MLSP112: PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2

TOPIC: LABORATORY SAFETY

2nd SEMESTER | S.Y 2022-2023
LECTURER: Sir Joshua Luigi D. Ramel, RMT
TOPIC • CLSI makes detailed step-by-step laboratory
SUBTOPIC procedures as compared to OSHA.
SUB SUBTOPIC
TJC (THE JOINT COMMISSION)
• Standard System for the Identification of the Fire
SAFETY STANDARDS AND AGENCIES
Hazards of Materials, (NFPA 704)
OSHA (OCCUPATIONAL SAFETY AND HEALTH
ADMINISTRATION)
• Occupational Health and Safety Administration
within the U.S. Department of Labor to set levels of
safety and health for all workers in the United
States.
• Authorized to conduct on-site inspections to
determine whether an employer is complying with
the mandatory standards (Bishop, 2013)
• General for all types of profession or occupation
(not just healthcare)
• Standards are guidelines based on their occupation.
• OSHA already regulate standards for safety in the
laboratory (healthcare)
• Standards that regulate safety in the laboratory:
- Bloodborne Pathogen Standard
- Formaldehyde Standard
- Laboratory Standard • The diamond should be found in all reagents.
- Hazard Communication Standard (must be • Divided into 4 small diamonds for more specific
placed in all workplace setting; how type of hazard.
communication works in response to a hazard) - Blue, Red, and Yellow uses a number-based
- Respiratory Protection Standard ranking to determine the severity of the hazard,
- Air Contaminants Standard as compared to the white diamond in which it
- Personal Protective Equipment Standard uses an acronym-based or signage to determine
what type or what specific hazard is present.
• Flash point is the temperature wherein a material
CLSI (CLINICAL AND LABORATORY STANDARDS or reagent evaporates to form an ignitable
INSTITUTE) - The lower the flash point, the more dangerous
• Clinical and Laboratory Standards Institute Non- it is.
profits educational organization that sets voluntary • The higher the number, the more dangerous the
consensus standards for all areas of clinical reagent is
laboratories.
• It provides excellent general laboratory safety and
infection control guidelines. CDC (CENTERS FOR DISEASE CONTROL AND
• Specific to our profession (Medical Laboratory PREVENTION)
Science)

