lab safety – Lablogatory

Violence in the Laboratory

The field of laboratory safety is very obviously about the protection and well-being of those who work within the labs. The topics of study within this field typically include chemical hygiene, biohazard safety, and even emergency management. One area of focus that historically has not been discussed under the lab safety umbrella, though, is workplace violence. Unfortunately, this topic definitely needs attention and a place among the other safety subjects.

Teaching laboratory staff how to recognize workplace violence (WVP) is important, and the activities that define acts of such aggression are numerous. The National Institute of Occupational Safety & Health (NIOSH) defines WVP as “any violent act, including physical assaults and threats of assault, directed toward team members at work or on duty and include physical injury, threats, abuse, hostility, harassment, discriminatory language/behavior and other forms of verbal violence that can potentially escalate to physical violence.”

The definition is important so staff can identify it, respond to it, and report it. A higher priority, however, is not only to learn the tools that will help staff recognize when potential threats at work arise, but to also be able to de-escalate a tense situations and mitigate any violence altogether. Teach laboratorians to pay attention signs of aggression such as disruptions, outbursts, throwing objects or threatening gestures.

Employees should be taught to respond to growing violence threats by remaining calm, listening, and by demonstrating empathy. Responding to people by yelling or getting into their personal space will only escalate the situation. Your tone of voice, the volume of your voice, your facial expressions and your posture all give signals to the person who is agitated, and if you respond inappropriately with these non-verbal cues, the situation could get worse. Training staff to de-escalate these situations can go a long way toward preventing certain violent incidents before they occur.

Unfortunately, part of the WVP program must be responding to active shooter threats. The Federal Bureau of Investigation (FBI) offers “Run-Hide-Fight” training that helps employees know how to respond when an active shooter situation arises. * There are details in the response that must be considered ahead of an incident. If you can run to an area of safety without getting hurt, go quickly, but do not try to coerce co-workers or patients to come with you. In these situations, you must first consider only your own safety if you wish to survive. If you are in a situation where you can hide in a safe place, be sure to turn off your phone and other electronic devices. Incoming calls can make noises which can alert the shooter to your position. If you must fight, use whatever you can find as a weapon, and fight to win. Do not give the shooter any opportunity to fire his weapon.

The laboratory may follow a facility WVP plan or it may create its own, but there should be a safety plan in place for such situations. Be sure to establish a strategy to identify and address the factors that contribute to violence throughout the workplace. Allow for and ensure prompt and accurate reporting of all incidents of violence including those that involve no physical injury. Empower leaders and employees with the necessary tools to eliminate violence in their areas.

The faster workplace violence can be detected, the sooner a good response may occur. However, as with personal wellness planning, prevention is always a solid approach. Avoiding violent situations altogether can be a part of the lab culture with regular education and training. Make sure there is a strong Workplace Violence Plan in action in your laboratory.

*https://www.fbi.gov/video-repository/run-hide-fight-092120.mp4/view

–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.

Beam Me Up, Scotty

Wouldn’t it be nice if the samples just magically appeared in the laboratory? Sometimes I wish we had a transporter like in Star Trek that could miraculously produce tubes in the rack already sorted and spun. The reality is, however, that we must rely on others to package and transport samples to the lab. Whether it’s blood, urine, body fluids, or even tissues samples, they make their way from the collection site to the lab. If you work in a hospital setting, samples are delivered to the lab by one of two methods, a pneumatic tube system (PTS), or an internal courier.

Although very convenient when they work, pneumatic tube systems have a few drawbacks. Tube carriers can quickly become an ergonomic safety concern if staff are not properly trained. It is best to limit the number of samples placed in a single tube as overcrowded tubes can be heavy and cause hand and wrist strains if not properly lifted. Sharps such as syringes or needles should never be transported via the PTS. The person opening the tube may not know they are in there and could easily receive a needlestick exposure. It is not a good idea to transport stool or respiratory samples through the PTS either. Specimen containers could open or break inside the tube carrier and give the recipient a not so nice surprise. Additionally, pneumatic tube carriers are known to aerosolize samples. If a spill were to occur, the pneumatic tube system would have to be cleaned or disinfected immediately. Most maintenance or facilities departments have special carriers designed to disinfect the system in the event of a spill. The hardest part may be getting staff to report the spill and initiating the proper cleanup.

