Laboratory Safety in Clinical Settings PDF

SAFETY IN THE CLINICAL LABORATORY CHAPTER 1 Keith C. Taguinod  Health, Safety and Security Health – A general state of physical, mental and emotional well-being. Safety – Condition in which the physical well-being of people is protected. Security – Protectio...

SAFETY IN THE CLINICAL LABORATORY CHAPTER 1 Keith C. Taguinod  Health, Safety and Security Health – A general state of physical, mental and emotional well-being. Safety – Condition in which the physical well-being of people is protected. Security – Protection of employees and organizational facilities. Credits to xabb_aubf20152016  Importance of Health and Safety in the Workplace The elimination, or at least minimization, of health and safety hazards and risks is the moral as well as the legal responsibility of employers. Ill health and injuries inflicted or caused by the system of work or working conditions cause suffering and loss to individuals and their dependents. Accidents and absences through ill-health or injuries result in losses and damage for the organization. xabb_aubf20152016  HAZARD - A thing that is dangerous or causes damage. - Anything that has the potential to cause harm or adverse effects to individuals, environment or property. xabb_aubf20152016  A. Chemical Hazard Arises from the exposure of chemical substances a. Toxic substances b. Corrosive substances c. Flammable/explosive substances d. Reactive substances  B. Biological Hazard Can cause disease or infections a. Pathogens b. Biological toxins c. Allergens  C. Physical Hazard Arises rom the physical condition of the environment a. Radiation - exposure to ionizing or non-ionizing radiation b. Noise c. Temperature extreme d. vibration  Physical Hazards Running in rooms and hallways Wet floors Lifting heavy objects Long hair not pulled back Dangling jewelry Open-toed shoes  D. Mechanical Hazard associated with machinery, equipment, and tools that can cause physical injuries, particularly from moving parts or improper operation a. Pinch points or crush injuries from moving machinery parts like conveyor belts or gears. b. Injuries from cutting tools, such as scalpels or saws, leading to lacerations or amputations.  E. Electrical Hazard the misuse or faulty installation of electrical equipment, wiring, or devices a. Electric shock b. Electric fire c. Electrocution  Electrical Hazards Avoid water and fluid contact Do not operate equipment with wet hands Observe for frayed cords, overloads; report Unplug and dry wet equipment Equipment grounded with three-prong plugs  Electrical Shock Accident Do not touch person Remove electrical source Turn off circuit breaker Unplug equipment Move equipment using wood or glass Must be nonconductive TYPE SOURCE POSSIBLE INJURY Biological Infectious agents Bacterial, fungal, viral or parasitic infections Mechanical Needles, lancets, and broken glass Cuts, punctures Chemical Preservatives and reagents Exposure to toxic, carcinogenic, or caustic agents Electrical Ungrounded or wet equipment and Burns or shock frayed cords Physical Wet floors, heavy boxes, and Falls, sprains, or strains patients xabb_aubf20152016  What is accident? refers to an unplanned and often preventable event that results in injury, illness, property damage, or exposure to hazardous materials Unplanned and unexpected events xabb_aubf20152016  CHARACTERISTICS Unintentional Preventable Varied outcomes Needs immediate response  Causes of Accidents ❑Improperly guarded equipment ❑Defective equipment ❑Hazardous conditions ❑Unsafe storage ❑Improper illumination ❑Improper ventilation xabb_aubf20152016  Examples Chemical spill Sharps Injuries Fire and Explosion Accidents  CHEMICAL SPILL In a clinical laboratory, chemical spills are typically classified: a. Minor b. Major  a. Minor spills Characteristics: Response: Small volume (usually less than 1 liter). 1. Alert: Notify others in the vicinity of the spill. 2. Wear PPE: Put on gloves, lab coat, and goggles to prevent Involves non-toxic, non-corrosive, or low-hazard exposure. chemicals. 3. Contain: Use absorbent materials or spill pads to contain the Does not pose significant health risks if handled spill. properly. 4. Clean: Use the spill kit to clean up the spill, following appropriate procedures for chemical disposal. No immediate danger of fire, explosion, or 5. Dispose: Place contaminated materials in designated exposure to hazardous fumes. hazardous waste containers.  b. Major spills Characteristics: Response Large volume (greater than 1 liter) or high 1. Evacuate: Evacuate the immediate area and notify all personnel. toxicity. 2. Alert Authorities: Contact the lab supervisor, safety Involves highly toxic, corrosive, flammable, officer, or emergency responders. or reactive chemicals. 