Laboratory Safety-2

**Chapter 3** **Laboratory Safety 2** **3-1. Describe when to use certain PPE based on hazards that may be present in a clinical lab** Risk assessments should be regularly performed: - Based on intended procedures/tasks - Based on intended organisms that may be handled - When there are c...

**Chapter 3** **Laboratory Safety 2** **3-1. Describe when to use certain PPE based on hazards that may be present in a clinical lab** Risk assessments should be regularly performed: - Based on intended procedures/tasks - Based on intended organisms that may be handled - When there are changes in procedures, equipment, or staff Risks identified from a hazard assessment should be prioritized, and a mitigation plan should be established based on that prioritization, including what PPE to use. Risk assessments need: - The involvement and support of lab management - Knowledge of the hazards and understanding of the work and the lab environment - The input from staff, depending on the work and lab facility capabilities he goals of a biological risk assessment include: - Identifying hazards associated with handling pathogens in the lab. - Identifying and implementing controls to minimize the risk of exposure to workers and the environment. In a clinical lab, the focus of a risk assessment will primarily be on the prevention of laboratory-associated infections from: - Spills/splashes to mucous membranes - Inhalation of aerosols - Percutaneous inoculation from cuts, needle sticks, non-intact skin - Ingestion (e.g., contamination from surfaces, fomites to hands, etc.) - Aerosolization, or the generation of aerosols, can occur during a lab procedure that can impart energy into a microbial suspension, producing aerosols or droplets that may contain infectious organisms. - Aerosols are very small particles \[\< 5 µm (microns) in diameter\] that can remain suspended in the air and can be inhaled and retained in the lungs. - Droplets are larger particles (ranging from 5 to 10 µm in diameter) that can settle onto surfaces and gloves due to gravity. Droplets may also come into contact with the mucous membranes of the person performing the procedure. - Work with potentially infectious aerosols or droplets may require the use of respiratory protection (e.g., N95, face mask) based on a laboratory risk assessment. Several common lab procedures may result in the generation of infectious aerosols or droplets, which may require additional PPE or other controls, including: - Pipetting and dispensing of pipette tips - Use of a vortex - Spills or splashes from liquid media - Heat fixing a microscope slide - Use of a sonicator - Use and unloading of a centrifuge - Inoculation of media (plate or tube) - Performing a subculture of a positive blood culture bottle - Performing a catalase test on the bench - Preparing samples for automated identification systems Clinical laboratories should try to utilize engineering controls such as containment devices as best possible if infectious hazards cannot be eliminated or substituted. Pathogenic organisms are classified according to their associated risk group and designated as either Risk Group 1, 2, 3, or 4, with Risk Group 4 being the highest risk. It is important to know the risk group(s) of the organism(s) that may be present to properly evaluate the exposure risks (e.g., if the organism is transmissible by the inhalation route, etc.). ABSA International, the American Biological Safety Association, provides a [[free and searchable database ]](https://my.absa.org/Riskgroups)for pathogenic organisms that can be consulted when conducting their own laboratory and task-specific risk assessments for the organisms they may handle. Determining what risk group level(s) the organisms that may be handled in a laboratory will help determine the proper laboratory biosafety level, features, and safety practices used. Laboratory design and associated safety practices are classified as 'Biological Safety Levels' (or Biosafety Levels) (BSL) and are designated as BSL-1 through BSL-4, with BSL-4 being the highest level of containment. Most clinical laboratories operate at a **BSL-2 level**, and a relatively smaller number will have a fully functional BSL-3 laboratory space. BSL-3 labs will commonly conduct higher-risk work such as handling cultures of *Mycobacterium tuberculosis*, mycology samples, or routine work with Risk Group 3 or 4 organisms. ([Note]: Most clinical laboratories will never work with a Risk Group 4 pathogen. Risk Group 4 pathogens are typically handled only in specialized high containment reference or research laboratories.) **3-2. Risk Groups and Biosafety Levels** Risk Group 1 (no or low individual and community risk) A microorganism that is unlikely to cause human or animal disease. Risk Group 2 (moderate individual risk, low community risk) A pathogen that can cause human or animal disease but is unlikely to be a serious hazard to laboratory workers, the community, livestock or the environment. Laboratory exposures may cause serious infection, but effective treatment and preventive measures are available and the risk of spread of infection is limited. Risk Group 3 (high individual risk, low community risk) A pathogen that usually causes serious human or animal disease but does not ordinarily spread from one infected individual to another. Effective treatment and preventive measures are available. Risk Group 4 (high individual and community risk) A pathogen that usually causes serious human or animal disease and that can be readily transmitted from one individual to another, directly or indirectly. Effective treatment and preventive measures are not usually available. Countries (regions) should draw up a national (regional) classification of microorganisms, by risk group, taking into account: 1\. Pathogenicity of the organism. 