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WEEK 2 Safety IN Immunology AND Serology Laboratory

IMMUNOLOGY AND SEROLOGY (Our Lady of Fatima University)

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PRELIMS: SAFETY IN IMMUNOLOGY AND SEROLOGY LABORATORY

BSMLS TERM
IMSE311 IMMUNOLOGY
LABORATORY
AND SEROLOGY 3 01
doing in the laboratories sa kanila rin
OUTLINE po ito nanggagaling
I. Safety Standards and ▪ when it comes to the guidelines and
Agencies
II. General Safety standardization the do's and don'ts
Practices that we are doing in the laboratories
III. Procedure Precaution
IV. Body Substance  Centers for Disease Control and Prevention
Isolation
(CDC)
V. Standard Precautions
VI. Safe Work Practices o Part of the U.S. Department of Health and
for Infection Control Human Services Public Health Service
VII. Laboratory Hazards  When it comes to the different
VIII. Biosafety
IX. Biohazard pathogens, it can be classified as
level one two three and four and with
those levels of pathogens we have
different restrictions for that. What
SAFETY STANDARDS AND AGENCIES would be the proper handling with
the level one pathogen, with the level
● U.S. Department of Labor, Occupational Safety
two three and four and it is mandated
and Health Administration (OSHA)
by the center disease control.
o When it comes to the department of labor and  Consider emerging diseases, public
the OSHA, they are the governing agencies health services
which is mandating the different guidelines  College of American Pathologists (CAP)
and standardization when it comes to the o Head of the laboratory – pathologists
employees specifically to the medical o Could be anatomical or a clinical pathologist
technologies employed or working in the  The Joint Commission
laboratory. Bakit? when it comes to the o Maintain the facilities of laboratory (specific
laboratory, we are handling biological hustle working area, criteria and standardization)
so with that they are mandating the proper o PH - DOH
PPEs, what would be the precautions that we
need to follow so that hindi po tayo GENERAL SAFETY PRACTICES
magkaroon ng harmful effects with those
1. Staff must wear laboratory coats and be additionally
pathogens.
protected from contamination by infectious agents.
● Clinical and Laboratory Standards Institute (CLSI)
2. Food and drinks should not be consumed in work areas or
o A nonprofit educational organization that stored in the same area as specimens. Containers,
provides a forum for the development, refrigerators, or freezers used for specimens should be
promotion, and use of national and standards marked as containing a biohazard.

▪ In connection with the different 3. Specimens needing centrifugation are capped and placed
normal values that we have in each into a centrifuge with a sealed dome.
test that we are doing in the
4. A gauze square is used when opening rubber stoppered
laboratory they are the one who take
test tubes to minimize aerosol production (introduction of
note of that
substances into the air).
▪ When it comes to the different SOPs
5. Autodilutors or safety bulbs are used for pipetting.
with the different tests that we are
Pipetting of any clinical material by mouth is strictly forbidden

