Safety and Infection

Control
Laboratory Safety

 Laboratory Safety And Regulation

 Laboratory Hazards:
Biological Fire
Chemical Radiation
Electrical
 Laboratory Waste Management
Laboratory Safety
The practice of safety should be uppermost
in the minds of all persons working in the
laboratory.

The Role of the Individual:

Must always be responsible for his/her safety.
Must follow the rules and use equipment properly.
Ensure that the workplace is safe.

The Role of the Employer:

Make sure that the employees have proper training, support,
equipment, workload, resources and environment.
Ensure that the workplace is safe.
Laboratory Safety
Structural Requirements:

Safety factors should considered in the design

and layout of the building:
Entrance and Exit Route
Blockage of Hallways and Doors
Location of Sprinklers and Fire Extinguishers
Storage of Flammable Materials
Ventilation System
Laboratory Safety
Potential Hazards:

Electric Shock
Toxic Vapors, Compressed Gases, Flammable Liquids
Poisons, Corrosive Substances
Radioactive Material
Mechanical Trauma
Handling Biologic Materials
upational Safety and Health Act

 Public Law 91-596

 Also known as the (OSHA), was
enacted in 1970.
Goal: Provide all employees (clinical
laboratory personnel included) with a safe
work environment.
 Under this legislation, OSHA is
authorized to conduct on-site
inspections.
OSHA Standards:
 Blood-Borne Pathogen Standard
 Hazard Communication Standard
 Formaldehyde Standard
 Laboratory Standard Respiratory Standard
 Air Contaminants Standard
 Personal Protective Equipment Standard
Blood-Borne Pathogens Standard

 Standard applies to all exposure to blood or other

potentially infectious materials in any occupational
setting.
 Universal Precautions and Personal Protective
Equipment are foremost among these infection control
measures.
 The Universal Precautions concept is basically an
approach to infection control that presumes that all
human blood, tissue, and most fluids are treated as if
known to be infectious.
Blood-Borne Pathogens Standard

 The standard also provides fairly detailed direction for

decontamination and the safe handling of potentially
infectious laboratory supplies and equipment, including
practices for managing laundry and infectious wastes.
 Employee information and training are covered
regarding recognition of hazards and risk of infection.
 There is also a requirement for HBV vaccination.
Components of the OSHA Blood-borne Pathogen Standard
Blood-Borne Pathogens Standard

POST-EXPOSURE PROPHYLAXIS
 Any accidental exposure to blood through needle stick,
mucous membranes, or non-intact skin must be reported to
a supervisor and a confidential medical examination must
be started immediately.
 Evaluation of the incident must begin immediately to ensure
appropriate post exposure prophylaxis(PEP)is
initiated within 24 hours.
 Needle sticks are the most frequently encountered exposure
in phlebotomy and place the phlebotomist in danger of
contracting HIV, HBV, and HCV.
Blood-Borne Pathogens Standard
Nosocomial/Health-Care–Acquired Infections
 The term nosocomial infection has been used to designate
an infection acquired by a patient during a hospital stay.
 Hepatitis, Acquired Immunodeficiency
Syndrome (AIDS), and Tuberculosis are
prevalent diseases that can be contracted
by laboratory personnel.
Post-Exposure Prophylaxis (Recommended by CDC)
Hazard Communication Standard:
“HazCom Standard”
 “Right to know Law”
 It defines hazardous substances and provides guidance for
evaluating and communicating identified hazards.
 Material Safety Data Sheets (MSDS), and Employee
Education.
 MSDS: (1) Physical and Chemical Characteristics
(2) Fire and Explosion Potential (3)
Reactivity Potential (4) Health Hazards
and Emergency First Aid (5) Methods for Safe
Handling and Disposal
Other OSHA Standards:
Formaldehyde Requires monitoring of
Standard formaldehyde standards.
Requires personal hygiene plan to
Laboratory Standard
minimize personnel exposure to
Respiratory Standard hazardous chemicals in the lab.
Established to minimize health
Air Contaminants
risk from exposure to air
Standard pollutants.
Requires Respiratory Protection,
Personal Protective
Eye Protection, Hearing Protection
Equipment Standard and Hand Protection.
LABORATORY HAZARDS
Biological Hazards
 Source: Infectious Agent
 Chain of Infection: Source, Host, Transmission
 Transmission: Direct Contact, Inhalation, Ingestion, etc.
 Prevention: Hand Washing & PPE
Universal Precaution (Modification)
*Body Substance Isolation (BSI)
*Standard Precaution
 Universal Precaution
 A guidelines (blood-borne pathogens; they consider all
Body body fluids and moist body substances to be
potentially infectious). Personnel should wear gloves at
Substance all times when encountering moist body substances.
Isolation  A major disadvantage of BSI guidelines are that they
(BSI) do not recommend handwashing following removal of
gloves unless visual contamination is present.
 The new guidelines which is mostly applied in lab.
Standard  Standard Precautions are as follows: (Handwashing,
PPE, Patient Care Equipment, Environmental Control,
Precaution Occupational Health and Blood-Borne Pathogens and
Patient Placement).
Personal Protective Equipment Standard

