Hematopathology Case Study: A 7 Year Old Transplant Patient with Neck Swelling

A 7 year old male with a history of restrictive cardiomyopathy status-post orthotopic heart transplant in June, 2010 that was on maintenance doses of tacrolimus and mycophenolate mofetil presented to his primary pediatrician left neck swelling. Starting in January 2017, the patient began with neck pain and swelling in the context of a recent gastrointestinal illness. Per CT report of the neck, a rim enhancing well-defined suppurative level III lymph node measuring 1.4 x 1.2 x 2.1 cm with adjacent soft tissue inflammatory changes extending into the left parapharyngeal space was identified. The patient was subsequently started on antibiotics and was discharged home with some improvement of swelling and pain.

The patient then presented again with continued neck swelling, although painless this time, and the patient’s cardiologist was contacted, who recommended a decrease in tacrolimus dosing. An otolaryngology evaluation was requested and given the concerning findings, the patient was admitted for further work-up, including a biopsy with a lymphoma protocol.

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EBER

 

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Flow Cytometry

 

Results

Flow cytometry revealed a kappa restricted CD10 positive mature B-cell population.

On biopsy examination, a population of monotonous lymphoid cells that are large in size with round to mildly irregular nuclear contours, open chromatin, and multiple inconspicuous nucleoli are present in a diffuse pattern. Abundant apoptotic bodies and mitotic figures are noted and occasional “starry sky” features are present. By immunohistochemistry, BCL6 highlights the neoplastic lymphocytes while BCL2 highlights background T-cells. EBER is negative.

Overall, despite a negative t(8;14) IGH/MYC translocation, the findings are best considered to be of an EBV-negative post-transplant lymphoproliferative disorder with morphologic features consistent with Burkitt lymphoma.

Discussion

Post-transplant lymphoproliferative disorders (PTLD) are a relatively rare complication in a variety of transplants that occurs in 2-10% of post-transplant patients. Overall, following a solid organ transplant (SOT), PTLD development is 1-5% of recipients with the highest incidence in intestinal and multivisceral transplantations (5-20%). Another factor is EBV status of the recipient, for which those that are EBV-naïve and lack cellular immunity to EBV are susceptible to graft-mediated EBV infection and ultimately developing an increased incidence in early PTLD. This population is overrepresented by pediatric transplant recipients1.

The presentation is highly variable and ranges from benign proliferations to overt lymphoproliferative disorders. Classifications for PTLD include early lesions, which are oligo- or polyclonal proliferations of EBV positive B cells have either a predominant infectious mononucleosis-like proliferation or a plasmacytic hyperplasia form. Polymorphic PTLD is a similar concept to the early proliferative lesions but the host architecture of the native structure is disrupted. Lastly, monomorphic PTLD is an entity that fulfills criteria for a non-Hodgkin lymphoma and is diagnosed according to the criteria of non-transplant associated lymphomas. Within pediatric registry studies, monomorphic PTLD accounts for 35-83% of all PTLD cases. B-cell lymphomas, particularly DLBCL, comprise the vast majority of monomorphic PTLD with plasmacytoma and T-cell lymphoproliferative disorders much less common2.

In this particular case, with the patient having been 7 years post-transplant and negative studies for EBV present, it is not surprising that germinal center phenotypic markers are highly expressed, such as CD10 and BCL6, which has been well elucidated by Jagadeesh, et al. Although not many genetic studies have been performed on post-transplant B-cell lymphomas, regardless of EBV status, there is some data demonstrating trisomies of 9 and/or 11 with translocations 8q24.1 (C-MYC), 3q24 (BCL6), and 14q32 (IGH). Rinaldi et al. noticed a lack of genetic lesions characteristic of postgerminal center derivation, such as gain of chromosome 3 (FOXP1, BCL6, and NFKBIZ) and 18q (BCL2 and NFATC1) together with losses of 6q (PRDM1 and TNFAIP3) in post-transplant DLBCL.  A number of DNA mutations have also been described including genes associated with somatic hypermutation (SHM) such as PIM-1, PAX5, C-MYC, and RhoH/TTF. These particular mutations are also found to be independent of EBV status1.

Overall, post-transplant lymphoproliferative disorders occur in a variety of transplant settings across many age groups and can be dependent on EBV and CMV status as well as the type and degree of immunosuppression. Although many variations take place in PTLD, patients with the monomorphic type are diagnosed according to their non-transplant counterparts. Current perspective includes further analysis of molecular and cellular mechanisms incorporated into research projects, which could better aid in prognostic implications and future therapeutics.