2. Some laboratory samples are walked down to the lab. Samples must be in a closed primary container and placed in a clean secondary container, usually a sample transport bag. Often, we see staff who are wearing gloves while walking samples to the lab. When asked, they state that they are carrying stool or COVID specimens and don’t want to contaminate themselves. The outside of the secondary container is considered clean, so there should be no need for gloves. Furthermore, if the gloves or outside of the transport bags are truly contaminated, these staff would be bringing contaminated items through the clean hallways of the facility. Then they would open the door to the lab, which is considered clean, with those same contaminated gloves. The Centers for Disease Control (CDC) has guidelines to mitigate the risk of bringing potentially infectious material into clean areas. The Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings document states that staff must “remove and discard PPE upon completing a task before leaving the patient’s room or care area”¹. Another thing to consider is what happens if one of the containers leaks during transport. Or even worse, what if a spill were to occur? Small amounts of blood or body fluid can easily be cleaned with an absorbent and disinfectant. A larger spill, say a 24-hour urine jug, or a hazardous material spill like a tissue sample in a large container filled with formalin, would need more attention. Staff should be trained in how to handle large volume spills and transporters should take precautions, such as using a cart and having a spill kit on hand when moving hazardous material like formalin.

Laboratory staff may not be the ones packaging and shipping samples to the lab, but they are often the recipients and have the responsibility to ensure they themselves and others remain protected. If staff should encounter specimen transport problem situations, be sure they have an effective pathway to communicate and escalate concerns. Often the staff sending specimens are not aware of the risks, so labs should provide that education- they will be thankful for it. Preanalytical processes are at the start of the road toward quality lab results, and everyone involved in each step should keep safe work practices at the forefront.

Centers for Disease Control. CDC’s Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings. (2022). Retrieved from https://www.cdc.gov/infectioncontrol/guidelines/core-practices/index.html

-Jason P. Nagy, PhD, MLS(ASCP)^CMis a Lab Safety Coordinator for Sentara Healthcare, a hospital system with laboratories throughout Virginia and North Carolina. He is an experienced Technical Specialist with a background in biotechnology, molecular biology, clinical labs, and most recently, a focus in laboratory safety.

The 3 Hazards of Hazardous Waste Management

Managing chemical (hazardous) waste in the laboratory is easily one of the most complicated areas of safety to understand. The regulations are set forth by the Environmental Protection Agency (EPA) and enforced by them or representatives of their state branches. For laboratories that are housed in hospitals or other large facilities, hazardous waste is often removed and handled through other departments like environmental services or maintenance. In the eyes of the EPA, the waste generated by the lab is the responsibility of the lab until it gets to its final disposal location. If other departments manage lab waste, the lab should routinely make sure it is being handled appropriately.

One of the most common areas where hazards occur in waste management regards storage. There are two types of chemical waste storage areas that can be designated in a facility, a Satellite Accumulation Area (SAA) and a Central Accumulation Area (CAA). Chemical waste is initially stored in a SAA which must be within the line of vision from where the waste is generated. Labs may store up to 55 gallons of waste in a SAA, and the EPA does not permit moving waste from one SAA to another. If the waste stored at the SAA is flammable, it should be kept inside of a flammable storage cabinet, but that cabinet would also need to be visible from the point of waste generation.

A second common issue surrounding hazardous waste is container labeling. In most US states, it is required that all containers of chemical waste display the words “hazardous waste.” The label must also show a description of the waste (i.e. stain waste, xylene waste, etc.). Finally, there must be some sort of hazard warning on the label. That warning may be in the form of a pictogram, a NFPA or HMIS warning label. If waste is poured into an empty reagent container, no elements from the original product label may be used, even if the waste is the same as the original reagent. Cross out the original label and place a new complete hazardous waste label on the container.

Containers placed in a SAA should not have an accumulation start date on the container. Facilities are allowed to store waste on site for specific periods of time based on the generator status selected as part of the EPA registration process. However, that storage time limit does not start until the waste is moved to the Central Accumulation Area. All waste in the CAA must be labeled with an accumulation start date.