3. Isolate the Area: Close off the spill area to prevent further contamination. Potential for fire, explosion, or release of 4. Ventilation: If the spill involves volatile chemicals, harmful fumes. increase ventilation (if safe) or evacuate to prevent inhalation of toxic fumes. Poses an immediate threat to the health of laboratory personnel or the environment 5. Wait for Professional Cleanup: Allow trained personnel or HAZMAT) team to clean up the spill safely. Common Causes of Chemical Spills: 1.Human Error 2.Equipment Failure 3.Container damage 4.Natural Disaster Prevention of Chemical Spills: Proper Storage: Store chemicals in compatible containers with clear labeling. Separate incompatible chemicals. Training: Ensure all personnel are trained in safe chemical handling, storage, and spill response procedures. Spill Kits: Keep spill kits readily available, containing absorbents, neutralizing agents, and protective gear. Regular Inspections: Check containers and storage areas for leaks or damage. Follow Protocols: Adhere to the lab’s chemical handling and disposal procedures.  A spill kit is an essential safety resource designed to manage and clean up hazardous chemical spills efficiently and safely. In a clinical laboratory, having spill kits readily accessible is crucial for preventing injuries, contamination, and environmental hazards following an accidental spill.  CHEMICAL HYGIENE PLAN The purpose of the Chemical Hygiene Plan (CHP) is to ensure that research faculty, staff, and students who handle hazardous chemicals have the proper training and safety protections required by law. The CHP is a written policy that sets forth engineering controls, administrative controls, work practices, and personal protective equipment that: 1) are intended to protect individuals from the physical and health hazards presented by hazardous chemical use in laboratories and research 2) meet the requirements of OSHA’s standard on Occupational Exposure to Hazardous Chemicals in Laboratories.  Written plan required by OSHA includes: Standard operating procedures Criteria to determine and implement control measures Employee training Chemical hygiene officer required  Chemical Labeling Chemical labeling refers to the process of providing clear, accurate, and consistent information on the labels of chemical containers. This is crucial for ensuring safety in laboratories, workplaces, and any environment where chemicals are used or stored. Proper labeling helps prevent accidents, facilitates safe handling, and ensures compliance with regulations.  National Fire Protection Association (NFPA) ❖The NFPA hazard identification label is a large diamond that contains four smaller diamonds of different colors. ❖It was created to quickly alert emergency personnel to the risks associated with hazardous chemicals ❖Some laboratories may use this diamond system to label secondary containers of hazardous chemicals that remain in the laboratory. The white diamond uses different symbols to indicate different special hazards. The diamond can include the following: A strike-out W for when the chemical reacts with water. OX, for when the chemical is an oxidizer. COR, for when the chemical is corrosive. The radioactivity symbol for when the chemical is radioactive. NFPA Hazardous material symbols xabb_aubf20152016  Material Safety Data Sheets (MSDS) OSHA requirement: employee’s right to know Proper handling and emergency measures associated with the chemicals Must have file available Vendors supply but facility is responsible to collect and maintain file  MSDS Information Physical and chemical characteristics Fire and explosion potential Reactivity potential Health hazards Emergency first aid Safe handling and disposal methods  GENERAL RULES FOR CHEMICAL SAFETY Always wear proper protective clothing—including lab coat, apron, gloves, and safety goggles—when working with chemicals. Always use proper chemical cleanup materials when cleaning up chemical spills. Never store chemicals above eye level. Never add water to acid. Never indiscriminately mix chemicals together. Never store chemicals in unlabeled containers. Never pour chemicals into dirty containers, especially containers previously used to store other chemicals. Never use chemicals in ways other than their intended use. xabb_aubf20152016  Sharp Injuries A sharp injury refers to an injury caused by sharp objects: Needles Lancets Broken glassware Puncture-resistant containers Conveniently located in work area Response to Sharp Injury: 1.Immediate Action: 1. Wash the wound with soap and water. 2. Encourage the wound to bleed gently but do not scrub the injury. 3. Apply an antiseptic and cover the wound with a clean dressing. 2.Report the Incident: Report the injury immediately to a supervisor or designated authority within the healthcare setting. 3.Medical Evaluation: Seek medical evaluation to assess the risk of infection and determine if post-exposure prophylaxis (PEP) is needed, particularly for bloodborne pathogens. 