Addressing management issues

July 1, 2009

Edited by C. Anne Pontius, MBA, CMPE, MT(ASCP)

Plan, prepare for disasters

Q I recently moved to Florida, an area that has had a
few close calls (and direct hits) with some scary storms. What do you
suggest I do to make sure the lab is prepared for a disaster?

A Working in Florida affords you the opportunity to
plan ahead and prepare for hurricanes, and, in the process, be prepared
for other disasters as well. Hurricane preparedness should be addressed
under a disaster plan. Some facilities have a specific hurricane plan
that is updated yearly. Hospital plans should include laboratory
services, and lab staff should be aware of the overall plan. Check with
a supervisor if you are not aware of the current plan or if you have
suggestions to improve your facility’s emergency preparedness.

Staffing is always a critical component. Be sure to
have updated list of cell phone numbers and home phone numbers of all
staff. Disaster preparedness includes updating the call list (staff
roster) at least once each year (prior to June 1 in the case of
hurricanes) with staff assignments — for before, during, and after the
disaster. Do not rely on information stored electronically, as power
outages are expected during severe storms; keep hard-copy lists of
staff, administrators, and emergency contacts. Make sure all staff
members know where to find emergency supplies. Every hurricane survival
kit should include flashlights, batteries, bleach, cleaning supplies,
food, distilled water, drinking water, battery-operated radio, blankets,
gloves, first-aid kit, and hand sanitizers.

Phones often do not work during or after a disaster,
so make staffing plans in advance. Be flexible, because staff members
may be on vacation, will evacuate ahead of the storm, or could be
directly affected by the hurricane. Transportation will also be
affected, as roads are often closed and fuel supplies may be scarce,
which can impact staff members’ access to transportation. Many hospitals
set up a transport service to get staff to and from work, so have
addresses and directions readily available.

Other things to consider include operations issues.
During hurricane season, maintain a surplus supply of routine inventory
from outside vendors, because transportation in and out of the area may
be impossible. Know in advance which vendors have local deliveries.
Ensure you have an adequate blood supply inventory, and know how to
contact the supplier in the event of an urgent need. Do you have
validated coolers and ice for blood inventory and other supplies, if
needed? How will results, supplies, blood, and other medical supplies be
delivered? If instruments use water, what would happen if there is a
problem with the water source? Calculate how much water will be needed
to maintain essential operation and keep an adequate supply available.

What is your backup laboratory if you have to send
tests outs? Do you have agreements with other hospitals/labs to do work
in times of disaster? Establish a list of hospitals/labs that might be
able to provide supplies and staff if needed.

Remember, the best plan is to plan ahead, but
disaster preparedness should be designed to be flexible in order to
accommodate unplanned circumstances. Hold a debriefing after any
disaster to look at what worked and what improvements are needed to help
refine future preparations.

Helpful emergency preparedness resources are
available online at www.nhc.noaa.gov ,
www.FEMA.gov
,
www.cdc.gov ,
and
www.redcross.org
.

— Marian J. Cavagnaro, MS, MT(ASCP) DLM
Director, Laboratory Services
Memorial Hospital West
Pembroke Pines, FL

Bottom line: Ms. Cavagnaro has done an excellent job
of laying out how you develop a disaster plan; there is no way to summarize
it — you need it all. Keep in mind that if a disaster does strike your
facility, even the best-laid plans may not cover every detail. Make sure
everyone in the laboratory is well trained on disaster preparedness and how
to implement it, which includes understanding that flexibility and
variations may be necessary to accommodate the circumstances of the
particular disaster.

Are workers’ clothes carrying germs?

Q People who work in labs typically get dressed at home
before going to work, but before they get to work they walk their dogs, hug
their spouses, take their children to school, and put gas in their cars. Are
their clothes and shoes contaminated by the time they get to the lab? Could
any of the bacteria they have encountered on the way to work contaminate the
lab environment? Would it make more sense for lab personnel and other
healthcare workers to change into clean clothes after they arrive to work?

You are correct. Most laboratorians do get dressed for
work at home and then may perform chores or make stops before entering the
laboratory. For routine lab testing, such as hematology and chemistry, this
should not present a problem. Many food service employees do the same thing.