The third hazard that crops up often in laboratories surrounds recordkeeping. Chemical waste vendors will come to the facility and they may remove waste containers from the CAA or any SAA. When they remove waste, they present a waste manifest which must be signed by a facility representative. Whoever signs that initial manifest must have a specific hazardous waste training that is required by the Department of Transportation (DOT). It is easy for a lab to monitor their own staff training, but if a different department signs waste manifests for lab waste, you need to check that those signing have the required training documentation.

Keep initial waste manifests in a file. The facility should receive final waste manifests within 45 days, and those final copies should be matched up with the initial paperwork so the lab can be sure all waste has been delivered to its final destination point. If the manifest records are kept in other areas of the facility, a lab representative should make routine checks to ensure records are kept up to date.

As you can see, it is fairly easy to make an error when managing hazardous waste for your facility. The regulations are complicated, and we only scratched the surface of them in this blog. Perform waste audits regularly, and include all storage areas and departments in the facility that may handle your waste. Reach out to the EPA or a state branch representative and feel free to ask questions. Managing hazardous chemical waste can be tricky, but it can be done so that the lab follows all regulations and laboratory staff can remain safe.

Letting Safety Slip

On a recent trip to my parents’ house for Thanksgiving, the second-row seat in my wife’s crossover vehicle broke. My wife and I, along with our two daughters were excited to set out for a long holiday weekend, the first in many years. We took that vehicle with three rows of seating so that when we visited my folks, everyone can fit in one car. While on vacation, we returned from a park, and my father exited the second row, followed by my daughter. The lever was flipped in order to fold the seat forward. When the lever was activated again to fold the seat back into its normal position, I noticed the pop-up indicator on the seat did not retract (the indicator lets you know when the seat is locked into place and safe for passengers). After tinkering with the lever, I discovered that the bottom right side of the seat was not locking completely into the floorboard. I immediately thought about the trip home. Our oldest child gets car sick when she rides in the last row, and our youngest’s car seat occupies the other second row seat. Should I take the risk and let my child ride in the semi-broken seat? After all, three out of the four sides were locked in place, and she would only be in danger if we got into an accident. I just had to make sure we drove extra carefully, and nothing would go wrong. The alternative was dealing with a carsick child- a very unpleasant option.

I share this story because I have seen lab staff having to make similar decisions and potentially compromising their safety. I wonder how many of you reading this blog have one piece of broken equipment in your lab that you continue to use. Maybe it is not all the way broken. Perhaps it is just a centrifuge with a broken latch or lock. It might be a drawer with a missing handle, and the drawer falls off the track when you open it all the way. There are worse scenarios. Right now there is someone working in a lab where the biological safety cabinet sash doesn’t go down all the way, and all the chairs have at least one rip in the leather. I know lab chairs are not cheap, and the company that comes out to fit the BSC costs a pretty penny, but how much do you think do you think it would cost if something catastrophic occurred because these issues were not addressed?

Sometimes we don’t think too much about broken equipment until something bad happens. Why would someone continue to use a broken centrifuge? Would you get on a rollercoaster if it were broken? Would you put your child in a seat that was not fully locked into place? I hope not. I sometimes hear managers say they are looking into fixing the issue, or they are waiting to get a quote, but they are still using the broken equipment. We should never be complacent when it comes to safety. Accidents will happen, fires will occur, and people will get injured while working in the lab. We put safeguards in place to reduce these occurrences, but when we choose to work with broken equipment, we negate all of those efforts. If you notice a piece of broken equipment, you need to take it out of service immediately and let your supervisor or manager know. Managers may not be aware of everything that happens in the department, and they depend upon staff to keep them in the loop when equipment gets damaged. Do not encourage working in an unsafe environment.

We made the executive decision to let our daughter ride in the far back row on the trip home. It was raining and we knew there would be a great deal of traffic. My child’s life was on the line, so of course I chose to do the right and safe thing. Did we have to make a few extra stops? We sure did, about three extra stops were included because she felt nauseated. We were actually about 15 minutes from home before she got sick. I knew it would happen; it was just a matter of time. I didn’t mind this time because it beat the alternative of having something happen to her if we were involved in an accident. In life we have to assume the worst will happen so we can make decisions that protect those we care about. It made the trip a little longer, a little messier, but for safety’s sake we have to be willing to take the long road, work a little harder, and maybe even be inconvenienced at times. Lab life isn’t always easy either, but it is worth the effort to protect those in our department. We should always take on the work to make sure the patients, our coworkers, ourselves, and even our loved ones are always as safe as possible.

