Safety and Quality

Assessment
Centers for Disease Control and Prevention (CDC)

Occupational Safety and Health Administration (OSHA)

Clinical and Laboratory Standards Institute (CLSI)

 Biologic Hazards
The health-care setting provides abundant sources of potentially harmful microorganisms. These
microorganisms are frequently present in the specimens received in the clinical laboratory.

Chain of infection- Understanding how microorganisms are transmitted

Infection control- procedures to control and monitor infections occurring within their facilities
Biologic Hazards
Once the infectious agent has left the reservoir, it must have a way to reach a susceptible host.
Means of transmission include:
1. Direct contact: the unprotected host touches the patient, specimen, or a contaminated object
(reservoir)
2. Airborne: inhalation of dried aerosol particles circulating on air currents or attached to dust
particles
3. Droplet: the host inhales material from the reservoir (e.g., aerosol droplets from a patient or
an uncapped centrifuge tube, or when specimens are aliquoted or spilled)
4. Vehicle: ingestion of a contaminated substance (e.g., food, water, specimen)
5. Vector: from an animal or insect bite
Biologic Hazards
-Universal Precautions (UP).
1987 , CDC
Under UP all patients are considered to be possible carriers of bloodborne
pathogens
-Body Substance Isolation (BSI)
guidelines are not limited to blood-borne pathogens; they consider all body fluids
and moist body substances to be potentially infectious.
Healthcare Infection Control Practices Advisory Committee (HICPAC)
◦ combined the major features of UP and BSI guidelines and called the new
guidelines
Biologic Hazards
Reducing exposure risk
Six major tactics reduce the risk of exposure to BB Pathogens
1. Engineering controls
2. Work practices
3. Housekeeping
4. Hepa B vaccination
5. Private rooms
6. PPEs
Biologic Hazards
Engineering Controls
These are physical and mechanical devices that are available to healthcare workers to
reduce or eliminate the potential to transfer infectious diseases.
Self sheathing needles
Autoclaves
Puncture proof sharps containers (80% capacity)
Biologic Hazards
Workplace Practice Controls
-Practices that are incorporated into all health care associates’
work habits to prevent the spread of infection.
◦ Handwashing- the single most important way to prevent the spread of
infection
◦ Alcohol based hand cleaners in place of hanwashing
◦ Disinfection- 10% bleach
Biologic Hazard
Workplace Practice Controls
◦ Antiseptic technique is used on skin surfaces because the solutions
are safe to human skin.
◦ Antiseptics
◦ 70% isopropyl alcohon either saturated into gauze or in prepack pads
◦ Tincture of iodine or povidone-iodine
◦ 2% chlorhexidine gluconate and 70% isopropyl alcohol
◦ Benzalkonium chloride, an alternate skin cleanser
◦ Zephrin chloride
◦ Hydrogen peroxide, alternate for people allergic to alcohol
Biologic Hazards
Workplace Practice Controls
◦ Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in
work areas
◦ Food and drink must not be kept in the same room with potentially infectious materials are present
◦ There should be a separate room for food consumption
◦ Before entering the said room, the protective garments should be removed
Biologic Hazard
Housekeeping
◦ Cleaning up spills and decontaminating soiled areas immediately
with a disinfectant such as 10% bleach that has been made up
fresh daily.
◦ Broken glass should not be picked up with the hands, a dustpan,
brush or tongs should be used
Biologic Hazards
Hepa B vaccination

◦ Must be available at no charge to the phleb

◦ Effective for 15 or more years in protecting the phlebs
◦ This vaccine does not protect the phleb from all types of hepatitis, only hepa
B
Biologic Hazard
Private room
◦ A private room reduces the possibility of transmission of infection
by separating the patient with a disease from other patients and
healthcare associates
◦ Anteroom
Biologic Hazards
PPE used in the laboratory includes gloves, fluid-resistant gowns, eye and face shields,
and Plexiglas countertop shields.
Biologic Hazards
◦ Hand Hygiene
◦ Hand contact is the primary method of infection transmission

◦ Includes both hand washing and using alcoholbased antiseptic

cleansers. Alcohol-based cleansers can be used when hands are
not visibly contaminated.
Biologic Hazard
◦ Biologic Waste Disposal
◦ All biologic waste, except urine, must be placed in appropriate containers
labeled with the biohazard symbol.