PPE DONNING: PPE REMOVAL:

1.GOWN 1.GLOVES*
2.HAIRNET 2.GOGGLES
3.SHOE COVER 3.GOWNS
4.MASK 4.HAIRNET
5.GOGGLES* 5.SHOE COVER
6.GLOVES 6.MASK
 Standard Precaution
Soiled Glove Removal:
1. Grasp the gloves to be removed on the palm side of your hand just
below the cuff, being careful not to touch bare skin on your wrist.
2. Pull the glove off by rolling it inside out. As you continue to roll up with
your fingers of the gloved hand, place the two fingers of your bare
hand inside the cuff of the second glove.
3. Pull the second glove off turning it inside out over the first glove.
4. Touching only the inside surface of the glove removed in step 3,
dispose the glove appropriately.
5. Wash your hands.
 Standard Precaution
Handwashing:
1. Wet hands with warm water.
2. Apply antimicrobial soap.
3. Rub to form a lather, create friction, and loosen debris.
4. Thoroughly clean between fingers, including thumbs, under fingernails
and rings, and up to the wrist, for at least 15 seconds.
5. Rinse hands in a downward position.
6. Dry with a paper towel.
7. Turn off faucets with a clean paper towel to prevent recontamination.
 Six Component of Chain of Infection
Components of Chain of Infection Breaking the Chain
bacteria, fungi, Early detection and treatment
Infectious Agent parasites, and viruses. of infectious agents.
a place where the Disinfecting the work area kills
infectious agent can the infectious agent and
Reservoir live and possibly eliminates the reservoir.
multiply.
The infectious agent Disposing of contaminated
must have a way to materials in biohazard
Portal of Exit exit the reservoir to containers and keeping tubes
continue the chain of and sample containers sealed.
infection.
 Six Component of Chain of Infection
Components of Chain of Infection Breaking the Chain
Direct contact, Droplet, Hand washing, Standard
Means of Airborne, Vehicle: ingestion Precautions and
Transmission of contaminated food or transmission-based
water, Vector. precaution.
After the infectious agent has Disinfection and
been transmitted to a new sterilization and strict
Portal of Entry reservoir it must have a adherence to Standard
means to enter the reservoir. Precautions.
Susceptible This can be another patient Observation of special
Host or the health-care provider. precautions .
Biological Hazards
Biological Spill
 Spills any biological fluid or other potentially infectious
material spill must be cleaned. Cleanup includes the following
recommendations:
(1) Wear protective equipment.
(2) Use mechanical devices to pick up broken glass or other sharp.
(3) Absorb the spill with paper towels, gauze pads, or tissue.
(4) Clean the spill site using a common aqueous detergent.
(5) Disinfect the spill site using approved disinfectant (Sodium
Hypochlorite) or 10% bleach, using appropriate contact time
(20 minutes).
(6) Rinse the spill site with water.
(7) Dispose of all materials in appropriate biohazard containers.
Biological Hazards
Biological Spill
 ALL BIOLOGICAL WASTES must be placed in appropriate
containers labeled with the biohazard symbol.
 Sinks should be disinfected DAILY using 1:5 or 1:10 dilution
of SODIUM HYPOCHLORITE.
 Hypochlorite's are the most widely used of the chlorine
disinfectants.
Biological Hazards
 HOW TO PREPARE?

