standardized on-scene incident management concept. Postamble READ the TEXTBOOK for the details to answer the UNIT OBJECTIVES. USE THE UNIT OBJECTIVES AS A STUDY GUIDE All test questions come from detailed material found in the TEXTBOOK (Not this PowerPoint) and relate back to the Unit Objectives