Three Safety Cultures Questions to ask Yourself, Your Staff and Your Leaders

Whether you are a newly graduated scientist or a seasoned individual starting at your fifth lab in your career, you might be surprised by the safety culture at the new facility. You could be so impressed by the safety culture at your new laboratory that you question how no one was seriously hurt at your former one. Or you could walk into the lab on your first day and immediately get a bad feeling in your gut. No matter how you feel on day one, two, or maybe day 32, just know that there are some things you can do to help understand your new perception of the culture. Any great piece of research starts with a question or two. Let’s examine some queries that can help you wrap your head around why some labs win, and others fall short when it comes to their safety culture.

First, let’s start with the why. When the safety culture does not look good, it is easy to assume that the deviant behaviors you witness are simply people taking advantage of the system. But not all bad behaviors are spawned from a desire to do harm. You need to find out what is influencing their unsafe behaviors. Most of the time, subpar safety behavior stems from a lack of understanding the consequences of unsafe actions. For example, some folks may not realize that handling their cell phone with gloved hands in the lab has the potential to transfer pathogens into the breakroom when they place that same phone on the table when they are eating their lunch. When the timing is right, you should have a conversation with the employee about what you saw and inquire if they are aware of the potential safety risks. You never know, you could discover that it was a topic skipped in safety training and you single-handedly just improved the quality of your safety training program!

The next question you should ask yourself is, are laboratory leadership aware of the safety issues present in their lab(s)? In most labs, the managers are often overburdened, spending most of their time chasing a schedule, trying to fill open positions, or putting out fires (figuratively we hope). Therefore, you should not assume that leadership is aware and allow unsafe practices to occur in the lab. Sometimes managers and supervisors are so hyper-focused on one thing, they might not be able to see a safety issue right in front of them. If you see unsafe habits, bring it up to lab leadership and share with them that your intentions are to avoid a potential harmful event from occurring. In some cases, managers are already aware of the situation and are trying to come up with solutions. Your conversation with them and perspectives about the safety concerns might be the missing piece that helps complete the puzzle they are trying to solve. So, you should feel comfortable bringing your concerns and be prepared to come with solutions to any problems you present to them.

Finally, ask yourself if the safety issues you see are isolated to a particular shift or certain individuals. Although it is the responsibility of laboratory leadership to champion the safety culture, it is up to the staff to feed and nurture its existence. When everyone works together, it is reflected positively in the safety culture, the audit results, and the injury and exposure reports. When gaps are present, there will be an increase in the negative indicators until the issues are identified and resolved. Instead of making assumptions about the safety culture of the entire lab, try to see where the gaps exist and then revisit the first question- why? It is a lot easier to coach a single individual that wears earbuds in the lab than the entire night shift crew that refuses to wear a lab coat until 5 minutes before the day shift supervisor appears. If that single person is the root of your safety concerns, don’t let their behavior go unchecked. As with negative attitudes in the department, poor safety habits can spread like wildfire. If a single individual’s behavior is not addressed, then others will soon follow suit. They will see that there are no repercussions to lax safety behaviors or worse, they will think nothing bad can come of cutting safety corners. Laboratory leaders and coworkers that normalize poor safety habits are only making the situation worse and damaging the safety culture of the lab while putting the entire staff at risk.

You should never assume a safety culture persists on its own. A good or bad safety culture is the sum of many different factors, and the reason behind the factors can be vast. So, before you are ready to write off a lab as unsafe, take the time to dig a bit deeper and find out what contributed to making the safety culture what it is today. If the lab has a great safety culture, find out why. The lab you are in today may not be the place at which you retire. Your path might lead to a different workplace that has an even worse safety culture than the one you left behind. By asking questions about what creates a great safety culture, you become equipped with the right tools and knowledge and will then be in a strong position to use what you know to improve the lives of others in your new lab.

Fright Knife

One of my favorite scary movies is the original Fright Night, a campy horror film from the 1980s. In it, the main character, Charlie, discovers he is living next door to a vampire. He realizes there is danger, so the first thing he does is research. He asks his friend “Evil Ed” about vampire knowledge and tries to get as much information as possible. He performs a risk assessment in his home and then puts into place some engineering controls (crosses, wooden stakes, windows nailed shut), some PPE (a garlic necklace), and even work practice controls (do not invite a vampire into your home). Charlie also utilizes help in the form of an out-of-work actor who starred in cheesy vampire flicks. These actions taken by Charlie make sense: he takes the time to learn about the danger, and then he prepares to deal with it safely.