  1. Morscio, et al. “Molecular pathogenesis of B-cell posttransplant lymphoproliferative disorder: What do we know so far?” Clinical and Developmental Immunology 2013.
  2. Mynarek, et al. “Posttransplant lymphoproliferative disease after pediatric solid organ transplantation,” Clinical and Developmental Immunology 2013.

 

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-Phillip Michaels, MD is a board certified anatomic and clinical pathologist who is a current hematopathology fellow at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. His research interests include molecular profiling of diffuse large B-cell lymphoma as well as pathology resident education, especially in hematopathology and molecular genetic pathology.

Microbiology Case Study: A 58 Year Old Female with Fever, Headache, and Vomiting

Case History

A 58 year old female presented to the emergency department with complaints of a fever (reaching 102.9°F) and headache with associated nausea and vomiting for the past 24 hours. Her past medical history was significant for a resection of a recurrent hemangiopericytoma by the neurosurgery service three weeks prior. The patient also noted clear drainage from this surgical site which had begun 5 days ago. Other symptoms noted at presentation included decreased appetite and dehydration. She denied back & neck pain, photophobia or stroke and seizure-like symptoms. Her vital signs were all within normal limits. On physical exam, a healing surgical wound was noted in the posterior auricular area with clear drainage, but no blood or exudates were visualized.  She had no tenderness when her spine was palpated and neurologic exam showed a left sided facial droop and tongue deviation which were noted previously and attributed to her multiple central nervous system surgeries. Complete blood count (CBC) showed a mild increase in white blood cells and anemia. An external ventricular drain was placed and cerebral spinal fluid (CSF) was sent to the microbiology lab for culture. Blood cultures and a swab from the surgical wound were also collected.

Laboratory Identification

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Image 1. Gram stain of the cytospin CSF showed many acute inflammatory cells and numerous Gram negative bacilli (1000x).

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Image 2. Growth of large, glossy, reddish-orange colonies on sheep blood agar (image taken after 72 hours of incubation).

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Image 3. Growth of large, deep red colonies on MacConkey agar (image taken after 72 hours of incubation).

 

Gram stain of the CSF showed numerous acute inflammatory cells and many Gram negative bacilli (Image 1). Culture of the CSF and wound swab showed large, glossy red colonies on sheep blood and MacConkey agars (Images 2 & 3). Analysis of the colony by matrix assisted light desorption ionization time of flight mass spectrometry (MALDI-TOF MS) identified the organism as Serratia marscescens.

Discussion:

Serratia marscescens is a facultative Gram negative bacillus that is a member of the Enterobacteriaceae family. S. marscesens is ubiquitous in the environment and the most frequent and clinically important species in the genus. Although S. marscesens usually doesn’t cause infection in healthy individuals, it is notorious for colonizing and causing infections in hospitalized patients, particularly those who are immunocompromised, in intensive care units (especially intubated patients) and those with indwelling catheters.  While respiratory infection are most common, S. marscesens has also been implicated in numerous other opportunistic infections such as urinary tract infections, wound infections and septicemia. Brain abscesses and meningitis are less common. S. marscesens has been implicated as the cause of outbreaks in hospitals and can often be traced back to pieces of medical equipment including nebulizers, bronchoscopes, laryngoscopes and contaminated solutions. Person to person transmission is also recognized and thought to be predominantly transmitted via direct contact.

In the laboratory, S. marscesens can be identified by its characteristic non-diffusible red pigment, prodigiosin. Care should be taken when interpreting the lactose reaction on MacConkey agar, as the red pigment may be confused with a positive reaction, while S. marscesens is known to be lactose negative.  As a member of the Enterobacteriaceae family, S. marscesens is able to ferment glucose, reduce nitrate to nitrite and has a negative oxidase reaction. A unique feature of this genus is that all Serratia spp. produce three proteolytic enzymes: lipase, gelatinase, and DNase. Commercial systems, including MALDI-TOF MS, are helpful in the identification of S. marscesens as well.

Treatment of Serratia marscescens infections can be difficult due to various antimicrobial resistance mechanisms, such as expression of extended spectrum beta lactamases (ESBLs), AmpC cephalosporinases and carbapenemases, exhibited by the organism. In the case of our patient, she was empirically started on vancomycin and piperacillin-tazobactam and taken to surgery for wound wash out, removal of hardware and repair of CSF leak. Her antibiotics were changed to meropenem and gentamicin. She was discharged to a rehabilitation facility and received meropenem for a total of 6 weeks.