BSMLS | BANDE, SY, TABIQUE pg. 1

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o Safety bulbs – tthis would be the color
orange one that is squeezed para maka kuha
ng liquid solutions using serological pipette,
volumetric pipette.
o Autodilutors – equipment sinasaksak para
gumana, kusang magsusuck ng liquid.
PROCEDURE PRECAUTIONS
 Universal precautions (UP) were instituted by the
CDC in 1985 to protect health-care workers from
exposure to bloodborne pathogens, primarily
hepatitis B virus (HBV) and HIV.
o HIV proficiency certificate – you are allowed
to handle different specimen.
 The guideline recommends:
o Wearing gloves when collecting or handling
blood and body fluids contaminated with
blood
o Wearing face shields when there is danger of
blood splashing on mucous membranes
o Disposing of all needles and sharp objects in
puncture resistant containers without
recapping
BODY SUBSTANCE ISOLATION (BSI)
 A modification of universal precautions
 Not limited to bloodborne pathogens and considers all
body fluids and moist body substances to be
potentially infectious.
 Disadvantage of the guideline is that it does not
recommend handwashing after removing gloves
unless visual contamination is present
STANDARD PRECAUTIONS
Assumes every person in the health care setting is potentially
infected or colonized by an organism that could be transmitted
Applies to all blood and body fluids, mucous membranes and
non-intact skin and stresses handwashing.
 Hand Hygiene
 Wearing of gloves
 Mask, Eye Protection, and Face Shield
 Gown
 Respiratory hygiene and cough etiquette
 Needles
To help prevent nosocomial infections, the CDC in 1994
implemented two levels of precautions.
 The first level is Standard Precautions
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o Formerly Universal Precautions
o Specifies precautions to use in caring for all
patients regardless of diagnosis or presumed
infection status.
 The second level is Isolation Precautions/
Transmission based Precautions
o Specifies precautions to use for patients
either suspected, or known to be infected
with certain pathogens transmitted by
airborne, droplet, or contact routes.
o Precautions that are based on how the
infectious agent is transmitted
PREVENTING INFECTIONS
PROCEDURE PRECAUTIONS
TRANSMISSION-BASED PRECAUTIONS/ ISOLATION
PRECAUTIONS
 Are to be used for patients known or suspected to be
infected or colonized with highly transmissible or
epidemiologically significant pathogens that require
special precautions in addition to standard
precautions.
 Isolation precautions are used less often and only
with patients who have specific infections.
ISOLATION PRECAUTIONS
Airborne Precautions
 These must be used in addition to standard
precautions for patients known or suspected to be
infected with microorganisms transmitted by airborne
droplet nuclei (particles smaller than 5 m).
Droplet Precautions
 These must be used in addition to standard
precautions for patients known or suspected to be
infected with microorganisms transmitted by droplets
(particles larger than 5 m)
 It is generated when a patient talks, coughs, or
sneezes and during certain procedures such as
suctioning.
Contact Precautions
 These must be used in addition to standard
precautions when a patient is known or suspected to
be infected or colonized with epidemiologically
important microorganisms that can be transmitted by
direct contact with the patient or indirect contact with
surfaces or patient-care items.
SAFE WORK PRACTICE FOR INFECTION CONTROL
 The use of CDC Standard Precautions is an
approach to infection control that prevents
occupational exposures to bloodborne pathogens.
BSMLS | BANDE, SY, TABIQUE pg. 2
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 OSHA requires laboratories to have a personal  Because most laboratory specimens have the
protective equipment (PPE) program. potential to contain infectious agents, they are
o Selection and Use of Gloves considered biohazards.
o Facial Barrier Protection and Occlusive
Bandages
o Laboratory Coats or Gowns as Barrier
Protection

Handwashing
Hands should always be washed at the following times:
1. before patient contact, when gloves are removed
2. prior to leaving the work area
3. whenever the hands have been knowingly
contaminated
4. before going to designated break areas, and before
and after using bathroom facilities.