As a lab safety professional, I often wonder why people who work in the laboratory do not follow the same pathway. They are educated in school and in training about the multiple dangers in the department, but many work throughout their lab careers utilizing unsafe practices. For example, it is common for staff in a histology lab to work with or near sharp blades in cryostats and microtomes without using any implements or safety guards. The number of reported cuts that repeatedly occur in these labs is shockingly high, and the number of unreported injuries is likely much higher. What is interesting is that when having conversations with those laboratorians, they are fine with accepting the risk and accepting the injuries or exposures when they occur.

The concept is the same, isn’t it? Vampire teeth can kill you, so you protect yourself. Bloodborne pathogens and sharps can also be deadly, but why isn’t there concern about the use of safe lab practices with blades? There may be a few reasons.

The use of large, sharp blades is, of course, common in histology labs. They are a part of the everyday job. Hands go near them when tissue is cut, when tissue blocks are changed, when moving the blade, and when changing the blade. In some busy cutting labs, a microtome blade can be changed up to twenty times a shift. This ubiquitousness of this item tends to create a sense of complacency about it. Yes, people have been injured, some badly, some amputations have even occurred, but in comparison to the number of tissue blocks cut, those reported injuries may seem like small numbers…unless it happened to you.

Another reason for complacency is that often, when blade injuries occur, the blade has been used with fixed (and essentially harmless) embedded tissue or when they haven’t been used at all. Many cuts are “clean” and minor, so there is no true perception of danger.

A third reason I have often heard about why blades are handled with no safety measures in place is that productivity in the lab is key. There are standards about how many tissue sections should be made during a standard shift, and using implements to move or change the blade would hinder those goals. Read that again- productivity, in the minds of some, is more important than staff safety – and that is an acceptable stance for them.

As a lab safety professional, one of my goals is to change that unsafe mindset. It does not matter in which section of the laboratory work is performed, staff should be made aware of the risks, and they should be taught how to utilize engineering controls, administrative controls, and PPE to avoid the hazards in the department. Then there should be ongoing management of the safety program which includes risk assessments, safety audits, and follow up when injuries or exposures do occur.

Train those who work with blades in the department. Show them how to work with and handle them safely by using magnet-tipped brushes and rubber-tipped forceps to change and move them. Teach them to always engage the blade guards when hands go anywhere near the blade. Talk about serious cuts and amputations that can occur when unsafe practices are utilized. Review work practices regularly to ensure staff remain safe each time they use the equipment associated with the blades. With sharp blades, the danger has already been invited into the lab. Take the next best precautions you need to make sure your blade doesn’t bite and become a “fright knife.”

“CHiPs” and Dips

A delivery truck is backing up to the loading dock of an empty warehouse. You are about to receive the first ever delivery from your supplier, and soon this new lab will be up and running. Are you going to unload the truck and stash the new chemicals in the corner? I hope not. Getting started with chemical management can be a little overwhelming, but it certainly can be done. Benjamin Franklin said, “By failing to prepare, you are preparing to fail.” It is best to start with a plan, preferably a chemical hygiene plan (CHP). So, let’s take a dip into a few important sections of the CHP.

The creation of a great CHP begins by listing the chemicals you have onsite and their associated hazards, and this will be your chemical inventory. Categorizing your chemicals by hazard type helps you to determine where and how they should be stored and handled once in the lab. It’s important to determine the compatibility of your chemicals before you place them on the shelves. Storing your inventory in alphabetical order may make it easier for staff to locate a particular item, but not all chemicals play nice with each other when they are neighbors. A bottle of chloric acid stored next to calcium hydroxide could be an accident waiting to happen. Make sure incompatible chemicals are kept apart, stored on separate shelves, or kept in separate bins. Do you store ethanol onsite? What about xylene? Both are flammable chemicals, so you may be able to store them in the same flammable safety cabinet. Separate corrosive storage cabinets may also be needed for your strong acids and bases.