2\. Mode of transmission and host range of the organism. These may be influenced by existing levels of immunity in the local population, density and movement of the host population, presence of appropriate vectors, and standards of environmental hygiene. 3\. Local availability of effective preventive measures. These may include: prophylaxis by immunization or administration of antisera (passive immunization); sanitary measures, e.g. food and water hygiene; control of animal reservoirs or arthropod vectors. 4\. Local availability of effective treatment. This includes passive immunization, post exposure vaccination and use of antimicrobials, antivirals and chemotherapeutic agents, and should take into consideration the possibility of the emergence of drug-resistant strains. **Biosafety Levels** Laboratory facilities are designated as basic -- Biosafety Level 1; basic -- Biosafety Level 2; containment -- Biosafety Level 3; and maximum containment -- Biosafety Level 4. Biosafety level designations are based on a composite of the design features, construction, containment facilities, equipment, practices and operational procedures required for working with agents from the various risk groups. Table relates but does not "equate" risk groups to the biosafety level of laboratories designed to work with organisms in each risk group. Typically, most routine specimens in a clinical laboratory can safely be handled in a BSL-2 lab following standard precautions with standard BSL-2 PPE. However, there may be some specimens and associated work that may require additional precautions or safety practices. Examples of common BSL-2 level specimens and work in clinical labs: - - - - - Examples of less common higher risk specimens and work in clinical labs that may require additional PPE or other safety considerations: - - - - - PPE commonly worn in a typical BSL-2 clinical lab setting following standard precautions and lab safety practices, include: - - - - Based on a risk assessment, when there may be additional or special circumstance hazards present in the lab, enhanced precautions, otherwise commonly known as "BSL-3 practices," may be necessary to implement in a BSL-2 setting. Additional PPE that may be commonly worn in a "BSL-2 enhanced" setting following enhanced precautions and lab safety practices can include the use of: - - - - According to the CDC/NIOSH Hierarchy of Safety Controls: - PPE should be considered the "last line of defense" against potential exposures and other workplace hazards. - PPE does not reduce or eliminate the hazard(s) that may be present. - PPE is not a substitute for engineering controls and prudent work practices, and PPE should be used in conjunction with other controls to ensure safety when possible. There are several types and manufacturers of PPE that labs can appropriately select from based on their identified work hazards. PPE will vary based on a laboratory-specific and activity or procedure-specific risk assessments. Sometimes, a lab needs to use enhanced precautions or add PPE based on a risk assessment. Examples of which can include: - When infectious aerosols or droplets may be generated. - When working with a higher risk or higher volume pathogen(s). - When there is a lack of or limited use of containment or engineering controls (e.g., no biological safety cabinet available). There may be times when the Laboratory Director or Safety Officer determines that enhanced precautions or 'BSL-3 practices' (e.g., use of double gloves, solid front gown, or respiratory protection) are needed based on a risk assessment, such as: - When working with organisms that may be transmitted by the inhalation route and are normally handled at BSL-3, but a BSL-3 laboratory is not readily available. - When certain higher-risk organisms are suspected, such as *Brucella* spp., *Coccidioides* spp., *Blastomyces dermatitidis*, *Francisella tularensis*, *Histoplasma capsulatum*, *Mycobacterium tuberculosis*, MERS-CoV, SARS, highly pathogenic influenza, etc. **3-3. Describe how to don and doff various types of PPE** "Donning" PPE refers to putting PPE on, and "doffing" PPE refers to taking it off. Donning and doffing procedures will vary between laboratories. PPE may also vary based on a laboratory risk assessment. Always follow your laboratory-specific PPE policies and procedures for donning, usage, doffing, and disposal. Donning and doffing areas should be clearly designated and physically separated from each other to avoid contamination of clean PPE and personal belongings with potentially contaminated PPE and biohazardous waste containers. Before donning PPE, remove personal items that may interfere, such as jewelry (e.g., rings that may puncture gloves), watches, coats/jackets, or additional bags, and