 SHELF-LIFE OF SODIUM HYPOCHLORITE

Biosafety Level
Sharp Hazards

 Sharp Objects in the laboratory (Needles,

Lancets, and Broken Glassware) for the
transmission of blood-borne pathogens.
 All sharp objects must be disposed in
Puncture-Resistant Containers.
 Puncture-Resistant Containers should be
conveniently located within the work area.
Blood-Borne Pathogens Standard

POST-EXPOSURE PROPHYLAXIS
 Any accidental exposure to blood through needle stick,
mucous membranes, or non-intact skin must be reported to
a supervisor and a confidential medical examination must
be started immediately.
 Evaluation of the incident must begin immediately to ensure
appropriate post exposure prophylaxis(PEP)is
initiated within 24 hours.
 Needle sticks are the most frequently encountered exposure
in phlebotomy and place the phlebotomist in danger of
contracting HIV, HBV, and HCV.
Chemical Hazards
Chemical Handling
a) Chemicals should never be mixed together unless specific
instructions are followed.
b) Acid should always be added to water to avoid the
possibility of sudden splashing caused by the rapid
generation of heat.
c) Wearing PPE (Goggles, Gloves, Gown, etc.,) and preparing
reagents under a fume hood are recommended safety
precautions.
d) Chemicals should be used from containers that are of an
easily manageable size and prepare in the fume hood.
e) Pipetting by mouth is unacceptable in the laboratory.
f) State and federal regulations are in place for the disposal of
chemicals and should be consulted.
Chemical Hazards
Chemical Hazards

Chemical Labelling
1. Flammable/Combustible
 Most hazardous materials in the Clinical Chemistry laboratory
because of possible fire or explosion.
 Classified according to flash point.
 Flammable Liquid (F.P. below 37.8°C (100°F))
 Combustible Liquids (F.P. above 37.8°C (100°F))
 Commonly used Flammable and Combustible solvents are
acetone, benzene, ethanol, heptane, isopropanol, methanol,
toluene, and xylene. Flammable Chemicals also include certain
gases, such as hydrogen, and solids, such as paraffin.
Chemical Hazards

Chemical Labelling
2. Corrosive Chemicals
 Corrosive chemicals are injurious to the skin or eyes by direct
contact or to the tissue of the respiratory and gastrointestinal
tracts if inhaled or ingested.
 Typical examples include acids (acetic, sulfuric, nitric, and
hydrochloric) and bases (ammonium hydroxide, potassium
hydroxide, and NaOH).
Chemical Hazards

Chemical Labelling
3. Reactive Chemicals
 Substances that, under certain conditions, can spontaneously
explode or ignite or that evolve heat or flammable or explosive
gases.
 Hydrogen is liberated if alkali metals (sodium or potassium) are
mixed with water or acids, and spontaneous combustion also
may occur.
 The mixture of oxidizing agents, such as peroxides, and
reducing agents, such as hydrogen, generate heat and may be
explosive.
Chemical Hazards

Chemical Labelling
4. Carcinogenic Chemicals
 Carcinogens are substances that have been determined to be
cancer-causing agents.
 Benzidine is a common example of a known carcinogen.
 For regulatory (OSHA) and institutional safety requirements,
the laboratory must maintain an accurate inventory of
carcinogens
Chemical Hazards
Chemical Hazards
Chemical Spill
a) 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.
b) All laboratory personnel should know the location and
proper use of emergency showers and eye wash stations.
c) Contaminated clothing should be removed as soon as
possible.
d) No attempt should be made to neutralize chemicals that
come in contact with the skin.
e) Chemical spill kits containing protective apparel, nonreactive
absorbent material, and bags for disposal of contaminated
materials should be available for cleaning up spills.
Radiation Hazards
 Radioactivity is encountered in the clinical laboratory when
procedures using radioisotopes are performed.
 Safety Policy should include Environmental and Personnel
Protection.
 Exposure to radiation during pregnancy presents a danger to
the fetus; personnel who are pregnant or think they may be
should avoid areas with this symbol.
 All areas where radioactive materials are used or stored must
be posted with caution signs, and should be restricted to
essential personnel only and regular and systematic
monitoring must be emphasized, and decontamination of
laboratory equipment.
 PNRI: Philippine Nuclear Research Institute
Radiation Hazards
Electrical Hazards
 Most Common Hazard encounter in the Laboratory.
 Hazards of electrical energy can be: Direct Hazard and
result in death, shock, or burns. Indirect Hazards can result
in fire or explosion.
 Precautionary Procedures to follow when working around
Electrical Equipment:
a) Use only explosion-proof equipment in hazardous
atmospheres.
b) Be particularly careful when operating high-voltage
equipment.
c) Use only properly grounded equipment (three-prong
plug).
d) Check for frayed electrical cords.
Fire Hazards
 A fire will extinguish if any of the three basic elements
(heat, air, or fuel) are removed.
What to do in case of fire? R.A.C.E.
 R.A.C.E. stands for:

