ACTIVITY

1
SAFETY IN THE CLINICAL LABORATORY

Unit Intended Learning Outcomes

At the end of the activity, the students are expected to:

1. Identify hazards properly related to handling chemicals, biologic specimens, and radiologic
materials.
2. Correctly perform donning and removing of personal protective equipment.
3. Select the correct means for disposal of waste generated in clinical laboratory.

Pre-laboratory Discussion

The clinical laboratory contains a variety of safety hazards, many of which are capable of producing serious
injury or life-threatening disease. Clinical laboratory personnel, by the nature of the work they perform,
are exposed daily to a variety of real or potential hazards such as electric shock, toxic vapors, compressed
gases, flammable liquids, radioactive material, corrosive substances, mechanical trauma, poisons, and the
inherent risks of handling biologic materials, to name a few. Each clinician should develop an
understanding of the risks associated with these hazards and must be safety conscious at all times.

Laboratory safety necessitates the effective control of all hazards that exist in the clinical laboratory at
any given time. Safety begins with the recognition of hazards and is achieved through the application of
common sense, a safety focused attitude, good personal behavior, good housekeeping in all laboratory
work and storage areas, and, above all, the continual practice of good laboratory technique.

Occupational Safety and Health Act (OSHA)

The Occupational Safety and Health Act (OSHA) was enacted by the U.S. Congress in 1970. This federal
law was enacted to provide all employees including the clinical laboratory personnel with a safe work
environment. Therefore, even if an OSHA standard has not been promulgated that deals with a specific
hazard or hazardous operation, protection of workers from all hazards or hazardous operations may be
enforceable under the OSHA Act. The OSHA standards that regulate safety in the laboratory include the:
• Bloodborne Pathogen Standard
• Communication Standard
• Respiratory Protection Standard
• Air Contaminants Standard

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 • Personal Protective Equipment Standard

BIOLOGIC SAFETY

All blood samples and other body fluids should be collected, transported, handled, and processed using
Universal Precautions (UP). Under UP, all patients are considered to be possible carriers of blood-borne
pathogens. The guidelines recommends wearing gloves when collecting or handling blood and body fluids
contaminated with blood and wearing face shields when there is danger of blood splashing on mucous
membranes and when disposing of all needles and sharp objects in puncture-proof resistant containers.

The modification of UP for body substance isolation (BSI) are not limited to blood-borne pathogens; they
consider all body fluids and moist body substances to be potentially infectious. According to BSI guidelines,
personnel should wear gloves at all times when encountering moist body substances. A major
disadvantage of BSI guidelines is that they do not recommend handwashing after removing gloves.

Spills

Any blood, body fluids or other potentially infectious material spill must be cleaned up, and the area or
equipment must be disinfected immediately. Safe clean up includes the following:
• Alert others in area of the spill
• Wear appropriate protective equipment
• Use mechanical devices to pick up broken glass or other sharp objects
• Absorb the spill with paper towels, gauze pads or tissue
• Clean the spill using a common aqueous detergent
• Disinfect the spill site using approved disinfectant or 10% bleach, using appropriate contact time
• Rinse the spill site with water
• Dispose all materials in appropriate biohazard containers

CHEMICAL SAFETY

The OSHA published the Hazard Communication Standard (Right to Know Law) for employees who may
be exposed to hazardous chemicals in the workplace. The intent of the law is to ensure that health hazards
are evaluated for all chemical that are produced and that this information is relayed to employees. The
required components addressed in this standard include the following:
• A hazard communication program to be developed and used within the facility
• Current inventory of all hazardous chemicals designated as hazardous
• Material Safety Data Sheet
• Documented training for employees

Chemicals should never be mixed together unless specific instructions are followed, and they must be
added in the order specified. This is particularly important in combining acid and water. Acid should always
be added to water to avoid the possibility of sudden splashing caused by the rapid generation of heat in

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some chemical reactions. Wearing goggles and preparing reagents under a fume hood are recommended
safety precautions.

Materials Safety Data Sheet (MSDS)

The MSDS is a major source of safety information for employees who may use hazardous materials in their
occupations. The manufacturers are responsible in providing sheets to purchasers, however, the facility
itself is responsible for obtaining and making MSDS available to employees. The following information
requirement include the following:
• Product name and identification
• Hazardous ingredients
• Physical and chemical characteristics
• Reactivity potential
• Health hazards and emergency first aid procedures
• Methods for safe handling and disposal
• Primary routes of entry
• Exposure limits and carcinogenic potential

Chemical Hygiene Plan

OSHA requires all facilities that use hazardous chemical to have a written chemical hygiene plan available
to employees. The purpose of the plan is to detail the following:
• Appropriate work practices
• Standard operating procedures
• PPE
• Engineering controls
• Employee training requirements
• Medical consultation guidelines

Each facility must appoint a chemical hygiene officer, who is responsible for implementing and
documenting compliance with the plan.