leave them in a secure location outside the laboratory. It is also recommended to leave personal cellphones outside the laboratory if possible, otherwise, they should stay secured in a pocket and not used/handled when wearing PPE or handling any hazardous materials. Additional PPE donning considerations include: - Tie back long hair (if present) - Select the appropriate size PPE and make sure it fits properly - Before use, visually inspect all PPE for rips, tears, loose or missing snaps or straps and discard and replace any defective PPE. Generally, PPE should be present at or near the laboratory entry, and replacement PPE should also be available in the lab in areas where it is used in order to provide convenient reapplication as needed. PPE should be donned in a designated space and at transition points. Additional PPE donning considerations include: - Clean hands prior to donning PPE, especially gloves. - Street clothing should not be exposed. - If additional donning assistance is needed, consider donning in front of a mirror or with a partner to ensure all PPE is donned correctly. While wearing PPE, try not to touch or adjust PPE more than necessary, and avoid touching anything not associated with the task at hand to minimize the potential spread of contamination. There are various strategies, sequences, methods, and techniques laboratories can establish for their PPE doffing procedures, and the procedural details will vary between laboratories based on the site-specific and activity-specific risk assessments, the procedures being conducted, and the PPE worn. PPE doffing order is more important than donning order because all PPE will be clean and donned before conducting work. Doffing will involve removing and discarding potentially contaminated PPE with caution. If an item of PPE becomes obviously or potentially contaminated during work (e.g., gloves or lab coat), doff them as soon and safely as possible, and don new. Contaminated PPE should not be doffed with bare hands. However, sometimes it may be possible to doff PPE with bare hands if able to remove the PPE from touching a clean (contamination-free) area of the PPE or if using an area of 'clean' inside out PPE to doff other PPE (as described further below). Always don and doff PPE according to lab-specific policies and procedures which should take into account removal from highest PPE contamination risk to least risk, while providing user best and longest protection in doffing process. The orders described below will be to remove typical and enhanced clinical laboratory PPE from those that may likely be the most contaminated to least contaminated. **Example of common standard precaution laboratory PPE doffing order:** Gloves - Lab Coat - Safety Glasses **Example of enhanced precaution PPE doffing order:** Outer Pair of Gloves - Face Shield or Goggles - Gown - Shoe Covers - Safety Glasses - Mask or Respirator - Inner Pair of Gloves Always discard or reuse PPE according to lab policies and procedures and perform hand hygiene after doffing PPE. To don (nitrile) gloves: - Inspect for any rips, punctures, deterioration, or other defects. - Can inspect by trapping air inside gloves and squeezing to detect small leaks. - Remove any jewelry that could puncture gloves. - Perform hand hygiene before putting on new gloves. - Obtain appropriate size and make sure they fit properly. - Should have tight cuffs. - Put gloves on one hand at a time, and fingers should comfortably fill the spaces. - Pull gloves over the lab coat's tight cuffs. - Keep gloved hands away from the face and avoid touching unnecessary objects or surfaces. When removing (doffing) gloves: - Firmly pinch with the thumb and index finger the wrist area of one glove with the other gloved hand and gently pull the pinched glove slowly forward and roll it onto itself, so it becomes inside out. - Either use the protected fingers still partially within the inside out and bundled glove to pinch at the wrist and remove the glove from the other hand. - Or, hold the fully removed and bundled first glove in the palm of the other still gloved hand and use ungloved fingers to firmly pinch the wrist area of the remaining gloved hand to slowly peel off the other glove. - Ensure glove removal does not cause additional contamination of hands. - Discard into a waste container. Disposable nitrile gloves should not be reused. - If gloves become damaged or noticeably contaminated during work they should be safely doffed and discarded as soon as possible. Hand hygiene should be performed and a new pair of gloves should be donned to resume work. - There are many styles to doffing gloves. Always follow your lab established PPE procedures. At times and depending on a lab-specific risk assessment, two pairs of gloves may be used as an enhanced precaution. If two pairs are worn: - The cuff of the inner pair (pair that is put on first) may go under the lab coat or gown cuff, with the outer pair of gloves going over the lab coat or gown cuffs. Or, both the inner and outer pair of gloves will overlap the lab coat or gown cuff, depending on lab-specific PPE procedures. - Note: If the inner and outer pair of gloves are different colors, it may be easier to notice small tears or rips in the gloves. - When doffing, the outer pair of gloves will