 

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-David Marbury, MD, is a 3rd year Anatomic and Clinical Pathology resident at the University of Mississippi Medical Center.

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-Lisa Stempak, MD, is an Assistant Professor of Pathology at the University of Mississippi Medical Center in Jackson, MS. She is certified by the American Board of Pathology in Anatomic and Clinical Pathology as well as Medical Microbiology. Currently, she oversees testing performed in both the Chemistry and Microbiology Laboratories. Her interests include infectious disease histology, process and quality improvement and resident education.

The Voice of Sint Maarten

It’s often difficult for a medical student to take time out of their schedule and work on projects in their community. Our free time is often encumbered with the “fire hose” of information that we all need to process and master before we sit for board exams. To be fair, there isn’t any free time per se. It is apparent (in medical school more than any other time I’ve known) that every minute of the time we schedule is, by choice, purposeful or not. With that noted, something exceptional happened this month in a span of three days that I am truly proud of. My “Z-Pack” Zika virus prevention initiative team all came together and tackled three extraordinary events around our Sint Maarten community.

If you’re just joining the Zika-related action, check out the background behind my work as well as some of the major accomplishments, achievements, and noteworthy lessons along the way this past year. My team’s work bridges a gap that exists between public health and the data we laboratorians acquire through diligent research.

The whirlwind of public health outreach events the Z-Pack was able to do were highly productive to the cause:

  • We have bolstered our public health and source reduction message on local radio, television, and print.
  • We have engaged and partnered with innumerable entities within this community and were an integral part of a mainstay annual health fair.
  • We engaged with local community members, not as students, but as public health liaisons fielding in-depth questions and addressing real concerns of the local population.
  • During these episodes, we were able to procure true data which we continue to collect, analyze, and use to formulate new approaches to positive health outcomes.

The first exciting development I listed was the debut into our media campaign. Being invited to the local radio to advertise our work and promote upcoming events was both exciting and reaffirming. In a short interview, I addressed Zika and other virus threats to the island community and discussed epidemiologic data and what it means in the scope of public health. Talking about our work alongside two of my team members and the project manager of the Ministry of Health’s vector control program was a thrill. A fellow team member and I were also fortunate enough to be flagged down by a local cable access television program to promote our work on a short video spot during our presence at the Lion’s Club Annual Health Fair I’ll discuss shortly. These media outlets reminded me of moments back in the laboratory when I had to present data clearly and field questions “on the fly.” Whether it was a staff meeting, educational resource assessment, or CAP inspection response, I couldn’t have been more prepared to handle the translational bridge from data to public view.

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Image 1: “Z-Pack” on the radio!

(Listen to the 16 minute radio spot here from PJD2 102.7FM/1300 AM The Voice of Sint Maarten)

I mentioned the Health Fair the local Lion’s Club sponsors each year, with booths that address a plethora of health education outlets from diet/nutrition, to diabetes, to (of course) mosquito reduction.  Partnering with our colleagues in the Ministry of Health we set up several tables in a tented booth and made available all kinds of educational resources for the public. There was a station designated to secondary interventions for combating mosquito risk reduction such as fogging guns and larvicides for standing water areas. I designed some clear-message flyers to distribute to patrons and others passing by our booth and was able to spark some interesting conversations with local community members and business owners who wanted more information—they wanted to distribute and display the same information in their offices and homes. Gaining popularity with the local community, we decided to record those interested parties and give them the title of “official community partners.” Not only will they feel more involved in the process of empowering and advocating for health for their community, but they will be motivated from within! I will say that my absolute favorite part of this health fair was the station our Ministry partners set up which included all their laboratory equipment they use to speciate, quantify, and analyze the local mosquito threat. This, alongside with our friends in local laboratory medicine who were collecting specimens to screen for Zika serologically, made this a very friendly environment for a laboratory professional like myself. You can bet I was happy to talk to visitors about epidemiology and risk reduction over a few microscopes!

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Figure 1: Clear-message informational flyers for public patrons to our booths at the health fair.
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Image 2: Health fair snapshots, a fogger gun, and some team building with microscopes.
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Figure 2: Preliminary data processing reveals an improvement in perceptions, attitudes, and behaviors toward Zika virus and overall arbovirus risk reduction.