Soiled Glove Removal

Laboratory Hazards
BIOSAFETY
 A term used to describe the safe handling of
biological substances that pose a risk to health.
 Biological hazards can be encountered in a
healthcare setting on a daily basis.
 Healthcare personnel must be able to recognize
them in order to take the precautions necessary to
eliminate or minimize exposure to them.
BIOHAZARD
 Anything harmful or potentially harmful to health is
called a biohazard (short for biological hazard)
 It should be identified by a biohazard symbol
o In biohazard, we need to eliminate the source; how
this particular biohazard transmit; what would be the
different susceptible host that possible we counter.
Pwedeng tayo, pwedeng mahawa tayo from the other
people and so on and so forth.
o Naka depende rin dito yung pinaka reservoir, kung
san ba mismo unang nanggaling yung pinaka
pathogen.
o Most likely, kapag sa source ang pinakagagawin
natin to eliminate is handwashing and biohazardous
waste disposable. That’s why we should take note the
color coding of the different garbage/container that
we use.
o Decontamination, kapag tayo ay naglilinis na ng mga
countertops and test tubes that we use.
o Specimen bagging, if that particular is intended for a
very contagious infectious diseases. You need to do
that particular specimen bagging. Dapat ito ay hindi
nakaexpose lalong lalong na kung itratransport mo na
from one laboratory to another laboratory, specimen
bagging is important.
o Handwashing; PPE; Aerosol prevention, dapat
ipractice na natin kapag tayo ay mag-auncup ng mga
vacutainer tubes. We should do it under biosafety
cabinets; Sterile/disposable equipment and pest
control.
o In susceptible host, we need to follow the standard
precaution because that would be the main object of
the standard precaution that we have.
o Immunization, since we are in a pandemic, one of the
mitigation to eliminate the spread of COVID-19 is
immunization of the host. These particular vaccines
are attenuated meaning they are strain of that
particular bacteria but it is less virulent.
o BCG vaccine is intended for tuberculosis
(TB).
o Polio vaccines, Oral polio vaccine, MMR
vaccine, Measles mumps rubella, varicella
zoster vaccine, all of these are in line with that
immunization on how we can get a protection
from that particular immunization.
o Healthy lifestyle, that would be the healthy foods that
we eat, physical activity that we should be active.

BSMLS | BANDE, SY, TABIQUE pg. 3

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o Exposure control plan, each institution have their own
exposure control plan.
o Postexposure prophylaxis, if ever kung ikaw ay
nakapag extract sa pasyenteng may HIV may
hepatitis b virus at kapag ikaw ay basta basta nalang
pina-inom ng mga antibiotics, that would be part of
the posexposure prophylaxis.
BIOLOGICAL HAZARDS
 The chain of infection requires a continuous link between
three elements: a source, a method of transmission,
and a susceptible host.
 The most likely source of infection in serological testing is
through contact with patient specimens.
 Exposure to virus such as the hepatitis viruses and
human immunodeficiency virus (HIV)
 The ultimate goal of biological safety is to prevent
completion of the chain by preventing transmission.
 Strict adherence to guidelines published by the Centers
for Disease Control and Prevention (CDC) and the
Occupational Safety and Health Administration
(OSHA) is essential.
CHAIN OF INFECTION RELATED TO BIOHAZARD
SYMBOL
BIOLOGICAL WASTE DISPOSAL
 All biological waste, except urine, must be place in
appropriate containers labeled with biohazard symbol.
 Any supplies contaminated with blood and body fluids
must also disposed in containers clearly marked with the
biohazard symbol or with red or yellow color-coding.
 Contaminated non-disposable equipment, blood spills,
and blood and body fluid processing areas must be
disinfected.
 The most commonly used disinfectant is 1:10 dilution of
sodium hypochlorite (household bleach) prepared
weekly and stored in aplastic, not a glass, bottle.
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BLOOD-BORNE PATHOGEN
 The term blood-borne pathogen (BBP) is applied to any
infectious microorganism present in blood and other body
fluids and tissues.
 Such pathogens, which can be present in a patient’s body
fluids even if there are no symptoms of disease, are
among the most significant biohazards faced by
healthcare workers.
 This may include pathogens such as human
immunodeficiency virus (HIV), hepatitis C virus
(HCV), and hepatitis B virus (HBV).
HBV AND HEPATITIS D VIRUS
 Hepatitis B (once called serum hepatitis)
o Is caused by HBV, a potentially life-threatening
blood-borne pathogen that targets the liver.
o It has been the most frequently occurring
laboratory-associated infection and the major
occupational hazard in the healthcare industry.
 Anyone infected with HBV is at risk of also acquiring
hepatitis D (delta) virus (HDV), which is a defective virus
that can multiply only in the presence of HBV.
Note:
 When it comes to the hepatitis B virus, it is correlated
with the hepatitis D virus (delta virus).
HBV VACCINATION
 The best defense against HBV infection is vaccination.
 Vaccination consists of a series of three equal
intramuscular injections of vaccine: an initial dose, a
second dose 1 month after the first, and a third dose 6
months following the initial dose.
 The vaccine also protects against HDV since it can only
be contracted concurrently with HBV infection.
 Success of immunization and proof of immunity can be
determined 1 to 2 months after the last vaccination dose
by a blood test that detects the presence of the hepatitis
B surface antibody (anti-HBs) in the person’s serum.
HBV EXPOSURE HAZARDS
 HBV can be present in blood and other body fluids such
as urine, serum, cerebrospinal fluid (CSF), and saliva.
 It can survive up to a week in dried blood on work
surfaces, equipment, telephones, and other objects.
 In a healthcare setting, it is primarily transmitted through
needlesticks (a single needlestick can transmit HBV)
and other sharps injuries and contact with contaminated
equipment, object, surfaces, aerosols, spills and
splashes.
 In nonmedical setting, it is transmitted primarily through
sexual contact and sharing of dirty needles.
BSMLS | BANDE, SY, TABIQUE pg. 4
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HEPATITIS C VIRUS (HCV)  HIV can enter the body through all the same routes as the
hepatitis viruses.
 Hepatitis C, caused by infection with HCV, has become
the most widespread chronic bloodborne illness in the
United Sates. SHARPS HAZARDS
 Found to be the primary cause of non-A, non-B
hepatitis.  Sharp objects in the laboratory, including needles,
 No vaccine is currently available. lancets, and broken glassware.
 The number-one personal safety rule when handling
needles is to never manually recap one.
HCV EXPOSURE HAZARD o Use only the “fishing technique/fishing
method”
 HCV is found primarily in blood and serum, less frequently  Devices available for needle disposal:
in saliva, and seldom in urine and semen.  Needle holders that become a sheath
 It can enter the body in the same manner as HBV.  Needles that automatically resheath or become
blunt
 However, infection primarily occurs after large or multiple
 Needles with attached sheathes.
exposures.
 All sharps must be disposed of in puncture-resistant,
 As in the case of HBV, sexual contact and needle sharing
leak-proof containers labeled with biohazard symbol.
are the primary means of transmission in nonmedical
setting.