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• Center for Disease Control and Prevention Federal
agency that carries out mandated public health laws
and reporting requirements.
• More on the workers, instead of the hazard
UNIVERSAL PRECAUTIONS (1987)
• All patients are considered possible carriers of
bloodborne pathogens (HIV/HBV)
• Wearing gloves when collecting or handling blood
and body fluids contaminated with blood
• Wearing face shields when in danger of splashing
blood and body fluids contaminated with blood.
• Doesn’t include urine and fluids not visibly
contaminated with blood.
• Updated version: Standard precautions (it has
limitations: it does not contain urine that do not
have visible contaminate blood; CSF, Saliva, Urine,
etc.)
BODY SUBSTANCE ISOLATION GUIDELINES (1987)
• Considers all body fluids and moist body substances
to be potentially infectious.
• Does not recommend handwashing after removal of
gloves (that is why this precaution needs some
revision)
STANDARD PRECAUTIONS (1996)
• Combines aspects of Universal Precautions and
Body Substance Isolation Guidelines
• Most accurate term, but still follows the basics.
• Treat all people as if they are infectious (patients)
DEPARTMENT OF HEALTH (DOH; PHILIPPINES)
• Development of policies regarding laboratory safety
• Accreditation of Clinical Laboratories
• They have the power to close laboratories if they
found that the certain laboratory does not follow
standards and precautions.
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GUIDELINES IN LABORATORY SETTINGS
• Standard Precautions (CDC, 1996)
1. Handwashing
2. Gloves
3. Mask, eye protection, face shield
4. Gown
5. Patient Care Equipment
6. Environmental Control
7. Linen
8. Occupational Health
9. Patient Placement
HAND HYGIENE
• When hands are visibly soiled with blood, bodily
fluids or proteinaceous material, wash hands with
soap and water.
• When hands are not visibly soiled, or after removing
visible dirt with soap and water, decontaminate
hands with an alcohol-based rub.
HANDWASHING
• Before direct patient contact
• After contact with patient’s specimens
• After contact with patient’s intact skin
• If hands will be moving from contaminated surface
to a clean one during patient care
• After contact with the inanimate objects in the
patient’s vicinity
• After removing gloves
• Before going to designated break areas
• Before and after using bathroom facilities
PERSONAL PROTECTIVE EQUIPMENT
• Wear PPE when the patient interaction is assured of
contact with blood or body fluids
• Remove or discard PPE before leaving patient’s
room or cubicle.
GLOVES
• Worn when user is in contact with blood or other
potentially infectious materials
• Do not wear the same pair of gloves for more than
one patient
• Change gloves during patient care if hands will
move from a contaminated site to a clean one
• NOT a substitute for hand washing
Transcribed by: JAMARA
• Latex allergy in patients
- You should always ask if a patient is allergic to
latex.
- Just in case, always bring a pair of non-latex
gloves with you.
• 1 pair of gloves = 1 patient
LABORATORY GOWN
• Worn to protect the clothing and skin of health-care
workers from contamination by patient body
substances and to prevent the transfer of
microorganisms out of patient rooms.
• Tie in the back at the neck and the waist and have
tightfitting cuffs
MASKS, GOGGLES, AND FACE SHIELDS
• Masks are worn to protect against inhalation of
droplets containing microorganisms from infective
patients
• Masks and goggles are worn to protect the mucous
membranes of the mouth, nose, and eyes from
splashing of body substances
• Face shields also protect the mucous membranes
from splashes
RESPIRATORY HYGIENE
• Contain respiratory secretions during patient care
PATIENT-CARE EQUIPMENT AND INSTRUMENTS
OR DEVICES
• Wear PPE according to corresponding level of
anticipated contamination
CARE OF THE ENVIRONMENT
• Policies and procedures for cleaning and
disinfections
TEXTILES AND LAUNDRY
• Avoid contamination of air, surface, and personnel,
and minimize agitation when handling
TRANSMISSION-BASED PRECAUTIONS (CDC, 1995)
• In addition to Standard Precautions
1. Airborne Precautions
2. Droplet Precautions
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3. Contact Precautions
• Airborne can remain suspended in the air
- Can determine through density (if it is light
enough to be suspended in the air, it is an
airborne type of microorganism)
• Droplet is where the organism is too heavy to be
suspended in the air (fall into surfaces)
OSHA (OCCUPATIONAL SAFETY AND HEALTH
ADMINISTRATION)
• Requires all employers to have a written
Bloodborne pathogen exposure control plan to
provide necessary protection, free of charge for
employees.
STANDARD AND TRANSMISSION-BASED
PRECAUTION FOR BLOODBORNE PATHOGENS
• Bloodborne Pathogens (BBP)
- Ex. Hepatitis B Virus, Hepatitis D, Hepatitis C,
and Human Immunodeficiency Virus (HIV)
- Hepatitis Virus have 5 kinds (from A to E)
- Hepatitis B, C, D is bloodborne pathogens
- Hepatitis A and E are foodborne pathogens
• Transmission Prevention Guidelines for
Phlebotomists:
- Change gloves in between patients
- Wash hands after removing gloves
- Dispose of biohazard materials properly
- Dispose of sharp hazards in puncture-proof
containers
- Do not recap needles with both hands; use
safety devices
Transcribed by: JAMARA
 - Follow institute’s protocol during personal
illness
- Maintain personal immunizations (Hepatitis B
vaccine should be updated (Keep track of your
immunization record and make sure they are
updated)
- Decontaminate Work areas
- Do not centrifuge uncapped tubes
- Do not eat, drink, smoke, or apply cosmetics in
the work area
• Exposure to BBP can occur when:
- Contaminated sharp pierces the skin of the
worker (sources of sharp: needle or glassware)
- Body fluid or blood splashes in the eyes, nose,
or mouth of the worker
- Cut, scratch, or abrasion of the health worker
has made contact with blood or bodily fluids of
the patient POSTEXPOSURE PROPHYLAXIS
- Human bite cut the skin of the worker
• Any accidental exposure to blood through
PROCEDURE TO BE FOLLOWED DURING BBP needlestick, mucous membranes or nonintact skin
• BBP Exposure by Needlestick or Sharps must be reported to a supervisor and a confidential
1. Carefully remove the sharp object medical examination must be started immediately
- In removing the sharp object, use forceps or • Evaluation of the incident must begin immediately
other mechanical devices instead of your hands to ensure appropriate postexposure prophylaxis
2. Wash the site thoroughly with soap and water (PEP) is initiated within 24 hours
for at least 30 seconds.
• BBP Exposure through Mucus Membrane
1. Flush with water or saline for at least 10 mins SAFETY DATA SHEETS (SDS)
2. For eye exposure, use eyewash station (remove
• Describes hazards, safe handling, storage, and
contact lenses)
disposal of hazardous chemicals.
3. Report incident to immediate supervisor
• For surface decontamination
1. Use 1:10 bleach solution on contaminated areas
- For surface decontamination, make sure to use
bleach solution on contaminated areas for 10-
20 minutes (always clean areas before working
or using the certain workplace)