4.Follow-Up: Regular follow-up testing may be necessary to monitor for any signs of infection. Fire/Explosive The NFPA code word for the order of action in the event of fire xabb_aubf20152016  Classes of Fire Class A fires – occur with ordinary combustible materials, such as wood, papers, or clothing, and require water or water-based solutions to cool or quench the fire to extinguish it. Class B fires – occur with flammable liquids and vapors, such as paint, oil, grease, or gasoline, and require blocking the source of oxygen or smothering the fuel to extinguish. Class C fires – occur with electrical equipment and require nonconducting agents to extinguish. xabb_aubf20152016  Class D fires – occur with combustible or reactive metals, such as sodium, potassium, magnesium, and lithium, and require dry powder agents or sand to extinguish (they are the most difficult fires to control and frequently lead to explosions). Class K fires – occur with high-temperature cooking oils, grease, or fats and require agents that prevent splashing and cool the fire as well as smother it. xabb_aubf20152016  Fire Extinguishers 1. Water Extinguishers (Class A) Color: Red Used for: Fires involving solid materials like wood, paper, textiles, and plastics (Class A fires). How it works: Cools the fire by soaking the material and lowering its temperature. Not for use on: Electrical fires, flammable liquids, or metal fires. xabb_aubf20152016 2. Foam Extinguishers (Class A and B) Color: Cream label Used for: Fires involving solid materials (Class A) and flammable liquids (Class B), such as petrol, diesel, and oil. How it works: Forms a blanket over the burning liquid, cutting off the oxygen supply and preventing re-ignition. Not for use on: Electrical fires unless it's a specially rated extinguisher. 3. Carbon Dioxide (CO₂) Extinguishers (Class B and C) Color: Black label Used for: Fires involving flammable liquids (Class B) and electrical equipment. How it works: Displaces oxygen, which smothers the fire and cools the burning material. Not for use on: Class A fires, as it does not have a cooling effect, and can lead to re-ignition. 4. Dry Chemical Extinguishers (Class A, B, C) Color: Blue label Used for: A wide variety of fires, including solids (Class A), flammable liquids (Class B), flammable gases (Class C), and electrical fires. How it works: Coats the fire with a fine powder that separates the fuel from oxygen. Not for use in confined spaces: The powder can reduce visibility and may cause breathing problems. 5. Wet Chemical Extinguishers (Class K) Color: Yellow label Used for: Fires involving cooking oils and fats, typically in kitchen settings (Class K). How it works: Forms a foam layer on the burning oil or fat, cutting off oxygen and cooling the fire. Not for use on: Electrical fires or flammable liquids. 6. Specialist Extinguishers (Class D) Used for: Fires involving combustible metals like magnesium, aluminum, and lithium. How it works: The extinguisher uses a specialist powder to extinguish metal fires by smothering them. Not for use on: Fires involving other types of fuel, as it is specifically designed for metal fires.  Fire Extinguisher Operation PASS Pull pin Aim at base of fire Squeeze handles Sweep nozzle side to side  To avoid accidents: The laboratory has to be designed according to international safety regulations. The workers must be trained in safe working procedures and must know their materials. xabb_aubf20152016  Laboratory Safety Plan Are plans for preventing sickness and injury to personnel and damage or destruction of physical assets. Fundamental Objectives – To improve safety skills and attitude of all personnel – To develop a surveillance program for promptly identifying hazards – To formulate plans for promptly correcting all hazards – To coordinate laboratory safety efforts with the overall xabb_aubf20152016  Relationship of Hazard and Accidents A. Hazards as Precursors to Accidents - Hazards represent potential risks that, if not managed, can lead to accidents. Example: A laboratory with poor ventilation (a hazard) increases the risk of an accident involving the buildup of flammable gases, leading to an explosion. B. Accidents as Consequences of Uncontrolled Hazards Accidents often occur when safety measures fail or are not implemented correctly. For instance, a chemical spill might result from improper storage or handling of chemicals.  INFECTION An infection occurs when harmful microorganisms such as bacteria, viruses, fungi, or parasites invade the body, multiply, and cause disease or damage to the tissues.  Chain of Infection xabb_aubf20152016 A. Infectious Agent This can be a bacteria, virus, parasites or prions. Any organism is capable of causing infection if all the links/components are present. B. Reservoir A reservoir is the place where an infectious agent lives and reproduces in such a manner that it can be transmitted. Infectious agents can live in or on people, animals, insects, soil or water.  