HUMAN IMMUNODEFICIENCY VIRUS (HIV)

 HV attacks the body’s immune system (specifically the

CD4 cells and CD8 cells), causing AIDS by leaving the
body susceptible to opportunistic infections.
 Opportunistic infections are cause by organisms that
would not ordinarily be pathogens to a normal healthy
individual.
 HIV infection has a poor prognosis and is of great concern
to healthcare workers.
o Early stage of HIV – develops within 2-3 weeks
after infection with HIV. During this time, some
people have flu-like symptoms, such as fever and
headache.
o Latent stage of HIV – after the early stage of
HIV; about 3-20 years normal.
o Late stage of HIV – AIDS is the final, most
severe stage of HIV infection. Because HIV has
severely damaged the immune system.
 Rapid weight loss, prone to skin
lesions, and they are
immunocompromised.
 They are prone with other diseases
like pneumonia and skin diseases.
Note:
 Under the standard precautions (universal
precautions), all of the patients are potentially
infectious and should be considered infectious.
HIV EXPOSURE HAZARD
 HIV has been isolated from blood, serum, saliva, tears,
urine, cerebrospinal fluid, amniotic fluid, breast milk,
cervical secretions, and tissue of infected persons.
 The risk to healthcare workers, however, is primarily
through exposure to blood.
REGULATIONS TO PROTECT HEALTH-CARE WORKERS
FROM BLOOD-BORNE PATHOGENS
 Monitored and enforced by OSHA
 The Occupational Exposure to Bloodborne Pathogens
Standard became law in 1991.
 It requires all the employers to have a written Blood-borne
Pathogen Exposure Control Plan and to provide
necessary protection, free of charge, for employees.
OCCUPATIONAL SAFETY AND HEALTH
ADMINISTRATION (OSHA)
Specifics of the OSHA standard include the following:
 Requiring all employees to practice universal (standard)
precautions.
 Providing PPE’s like lab coats, gowns, face shield, and
gloves to employees and providing laundry facilities for
non-disposable protective clothing.
 Providing sharps disposal containers and prohibiting
recapping of needles.
*Puncture resistant dapat and leak proof
 Prohibiting eating, drinking, smoking, and applying
cosmetics in the work area.
*Dapat may separate room kung saan kakain
 Labeling all biohazardous material and containers.