typically be removed first. Then the rest of the PPE will be doffed, and the inner pair of gloves doffed last. **3-4. Chemicals \-- Past and Present: Introduction** #### On March 26, 2012, the Occupational Safety and Health Administration (OSHA) published its Final Rule, which updated the Hazard Communication Standard to align with the Globally Harmonized System of Classification and Labeling of Chemicals ([[GHS]](https://www.medialab.com/courses/s_page.aspx?step=1&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c)) #### **GHS**-Globally Harmonized System (of Classification and Labeling of Chemicals); a unified approach to classifying chemical hazards, designing warning labels, and organizing information on SDSs. GHS created pictograms that help to quickly and easily identify hazards associated with a chemical. Top of Form GHS is a worldwide initiative to promote standard criteria for classifying chemicals according to their health hazards, physical hazards, and environmental hazards. It uses [[pictograms]](https://www.medialab.com/courses/s_page.aspx?step=1&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c), hazard statements, and signal words like "Danger" and "Warning" to communicate hazard information on product labels and safety data sheets ([[SDSs]](https://www.medialab.com/courses/s_page.aspx?step=1&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c)). **Pictogram**-A symbol plus other graphic elements intended to convey specific information about the hazards of the chemical. Each pictogram consists of a black symbol on a white background within a red diamond border. **SDS**-Safety Data Sheet; a 16-section information guide that pertains to a particular chemical. Sections outline chemical properties and hazards, first-aid measures, environmental toxicity, and more. SDSs should be in compliance with GHS standards. SDSs were previously called Material Safety Data Sheets (MSDSs), but this has since phased out to be just SDS. Top of Form Top of Form The primary goal of GHS is to protect human health and the environment by providing chemical users and handlers, emergency first responders, and the public with enhanced and consistent information on chemical hazards.  Hazard Communication Standard (HCS) The Hazard Communication Standard (HCS), also known as Haz-Com or the Right-to-Know Law, is an OSHA regulation to help control workplace exposure to chemicals. The HCS requires chemical manufacturers to determine the physical and health hazards of each product they make. They also have to let users know about those hazards through the use of: - - - The portion of the OSHA Standard that is specific to laboratories is 29 CFR1910.1450, \"Occupational exposure to hazardous chemicals in laboratories.\" Part of this regulation requires laboratory leadership (eg, directors, administrative directors, supervisors, and managers) to develop a documented chemical hygiene plan (CHP). The CHP defines provisions for procedures, special equipment, personal protective equipment ([PPE](https://www.medialab.com/courses/s_page.aspx?step=3&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c)), and work practices that, if used correctly, will protect employees from the hazards associated with chemical exposure. Within the CHP, you will find: - Provisions for worker training - The laboratory\'s policy regarding chemical exposure monitoring, where appropriate - Specific information regarding medical consultation when exposure occurs - The laboratory\'s criteria for the use of PPE and engineering controls - Special precautions for particularly hazardous substances - The person who is designated as the Chemical Hygiene Officer (the person responsible for the implementation of the CHP) Your employer has a responsibility to educate you about chemical hazards and safety procedures that will prevent injuries. You should have also received training from your employer on the [[GHS]](https://www.medialab.com/courses/s_page.aspx?step=5&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c) chemical label elements and [[SDSs]](https://www.medialab.com/courses/s_page.aspx?step=5&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c), if your workplace has hazardous chemicals. As an employee in a workplace with hazardous chemicals, it is your responsibility to: - Read the manufacturers\' labels and [[SDSs]](https://www.medialab.com/courses/s_page.aspx?step=6&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c), and follow the instructions and warnings. - Access pertinent safety information through your supervisor. - Contact your supervisor if you are concerned about a potential hazard, either in the facility or in your work procedures. **3-5. Labeling Systems** [[GHS]](https://www.medialab.com/courses/s_page.aspx?step=7&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c) is a single unified approach to classifying chemical hazards, designing warning labels, and organizing information on [[SDSs]](https://www.medialab.com/courses/s_page.aspx?step=7&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c). In the United States, all new shipments of chemicals and SDSs must comply with these labeling requirements. The GHS label will be present on the primary container of the hazardous chemical in the workplace. It must be maintained on the supplied