Now that we have the chemicals separated, what do you do when it is time to use them? Your CHP should outline training and personal protective equipment (PPE) requirements for the different hazards as well as any engineering controls required to ensure work can be performed safely. Do you have a biological safety cabinet (BSC) in your lab? Be careful, not all BSCs can or should be used as a chemical fume hood (CFH). A CFH is designed with specialized filters and/or ducting to eliminate hazardous vapors that BSCs lack. Only a few classes of BSCs can provide protection from volatile chemical fumes. Check with the manufacturer to determine if it is safe to handle volatile chemicals in your BSC.

Next, you decide how you are going to dispose of the chemical waste you may generate in the lab. Never assume that liquid chemical waste is allowed to be poured down the drain. Some acids and bases that are poured down the drain will alter the pH of your wastewater. The Environmental Protection Agency (EPA) and the local wastewater authority will not be fans of that practice. Hazardous waste disposal requirements vary from state-to-state, so be sure to know the laws in your area for your place of business (see website: EPA Hazardous Waste Programs).

So now your chemicals stored properly, you know how to use them safely, but what is the plan when something unexpected happens? The accidental release of chemicals can be quite dangerous, and so can a poor response. A well written spill response procedure and periodic training can make clean-up a much less risky operation. The first and most important step is to correctly identify the chemical that spilled. Make sure staff know the location of your Safety Data Sheets (SDS), know how to access them, and that they are up to date. You may use an online database to access the SDS, and some services will even automatically update the SDSs to ensure you are viewing the most current version.

Make sure there is a spill kit in the lab that can effectively handle the accidental release of the different types of hazardous materials in your area. The kit should include the materials for a biohazardous spill as well. Ensure you have a well written procedure that describes the steps to safely and effectively clean up the spill. Your procedure should outline actions such as securing and surveying the site, donning the required PPE, laying down barriers to prevent spreading, and applying absorbents. Also include information about extraction of the clean-up material and proper disposal. Remember, the waste created from a chemical spill is considered a hazardous waste and must be treated as such. Absorbed chemical waste should be placed in a bag specially designated for hazardous waste (and segregated for offsite removal by your waste vendor.

The drafting of a CHP does take time and attention, but you cannot stop there. Your CHP is a living document that requires attention, and once it is created, you never want to let it go stale. It is important to keep your CHP fresh by updating it often. In fact, OSHA and most accrediting agencies require laboratories to review their CHP annually and assess its effectiveness. Keep staff knowledge about your CHP crisp. When staff know how to locate and use their CHP, they are more prepared to work safely with hazardous materials.

A Culture of Safety Transparency- Three Reasons Why

Gena was working in the microbiology lab when she failed to notice a possible N. meningitidis from a cerebrospinal fluid culture. Not thinking there was any danger, she prepped the organism for identification on the analyzer, but she used a vortexer that was not in the biological safety cabinet and did not cap the tube. The next day when she saw the organism identification, she realized she had created an aerosol the previous day in the open lab when co-workers were nearby. She was afraid of getting in trouble, so she did not report the incident. Three days later, Gena was in the hospital and not expected to recover. Two other co-workers had also fallen ill with minor symptoms. After the investigation, the manager did not relay the details of the incident to all of the staff fearing that the department would get in trouble with hospital administrators. One lab employee decided to call OSHA and report what she felt were unsafe working conditions.

There are at least three reasons it is important to create a safety culture in the laboratory where all staff members feel comfortable discussing potential safety issues, incidents, and near-misses. The first reason is so that every single safety incident in the department will be reported. Even something as minor as a paper cut that occurs within the walls of the lab should be reported. A tiny wound can quickly become an infection if skin is broken while working in an area where bloodborne pathogens are present. Staff should understand why reporting is essential, and they should be aware of the follow-up procedures that are put in place by the organization. To get lab employees to realize near-miss situations may be more difficult- there needs to be education about unsafe practices and potential consequences. For example, an employee might successfully retrieve a lost specimen from a sharps container without injury, but they and others should understand the high potential consequence of that action, and it should be reported. That is a tie to discuss unknown source exposures and potential impacts.