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 HAZARD IDENTIFICATION • Infectious agent, reservoir, portal of exit,
means/mode of transmission, portal of entry,
susceptible host.

PREVENTIVE
MEASURE/
DESCRIPTION
BREAKING
THE CHAIN
Bacteria, Fungi, Early
INFECTIOUS Parasite, Virus detection
AGENT and
treatment
Place where the For the
infectious agent portal of exit,
can live and it is a way of
possibly multiply exit the
- Humans or reservoir to
Animals find a host
- Inanimate and to
objects (Fomites) prevent this,
- The reservoir proper
should not die disposals are
RESERVOIR immediately necessary.
- Fomites are
inanimate objects
that are
considered
BIOLOGICAL HAZARD reservoir
- Reservoir may or
• These microorganisms are frequently present in the may not exhibit
specimens received in the clinical laboratory. symptoms of
• Refers to biological substances that pose a threat infections.
to the health of living organisms, primarily that of
humans A way to exit the - Proper
reservoir to disposal of
CHAIN OF INFECTION
continue the chain biohazards
of infection and sharps
PORTAL OF EXIT - Ex. Nose, Mouth, - Proper
Mucus sealing of
membrane, Blood containers
or Bodily Fluids and
specimens
Means of - Hand
infectious agent washing
to reach a - Standard
MEANS OR susceptible host Precautions;
MODE OF - Direct contact Transmission
TRANSMISSION (skin to skin or -based
have contact with precautions
inanimate objects
of the patient)
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 - Droplet (not SHARPS HAZARD
suspended in the
air) • Including needles, lancets, and broken glassware
- Airborne • Serious biological hazard for possible exposure to
(suspended in the bloodborne pathogens caused by accidental
air) puncture
- Vehicle - Even if the sharp does not come in contact with
(contaminated a patient, it is still considered a sharp hazard
food or water) • When handling needles, NEVER manually recap with
- Vector (insects both hands
and other • Needle safety devices must be activated before
invertebrates; it disposing of the entire blood collection assembly
differentiates with • Puncture-resistant, leak-proof containers labeled
animals that are with the biohazard symbol
reservoir for in • Containers should be located in close proximity to
the vector, the phlebotomist’s work area
infectious agents
do not multiply)
CHEMICAL HAZARD
Means of an - Disinfection
infectious agent and • During processing of samples or preservatives in
to enter a sterilization sample containers
susceptible host - Standard • When skin or eye contact occurs, the best first aid
PORTAL OF is to:
- Nose, mouth, precautions
ENTRY - Flush the area immediately with water for at
mucus -
membrane, open Transmission least 15 minutes and then seek medical
wounds -based attention
precautions - Know the location of and how to use the
Patient or other - Standard emergency shower and eyewash station in the
healthcare worker precaution laboratory
(immunocompro - • Safety showers – 30-50 gal/minute at 20-50 psi
SUSCEPTIBLE
mised) Immunizatio
HOST GUIDELINES FOR SPILLS
n
- Healthy • Alert others in area of the spill
lifestyle • Use mechanical devices to pick up broken glass
• Absorb the spill with paper towels, gauze pads, or
NOSOCOMIAL/HEALTH-CARE ACQUIRED tissue
INFECTIONS • Clean the spill site using a common aqueous
detergent
• An infection acquired by a patient during a hospital • Disinfect the spill site using approved disinfectant or
stay 10% bleach, using appropriate contact time
- Patient is immune compromised. • Rinse the spill site with water
- Health care setting is not being sanitized
• Dispose of all materials in appropriate biohazard
properly.
containers
HEALTH-CARE ACQUIRED INFECTION (HAI)
• Refers to an infection acquired by a patient as the
result of a health-care procedure that may or may
not require a hospital stay