container in your work area. The GHS label, or label elements, can also be used for secondary containers. However, your workplace unit may use alternative means for communicating the same information in a different written or displayed format. If containers of hazardous chemicals leave your work area, they must be labeled in accordance with the GHS labeling requirements. A label that is on a primary container of a hazardous chemical and is in compliance with GHS will contain the following: - The identity of the chemical, using the product identifier present on the SDS - The name, address, and telephone number of the chemical manufacturer, importer, or responsible party (applies to the shipped container) - Appropriate hazard warnings, communicated through the appropriate [[pictogram]](https://www.medialab.com/courses/s_page.aspx?step=7&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c)(s) - Signal word(s) - Hazard statement(s) - Precautionary statement(s) A sample label, provided by OSHA on their [[website]](https://www.osha.gov/Publications/OSHA3492QuickCardLabel.pdf), is shown in the bottom image. Before you handle or open a chemical container, *carefully read the label and follow the instructions*. If you are unsure about information on the label, ask your supervisor before you proceed. #### The [[NFPA]](https://www.medialab.com/courses/s_page.aspx?step=8&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c) (National Fire Protection Association, provides the multi-colored diamond label for classifying chemicals and quickly portraying their hazards. The red section denotes fire hazards, the blue section denotes health hazards, the yellow section denotes reactivity hazards, and the white section denotes hazards specific to that chemical).  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. The different colored diamonds indicate: - - - - The red, blue, and yellow diamonds use a numbering system from 0 - 4 to indicate the severity of each fire, health, and reactivity hazard, respectively. \"0\" indicates no hazard, and \"4\" indicates the most severe hazard. The white diamond uses different symbols to indicate different special hazards. The diamond can include the following: - - - - Some laboratories may use this diamond system to label secondary containers of hazardous chemicals that remain in the laboratory. Besides the [[NFPA]](https://www.medialab.com/courses/s_page.aspx?step=9&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c) diamond, other labeling systems may also be used for secondary containers of hazardous chemicals. These labels also use a color-coded system to alert the user to the type of hazard posed by the chemical substance. A numeric system is used that rates the degree of hazard. The colors indicate the same types of hazards as the NFPA diamond. The numbering system is usually the same as well, with \"0\" indicating no hazard and \"4\" indicating the greatest hazard, although the criteria for assigning a number may vary. A section may be included on the label to identify the appropriate [[PPE]](https://www.medialab.com/courses/s_page.aspx?step=9&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c) for handling that chemical. The recommended PPE is appropriate to the hazard\'s route of entry to the body and protects the potentially affected organs. When a substance containing a hazardous chemical is transferred from its original container to a secondary container, the secondary container must be labeled with the identity of the chemical and any hazards it presents. These include the route of entry to the body, health hazards, physical hazards, and any affected organ(s). Containers into which hazardous chemicals are transferred from labeled containers, and which are intended *only* for the immediate use of the employee who performs the transfer, do not need to be labeled. **3-6. Safety Data Sheets: Sections** As an employee, you have the right to know the types of hazardous substances that are used in your workplace. Safety data sheets ([[SDSs]](https://www.medialab.com/courses/s_page.aspx?step=13&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c)) must be available to you for each chemical used in the laboratory, either in paper or electronic form. Ask your supervisor for the exact location. Before working with a chemical: - Review the safety data sheet for the chemical. - Identify any health hazard associated with the chemical. - Identify if work should be conducted in a chemical fume hood, or if any other special equipment should be used, such as a bottle carrier. - Identify any personal protective equipment that you must wear. The intent of the [[SDS]](https://www.medialab.com/courses/s_page.aspx?step=15&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c) is to answer these questions: - What is the material? - What information needs to be known immediately? - What should be done in cases of emergency situations? - How can hazardous situations be prevented from occurring? - What other useful information is there on this material? SDSs supplied by chemical manufacturers are in a uniform format that includes 16 specific sections. The SDS will include the section numbers, the headings, and associated information under each heading. The 16-section headings are: 1. Identification 