BSMLS | BANDE, SY, TABIQUE pg. 5

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 Providing immunization for the hepatitis B virus free  Describes the effects of overexposure or exceeding
of charge. the threshold limit value of allowance exposure for
 Establishing daily work surface disinfection protocol. an employee in an 8-hour a day
The disinfectant of choice for blood borne pathogens is  Describes protective personal clothing and
Sodium Hypochlorite (Household bleach freshly diluted equipment requirements, first aid practices, spill
1:10 ratio) information and disposal procedures.
 Providing medical follow up to employees who have
been accidentally exposed to blood borne pathogens. CHEMICAL WASTE DISPOSAL
 Documenting regular training of employees in safety
standards  Hazardous chemical waste should be disposed of per
current EPA regulations
OSHA’s Exposure Control Plan o Environmental Protection Agency or EPA
regulations.
Categories of Exposure:  Local regulations and the Department of
 Category I – DAILY exposure to blood and vodily Transportation also track disposal of hazardous
fluids chemical waste
o We as MedTech belongs to this category of  Many kits in testing contain sodium azide which can
exposure be disposed down the drain with plenty of water to
 Category II – REGULAR exposure to blood and avoid buildup in plumbing.
bodily fluids o Sodium Azide is the most common used
 Category III – NO exposure to blood and bodily chemical here
fluids
RADIOACTIVE HAZARDS
CHEMICAL HAZARDS
 Radioactivity is encountered in the clinical laboratory
General Rules for safe handling of chemicals include: when procedures using radioisotopes, such as
 Taking precautions to avoid getting chemicals on radioimmunoassay are performed.
your body, clothes and work area  The effect of radiation is related to the length of
 Wearing PPE such as safety goggles when pouring exposure and are cumulative.
chemicals  Persons working in the radioactive environment are
 Observing strict labeling practices required to wear measuring devices to determine
 Following instructions carefully the amount of radiation they are accumulating
 Preparing reagents under a fume hood  Exposure to radiation during pregnancy presents
o MSDS – Material Safety Datasheet, dito danger to the fetus, and personnel who are or who
nakalagay yun label and lahat ng dapat think they may be pregnant should avoid areas with
natin malaman, radioactive symbol/warning.
 Chemical should never be mixed together, unless o teratogenic = leads to spontaneous
specific instructions are followed, and must be abortion and miscarriage
added in the order specified.
o Hiwalay flammable, corrosives, normal RADIOACTIVE WASTE DISPOSAL
concentration, acids and bases etc.
 Disposal of radioactive waste is regulated by the
MSDS – Material Safety Datasheet Nuclear Regulatory Commission (NRC)
 Such waste must be separated from other waste
materials in the laboratory and may be disposed of
 Describes hazards, safe handling, storage and
by storing in the locked, labeled room until the
disposal of hazardous chemicals.
background count is reduced by the specific number
 Each MSDS contains basic information about the
of half-lives.
specific chemical in product
o Hindi agad tinatapon kasi pinapababa muna
o Trade name,
yung threshold ng mga radioactive waste
o chemical name and synonyms,
materials.
o chemical family,
o Manufacturer’s name and address,
o Emergency telephone number for further ELECTRICAL HAZARDS
information about the chemical
o Hazardous ingredients,  Contains electrical equipment in the laboratory
o Physical data  Check for frayed cords and overload circuits
o Fire and explosion Data  Check danger of water or fluid coming in contact
o Health Hazard with equipment
o And Protection information  Equipment should not be operated with wet
hands