On a more serious note, I want to speak briefly on the amazing opportunity that our community meeting offered for my team and I to learn some real truths about public health here on the island. With the success of partnering with laboratory services, research work in the field, and participating in a growing media campaign, the Z-Pack arranged a community meeting at a local religious center. Our “community meetings” as proposed in part from our earlier work focus on presenting audience and culturally specific information about reducing arbovirus risks and addressing health within the community. A community liaison connected us to a local Islamic center, where we conducted one of these meetings. Our presentation was received well, and a vigorous discussion followed. Having a partner from the Ministry of Health with us that day provided some clout to our discussions. I drew heavily on my interpersonal skills as a laboratorian when I fielded some really challenging questions from the adult crowd. Concerns in this particular community included specific objections to the effectiveness of the Ministry’s work on reducing mosquito populations, frustration over tourist-heavy areas receiving unfair attention, and true worry over improving health outcomes in a constructive and collaborative way. Taking the time to share their personal experiences was greatly appreciated by my team. Really engaging with the community on an individual level really makes it feel as though we are creating positive change. As a part of our work, data was collected on the effectiveness of our message. Still in its early stages, the data (Figure 4) shows qualitative improvements toward answers in post-presentation surveys which reflect new facts learned, potential for social/behavioral change, and establishment of health risk as a community priority.

 

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Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.

Myers-Briggs Type Indicator

Let me be honest and straightforward: this was not my favorite model when I first learned about it. Until, that is, I went through the certification to become a trainer and I fell head over heels in love, despite it being more complicated and intricate than the other models used and discussed in the Leadership Institute. The MBTI provides a deep understanding of your personality traits, natural skills, and tendencies while highlighting skills you have learned along the way. As an added bonus, this understanding isn’t tied to any life role (work, parent, child, friend, etc.). I, for instance, have a slight preference for extraversion with a lot of introversion tendencies. However, I usually come across as highly extraverted, as I learned to act more extraverted because my sister was very shy growing up and I wanted to balance it out.

The MBTI focuses on your innate personality preference, organized into four dichotomies:

  • Extraversion vs. Introversion (E –I)
  • Sensing vs. Intuition (S – N)
  • Thinking vs. Feeling (T – F)
  • Judging vs. Perceiving (J – P)

Your preferences in each category, when combined, are your type. For example, if I had a preference for Introversion (I), Sensing (S), Feeling (F), and Perceiving (P), my type would be ISFP. This type gives me insights into how I interact with others, process information, come to conclusions, and approach the outside world. Understanding this will allow me to know my strengths and weaknesses as well as those of others. As a leader, applying that knowledge effectively in different situations and with different people is essential.

 

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-Lotte Mulder earned her Master’s of Education from the Harvard Graduate School of Education in 2013, where she focused on Leadership and Group Development. She’s currently toward a PhD in Organizational Leadership. At ASCP, Lotte designs and facilitates the ASCP Leadership Institute, an online leadership certificate program. She has also built ASCP’s first patient ambassador program, called Patient Champions, which leverages patient stories as they relate to the value of the lab.

 

Yin and Yang

Who would have thought that our personality is made of contradicting elements?

I truly enjoyed the MBTI course, it was an eye opener of who I am and a trip inwards. Knowing who we really are, our talents, comfort zones and blind spots will help us become better leaders.

So now I know and after all these years (on a personal or professional level) that I am an “ENFP,” these four letters mean that I tend to be extraverted, intuitive, feeling and perceiving. I do agree with the assessment as it reflects who I am and decided after taking the course to put my Middle Eastern Ego aside and not challenge the blind spots.

ENFPs see new possibilities in people, situations, tasks and projects at hand. We tend to have high energy and flexibility. In my line of work, being the Chief Quality Officer at MedLabs Consultancy Group in Amman-Jordan, I find these personal traits very critical to our success as a company to ensure the highest compliance in implementing quality standards throughout our network of laboratories spanning four countries and exceeding 50 in total. Being a people’s person is a great asset in order to touch the hearts, minds and souls of our staff to sustain these quality standards, being 150% convinced rather than simply following the rules. We are trying to “personalize” Quality and Safety, this can only be accomplished through connecting with each staff member and it requires inspiration, a trait that is “built in” ENFPs.

Looking at the blind spots, I find that we tend to get overexcited about projects, juggling many at the same time and loosing track of priorities in the hope of making a difference. Guilty as charged.

I am learning to take one project at a time, see it through completion and start the next one in the pipeline, this gave me and my colleagues a breather and time to reflect if the road that we are taking is indeed the correct one.

So now I am asking myself, what if I did not have the great opportunity to be part of the ASCP Leadership Program and I have missed out on MBTI? What if I did not realize that I am an ENFP? What if I could not appreciate the blind spots?