2. Hazard identification 3. Composition/information on ingredients 4. First-aid measures 5. Fire-fighting measures 6. Accidental release measures 7. Handling and storage 8. Exposure controls/personal protection 9. Physical and chemical properties 10. Stability and [[reactivity]](https://www.medialab.com/courses/s_page.aspx?step=15&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c) 11. Toxicological information 12. Ecological information 13. Disposal considerations 14. Transport information 15. Regulatory information 16. Other information (includes the date of preparation or last revision) **3-7. Lab Safety Precautions: General** Laboratory safety includes a number of precautions designed to protect you and your coworkers. Remember that eating, drinking, smoking, and applying cosmetics or lip balm are **forbidden** in areas where chemicals are present. Do not sniff or taste chemicals. Do not store food in areas where chemicals are present. Promptly clean up minor spills. Know the location of the chemical spill kits in the laboratory and consult the [[SDS]](https://www.medialab.com/courses/s_page.aspx?step=33&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c) or container label for the proper [[PPE]](https://www.medialab.com/courses/s_page.aspx?step=33&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c) that should be worn when containing a spill. Dispose of waste properly. In the event of a major spill of a hazardous chemical, follow your laboratory\'s emergency response plan. Do not attempt to clean up the spill unless you have been appropriately trained and are authorized to do so. **After working with chemicals and removing your gloves, wash your hands thoroughly.** [[PPE]](https://www.medialab.com/courses/s_page.aspx?step=35&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c) is an essential way to protect yourself from the dangers of chemicals. You\'ll find on the label or [[SDS]](https://www.medialab.com/courses/s_page.aspx?step=35&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c) exactly what kinds of clothing, gloves, and coverings you\'ll need to keep yourself safe. Also, the laboratory\'s CHP will include information about necessary PPE and engineering controls that will reduce your exposure to hazardous chemicals. At a minimum, chemical safety goggles and rubber or nitrile gloves (not necessarily utility gloves) are necessary parts of your PPE. If a hazardous chemical is splashed into the eyes, vision could be impaired. Laboratory employees who use hazardous chemicals in their work should be very familiar with the path to the eyewash station from their work area, ensuring that the eyewash can be reached quickly and without obstruction. Once you have activated the eyewash, hold your eyelids open and roll your eyeballs so fluid will flow on all surfaces of the eye and under the eyelid. Continue this for at least 15 minutes under a steady flow of tepid water. Tepid water is defined to be water between 60°F (16°C) and 100°F (38°C). An emergency eyewash may go unused for long periods of time, but when an emergency occurs, it must function properly. The few seconds immediately following a chemical splash are often critical to minimizing eye damage. It's extremely important that eyewash stations and showers are kept in proper working order; if they are not, the consequences could be serious. An emergency eyewash should be located on the same level as chemical hazards, unobstructed, and within 10 seconds of reach. A plumbed eyewash (one that is connected to a water source) should be tested weekly. Eyewashes have additional requirements: - Eyewashes must supply a controlled flow of tepid water to both eyes simultaneously at a velocity low enough so as not to injure the user. - Eyewashes must deliver at least 0.4 gallons/minute for 15 minutes at a minimum of 30 psi of flow pressure. - Eyewashes must be large enough to provide room for the eyelids to be held open with the hands while the eyes are in the stream of water. - If the eyewash nozzle has a protective cover, it should NOT require a separate action by the user to remove the cover and activate the wash. - The water flow must remain on without requiring the use of the operator's hands and remain on until it is intentionally shut off. - The valve that provides water and the sink itself must be resistant to corrosion. - The eyewash must be marked with signs. Chemicals need a method of storage that, as much as possible, separates those that are incompatible and should not have contact. Alphabetical order should not be the basis for storing chemicals. When chemicals are stored alphabetically, there is a potential for incompatible chemicals to come into contact with each other. Storing according to the category of chemicals is a much better method than storing them alphabetically. However, in some cases, incompatible chemicals may still be grouped together. For example, you may decide to store all acids together, but nitric acid is incompatible with acetic acid and these two acids should be separated in storage. The chemical label will provide information about the potential hazard, and the [[SDS]](https://www.medialab.com/courses/s_page.aspx?step=38&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c) for the chemical will specify how it should be stored