R- Rescue

A- Alarm

C- Contain

E- Extinguish
What to do in case of fire? R.A.C.E.
 R.A.C.E. stands for:

Rescue anyone in immediate

danger

Activate the institutional fire

alarm system

Close all doors and potentially

affected areas

Attempt to extinguish the fire, if

possible
Physical Hazards
 Physical hazards are not unique to the laboratory, and
routine precautions observed outside the workplace apply.
 General precautions to consider are:
a)To avoid running in rooms and hallways
b)Watch for wet floors
c) Bend the knees when lifting heavy objects
d)Keep long hair pulled back
e)Avoid dangling jewelry and maintain a clean,
organized work area
f) Closed-toe shoes that provide maximum support are
essential for safety and comfort
Physical Hazards
Mechanical Hazards
 In addition to physical hazards such as fire and electric
shock, laboratory personnel should be aware of the
mechanical hazards of equipment such as centrifuges,
autoclaves, glassware and etc.,
Ergonomic Hazards
 Physical actions can, over time, contribute to repetitive
strain disorders such as tenosynovitis, bursitis, and
ganglion cysts.
 The primary contributing factors associated with repetitive
strain disorders are position/posture, applied force, and
frequency of repetition.
Ergonomic Hazards
Summary of Safety Hazards
 Compressed
OTHER LABORATORY HAZARDS
Gases Hazards
Compressed gases, which serve a number of functions in
the laboratory, present a unique combination of hazards in
the clinical laboratory: danger of fire, explosion,
asphyxiation, or mechanical injuries.

Cryogenic Materials Hazards

Liquid nitrogen is probably one of the most widely used
cryogenic fluids (liquefied gases) in the laboratory. There
are, however, several hazards associated with the use of
any cryogenic material: fire or explosion, asphyxiation,
pressure buildup, embrittlement of materials, and tissue
damage similar to that of thermal burns.
Laboratory Waste Management
The safe handling and disposal of chemicals and other
materials require a thorough knowledge of their properties
and hazards.
Generators of hazardous wastes have a moral and legal
responsibility, as defined in applicable local, state, and
federal regulations, to protect both the individual and the
environment when disposing of waste.
• There are Four Basic Waste-disposal Techniques:
1. Flushing Down the drain to the Sewer System
2. Incineration
3. Landfill Burial
4. Recycling
 Laboratory Waste Management
Types of Laboratory Waste:

Biodegradable Waste (Green Plastic Bag)– Originates from plant

or animal sources, which may be broken down by other living
organisms.

Non-Biodegradable Waste (Black Plastic Bag) – A type of waste

which cannot be broken down by other living organisms.

Hazardous Waste/Medical Waste (Yellow Plastic Bag) – A type of

waste that pose potential threat to human health or the
environment when improperly treated, stored, transported and
disposed.
 LABORATORY WASTE MANAGEMENT
(REFERENCE: DEPARTMENT OF HEALTH)
COLOR TYPE OF WASTES
RED SHARPS, NEEDLES
YELLOW INFECTIOUS WASTES
YELLOW WITH BLACK BAND CHEMICAL WASTES
ORANGE RADIOACTIVE WASTES
NON-INFECTIOUS WET WASTES,
GREEN
BIODEGRADABLE WASTES
NON-INFECTIOUS DRY WASTES, NON-
BLACK
BIODEGRADABLE WASTES
EXPIRED DRUGS, PHARMACEUTICAL
WHITE
WASTE
Chemical Waste
Chemical Waste In some cases:
1. Permissible to flush water-soluble substances
down the drain with copious quantities of water.
2. Strong Acids or Bases should be neutralized
before disposal.
3. Foul-smelling chemicals should never be
disposed of down the drain. Develop potential
toxicity.
4. Solvents such as Xylene and Acetone may be
filtered for reuse.
 Chemical Waste
Chemical Waste In some cases:
5. Flammable material also can be burned in
specially designed incinerators with afterburners and
scrubbers to remove toxic products of combustion.