A second reason for a culture of transparency in the lab is to help the staff know the organization s working to keep them safe and to make them comfortable enough to talk to leadership about incidents and questions they may have about them. Sometimes, if employees feel leadership is not doing a good job of this, they will report to agencies outside of the workplace. It is easy for an employee to report incidents to OSHA, and if that happens, the lab will need to do much more work for the response. When an incident occurs, being open and honest about the details, the response, and the follow up to ensure it does not happen again can go a long way toward comforting staff. Hiding information just helps to generate rumors and a feeling by some that they are not working in a place that is doing all it can to keep their employees safe. It can be difficult after certain events to tell the story. While names may not be mentioned, it is likely in many situations that staff will know who the involved parties are. That is still better than hiding information. When OSHA responds to a safety report, even if the response is written and no inspectors come on site, the incident report and the written response from the organization must be posted in the department per regulation. The employees are going to know what happened either way. It is always best to be up front about incidents and to make staff aware that their safety is important and monitored, and that issues have swift follow-up.

Safety transparency also has a third benefit- it generates an overall better safety culture for the laboratory. When staff are comfortable reporting issues without punishment or pushback, and when they see they can work with leadership to continually correct issues, safety becomes a natural part of the job. Openly reporting incidents in staff huddles, discussing routine safety fixes and improvements, and educating about near-misses are all normal in a department where the safety culture is strong. A strong safety culture means fewer incidents and fewer injuries and exposures, a goal for which all labs should strive. Once Gena realized her mistakes in the microbiology lab, she should have felt comfortable enough to report them for her safety and for the safety of others in the department. Even if she were new to the field or to the department, her leadership should have conveyed to her how vital it is to report safety incidents or potential safety issues. When staff understand that their organization cares about them and will work to protect them, even when something goes wrong, they will feel confident they work in an environment where safety transparency is the norm, and where the safety culture is strong.

It’s Getting Hot in Here

Each laboratory is required to create and maintain a fire prevention plan. What exactly does this plan entail? A fire prevention plan should include, at minimum, the identification of potential fire hazards in your lab, your available firefighting tools, and an action plan that outlines employees’ responsibilities during a fire or evacuation.

First, it is best to determine what fire risks are present in your labs. The best way to begin would be to inventory any flammable chemicals used and stored on-site. Some flammable materials such as alcohol can accumulate quickly, and it is necessary to know how much is stored in the department and where. The Occupational Safety and Health Administration (OSHA) mandates that quantities of flammable liquids greater than 25 gallons in a single room must be stored inside of a flammable storage cabinet (1926.152(b)(2)). The National Fire Protection Agency (specifically standards NFPA 45 and 30) takes it a bit further and focuses on limits based on total square footage in the lab. The NFPA limits the amount of flammable liquid stored outside a flammable storage cabinet to no more than 1 gallon per 100 ft², or 2 gallons per 100 ft² if you use fire safety cans. This storage limit doubles if an automatic fire suppression system is in place. The limitation of flammable materials in a concentrated area enables a fire suppression system to more easily extinguish a fire if one were to occur.

Next, look at the amount of combustible items stored around the lab. Are there several boxes of paper stacked next to photocopiers? Large amounts of combustible material in a single area can help fuel a potential fire. Are items stored too close to the ceiling? Check to see that there is at least 24 inches of clearance from the ceiling so that sprinklers are not blocked. Finally, inspect your electrical equipment. Look for daisy chains or permanently placed extension cords in the lab. As part of routine physical environmental rounding, it is best to search for these prohibited situations while also seeking out frayed cords and damaged electrical equipment.

Another component of the labs’ fire prevention is having the correct tools in place to combat a fire should one occur. The local fire authority will determine how many fire extinguishers are required in the laboratory and where they should be placed. To ensure adequate operation of this firefighting equipment, extinguishers should undergo routine checks which include annual maintenance. OSHA also requires a monthly visual inspection of all portable extinguishers (OSHA-1910.157(e)(2)). Verify that staff know the locations of their nearest fire extinguishers and that they can operate the specific types provided. Is there an automated sprinkler system in the facility? Staff should be aware of the location of fire pull alarms and have education about the alarm process (including calling any emergency numbers).