and which, if any, chemicals are incompatible with it. Acids and bases should be stored in separate areas or cabinets. Acids should not be stored under a sink where they may become contaminated with water. Liquid acids and bases should not be stored above shoulder height to prevent an accidental splash of chemical into the eyes if the bottle falls or leaks when it\'s removed from the shelf. At the workstation, store the lowest volume of chemical possible. Identify chemicals that are no longer used in the laboratory, especially flammable and combustible liquids. These should be disposed of in the manner defined by local, state, and federal regulations. When a chemical has multiple hazards, the hazards need to be prioritized to determine where to store the chemical safely. Flammability takes priority over other hazards. Areas, where flammables are used and stored, should have adequate ventilation to protect against fire. [[Oxidizers]](https://www.medialab.com/courses/s_page.aspx?step=39&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c), such as peroxides, must be separated from flammables and stored in a cool, dry location. - Chemicals that are flammable or combustible should be stored in a fire-resistant cabinet; only a minimal amount should be stored on open shelving in the technical work areas. - Be conscientious about storing flammable and combustible chemicals far from sources of ignition. - Conduct work involving flammable and combustible chemicals within a chemical fume hood if possible. Certain chemicals in use in the laboratory, such as formaldehyde, are hazardous if your exposure to them is prolonged. The amount of the chemical to which you can be exposed before possible danger is called the *threshold limit value (TLV)*. Monitoring badges are used from time to time to measure your exposure. These are worn in the \"breathing zone\" for a certain period of time: fifteen minutes for short-term exposure or eight hours for long-term exposure. Based on the results of this monitoring, additional personal safety measures, such as ventilation or face-fitted masks, may be implemented for your protection. **3-8. ab Safety Precautions: Laboratory Rules** Make these common sense rules a part of your job: - Identify hazards before you start a job. - Ask your supervisor when in doubt. - Know how and where to get help. You should also: - Learn basic first aid measures. - Read chemical labels. - Read [[SDSs]](https://www.medialab.com/courses/s_page.aspx?step=42&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c). - Follow warnings and instructions. - Use the correct engineering controls and [[PPE]](https://www.medialab.com/courses/s_page.aspx?step=42&currentassignment=53086091&currentassignmenthash=283ab0df51a5fa900fd8fe38fe23eddd&oid=104886683&o=925b374eb433b8d5d3305e867047a73c). - Practice sensible, safe work habits. - Know your laboratory\'s CHP. - Know the location of SDSs, CHP, and other laboratory safety materials. - Know the location of the eyewash stations that are closest to the areas where chemicals are used. - Know how to use the eyewash correctly. - Know the location of spill kits. ### **Keep It Safe!** Your laboratory has provided you with the equipment and training to protect you from chemical hazards. As a responsible member of the laboratory team, it is up to you to utilize safe work practices. **3-9. Bloodborne Pathogens** **What are bloodborne pathogens?** **Bloodborne pathogens** are infectious microorganisms in human blood that can cause disease in humans, or​ Bloodborne pathogens are microorganisms such as viruses or bacteria that are carried in blood and can cause disease in people These pathogens include, but are not limited to, hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV). Needlesticks and other sharps-related injuries may expose workers to bloodborne pathogens. Workers in many occupations, including first responders, housekeeping personnel in some industries, nurses and other healthcare personnel, all may be at risk for exposure to bloodborne pathogens. **What can be done to control exposure to bloodborne pathogens?** In order to reduce or eliminate the hazards of occupational exposure to bloodborne pathogens, an employer must implement an exposure control plan for the worksite with details on employee protection measures. The plan must also describe how an employer will use engineering and work practice controls, personal protective clothing and equipment, employee training, medical surveillance, hepatitis B vaccinations, and other provisions as required by **OSHA\'s (Occupational Safety and Health Administration)** Bloodborne Pathogens Standard ([[29 CFR 1910.1030]](https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030)). Engineering controls are the primary means of eliminating or minimizing employee exposure and include the use of safer medical devices, such as needleless devices, shielded needle devices, and plastic capillary tubes. 5 Ways to Prevent Sharps and Needlstick Injuries **You Are at Risk!