Donning a clean lab coat after entering the laboratory
should protect the environment from any contamination acquired along the
way. The human body naturally hosts more microorganisms than clean clothes
would pick up between home and the laboratory. Also, clothing generally
should not come into contact with specimens or reagents and probably does
not shed microorganisms.

Microbiology, especially if cell cultures are involved,
may present a different dilemma. More care must be exercised to prevent
contamination. Again, a clean lab coat should suffice unless one is entering
a sterile environment. In this case, a complete change of clothing, possibly
even a shower, and adding hair and shoe coverings might be necessary.

Laboratory personnel should also consider the reverse.
They should never wear or take any contaminated items home. If contamination
of street clothing is expected, scrubs or a lab coat is mandatory. The
scrubs or lab coat must then be left at the laboratory for cleaning.

— Madonna Ann Bachman, BS MT(ASCP), CLC(AMT)
Regulatory Compliance Department Director
DoctorsManagement

Knoxville, TN

A There are few studies that look at the contamination of
uniforms of healthcare workers worn from home as they are beginning their
work day, but according to the Association for Professionals in Infection
Control, or APIC, in its report on the use of scrubs and related apparel in
healthcare facilities: “To date, there have been no indications in the
literature that scrub apparel worn home has been responsible for the
transmission of infections of any kind.” According to the Centers for
Disease Control and Prevention and the World Health Organization, their
guidelines regarding uniforms and the microbiology laboratory are as
follows:

“Protective coats, gowns, smocks, or uniforms designated
for laboratory use must be worn while working in the laboratory. This
protective clothing should be removed and left in the laboratory before
leaving for non-laboratory areas. All protective clothing is either disposed
of in the laboratory or laundered by the institution; it should never be
taken home by personnel.”

In a recent study examining the microbial contamination
of medical students’ white coats, the students perceived the coats as
“clean” as long as the garments were not visibly contaminated with bodily
substances, even after wearing the coats for several weeks. The heaviest
bacterial load was found on the sleeves and the pockets of these garments;
the organisms most frequently isolated were Staphylococcus aureus,
diphtheroids, and Acinetobacter spp. The sleeves of the coat may make
contact with patients and, potentially, serve to transfer environmentally
stable microorganisms.

Therefore, one may draw the conclusion that laboratory
staff should not wear scrubs out in the community. An example of great
infection prevention and control activities occurred in hospitals in
Scotland; they simply do not wear their scrubs in public places. To prevent
cross-contamination and cut down on hospital acquired infections, their
dress code prohibits medical staff from wearing their uniforms outside of
work, except where it is part of the workers’ duties to work in the
community or in emergencies. The dress code applies to all staff, regardless
of whether or not they are required to wear uniforms.

— Irena L. Kenneley, PhD, APRN-BC, CIC
Assistant Professor
Case Western Reserve University
Frances Payne Bolton School of Nursing
and APIC National Scientific Research Council member
Madison, OH

Further reading

Association for Professionals in Infection Control and
Epidemiology. APIC State of the Art Report: Use of Scrubs and Related
Apparel in Health Care Settings.
www.apic.org/AM/Template.cfm?Section=State_of_the_Art_Reports&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=579 .
Published October 1997. Accessed June 1, 2009.

Centers for Disease Control and Prevention, National
Institutes of Health. Biosafety in Microbiological and Biomedical
Laboratories. www.cdc.gov/od/ohs/pdffiles/4th%20BMBL.pdf . Published April
1999. Accessed May 25, 2009.

World Health Organization. Laboratory Biosafety Manual,
2nd edition.
www.who.int/csr/resources/publications/biosafety/who_cds_csr_lyo_20034/en/ .

Published February 2003. Accessed June 3, 2009.

Bottom line: Yes, people’s clothes carry bacteria, but these are not typically
contaminants to the laboratory testing environment. Where such
contamination is possible, protocols for testing should include proper
procedures to eliminate the possibility of contamination. The
microbiology and genetic testing areas are the most likely places where
such procedures are necessary.

Anne Pontius is a senior medical practice
consultant with State Volunteer Mutual Insurance Company in Brentwood,
TN, and president-elect of CLMA 2007-2009. Send questions to Ms. Pontius
at
[email protected]
.

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