Lastly, the fire prevention plan should detail information about staff response to a fire, including fire drill and evacuation training. The safest way to evacuate is to have a predetermined evacuation route and muster (meeting) location. Staff should physically walk their full evacuation route annually all the way to their muster location and back. If this route becomes impassable, there should be an alternative evacuation route. During drills, walk one route to the muster location, then walk back via the alternate route. It is also wise to outline the expectations of staff members once they reach that muster location during the drill. If a large group evacuates at the same time, using a checklist or a buddy system can help staff keep track of who is present and who is not. Encourage your staff to stay at the muster location and not to wander off. If a supervisor is taking a roll call at the muster location, a staff member might be counted as missing if they leave to chat with a buddy in a different area. The last thing anyone wants is for a rescue worker to run into a burning building to search for a person who is not even at work that day. As the laboratory grows, so should the fire prevention plan. The addition of new equipment or a change in the current procedure warrants a review of the plan. It is recommended that fire safety policies and procedures are reviewed annually, and when changes are made, communicate that information to staff quickly. Ensuring that equipment is in place, that items are stored properly, and that staff are made ready to respond can lead to much better outcomes should a real fire occur in the laboratory.

Journey into Mystery: Unknown Source Exposures

In 1962, Marvel Comics introduced a new super-hero in their comic book titled “Journey into Mystery!” That character would become famous both in the book and eventually on the big screen. He was the mighty Thor. Through the years this Norse god of thunder would have many adventures and travel into many strange and unusual places all to protect his home of Asgard and to save the people of his adopted home planet, Earth. While the character of Thor willingly chose to journey into those many unknown places, those who work in the laboratory with bloodborne pathogens should not.

Evan popped the tops off of the serum separator tubes and placed them into the analyzer rack. He used a counter-mounted shield to protect himself from a splash. He picked up the rack containing five specimens and walked over to the chemistry analyzer to run them, but as he neared the analyzer his grip loosened, and he dropped the rack. It fell about an inch onto the analyzer and serum splashed up into Evan’s eyes. He did not know from which tube or tubes was the source of his exposure.

Rose was running late when she started her shift in the histology grossing lab. She did not notice that the small sharps container for scalpel blades was over full at the bench. When it was time to change her blade, Rose reached up without looking to eject the blade into the sharps container. She felt a sharp pain and saw that she had cut herself on several used blades that were sticking up out of the container access hole. Her injury had to be treated as an unknown source exposure.

If a bloodborne pathogen exposure occurs in the lab, there are several regulations that should be in place to help protect the exposed employee. OSHA’s Exposure Control Plan includes hepatitis vaccinations for employees, and follow up source testing instructions to discover the HIV and hepatitis status of the known source patient. Prophylaxis for an HIV exposure in the lab must be administered quickly to be effective, usually within 2 hours of the exposure, so rapid testing is key.

There are, unfortunately, accidents that occur for which the bloodborne pathogen source cannot be determined. The incidents described above could have been prevented, and they should have been, because treatment for an unknown source exposure is a journey no ne should want to make. In some cases, like with the sharps exposure, it is impossible to determine the source. In other cases, as with a rack of tubes, it is too costly and there is no time to test all possible exposure sources.

In some facilities, after an unknown source exposure, the policies call for complete serological testing of the exposed victim for HIV and hepatitis. This does not provide useful information, however, it only provides the serological status before the exposure, it does not alter the necessary treatment.

Treatment for an unknown source exposure usually consists of the immediate administration of prophylactic drugs. While these drugs are designed to help prevent the post-exposure development of HIV or hepatitis, they are known to be toxic to the body and can have many ill effects. Personal consequences can occur as well after such an exposure. As a precaution, the exposed victim may be told to avoid intimate relationships for six months. Clearly, this is not a journey anyone would willingly want to take.

All exposure incidents in the laboratory setting should be prevented, and the majority of them can be prevented easily. Pay attention to the surroundings and look for potential sources of exposure. Consistently use proper PPE including face protection whenever handling open specimens or performing maintenance on an analyzer where tubing or reservoirs are involved. Empty sharps containers when ¾ full, and never allow anyone to open them or dig through them, even for a lost specimen. The risk is too high.

In many ways, the work of a laboratorian should be a journey into mystery. There are test results to produce, diagnoses to be made, and new techniques to discover. With the work in the lab environment, all exposure risks should be assessed, and they should be mitigated using engineering controls, safe work practices, and PPE so that this work can be performed safely. Let the scientific mysteries be those that prevail and not the scary alien consequences of an unknown source exposure.