** Healthcare workers come into contact with materials that may contain [[bloodborne]](https://www.medialab.com/courses/s_page.aspx?step=2&currentassignment=53086094&currentassignmenthash=bbe9047a66e6e153ec3d7c446cbdaa6f&oid=104790767&o=5095ca4293e49cd1e81d1b42c9716e19) pathogens. Bloodborne pathogens are infectious organisms, usually viruses, that live in human blood and body fluids. The bloodborne pathogens that are most likely to be present in human body fluids and are, therefore, of greatest concern to healthcare workers are: - - - Currently, most workers in the United States are unlikely to encounter the Ebola virus or individuals with Ebola Virus Disease (EVD). However, healthcare workers are at greater risk for occupational EVD exposure than workers in most other professions. OSHA's requirements and recommendations for protecting workers at greater risk for EVD exposure are discussed at the end of this course. **Components of the OSHA Bloodborne Pathogens Standard** 1. 2. - - 3. - - - - 4. Accident occurs ### What to do if an exposure in **Standard Precautions?** The consistent use of standard precautions protects health care workers from exposure to [bloodborne](https://www.medialab.com/courses/s_page.aspx?step=23&currentassignment=53086094&currentassignmenthash=bbe9047a66e6e153ec3d7c446cbdaa6f&oid=104790767&o=5095ca4293e49cd1e81d1b42c9716e19) pathogens. Standard precaution guidelines state that all blood and body fluids should be handled as if they are infectious and capable of transmitting disease. Standard precautions apply to: - Blood - Body fluids - Secretions (except sweat\*) - Excretions - Non-intact skin - Mucous membranes \*Note that sweat is listed among the body fluids that can transmit the Ebola virus. **3-10. Methods of Control** If you follow this hierarchy of controls presented to the right, you will minimize the risk of infection from exposure to [[bloodborne]](https://www.medialab.com/courses/s_page.aspx?step=25&currentassignment=53086094&currentassignmenthash=bbe9047a66e6e153ec3d7c446cbdaa6f&oid=104790767&o=5095ca4293e49cd1e81d1b42c9716e19) pathogens and other potentially infectious materials. The next few pages will acquaint you with these ways to keep yourself safe. **Engineering Controls** Engineering controls are devices that isolate the worker from the hazard of exposure. Examples include: - - - - - - Proper use of engineering controls in your workplace will help protect you from [[bloodborne]](https://www.medialab.com/courses/s_page.aspx?step=26&currentassignment=53086094&currentassignmenthash=bbe9047a66e6e153ec3d7c446cbdaa6f&oid=104790767&o=5095ca4293e49cd1e81d1b42c9716e19) pathogens.  **Work Practice Controls** Work practice controls specify how to perform a task. Wherever there is a risk of exposure to [[bloodborne]](https://www.medialab.com/courses/s_page.aspx?step=27&currentassignment=53086094&currentassignmenthash=bbe9047a66e6e153ec3d7c446cbdaa6f&oid=104790767&o=5095ca4293e49cd1e81d1b42c9716e19) pathogens or other potentially infectious materials ([[OPIM]](https://www.medialab.com/courses/s_page.aspx?step=27&currentassignment=53086094&currentassignmenthash=bbe9047a66e6e153ec3d7c446cbdaa6f&oid=104790767&o=5095ca4293e49cd1e81d1b42c9716e19)), these restrictions apply: - - - - - - **Sharps** A sharp is any object that can penetrate the skin. Examples include: - - - It is important to handle and dispose of sharps properly to prevent injury and potential infection. **Needles, Safety Needles, and Needleless Systems** Most hospitals use some form of needle/holder combination that incorporates a needle safety device. This device has a mechanism that will cover the needle after use. It must be activated as soon as the task is completed. The device that is pictured here is just one of many options that are currently available. There are also needleless systems that use special adapters that can be attached to some intravenous lines and will permit blood to be obtained without the use of needles. **Sharps Safety Summary** **DO\...** place all needles and other sharps in puncture-resistant sharps disposal containers as soon as possible after use. use extreme caution or a safety device when removing a scalpel blade from its handle. **DO NOT\...** recap, bend, shear, or break needles. remove needles from needle holders or disposable syringes. fill sharps containers above the line on the sharps container that indicates maximum fill (no more than 3/4 full). https://www.medialab.com/courses/imgs/4786-1448924.png **3-11. Exposure Incident** Even after taking all the proper precautions, there is still a small chance of an exposure incident. An **Exposure incident** occurs when: Blood or another potentially infectious body fluid comes into direct contact with mucous membranes or non-intact skin. **Parenteral exposure** means: Exposure occurring as a result of piercing the skin barrier through needlesticks, cuts, or abrasions. If an Exposure Occurs If an exposure occurs, wash the affected area immediately with soap and water. Contact your supervisor immediately, regardless of the situation or the time of day. Your supervisor will refer you for an immediate evaluation and any necessary treatment. Confidentiality will be maintained and your blood will be tested only with your consent. **Avoiding Exposure** Using safe work practices will help prevent infection caused by exposure to [[bloodborne]](https://www.medialab.com/courses/s_page.aspx?step=57&currentassignment=53086094&currentassignmenthash=bbe9047a66e6e153ec3d7c446cbdaa6f&oid=104790767&o=5095ca4293e49cd1e81d1b42c9716e19) pathogens. - - -