The simple answer is: I will be a classical leader in it for the title, with little contributions and not much of a positive effect on those who are around me. My job will be stale, with no spirit and dull, so I guess Yin and Yang actually works.

 

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-Nael M. Soudi holds a bachelor degree in Microbiology from State University of New York at Plattsburgh (USA). He completed both his Master Degree in Molecular Biology and a postgraduate program in Cytotechnology at Johns Hopkins University (USA). Mr. Soudi is a certified Practitioner in Health Care Quality (CPHQ) and a certified consultant and inspector with the Healthcare Accreditation Council. He is also certified by the International Academy of Cytology (IAC) and the American Society of Clinical Pathologists (ASCP) – Cytology. Mr. Soudi is fully licensed by the American Society of Clinical Pathologists and the College of American Pathologist (CAP) as a Certified Inspector. He is a frequent presenter at regional and international conferences discussing topics in Cytology, leadership, accreditation and healthcare quality. 

Microbiology Case Study: A 64 Year Old with Coronary Artery Disease

Case History

The patient is a 64 year old man with a past medical history significant for coronary artery disease, chronic systolic heart failure, poorly controlled type 2 diabetes mellitus, atrial fibrillation, chronic respiratory failure on home oxygen, squamous cell carcinoma of the larynx status post chemotherapy, and radiation and lung adenocarcinoma status post microwave ablation. On the morning of presentation, the patient’s wife was unable to wake him and found him to have low oxygen saturation with a home monitor. Three days prior to presentation, the patient had been evaluated in the emergency department for leg and back pain for which he was prescribed hydromorphone. He had also been experiencing nausea for several days, with fever (101° F) and chills. His wife endorses several sick contacts at home. He has been admitted to the hospital numerous times within the past year for respiratory failure, most recently 6 months ago. The patient also was given a course of antibiotics one month prior for a “cold.”

Enroute to the emergency department, EMS administered naloxone without significant response. Upon arrival to the hospital, his vital signs were: temperature 97.9° F, heart rate 69, respiratory rate 23, blood pressure 104/57, 95% SpO2. He was found to have a white blood cell count of 15,690/cm2 and a chest x-ray showed diffuse patchy airspace opacities concerning for multifocal pneumonia. A viral swab was collected and blood cultures were drawn. He was started on levofloxacin for suspected community acquired pneumonia.

His blood cultures were found to be growing gram negative coccobacilli.

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Figure 1. Gram stain from a positive blood culture illustrating small Gram negative coccobacilli (100x, oil immersion).

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Figure 2. Chocolate agar illustrating the convex, smooth and gray colonies.

MALDI-TOF identified the organism as Pasteurella multocida. Further investigation revealed that the patient recently acquired a puppy (4-month-old) that bit him while playing. Antibiotics were switched to IV ceftriaxone and the patient recovered. He was later discharged on IV antibiotics and home healthcare.

Discussion

Pasteurella multocida is a non-motile gram negative coccobacillus that is oxidase-positive and glucose fermenting. Most isolates don’t on MacConkey agar. It is a known cause of disease amongst humans and animals, but is commonly a commensal organism found in domesticated and wild animals. It is most notably found in the oropharynx of cats, dogs, pigs, and birds. The majority of P. multocida infections are due to animal exposure, either from traumatic inoculation or proximity. Soft tissue infections are most common, resulting from animal bite or scratch. It has also been known to cause pulmonary disease in the form of multifocal pneumonia in those with pre-existing chronic lung disease. It is also a rare cause of septic arthritis, osteomyelitis, endocarditis and meningitis in those with disseminated disease.

P. multocida virulence factors include an endotoxin and an antiphagocytic capsule. It grows well on routine laboratory media but not on MacConkey. Colonies appear convex, smooth, gray and nonhemolytic. Mucoid variants can also occur. It has been described as having a musty or mushroom odor, although sniffing plates is not recommended. Susceptibility testing is usually not required as it is universally susceptible to β-lactams. However, CLSI does provide breakpoints for suggested drugs should the need for testing arise.

References

Tille, P. M., & Forbes, B. A. (2014). Bailey & Scott’s Diagnostic Microbiology (Thirteenth edition.). St. Louis, Missouri: Elsevier.

Kuhnert P; Christensen H, eds. (2008). Pasteurellaceae: Biology, Genomics and Molecular Aspects. Caister Academic Press.

 

-Clayton LaValley, MD is a 1st year anatomic and clinical pathology resident at the University of Vermont Medical Center.

