Chapter

1
Safety in the Clinical laboratory
Terms to remember
Bio hazardous
Chain on infection
Chemical Hygiene Plan
Material Safety Data Sheet
Occupational Safety and Health Administration(OSHA)
Personal Protective Equipment (PPE)
Post exposure prophylaxis(PEP)
Radioisotopes
Standard Precaution
Universal Precaution (UP)
Biological Hazards
It includes the chain of infection
Biological – harmful microorganisms
The health-care setting provides abundant sources of potentially harmful
microorganisms. These microorganisms are frequently present in the specimens
received in the clinical laboratory.

COI – Continous link between a Source, Method of Transmission, Susceptible Host.

The source is the location of potentially harmful microorganisms, such as a

contaminated clinical specimen or an infected patient. Microorganisms from the
source are transmitted to the host. This may occur by direct contact (e.g., the host
touches the patient, specimen, or a contaminated object), inhalation of infected
material (e.g., aerosol droplets from a patient or an uncapped centrifuge tube),
ingestion of a contaminated substance (e.g., food, water, specimen), or from an
animal or insect vector bite. Once the chain of infection is complete, the infected
host then becomes another source able to transmit the microorganisms to others.

BIOHAZARD SYMBOL is used to demonstrate how following prescribed safety

practices can break the chain of infection with particular emphasis on laboratory
practices.

HANDWASHING IS BEST WAY TO BREAK THE CHAIN OF INFECTION! AND THE FATHER
OF HANDWASHING: IGNAZ SEMMELWEIS
PROPER HANDWASHING, proper disposal of waste (medical waste) and wearing of
PPE are of major importance in the laboratory
 History
Occupational safety and health administration (OSHA) and Centers
for Disease and Control Prevention (CDC) Drafted guideline for
blood borne pathogen
Specially to:
HBV
HIV
OSHA - Concern over exposure to blood-borne pathogens, primarily hepatitis B virus
(HBV) and human immunodeficiency virus (HIV), resulted in the drafting of guidelines
and regulations the Occupational Safety and Health Administration (OSHA) to prevent
exposure.

In 1987 the CDC instituted Universal Precautions (UP). Under UP all patients are
considered to be possible carriers of blood-borne pathogens. The guideline
recommends wearing gloves (when collecting or handling blood and body fluids
contaminated with blood) wearing face shields (When there is danger of blood
splashing on mucous membranes )and disposing all needles and sharp objects in
puncture-resistant containers).
 • 1987
- CDC instituted Universal Precaution (UP) as patients are
possible carriers of blood-borne pathogens.
- Urine and other body fluids are not included
In 1987 the CDC instituted Universal Precautions (UP). Under UP all patients
are considered to be possible carriers of blood-borne pathogens. The guideline
recommends wearing gloves (when collecting or handling blood and body fluids
contaminated with blood) wearing face shields (When there is danger of blood
splashing on mucous membranes )and disposing all needles and sharp objects
in puncture-resistant containers).

The CDC excluded urine and body fluids not visibly contaminated by blood
from UP, although many specimens can contain a considerable amount of
blood before it becomes visible.
 Universal Precaution has been modified as Body substance
Isolation(BSI)

It includes:
-All specimens are infectious
-Laboratory personnel should wear gloves.
Disadvantage: Hand washing is not recommended after the
removal of gloves

• The modification of UP for body substance isolation (BSI) helped to alleviate this
concern. BSI guidelines 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 are that they do not recommend
hand washing following removal of gloves unless visual contamination is present.
 During 1996 Standard Precaution has been made, it is the
combination of BSI and UP
- Occupational exposure to blood borne pathogens standardize a
law and monitor by OSHA.

• In 1996 the CDC combined the major features of UP and BSI

guidelines and called the new guidelines Standard Precautions.
• Proper hand washing, proper disposal of waste (medical waste)
and wearing of PPE are of major importance/ emphasis in SP.
Standard Precaution
- Disinfection protocol using Sodium hypochlorite(1:10)
- Wearing of Personal Protective Equipment (PPE) including:
Gloves- Nitrite/Vinyl gloves
Eye and face shield- to protect mucous membranes of the
eyes, nose, and mouth during procedures.
Mask- N95 must be used during patient care activities related
to suspected mycobacterium exposure
Laboratory gown- to protect skin and to prevent soiling of
clothing during procedures and patient care activities

Sodium hypochlorite (1:10) = HIV – 2MINS HEPA B – 5MINS

Standard Precaution
- Disposal of Biological waste:
-Incineration
-Autoclaving
- Pick-up by certified hazardous waste company.

