Having worked in clinical laboratories for fifty years, I have seen the good and bad but also the tremendous improvements in safety that have taken place. Many moons ago I remember visiting a facility where smoking was permitted throughout the laboratory, including microbiology! Oh, times have changed!
OHSA program
Safety in the clinical laboratory is essential to comply with the federal Occupational Safety and Health Administration (OSHA) regulations. Over and above this, we have an obligation to protect the health and well-being of our employees and our patients. Recognition of the latter leads to a true culture of safety.
The OSHA program for laboratories was inaugurated in 1991, and subsequently, the plan incorporated needle stick safety regulations. These regulations require that basic safety rules be observed by clinical laboratories, including policies to prevent exposure to biological, chemical, electrical, and fire hazards.
Biological hazards
Biological hazards immediately come to mind when thinking of clinical laboratory safety. It is essential there be protection from exposure to infectious diseases transmitted by contact with blood, blood products, and any other potential sources of infection transmission such as stool, urine, and sputum. The most commonly recognized blood-borne infectious diseases in this context are Hepatitis B and C and HIV but certainly, the hazards posed by transmission of other viruses, bacteria, Tubercle bacilli and fungal organisms are very real.
It is essential that laboratory leadership ensure safety procedures are in place and enforced to prevent transmission of infectious diseases from patient specimens. There needs to be protection of hands and skin, but also critical is protection of the eyes and mucous membranes. I personally am a big fan of plastic face shields that can provide protection of eyes and mucous membranes. I became an advocate of face shields the first time I wore one while performing an autopsy. I was appalled by the aerosol that covered the face shield when the autopsy was completed. To this day, I live in amazement I am not infected with Hepatitis C. In lesser amounts, aerosols develop when working with sputum, urine, and other body liquids.
Personal protective equipment
In microbiology, many specimens are best handled in a biological safety cabinet and wearing appropriate personal protective equipment (PPE) is vital. The front of the PPE gown should be kept closed. Ideally, the gown should close in the back. The gown should be knee-length and have long sleeves, with cuffed wrists. The fabric should be fluid resistant, and the PPE should be laundered by the employer and under no circumstances taken home by the employee. Always keep in mind that the PPE and gloves must not be worn outside the work area. There should be policies prohibiting the wearing of PPE in lunch and break areas, waiting room, lobby, or outside the confines of where the PPE has been utilized in order to prevent contamination.
In addition to wearing PPE, it is essential for phlebotomists to wash their hands before gloving for a procedure.
Following phlebotomy, the used needle must be discarded in a rigid container that is kept in a safe location beyond the reach of inquisitive children who might be intrigued to inspect the contents of the red box. Ultimately, all needles should be disposed of with the biohazardous waste in a rigid, closed safety container. When gloves are removed, hands again are washed.
Sharps
When we talk “sharps” in the laboratory, we immediately think of phlebotomy and the needles used. However, needles are not the only sharps causing injury in the laboratory. Other devices such as scalpels, broken glass from microscopic slides, and coverslips and glass capillary tubes, to name a few, can cause injury and disease transmission. These should also be discarded in the sharps container.
Equally as important is disinfection of all work areas throughout the laboratory. Disinfection is essential at intervals during the day; for example, when leaving the work area on break, after any spill and certainly at the end of the workday. There are EPA and FDA approved disinfectants that can be used.
Remember, accidents do happen! When a needle stick or other exposure to potentially infectious material occurs, you must have a written procedure in place to ensure evaluation of the source patient and ensure protection of the employee from HIV, HCV, and HBV in so far as possible. Collect blood from the injured employee and source patient and obtain baseline results for these three viral infections. If the source patient tests positive for any of these infectious agents or if the source patient cannot be identified, prophylaxis is given to the employee and the laboratory studies for these infectious diseases are repeated on the employee at six weeks, three months, and six months.
Safety procedures
In addition to biological hazards, you must remember chemical, fire, and electrical hazards and have written policies and procedures to guide employees. In addition, procedures and contracts must be in place for the safe disposal of biological and chemical hazards and these must conform to local and federal regulations.
It is essential that your facility have a posted floor plan. This can be vitally important in the event of an accident particularly a fire or chemical spill. Depending upon the size of the facility, you may need to post the floor plan information in several locations. The floor plan should clearly show areas of egress from the laboratory and the location of fire extinguishers, fire alarms, eyewash, safety shower, spill kits, and the Safety Data Sheet library. Location of electrical panels should also be included. It is helpful to incorporate emergency telephone numbers. It is imperative while reviewing the egress plan to assure that there be nothing blocking access to exits, fire extinguishers, fire alarms, safety showers, and eyewashes.
It is a requirement to review the safety program of the laboratory with all new employees. It is also a requirement to review the safety program on an annual basis with all employees, regardless of the length of service. There should be documentation of these reviews in the employee personnel file.
Safety audits
In addition, annual safety audits must be performed. This not only provides reassurance that all is being done in a proper manner, but also that any new potential threats are identified and appropriate safety procedures included in the safety manual. Audit templates can be found using Google, where you can locate blank audit forms developed by major institutions that, with appropriate modification, will allow you to do a thorough examination of safety in your laboratory. Some often-ignored areas that can be addressed by using a template include proper labeling and storage of chemicals, the need for a biological safety cabinet, use of fire-resistant cabinet for flammables, documentation of a complete Safety Data Sheet inventory, inappropriate storage of food or beverages in the laboratory, and expired waste disposal contracts. Be sure to involve employees in the safety audit to avoid overlooking any issues. A thorough audit involving employees sends the message loud and clear “We are concerned about your safety and the safety of our patients—please contribute to help us accomplish our goal.”
