Intro to Clinical Lab Science- Safety

Intro

 Most safety rules are based on common sense

 Most accidents occur when these rules are not followed
 OSHA ( Occupational Safety and Health Administration) make sure employers give employees
safe working conditions
o This can include making sure employees have appropriate vaccinations
 3 Areas of concerns In lab
o Physical
o Chemical
o Biological

General Lab Rules

 Never eat, drink, smoke or put fingers, pencils or pens in the mouth
 Never place food or drinks in the refrigerator used for storing reagents or specimens
 Never apply makeup, handle contact lenses, or rub eyes in lab
 Never wear long chains, large or dangling earrings or loose bracelets
 Wear a full length buttoned lab-coat
 Do not wear PPE outside of the clinical laboratory
 Tie back hair that is longer than shoulder length
 Wear comfortable sturdy, shoes with closed toes
 Keep fingernails short and well-manicured

Physical Hazards

 Fire and electrical shock are potential hazards associated with the use of electrical equipment
 Equipment must be kept in good condition and the manufacturer’s instructions must be
followed such as routine maintenance and repairs
 Use only UL approved grounded plugs
 No extension cords
 No electrical circuit overloading
 Use surge protectors
 Unplug device before servicing, use warning sign when out of order
 Use signs for high voltage areas

Chemical Hazards

 Chemical hazards include contact with

o Corrosives
o Caustics
o Flammable materials
o Toxic or carcinogenic substances
  Exercise caution when handling any chemicals
 SDS should be available on any chemical in the workplace
 SDS contains
o General information for the product
o Precautionary information
o Emergency information
 Products with hazardous warning label requires an SDS
 SDS should be readily accessible to employees
 Public employee Hazardous Chemical Protection and Right to know Act’ 88
 NFPA Labeling System
o Fire Diamond, allows for a chemical’s danger to be quickly assessed
o Made up of 4 smaller diamonds
 Blue –Health Hazard
 Red- Fire Hazard
 Yellow- Reactivity
 White- Specific Hazard
 ( How Far to Run)
 Follow the emergency procedure in the SDS
 Immediately wash skin or eyes with water if they come in contact with any chemicals
 Flammable or volatile chemicals must be stored in a well ventilated area
 Immediately recap all bottles after use
 All chemicals must be labeled with the required SDS information
 Always wear the correct PPE
 Always use proper chemical clean-up materials when cleaning up a chemical spill
o Some spills should be left to others to clean up
 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 others than their intended use
 Chemical Compatibility

Biological Hazards

 Includes specimens or reagents that are capable of transmitting disease or contain pathogenic
organisms
 Use extreme caution and common sense when working in the lab
 Standard precaution-the best strategy for successful nosocomial infection control
o Goal is to minimize the risk of infection transmission from both recognized and
unrecognized sources

Biosafety levels
  BSL1 –basic level with no special barriers other than a sink for hand washing
 BSL2- for working with any human-derived body fluids, blood, tissues,or primary human cell
lines where the presence if an infectious agent may be unknown. Not for agents transmittable
by aerosol route.
o Primary barriers
 Splash shields
 Face protection
 Gowns
 Gloves
 Watch for sharps
 BSL3- agents with a potential for respiratory transmission, may cause serious and potentially
lethal infection. Controlled access to the lab and special ventilation requirements
 BSL4- dangerous and exotic agent that pose a high risk of life threatening disease, which may be
transmitted via the aerosol route and for which there is no available vaccine or therapy
o Primary barriers
 Full body, air supplied positive-pressure personnel suit
 Separate building or completely isolated zone

Standard Precautions

 All human blood and certain human body fluids are treated as if they are known to be infectious
for HIV, HVB, HVC and other known not yet identified blood borne pathogens
 These standards must be observed with all patients
 Handwashing
 Gloves
 Wear mask and eye protection or face shield during procedures that cause splashes of body
fluids
 Never recap needles ( use needles with safety features and one handed technique to secure
them
 Use resuscitation devices as an alternative to mouth-to mouth
 Use private room for patient if possible

Transmission based precautions

 Transmission-based precautions are used for patients known or suspected to be infected or

colonized with infectious agents that can be transmitted easily
o Airborne precautions- used when patients are infected or thought to be infected by
organisms that can be transmitted by air-droplet nuclei
 N95 respirator must be worm when entering these patients rooms
 TB
o Droplet precautions- used on patients that are known or suspected of being infected by
microorganisms that can be spread by droplets caused by sneezing, couching, talking, or
during certain procedures( wear mask if within 3 feet of patient)
 Particles are larger than 5 micrometers
 N.meningitidis, m.pneumoniae, pertussis
 o Contact precautions –used when a patient is known or suspected of being infected by
direct contact with the patient or by indirect contact with surfaces or patient care items
 C.diff, ABRB, shingles