RADIATION SAFETY

A radiation safety policy should include environmental and personnel protection. All areas where
radioactive materials are used or stored must be posted with caution signs, and traffic in these areas
should be restricted to essential personnel only. Regular and systematic monitoring must be emphasized,
and decontamination of laboratory equipment, glassware, and work areas should be scheduled as part of
routine procedures. Records must be maintained as to the quantity of radioactive material on hand as
well as the quantity that is disposed. Users should be monitored to ensure that the maximal permissible
dose of radiation is not exceeded. Radiation monitors must be evaluated regularly to detect degree of
exposure for the laboratory employee. Records must be maintained for the length of employment plus
30 years.
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FIRE SAFETY

The Joint Commission (JC) requires that all healthcare institutions post evacuation routes and detailed
plans to follow in the event of a fire. Laboratory personnel should be familiar with these procedures. When
a fire is discovered, all employees are expected to take the actions in the acronym RACE:
Rescue – rescue anyone in immediate danger
Alarm – activate the institutional fire alarm system
Contain – close all doors to potentially affected areas
Extinguish/Evacuate – attempt to extinguish the fire, if possible or evacuate, closing the door.

NFPA 704

Standard system for the identification of hazards of materials for emergency response is a standard
maintained by the U.S. based National Fire Protection Association. It defines the colloquial fire diamond
used by emergency personnel to quickly and easily identify the risks posed by hazardous materials. This
helps determine what, if any, special equipment should be used, procedures followed, or precautions
taken during initial stages of an emergency response.

NFPA Hazardous Material Symbol

Fires have been divided into four classes based on the nature of the combustible material and
requirements for extinguishment:
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 • Class A : ordinary combustible solid materials, such as paper, wood, plastic and fabric
• Class B : flammable liquids/gases and combusting petroleum products
• Class C : energized electrical equipment
• Class D : combustible/reactive metals, such as magnesium, sodium and potassium

Just as fires have been divided into classes, fire extinguishers are divided into classes that correspond to
the type of fire to be extinguished. The acronym PASS can be used to remember steps in the operation:
Pull pin
Aim nozzle
Squeeze trigger
Sweep nozzle

ELECTRICAL HAZARDS

Direct hazards of electrical energy can result in death, shock, or burns. Indirect hazards can result in fire
or explosion. There are many precautionary procedures to follow when operating or working around
electrical equipment
• Use only explosion-rated equipment in hazardous atmospheres
• Use only properly grounded equipment (three-prong plug)
• Check for frayed electrical cords
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 • Promptly report any malfunctions or equipment producing a “tingle” repair
• Never operate electrical equipment with wet hands
• Know the exact location of the electrical control panel for the electricity to work area
• Use only approved extension cords in temporary applications and do not overload circuits
• Have ground, polarity, and leakage checks and other periodic preventive maintenance performed
on outlets and equipment

DISPOSAL OF HAZARDOUS MATERIALS

The safe handling and disposal of chemicals and other materials require a thorough knowledge of their
properties and hazards. Generators of hazardous wastes have a moral and legal responsibility, as defined
in applicable local, state, and federal regulations, to protect both the individual and the environment
when disposing of waste. There are four basic waste disposal techniques: flushing down the drain to the
sewer system, incineration, landfill burial, and recycling.

The most appropriate way of identifying the categories of health care waste is by sorting the waste into
color coded plastic bags or containers.

Color of Container Bag Type of Waste

Black Non-infectious Dry Waste

Green Non-infectious Wet Waste (kitchen, dietary, etc.)

Yellow Infectious and Pathological Waste

Yellow with Black Band Chemical Waste including those with heavy metals

Orange Radioactive waste

Red Sharps and Pressurized Containers

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 Teaching and Learning Activities

Pre-Analytical Phase

1. Prepare all necessary protective equipment

2. Perform correct hand washing
3. Observe universal precautions in handling biological, chemical and radiologic specimens

Analytical Phase

Materials

Gloves
Laboratory Gown
Goggles/Face shields
Face Mask
Hair net

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Procedure

Donning Personal Protective Equipment

1. The gown is put on first and tied at the neck and waist.
2. Place face protection over the nose and mouth.
3. Mask with ties are fastened first at the top, adjusted to the nose and mouth, tied at the neck and
refitted to the nose and mouth. The mask is held in place with one hand while the other hand
places the straps over the head and a final adjustment is made.
4. When needed, goggles and face shields are put on after mask and adjusted for fit.
5. Hair net is applied after wearing eye goggles and face shields.
6. Gloves are donned last and securely pulled over the cuffs of the gown.