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 RADIOACTIVE HAZARDS
• Encountered in the clinical laboratory when
procedures using radioisotopes, such as
radioimmunoassay, are performed
• Exposure to radiation during pregnancy presents a
danger to the fetus, and personnel who are or who
think they may be pregnant should avoid areas with
CHEMICAL FUME HOOD VS. BIOSAFETY CABINETS the radioactive symbol

ELECTRICAL HAZARDS
• Electrical cords should be checked regularly for
fraying (hubad na cable) and replaced
• All socket should be checked for electrical
grounding and leakage at least annually
• No extension cords should be used in the laboratory
- It is okay to have extension cords but should
not be placed in a hazardous area
- Also, limit the use of the extension cords (do
not practice octopus cords or plugs)
- Do not hold cables or wires with wet hands
- Take into consideration the voltage of the wires
• Chemical Fume Hood is designed to remove
chemical fumes and aerosols from the work area
- Has high power exhaust fan for chemical
reagents that has foul odor, is volatile (workers FIRE/EXPLOSIVE HAZARDS
safety)

- Class E are military explosives

- Combustible metals in laboratory (iron fillings,
magnesium ribbons, etc.)
• Biosafety cabinet is circulated and filtered first and
not exhausted out immediately (meant for
specimens)
- Have downward pushing air that is pushed by
the (HEPA-filtered air) High Efficiency
Particulate Air
- Because it is pushing air downwards, it makes
sure there are no suspended air particles inside
(no chance of airborne pathogens)

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• There are certain or specific fire extinguishers
depending on the class of fire.
• Initial steps to follow when a fire is discovered are
identified by the code word RACE
1. Rescue – anyone in immediate danger
2. Alarm – activate the institutional fire alarm
system
3. Contain – close all doors to potentially affected
areas
4. Extinguish/Evacuate – extinguish the fire, if
possible, or evacuate, closing the door
PHYSICAL HAZARDS
• Avoid running in rooms and hallways
• Be alert for wet floors
• Bend the knew when lifting heavy objects or
patients
• Keep long hair tied back and remove dangling
accessory to avoid contact with equipment and
patients
• Wear comfortable, closed-toe shoes with nonskid
soles to provide maximum support
• Maintain a clean, organized work area
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CLEANING AND MAINTENANCE
CLEANING REAGENTS
• 1:10 dilution of chlorin bleach – disinfect and clean
bench tops
- Should be in contact with surface for 20
minutes
- Effective to inactivate HBV and HIV
• 70% Ethanol solution
• 5% Phenolic Solution (Lysol)
CHEMICAL STORAGE
• Safety carriers should always be used to transport
glass bottles of acids, alkalis, or organic solvents in
volumes larger than 500 mL
• Approved safety cans should be used for storing,
dispensing, or disposing of flammables in volumes
greater than 1 quart
• Steel safety cabinet with self-closing doors or
explosion-proof refrigerators
SIGNAGE AND LABELLING
• Manufacturers of laboratory chemicals
• All in-house prepared reagents and solutions should
be labelled in a standard manner and include the
chemical identity, concentration, hazard waning,
special handling, storage conditions, date prepared,
expiration date (if applicable), and preparer’s initials
Transcribed by: JAMARA