6. Hazardous substances that are explosive (e.g.,

peroxides) and carcinogens should be transformed
to less hazardous forms whenever feasible.

7. Solid chemical wastes that are unsuitable for

incineration must be buried in a landfill.
Radioactive Waste

If the half life of the radioactive waste is

< 90 days:
a. Decay in Storage
b. Dispose in trash or in sink

If the half life of the radioactive waste is

> 90 days:
a. Contact Licensed Disposal Company
 Don’t quit.
Nothing last forever.
Not even pain.
Best Practices in
Phlebotomy
 Best Practices in Phlebotomy
 Ensure blood is sampled safely, no exposure to blood-
borne pathogens to patients, health care workers,
environment.
 Scope of best practices restricted to infection control.
 Labelling.
 Selecting the right equipment for the right patient.
 Protecting the sample from contamination.
 Steps of Safe Blood Sampling
Step 1: Select equipment, prepare area.
Step 2: Prepare patient, collect blood sample.
Step 3: Transfer blood sample.
Step 4: Waste management.

Other practice issues: type of phlebotomy equipment

Step 1: Select equipment, prepare area
 Wash and/or disinfect your hands first.
 Avoid collecting blood if local infection or other skin condition (E.G., weeping dermatitis,
skin lesions) compromises the skin integrity of your hands.
 Cover any small cuts on your hands (E.G., with a Band-Aid/plaster).
 Prepare a clean, designated and if possible, dedicated area for collecting blood samples.
 Wear a new pair of gloves for each patient.
 Use a sterile single-use lancet or phlebotomy set for each patient.
 Inspect packaging for breaches in integrity.
 Do not use equipment that may not be sterile (punctured, torn or damaged).
Step 1: Select equipment, prepare area
Step 2: Prepare patient, collect blood sample
 Wash visibly soiled/dirty skin.
 Antiseptic -clean, single use swab & maintain product-specific recommended contact
time.
 Do not use cotton balls stored wet in a multi-use container.
 Don’t touch the puncture site after skin disinfection or before blood sampling.
 Discard in an appropriate sharps disposal container any needle or lancet that has
touched a non-sterile surface prior to sampling.
 When the use of a tourniquet is indicated, use a clean device that has not been
contaminated with blood or body fluids.
 Anticipate and take measures such as appropriate patient restraint to prevent sudden
patient movement during and after blood sampling.
Step 2: Prepare patient, collect blood sample
Step 2: Prepare patient, collect blood sample
 Wash visibly soiled/dirty skin.
 Antiseptic -clean, single use swab & maintain product-specific recommended contact
time.
 Do not use cotton balls stored wet in a multi-use container.
 Don’t touch the puncture site after skin disinfection or before blood sampling.
 Discard in an appropriate sharps disposal container any needle or lancet that has
touched a non-sterile surface prior to sampling.
 When the use of a tourniquet is indicated, use a clean device that has not been
contaminated with blood or body fluids.
 Anticipate and take measures such as appropriate patient restraint to prevent sudden
patient movement during and after blood sampling.
Step 3. Transfer blood sample
 When using a syringe and a needle to perform phlebotomy, transfer the collected blood
slowly and directly into the collection tubes without removing the needle to prevent
spillage or splashing.
 Cover the tubes.
 Avoid recapping needles and other manipulations of used needles.
 If recapping is necessary, use one hand only to avoid puncturing the hand holding the
cap.
 Collect used sharps at the point of use in puncture resistant and leak-proof sharps
containers.
 Prepare blood collection tubes for storage or transport according to recommended
national and/or international packaging requirements.
Step 3. Transfer blood sample
Step 3. Transfer blood sample
 Disinfect the sampling area to
eliminate the risk of contamination of
equipment with blood or body fluids
for future use, particularly if spillage or
splashing of blood occurred.
 Wash hands after removing gloves.
Step 4. Waste management
 Seal sharps containers before they are
completely full for transport to a
secure area in preparation for disposal.
 Manage waste in an efficient, safe and
environment-friendly way to protect
people from voluntary and accidental
exposure to used equipment.
 Type of Phlebotomy Equipment

 Single-use, vacuum-based phlebotomy equipment is available

to reduce the risk of environmental contamination.

 Safer injection devices are increasingly available to prevent

reuse of injection equipment and needle-stick injuries.