Removing Personal Protective Equipment

1. Gloves are the most contaminated. They are removed first.

2. The first glove is pulled off using the gloved hand so that it will end up inside out in the still gloved
hand.
3. Remove the second glove by sliding the ungloved finger inside the glove of the other hand remove
the glove without touching the outside glove.
4. Dispose the gloves in a biohazard container.
5. Untie the gown and remove it by touching only the inside of the gown.
6. Dispose of the gown in the biohazard container
7. Remove the mask touching only the ties or bands
8. Unfasten the lower tie first so that the mask will not fall forward while removing the lower tie.
Dispose of the mask in a biohazard container.
9. Remove hairnet otherwise.

Post-Analytical Phase

1. Segregate and dispose all wastes into proper trash bins.

2. Disinfect the working area using 10% sodium hypochlorite.
3. Remove all the PPE properly after the activity.

References

1. Bishop, M.L., Fody, E.P., Schoeff, L.E. (2013). Clinical Chemistry: Principles, Techniques and
Correlations 7th ed. Philadelphia: Lippincott Williams and Wilkins.
2. Nuevo, J.J. (n.d.). Clinical Chemistry 1 Laboratory Manual (Outcomes Based Education Format).

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 3. Strasinger, S.K., Di Lorenzo, M.S. (2014). Urinalysis and Body Fluids 6th ed. Philadelphia: F.A. Davis
Company

Name: ___________________________________ Date: ______________

Section: ________________ Group: _________ Score: ______________

Review Questions

1. Give examples of biological, chemical, fire, electrical, and mechanical hazards in the clinical
laboratory.

2. List the responsibilities of employer and employee in providing a safe workplace.

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3. Tabulate the different types of fire with their corresponding type of fire extinguisher.

4. Describe the acceptable methods for handling and disposing biologic waste and sharp objects in
the clinical laboratory.

5. Describe precautions that laboratory personnel should take with regards to biologic and
chemical spills.

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 Assessment Criteria for Passing

Unit Intended Learning Outcomes To achieve this unit, the learner must:

1. Identify hazards properly related to handling
chemicals, biologic specimens, and radiologic
materials.
2. Correctly perform donning and removing of
personal protective equipment.
a. Discuss and know the importance of
knowing the different laboratory hazards
and be able to apply laboratory safety
practices
a. Carry out properly the procedures on
donning and removing personal protective
equipment

3. Select the correct means for disposal of waste a. Apply proper waste disposal.
generated in clinical laboratory. b. Identify the different color coded waste
bags in accordance with their specific type
of waste.

Rubrics

Weight 1 - Unsatisfactory 2 - Developing 3 - Satisfactory Score

Pre-Analytical

Materials 2 out of 4 materials 3 out of 4 materials 4 out of 4 materials

(15%) are available are available are available

Perform handwashing
Hand-Washing/ Disinfect Hands Unable to perform Perform handwashing
correctly with
(10%) handwashing correctly
assistance

Analytical

Puts on gown with opening at

Able to wear Able to wear
the back Incorrect or did not
laboratory gown but laboratory gown
wear laboratory gown
(5%) with assistance correctly

Ensures that the gown is

completely buttoned Incorrect or the gown Only one button is All buttons are
is not buttoned closed completely closed
(10%)

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Position mask with proper side
Able to wear mask
facing outward and fastens top
Incorrect or did not but not positioned Able to wear mask
tie above the ears
wear mask correctly/ with correctly
(5%) assistance

Puts on gloves and pulls glove

Able to wear gloves Able to wear gloves
over cuffs Incorrect or did not
but not pulled over and pulled it over
wear gloves
(5%) cuffs/ with assistance cuffs correctly

Removes gloves touching only

the inside Incorrect removal of Able to remove gloves Able to remove gloves
gloves but with assistance properly
(10%)

Removes laboratory gown Able to remove Able to remove

Incorrect removal of
laboratory gown but laboratory gown
(10%) laboratory gown
with assistance correctly
Unfasten mask at neck then
head Incorrect or did not Able to remove mask Able to remove mask
removed mask but with assistance correctly
(10%)

Remove hairnet Able to remove the

Incorrect or did not Able to remove the
hair net but with
(5%) removed hairnet hairnet correctly
assistance
Post-Analytical

Waste Disposal ³4 type of wastes 2-3 types of wastes All wastes were
were not disposed to were disposed to disposed to
(15%) appropriate bag appropriate bag appropriate bag

Total Score:

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