The waste is then decontaminated following institutional policy: incineration,

autoclaving, or pickup by a certified hazardous waste company.

Incineration – burning of waste

Autoclaving – sterilizing using steam under high pressure
 Standard Precaution
Urine can be discarded in the sink
-Avoid Splashing
-Flush with water
-Disinfect

Urine may be discarded by pouring it into a laboratory sink. Care must be taken to
avoid splashing, and the sink should be flushed with water after specimens are
discarded. Disinfection of the sink using a 1:5 or 1:10 dilution of sodium hypochlorite
should be performed daily (shelf-life: 1 month)
Sharp Hazard
• Needles
• Lancet
• Brocken Glassware
-It must be disposed in puncture resistant container, located
near the workplace.
 Chemical Hazard
• In case of chemical spill accident in the laboratory, flush the
infected area of the skin with large amount of water for at
least 15 minutes.

• Mouth pipetting is not allowed.

The same general rules for handling bio-hazardous materials apply to chemically
hazardous materials; that is, to avoid getting these materials in or on bodies, clothes,
or work area. Every chemical in the workplace should be presumed hazardous.

CHEMICAL SPILL. When skin contact occurs, the best first aid is to flush the area with
large amounts of water for at least 15 minutes and then SEEK medical attention. For
this reason, the personnel must know the location and proper use of emergency
showers and eye wash stations. Contaminated clothing must be removed immediately,
do not neutalize the spill.
 Chemical Handling
• Never mix chemicals without instruction
• Chemical container should in a manageable size.
• Acid should always be added to water.

CHEMICAL HANDLING. Chemicals should never be mixed together (unless specific

instructions are followed, and they must be added in the order specified.) This is
particularly important when 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 some chemical reactions. Wearing goggles and preparing
reagents under a fume hood are recommended safety precautions. Pipetting by
mouth is unacceptable in the laboratory.
 Chemical Hygiene Plan
OSHA also requires all facilities that use hazardous chemicals to have
a written chemical hygiene plan (CHP) available to employee.
• Written Documents in the facilities.
• Readily available in the working area for the laboratory personnel.
-Each facility must appoint a chemical hygiene officer, who is
responsible for implementing and documenting compliance with the
plan

The purpose of the plan is to detail the following:

1. Appropriate work practices

2. Standard operating procedures
3. PPE
4. Engineering controls, such as fume hoods and flammables safety cabinets
5. Employee training requirements
6. Medical consultation guidelines
Chemical Labelling
• The National Fire Protection Association (NFPA) has developed
the Standard System for the Identification of the Fire Hazards
of Materials, NFPA 704.
• Hazardous chemicals should be labelled with a description of
their particular hazard, such as poisonous, corrosive, or
carcinogenic
• Diamond shape Symbol

Hazardous chemicals should be labeled with a description of their particular

hazard, such as poisonous, corrosive, or carcinogenic.
NFPA Hazardous Material symbol

This symbol system is used to inform fire fighters of the hazards they may
encounter with fires in a particular area. The diamond-shaped, color-
coded symbol contains information relating to health, flammability,
reactivity, and personal protection/special precautions.
Each category is graded on a scale of 0 to 4, based on the extent of
concern. These symbols are placed on doors, cabinets, and containers.
Material Data Safety Sheets(MSDS)
• The OSHA Federal Hazard Communication Standard requires
that all employees have a right to know about all chemical
hazards present in their workplace.
-Protocol and Guideline
-Methods for safe handling and disposal
-Reactivity potential

The information is provided in the form of Material Safety Data Sheets

(MSDSs) on file in the workplace. By law, vendors are required to provide
these sheets to purchasers; however, the facility itself is responsible for
obtaining and making MSDSs available to employees. Information contained
in an MSDS includes the following:
 Radioactive Hazard
• Radioactivity is encountered in the clinical laboratory when
procedures using radioisotopes are performed.
the effects of radiation are cumulative related to:
-The amount of radiation exposure.
-combination of time, distance, and shielding.