◦ The waste is then decontaminated following institutional policy:

incineration, autoclaving, or pickup by a certified hazardous waste company

◦ Urine may be discarded by pouring it into a laboratory sink under a Plexiglas

countertop shield.
Biologic Hazards
Isolation Techniques
◦ Isolating a patient- help the healthcare team break the chain of
infection
◦ Was first published in 1887.
◦ Isolation but still allowed nosocomial transmission because of aseptic technique
◦ 1910- cubical system- septic technique
◦ 1960- private rooms or ordinary rooms
◦ 1970- CDC recommended use of 7 isolation categories, a practice called category-specific
isolation
Biologic Hazards
Category Specific Isolation
◦ Required knowing that a patient needed to be isolated
◦ Often, patient would come to the hospital with an illness
that was later determined to be a disease requiring
patient isolation. This would occur after many patient had
already been eposed.
Biologic Hazards
◦ Category Specific Isolation
◦ Strict isolation
◦ With contagious dse- chickenpox, DPT, Pneumonia
◦ Contact Isolation
◦ Dse that is transmitted by direct contact- scabies,
◦ Respiratory Isolation
◦ Dse transmitted through the air- mumps, pertussis or rubella
◦ TB Isolation
◦ Similar to respiratory trans
◦ Tb is an opportunistic disease
Biologic Hazards
Category Specific Isolation
◦ Drainage/Secretion Isolation
◦ Patients with open wounds (wound and skin precautions)
◦ Enteric Precautions
◦ Severe diarrhea due to contagious bacteria- Salmonella, Shigella or Vibrio cholerae
◦ Transmission by contact with infected feces
◦ Protective or Reverse Isolation
◦ Protecting the patient from healthworkers
Biologic Hazards
Disease Specific Isolation
◦ Established in 1983 to overcome the shortcomings of CSI
◦ Category of blood and other body fluids are added
◦ Protective or reverse Isolation was eliminated because it was proven to
be inefficient
◦ TB isolation was improved
◦ Private room with negative air pressure and the use of High-efficiency
particulate air(HEPA) filter respirators instead of surgical masks
Biologic Hazards
Transmission-based Precautions
◦ 1996 revised
◦ Two tiers
◦ 1st tier- Standard precautions
◦ 2nd tier- TBP
◦ Intended for patients diagnosed with or suspected of having a specific
transmissible disease
 AIRBORNE DROPLET PRECAUTIONS CONTACT PRECAUTIONS
PRECAUTIONS
EX OF Rubeola, varicella, TB DPT, Mycoplasma, Clostridium difficile, E.
DISEASES pneumonia, pertussis, coli, Shigella, hepatitis A,
influenza, mumps, herpes simplex, scabies,
rubella Staphylococcus( open
wounds)

PRIVATE YES YES YES

ROOM
RESPIRATORY YES, with TB NO NO
PROTECTION
MASK Persons susceptible to YES, if working within 3 NO
measles or varicella feet or 1 meter of
should avoid contact patient
 Sharp Hazards
◦ including needles, lancets, and broken glassware, present a serious biologic
hazard, particularly for the transmission of blood-borne pathogens.

◦ disposed in puncture-resistant, leak-proof container with the biohazard

symbol.
 Chemical Hazards
◦ same general rules for handling biohazardous materials apply to
chemically hazardous materials

◦ Chemical Spills and Exposure

◦ Skin contact> flush with water for 15 mins
◦ Never attempt to neutralize XXXXXXXX
◦ Emergency showers and eye wash stations
 Chemical Hazards
◦ Chemical Handling
◦ never be mixed together unless specific instructions are followed(added in order specified)
◦ Wear goggles and mix reagents in fume hoods
Chemical Hygiene Plan
chemical Hygiene Officer
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 Hazard
Chemical Labeling
◦ should be labeled with a description of their particular hazard, such as poisonous, corrosive, flammable,
explosive, teratogenic, or carcinogenic
◦ National Fire Protection Association (NFPA)—ID of Fire Hazard
Chemical Hazard
Material Safety Data Sheets (MSDS)
◦ 1. Physical and chemical characteristics
◦ 2. Fire and explosion potential
◦ 3. Reactivity potential
◦ 4. Health hazards and emergency first aid procedures
◦ 5. Methods for safe handling and disposal
◦ 6. Primary routes of entry
◦ 7. Exposure limits and carcinogenic potential
 Radioactive Hazards
-Radioactivity may be encountered in the clinical laboratory when procedures using
radioisotopes are performed.

-amount of radioactivity present in the clinical laboratory is very small> cumulative

exposure

-amount of radiation exposure is related to a combination of time, distance, and

shielding
 Electrical Hazards
◦ same general rules of electrical safety observed outside the workplace apply
◦ Equipment should not be operated with wet hands.
◦ 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
to avoid transferring the 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.
 Fire/Explosive Hazards
◦ Joint Commission (JC)
◦ requires that all health-care institutions post evacuation routes and detailed
plans to follow in the event of a fire. (RACE)
◦ Rescue—rescue anyone in immediate danger
◦ Alarm—activate the institutional fire alarm system
◦ Contain—close all doors to potentially affected areas
◦ Extinguish/Evacuate—attempt to extinguish the fire, if possible or
evacuate, closing the door