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-Christi Wojewoda, MD, is the Director of Clinical Microbiology at the University of Vermont Medical Center and an Assistant Professor at the University of Vermont.

 

 

Your Reaction to Safety

The toddler’s father let her hand go so he could pay for their dinner at the busy airport. The little girl quickly wandered away and suddenly found herself at the top of a long escalator that was going down. No one was watching.

Mrs. Anders was walking home as she did every day from the neighborhood pool. She was very hard of hearing, but she was as friendly as she could be. As she waved to you while crossing the street, you see the car speeding toward her at too fast a pace.

You may have encountered a situation similar to one of these, or you may have seen something like it in a suspenseful movie or television program. The scenario is something that can create a reaction in you, a feeling of sudden dread, and the urge to take quick action. That’s a good response, and it could save someone from a serious incident.

But is your reaction the same in the lab where you work?

Lisa processed some CSF samples at the front desk that were delivered from another lab. She later received a call from the sending lab alerting her that the patient was positive for CJD, a prion disease, and the specimens were sent in error. When she went to clean up the processing area and tell the other staff, Lisa saw her co-worker leaning on the counter and using the computer with no PPE.

In the morning, Ken dropped a glass bottle of hydrochloric acid on the lab floor, and it shattered and spilled. He went to get the spill clean-up kit, but before he returned, the pathologist walked into the department wearing open-toed shoes.

Now let’s try something a bit subtler:

Robert is working in the chemistry department and he uncaps the next batch of tubes to be analyzed behind the safety shield on the counter. He places the tubes in the rack and carries the rack over to the analyzer. He’s not wearing any face protection.

Sheila was the supervisor in hematology, and she was walking through the department as Dwayne was on the phone with a service representative about the broken analyzer. The rep asked to speak to Sheila. Dwayne hands her the phone with his gloved hands, Sheila is wearing no PPE.

As a lab safety professional, one of my goals is to help lab staff have that same urgent gut reaction- that feeling that something is wrong and needs immediate correction- in all of those lab scenarios above, particularly the subtle ones. In each of those moments, the risk of danger or infection is very high and needs to be mitigated. All too often, however, these events occur in labs and no one reacts. That’s a safety culture problem.

There are many possible reasons for that typical lack of response. People are busy, the unsafe practices are common, or safety is simply not a priority. Lab injuries and exposures continue to occur across the nation, so the issues need to be addressed, and there are ways to do that successfully.

One method I use in safety training (that I’ve written about before) is the development of “Safety Eyes.” I call that the latent super-power that everyone possesses, but it needs to be taught and honed. When you work in a particular environment every day, it can become difficult to see the safety problems without training and practice. Take pictures of unsafe lab practices or problems and show them to staff. Have them identify the issue. As they practice, they will begin to see issues more often. Take practice safety walks with staff and look for issues. These actions will help everyone’s “Safety Eyes” to develop and become powerful tools in the department.

Of course, just seeing the issue is not enough. The second important piece here is teaching staff to respond when they do spot a problem. That can take some training and empowerment that may be new ideas for many. Teach staff to coach their peers for safety. This behavior will show others that safety is a priority, and over time more and more staff will begin to follow suit.

To produce the reaction you want in your laboratory—the issue is noticed, there is a sudden sense of dread or a gut reaction, and then there is a correction made—takes consistency. The lab safety leader will need to provide education about the regulations. Next, develop the “Safety Eyes” of the staff through pictures and safety walks. Finally, teach them to respond to the problems. As people, we are aware of the immediate danger when we see a toddler at the top of the stairs. The possibility of harm is clear to us. If you can produce that clarity for your staff with lab safety issues, you can get those reactions that can only improve your safety culture, and you can drastically reduce those injuries and exposures.

 

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Dan Scungio, MT(ASCP), SLS, CQA (ASQ) has over 25 years experience as a certified medical technologist. Today he is the Laboratory Safety Officer for Sentara Healthcare, a system of seven hospitals and over 20 laboratories and draw sites in the Tidewater area of Virginia. He is also known as Dan the Lab Safety Man, a lab safety consultant, educator, and trainer.

Help Researchers Tackle Antimicrobial Resistance in Tuberculosis

Researchers at the University of Oxford are researching antibiotic resistance in Tuberculosis, and they want help reading MIC plates. You don’t have to fly to England, though–you can do it online! Visit the project Bash the Bug on Zooniverse to learn more, view a short tutorial, and get started.

You can read more about the Bash the Bug project here.