Chain of infection

 Pathogens have a life and growth cycle that is a chain. If you break this chain you stop the
infectious process
 Reservoir host- insect, animal, or human
o Pathogen must gain access to a host to survive
o The organism receives nourishment from the host so it can grow and multiply
o The organism may cause infection in the host or they be transmitted from the host to
other healthy individuals
 Means of Exit- The organism can escape a host by
o Mouth,
o nose
o eyes
o ears
o Intestines
o Urinary tract
o Reproductive tract
o Open wound
 Means of transmission- may be spread by direct or indirect transmission
o Direct- when another individual comes in direct contact with an infected person or with
the discharges of an infected person
o Indirect-occurs when droplets are expelled by coughing or sneezing, by vectors by
contaminated food or drink or by contaminated objects
 Means of entry- the organism must find a means of entry
o Same as means of exit
 Susceptibility of the host
o Factors that affect the susceptibility of the host are
 Location of entry
 The number of organisms
 The living environment of the host
 The health of the host

Biohazard exposure Routes

 Airborne- inhaled when splashes and aerosols are generated

o Centrifugation of specimens
o Removal of stoppers
o Improperly aliquoting specimens
o Improperly storing, mixing or handling of chemicals
 Ingestion-biohazardous substance can be ingested when the healthcare worker neglects to wash
contaminated hands
 o And when food, drink, cigarettes are handled after being in the lab
o Covering mouth with hand when coughing or sneezing
o Biting nails
o Chewing on pens or pencils
o Licking fingers
 Non-intact skin- biohazardous substances can enter through both visible and invisible
preexisting abrasions, burns, cuts, scratches, sores, dermatitis, and chapped skin
o Cover with waterproof or impermeable tape or bandages
 Percutaneous – through the skin
 Permucosal- through mucous membranes
o Mouth
o Nose
o Conjunctive of the eye
 Direct inoculation with blood or body fluids by accidental needle-sticks and injuries from other
sharps

Reporting needle sticks

 Immediately notify the supervisor and employee health department at your instituation-
medication may be required
 The supervisor will make a note of the patient involved
 Contact Student Health

Blood borne pathogens

 Any infectious microorganisms that is present in blood and other body fluids and tissues
o Most significant biohazards facing health care workers
o Most well-known are
 HIV
 HVB
 HVC
o Others
 Other hepatitis viruses
 CMV
 Malaria
 Borrelia
 Creutzfeldt-jakob disease
 Syphilis
o Can be present in a patient’s body fluid even when patient is symptom free

Controls for Blood Borne Pathogens

 Engineering controls- used to eliminate health hazards from the workplace

o E.g- biosafety cabinets, autoclaves, negative pressure rooms, needle safety devices
 Work practice controls
o Needles and sharp instruments
  Do not recap needles
 Do not bend or break needles
 Do not remove needles from syringes
 Immediately after use dispose of sharps in the sharps container
o Laboratory specimens
 Transport place specimens in a well-constructed container with a secure lid,
then place in a second container
 Use biologic safety cabinet if procedures generate droplets or spattering
 Immediately decontaminate work areas with an approved disinfectant
 Decontaminate any equipment that has been contaminate before attempting to
repair
 No mouth pipetting
 Personal Protection Equipment (PPE) – used to protect the healthcare provider from exposure
to biohazardous material
o Gloves-should be changed after contact with each patient and after handling patient
samples
 Always wear gloves when there is a potential of coming in contact with patient’s
blood , body fluids, mucous membranes, or skin that is non intact
 When handling any item or working on any surface that could be contaminated
 When cleaning and decontaminating spills of blood
o Gowns
 Should be changed if they become soiled or wet after cleaning body fluid spills
 Wear full length lab coat when working in clinical lab
 Follow transmission-based precautions when entering patients rooms
o Masks and eye protection
 Regular eyeglasses are not considered protective
 Wear whenever there is a potential for generating droplets of blood or body
fluids

Hand Washing

 Hand washing is the single most effective means of preventing infections

o Situations that require hand washing
 Arriving at work
 Before and after each patient
 Between procedures on the same patient
 Before putting gloves on
 After taking gloves off
 Before leaving lab
 Before and after going to the restroom
 Whenever hands become visibly or knowingly contaminated
 TAKE CARE OF WOUNDS
 Do not wash gloves
 Hand washing procedure
o Remove all jewelry
 o Turn on water and adjust to a tepid temperature
o Wet hands kepping fingertips lower than your wrist
o Apply soap to both hands
o Completely wash both hands by rubbing hands together
o Check under fingernails for possible debris and remove and debris
o Rinse your hands in a downward movement , keeping fingertips below elbows
o Dry hands completely
o Turn faucet off with clean paper towel

Infectious Waste

 Follow clinical lab policies for disposing of infective waste

 Must be separated from regular waste at the point of origin
 Biohazard waste must be incinerated before it can be landfilled