• Laboratory personnel should be familiar with the radioactive hazard

• It must be displayed on the doors of all areas where radioactive material is present.

The amount of radioactivity present in the clinical laboratory is very small and
represents little danger; however, the effects of radiation are cumulative related to
the amount of exposure. The amount of radiation exposure is related to a
combination of time, distance, and shielding. Persons working in a radioactive
environment are required to wear measuring devices to determine the amount of
radiation they are accumulating.
Electrical Hazards
The laboratory setting contains a large amount of electrical
equipment with which workers have frequent contact
-Equipment should not be operated with wet hands.
- Equipment that has become wet should be unplugged and
allowed to dry completely before reusing.
- Equipment also should be unplugged before cleaning. All
electrical equipment must be grounded with three pronged
plugs.
- When an accident involving electrical shock occurs, the
electrical source must be removed immediately.
 • The following are the safety precautions must be observed related
to electrical hazards
• When an accident involving electrical shock occurs, the electrical
source must be removed immediately. This must be done without
touching the person or the equipment involved in order to avoid
transfer of current. Turning off the circuit breaker, unplugging the
equipment, or moving the equipment using a nonconductive glass or
wood object are safe procedures to follow.
• Actions to Take if Electrical Shock Occurs
• • Shut off the source of electricity.
• • If the source of electricity cannot be shut off, use non-conducting
material (e.g., hand inside a glass beaker) to remove the source of
electricity from the victim.
• • Call for medical assistance.
• • Start cardiopulmonary resuscitation if indicated.
• • Keep the victim warm.
Fire Hazard
• The Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) requires that all health-care
institutions post evacuation routes and detailed plans to
follow in the case 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:
R- Rescue
A- Alarm
C- Contain
E- Extinguish/ Exit

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—attempt to extinguish the fire, if possible; exit the area
 - The NFPA classifies fires with regard to the type of burning material. It also classifies the
type of fire extinguisher that is used to control them.
- The multipurpose ABC fire extinguishers are the most common, but the label should always
be checked before using. It is important to be able to operate the fire extinguishers. The
acronym PASS can be used to remember the steps in the operation.
Class A fires occur with ordinary combustible materials, such as wood, papers, or clothing,
and require water or water-based solutions to cool or quench the fire to extinguish it.
Class B fires occur with flammable liquids and vapors, such as paint, oil, grease, or gasoline,
and require blocking the source of oxygen or smothering the fuel to extinguish.
Class C fires occur with electrical equipment and require nonconducting agents to extinguish.
Class D fires occur with combustible or reactive metals, such as sodium,
potassium,magnesium, and lithium, and require dry powder agents or sand to extinguish
(they are the most difficult fi res to control and frequently lead to explosions).
Class K fires occur with high-temperature cooking oils, grease, or fats and require agents that
prevent splashing and cool the fi re as well as smother it.
• Class A extinguishers use soda and acid or water to cool the fi re.
• Class B extinguishers use foam, dry chemical, or carbon dioxide to smother the fire.
• Class C extinguishers use dry chemical, carbon dioxide, Halon, or other non-conducting
agents to smother the fire.
• Class ABC (multipurpose) extinguishers use dry chemical reagents to smother the fire. They
can be used on class A, B, and C fires.
• Class K extinguishers use a potassium-based alkaline liquid specifically formulated to fight
high-temperature grease, oil, or fat fi res by cooling and smothering them without splashing.
Some class K extinguishers can also be used on class A, B, and C fires.
It is important to be able to operate the fire extinguishers. The
acronym PASS can be used to remember the steps in the
operation:
1. Pull pin
2. Aim at the base of the fire
3. Squeeze handles
4. Sweep nozzle side to side.
Physical Hazard
Physical hazards are not unique to the laboratory
General precautions to consider are :
• avoid running in rooms and hallways
• watch for wet floors
• bend the knees when lifting heavy objects
• keep long hair pulled back
• avoid dangling jewelry
• maintain a clean, organized work area.
• Closed-toe shoes that provide maximum support are essential
for safety and comfort.
Physical hazards are not unique to the laboratory, and routine precautions
observed outside the workplace apply.
General precautions to consider are the following to avoid accidents of
physical hazards
- Wear closed-toe shoes for maximum support essential for safety and comfort
End...