3. Portal of Exit ▪Path by which infectious agent leaves the reservoir. ▪excretions and secretions ▪non‐ intact skin (e.g., draining wounds) ▪respiratory tract (e.g., sneezing, coughing, talking) ▪gastrointestinal tract (e.g., vomiting, diarrhea, stool) ▪mucous membranes (eyes, nose, mouth, vagina) D. Modes of Transmission ▪is how the pathogen moves from place to place ▪Contact transmission is the most common route of transmission of organisms in health care settings. ▪Droplet transmission refers to large droplets that are generated from the respiratory tract of infected individual during coughing, sneezing or laughing or during such procedures as suctioning. ▪Airborne transmission occurs when an individual with an organism/disease that is transmitted by the airborne route expels the organism from their respiratory tract by coughing, laughing, singing and sneezing. E. Portal of Entry ▪The point where the infectious agent enters a new host lace. non‐intact skin (e.g., broken skin such as bed sores or wounds coming in contact with contaminated material) respiratory tract gastrointestinal tract (e.g., eating contaminated food) mucous membranes (e.g., eyes, nose or mouth exposures with infectious agents) F. Susceptible Host ▪The susceptible host is the person who may become infected. Factors that increase the risk of susceptibility are: ▪ age (either very young or very old) ▪ underlying medical conditions e.g. diabetes ▪ treatments or invasive devices ▪ poor nutrition/general health ▪ burns ▪ surgery ▪ immunosuppression. Breaking the Chain  Regulations and Guidelines Universal Precautions (UP) 1987, blood-borne pathogens (HIV, HBV) Gloves and face shields with visibly bloody specimens Puncture-resistant containers  Standard Precautions (SP) Hand washing Immediately after removing gloves Gloves Blood, body fluids, secretions, excretions, contaminated items Mask, Eye Protection, Face Shield Mucous membrane protection, sprays, aerosols Gown Appropriate for the amount of fluid  Standard Precautions (SP) (cont’d) Patient-care equipment Dispose or sterilize as per protocol Environmental Control Cleaning and disinfection of surfaces Linen Prevent exposure when handling Blood-borne Pathogens No needle recapping Patient Placement Isolation if needed  Occupational Exposure to Blood-borne Pathogens Standard Monitored and enforced by OSHA 1. All employees practice UP and SP 2. Employer provides gowns, coats, face and respiratory protection, gloves and laundry facilities for nondisposables 3. Provides sharps disposal, prohibits needle recapping 4. Prohibits eating, drinking, smoking, applying cosmetics in work area 5. Label all hazardous materials 6. Provide free immunization for HBV 7. Establish daily disinfectant protocol 8. Household bleach 1:10 9. Provide medical follow-up for workers exposed to blood-borne pathogens 10. Document regular employee safety training  Post-exposure Prophylaxis Report accident immediately to supervisor Testing must be done immediately You and the patient HIV exposure prophylaxis must start within 24 hours  Personal Protective Equipment (PPE) Gloves: not a substitute for hand washing Types: sterile and nonsterile, powdered and nonpowered, latex and nonlatex Latex allergy Dry, itchy rash on hands = delayed reaction Facial flushing , breathing difficulty = immediate reaction Report any symptoms to supervisor; reactions can be fatal  Personal Protective Equipment (PPE) (cont’d) Fluid-Resistant Labcoats Protect skin and clothing Completely buttoned, gloves pulled over wrist cuffs Wear when working with specimens, remove when leaving lab Change when visibly soiled Discard disposable as biohazardous waste and nondisposable in designated laundry bins  Personal Protective Equipment (PPE) (cont’d) Face Protection Goggles, full-face plastic shields, Plexiglas countertop shields Splashes and aerosols caused by uncapping, pouring, transferring, and centrifuging Never centrifuge uncapped specimens Contaminated specimen container exteriors Disinfect exterior Request new specimen as per protocol Most health care-associated infections are preventable through good hand hygiene – cleaning hands at the right times and in the right way. The WHO Guidelines on hand hygiene in health care support hand hygiene promotion and improvement in health care facilities worldwide. xabb_aubf20152016 xabb_aubf20152016  Disposal of Biological Waste Specimens and contact materials Waste containers have biohazard symbol Containers disposed of per protocol Urine can be poured down the sink, no splashes Containers go in nonbiohazardous waste Flush sink with water Daily 1:5 or 1:10 sodium hypochlorite flush Also use on counter tops Store protected from light  Waste Disposal Treatment Final Disposal Incineration – Landfill Chemical disinfection – Burying inside Autoclaving premises Encapsulation – Discharge into Microwave irradiation sewer xabb_aubf20152016  5S Sort : making things cleaned up. Set on order : organize, identify and arrange everything in a workplace. Shine : regular cleaning and maintenance Standardize : make it easy to maintain Sustain : maintaining what has been accomplished xabb_aubf20152016