BSMLS | BANDE, SY, TABIQUE pg. 6

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 During accident with electrical shock, the electrical o Oxidizer OXY

source must be removed immediately without o Acid ACID
touching the person or equipment o Alkali ALK
 Turn off the circuit breaker before unplugging o Corrosive COR
the equipment using non-conductive glass or o Use NO WATER
wood object
o Radiation Hazard
 Victim should receive immediate medical
 Instability
assistance
o 4 –May detonate
FIRE AND EXPLOSIVE HAZARDS o 3 –shock and heat may detonate
o 2 –violent chemical change
 Involves potentially volatile or explosive chemicals
o 1 –unstable if heated
that requires procedures for handling storage
 Flammable chemicals should be stored in safety o 0 –stable
cabinets and explosions-proof refrigerators
 Cylinder of compressed gas should be located away
from heat

WHEN A FIRE IS DISCOVERED?

RACE
 RESCUE rescue anyone in immediate danger
 ALARM activate the institutional fire alarm
systems
 CONTAIN close doors to potentially affected areas
 EXTINGUISH/EVACUATE attempt to extinguish the
fire if possible or evacuate closing the doors
o You should be knowledgeable of the floor
plan to know the exits and evacuation area

OPERATING THE FIRE EXTINGUISHER

PASS
 PULL Pull the pin
 AIM Aim at the base of the fire
 SQUEEZE Squeeze handles
 SWEEP Sweep nozzles side to side

NATIONAL FIRE PROTECTION ASSOCIATION (NFPA)

Labeling System
 RED Designates Flammability FOUR CLASSES OF FIRES
 BLUE Indicated health hazard
 YELLOW Indicated Reactivity  CLASS A – Ordinary combustible, solid materials
 WHITE Indicate special consideration (Paper, Wood)
 CLASS B – Flammable liquid/gasses and
STANDARD SYSTEM FOR THE IDENTIFICATION OF combustible petroleum products
FIRE HAZARD MATERIALS  CLASS C – Energized electrical equipment
 Health Hazard  CLASS D – Combustible/Reactive Metals (Mg, Na,
o 4 –Deadly K)
o Magnesium, Sodium, Potassium
o 3 –Extreme Danger
 CLASS E – Detonation (Higher Pressure/Simple
o 2 –Hazardous
Explosion)
o 1 –Slightly hazardous
o 0 –Normal Material FIRE EXTINGUISHERS
 Fire Hazard
o FLASHPOINT-HIGHEST  CLASS A EXTINGUISHERS
o 4 –below 73 o Use soda and acid or water to cool the fire
o 3 –below 100
o 2 –below 200  CLASS B EXTINGUISHERS
o 1 –Above 200 o Use foam, dry chemical, or carbon
o 0 –Will not burn dioxide to smother the fire
 Specific Hazard

BSMLS | BANDE, SY, TABIQUE pg. 7

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 CLASS C EXTINGUISHERS
o Use dry chemical, carbon dioxide, halon
or other non-conducting agents to
smother the fire

 CLAS ABC EXTINGUISHERS (MULTI-PURPOSE)

o Use dry chemical reagents to smother the
fire
o They can be used on Class A, B, C fires.

 CLASS K EXTINGUISHER
o Use a potassium based alkaline liquid
specifically formulated to fight high-
temperature grease, oil, or fat fires by
cooling and smothering them without
splashing
o Some class K extinguishers can also be on
Class A, B and C fires.

PHYSICAL HAZARD

 Not unique in the laboratory

 Routine precautions observed outside the workplace
apply
 Include not running in rooms and hallways
 Watching for wet floors
 Bending the knees when lifting heavy objects
 Keeping long hair pulled back
 Avoid dangling jewelry
 Closed toed-shoe that provide maximum support

BSMLS | BANDE, SY, TABIQUE pg. 8

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