Safety in the Clinical Laboratory

March 18, 2021Chemical pathologyLab Tests

The clinical laboratory has various types of safety hazards. Some of these may be very dangerous and life-threatening.

The people working in the laboratory must know the various types of hazards in the laboratory and know the possible precautions to avoid those accidents.

These dangers can be reduced by eliminating hazards where possible, establishing clean, safe work habits, taking proper precautions, and maintaining awareness of safety practices.

The main type of hazards in the laboratory are:

Possible Safety hazards

Physical hazards:

1. These are quite common, and these need to be avoided e.g.
   1. Running in the rooms and hallways.
   2. When the floor is wet, be careful.
   3. Take care while lifting heavy objects.
   4. Ladies should keep their long hair tight and on their backside.
   5. Avoid loose jewelry.
   6. Wear closed-toe shoes that provide maximum support.
   7. Try to keep the working area neat and clean.
   8. Also, keep the working area well-organized.

Sharp edge instruments:

1. Sharp edge instruments like a needle, broken glasses and lancets give rise to biological hazards like:
   1. Give rise to blood-borne pathogens diseases.
   2. These may give rise to bleeding.
   3. Dispose of all these sharp edges articles in a safe place, like metal containers.
   4. Cut the needle of the syringe by the cutter.
   5. Also, crush the plastic syringes.
   6. Broken glassware:
      1. Beakers, test tubes, and flask with broken edges are hazards in the lab.
      2. Remove all these broken edges of glassware.

If you want to close the needle in the syringe, then follow the following diagrammatic method.

Syringe Needle precautions while closing the syringe

Fire and explosives:

1. In the laboratory, there are so many explosive and volatile chemicals used in the routine.
2. Flammable chemicals should be kept in the safety cabinet and explosion-proof refrigerators.
3. Should keep the compressed gas cylinders away from the heat.
4. The JCAHO gives the fire protection guidelines.
5. Whenever fire erupts, should take the following measures:
   1. Rescue anyone in immediate danger.
   2. Activate the institutional alarm.
   3. Close all the doors of the fire area.
   4. Try to extinguish the fire.
   5. Fire blankets should be available in the lab.
   6. May use Multiple purpose fire extinguishers.
6. One can follow the guidelines given by the national fire protection association (NFPA).

Chemicals:

1. These should be labeled as carcinogenic, poisonous, or corrosive.
2. Strong acids and alkalies are the most common corrosive chemicals to which lab technicians are exposed.
3. NFPA 704 gives the color coding for the materials. This color-coding will help the firefighter.
4. When mixing the acid and water, then first take the water and then add the acid slowly. Because by the addition of the acid, there will be heat production. If you add water to acid, that may burst out.

Safe method to add acid to water to avoid accidents

1. In the case of chemical spills, the best option is to flush the area with water.
2. Remove the contaminated clothes as soon as possible.
3. OSHA gives the written chemical hygiene plan (CHP).
4. It consists of:
   1. Appropriate work practice.
   2. Standard operating procedure.
   3. Personal protective equipment.
   4. Use of fume hoods and flammable safety cabinet.
   5. Employee training equipment.
   6. Medical consultation guidelines.
5. Label hazardous chemicals.

Toxic fumes:

1. There are solvents whose fumes (vapors) are toxic.
2. Extracts with chlorinated hydrocarbons, chemicals that cause damage to the liver.
3. Few solvents cause bone marrow depression with leucopenia, thrombocytopenia, and anemia.
4. There are few chemicals that are carcinogenic.
5. Precautions:
   1. In the case of organic solvents, use a hood and work in a well-ventilated area.
   2. Avoid contamination of the skin because these can get absorbed slowly. Wash immediately with soap and water.

Electrical hazards:

1. There are so many pieces of equipment working on electricity.
2. Avoid wet hands to operate the equipment.
3. Look after the damaged wires and avoid overload the circuits.
4. If any equipment becomes wet, then immediately unplug the wires and let it dry before using it.
5. Try to ground all the equipment.
6. If accidents occur and someone has an electric shock, immediately shut off the electricity without touching the person or equipment.
   1. Close the circuit breaker.
   2. Move the equipment with some nonconductor objects like wood or glass.

Biological factors (Infections):

1. Laboratory staff is always exposed to sources of potentially pathogenic microorganisms.
2. Hospitals are always filled with sick patients and some of these have contagious diseases.
3. Most of the samples like blood, body fluids, urine, CSF, and tissues have pathogenic organisms.
4. The spread of infections may be by:
   1. By direct contact of the laboratory staff. To the patient sample.
   2. By inhalation of the infected material, e.g., by droplet infection or if you are centrifuging the tube without caping it.
   3. By ingestion of contaminated foods and water.
   4. Then you may spread the infection to your colleagues.
5. Personel handwash and wearing personal protective clothes and pieces of equipment are important.
6. Special precautions are needed while handling the sample of a patient with HBV, HIV, and HCV viruses.
   1. Wear gloves while collecting the blood from the possible cause of HBV, HCV, or HIV.
   2. Wear the face mask if there is any possibility of the splashing of the blood.
   3. Dispose of all the sharp needles and objects in the puncture-resistant containers.
   4. Follow the CDC universal precautions (UP).
   5. In 1996 CDC combined the UP and Body surface isolation (BSI) and gave the guidelines:
      1. Advised to wash the hands after handling the blood or body fluids or secretions.
      2. Wash hands immediately after removing the gloves.
      3. Wear gloves when touching the blood, body fluids, secretions, excretions, and contaminated items.
      4. Wear gloves when touching the mucous membranes or nonintact skin.
      5. Change the gloves on the same patient if there is a possibility of a high concentration of pathogens.
      6. Immediately remove the gloves and wash your hands before going to another patient.
      7. Waer the mask, eye protection, and face shield to protect the mucous membranes of the eye, nose, and mouth during the procedure where there is any danger of the splash or spray of the blood, body fluids, excretions, and secretions.
      8. Wearing the gown protects the clothes and skin during the procedure.
      9. If the gown is soiled, remove it immediately and wash your hands to prevent others from spreading the infection.
      10. Clean the patient care equipment and sterilize it.
   6. Never recap the used needle, better to dispose of it. Or follow the direction given in the above diagram.
   7. Most important in the case of prick or bleeding: Don’t stop the blood immediately; best is to bleed under the tap water as much as possible, and then use disinfectants and stop the bleeding.

Carcinogens:

The original list of OSHA published in 1974 pointed to 14 carcinogens. They revised the list in 1978.

OSHA list of carcinogen:

1. Ethyleneimine       2. 2-Acetylaminofluorene    3. Benzidine    4. Methyl chloromethyl ether   5. 4-Nitrobiphenyl    6. N-nitrosodimethylamine   7. 4’4′- methylene bis ( 2-chloroaniline)  8. Alpha-naphthylamine   9. Beta-naphthylamine   9. 3,3, Dichlorobenzidine    10. 4- Dmethylaminoazobenzene
2. Benzidine is used to measure hemoglobin. Now there are alternatives noncarcinogens are available like ortho-substituted tetramethyl-benzidine for benzidine. o-tolidine and dianisidine, are weak carcinogens are used as chromogens in the enzymatic reaction in which H2O2 is produced with glucose oxidase and uricase.

Radioactive materials:

Radioactive material sign

1. This is needed in case using radioactive material like radioisotopes.
2. Mostly the radioactivity in the laboratory is very minimal and very little dangerous.
3. The best option is to wear a measuring device.
4. Should avoid exposure to pregnant ladies because that will cause harm to the fetus.
5. The ladies should avoid such areas of radiation.