Transparency in Injury Reporting

Susan was getting ready to work in the microbiology lab. She sat down after donning her lab coat, but before she put on gloves, she picked up some reports that were on the counter. As she picked them up, she noticed she got a small paper cut on her finger. Thinking nothing of it, she put her gloves on and went to work.

Chuck opened the door to walk into the back of the main lab. A cardboard box was in the walkway, and Chuck hit it with his toe and fell to his knee. He figured he wasn’t hurt, so he didn’t say anything since filling out paperwork was such a nuisance- and no one saw it happen.

Jean was walking into the hospital during the ice storm to get to work. Shortly after she closed the car door, she slipped and landed on her wrist. It hurt a little, but she figured it would be fine, so she didn’t say anything.

Accidents happen often in the laboratory setting, and many of them go unreported. The first thing that should occur after an injury is first aid. Then the incident needs to be reported. That may mean telling someone in charge in the department- a lead technologist or a manager. That can vary depending on the department and the time of day. Next, the incident should be reported to an institutional Occupational Health department or to a designated authority (such as the emergency Department) if the Occupational Health office is closed. This step is vitally important.

Make sure the details of the incident are recorded accurately, and that any witnesses are identified. Some facilities use an electronic reporting system, and others require a nurse to fill out the forms. Good communication is important here so that a thorough follow-up by the lab safety professional can occur later. The fewer details left out, the better.

We are human, and accidents happen, but the route to a better safety culture in the department is transparency. All injuries at work need to be reported. There is no shame in an injury, and there should be no reprisals, and reporting leads to prevention of injuries. The communication about the event is crucial- the reporting may prevent someone else from being injured in the same way. In some labs there have been serious injuries that occurred because no one reported a previous similar event. That can and should always be avoided. There are other reasons to report injuries as we – those stories at the beginning of the article did not have a happy end – because they were not reported.

After a week, Susan noticed that her little paper cut had become red and swollen. She made an appointment with her physician who prescribed an antibiotic. The antibiotic didn’t work, and after a serious bout of septicemia, Susan had to have part of her hand amputated to prevent the spread of the rare bacterial infection.

A day after Chuck tripped, Elaine walked into the lab and tripped on the same cardboard box. Elaine fell hard and broke her hip. She needed immediate surgery. She would have retired in another month.

 

Two weeks after her fall in the parking lot, Jean decided to go to the urgent care since her wrist was still hurting. An x-ray revealed a fracture that would need a surgical repair. Jean went to the Occupational Health office to report the event. Because there was such a delay in reporting, the compensation department decided they could honor the claim, and Jean’s medical follow-up was not covered.

There are many reasons to report an injury at work. The first one is about you- protect your own health and your future- that’s worth a few minutes of paperwork and a short visit to the Occupational Health office. The second reason to report is about everyone else. If something is unsafe in your environment and it has caused an injury, let someone know. That sort of communication and transparency is important to the entire team. Accidents happen, but even when they do, we can respond quickly and communicate so that safety improves after the event. As a lab safety professional, make sure you talk about accident transparency, and make sure it is something practiced by the entire team.

 

Scungio 1

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.

Packing for the Trip

If you are sending specimens outside of your lab for testing or for other purposes, there are many things to consider. Not just anyone in the laboratory should prepare the specimens for shipment, specific training is required. Staff needs to have knowledge about packing procedures, specimen safety considerations, and how to fill out the necessary paperwork.

The safe transport of laboratory specimens is regulated by at least four different agencies. The United States Department of Transportation (DOT) generates specimen packaging and shipping regulations and updates them every October. They become effective on April first of the following year. The International Civil Aviation Organization (ICAO) provides technical instructions for domestic and international air shipments. Dangerous Goods regulations are published by the International Air Transportation Association (or IATA). These annual updates take effect every first of January, and they comply with ICAO instructions as well. The fourth regulatory body affecting specimen shipping is the United States Postal Service (USPS). The USPS regulations are synchronized with those of both the DOT and IATA. In fact, most of these regulatory agency’s shipping regulations are similar because they have been harmonized with the United Nations Model Regulations.

Dangerous Goods are categorized under classes and divisions, and laboratory specimens fall under Class 6, Division 2; Infectious substances. For the purposes of shipping, these infectious substances are further divided into Category A (specimens known or reasonably expected to contain pathogens) and category B (human or animal specimens which do not contain pathogens). Very specific training for lab staff is required for those who will package and ship these types of products. A laboratory that sends such specimens is considered the shipper, and shippers are viewed in the eyes of the law as responsible for the package until it reaches its final destination. That responsibility involves proper and regular training, specific packaging instructions, and management of shipping paperwork.

Dangerous Goods packing and shipping training includes General Awareness information. This includes an overview of the various regulations surrounding specimen shipment as well as enabling the trainee to recognize and identify the hazardous materials that fall under the regulations. Function-Specific training is general instruction on how to package dangerous goods, how to properly label parcels, and how to fill out the required paperwork. Training shippers about Safety is also required. Staff must be given information about the hazards associated with handling dangerous goods, and there must also be training given about how to handle emergencies such as accidents or spills. Lastly, Security training is required because the materials being shipped could be misused in a way that could cause harm to others (i.e. a terrorism event).

The paperwork that must be filled out and that must accompany the package is called a waybill or a shipper’s declaration. A lab must have two original completed and signed forms. Two of the signed forms travel with the shipment to its final destination, and one will be retained by the carrier. There are very specific instructions about how to fill out a shipper’s declaration, and only those trained should do so.

Not all specimens and chemicals shipped by a lab are considered Dangerous Goods, and they may not fall under the regulations for labs that transport them. The DOT designates some items as “Materials of Trade,” and they are not regulated under transport laws. Material of Trade are those items which are carried on a motor vehicle to directly support a principal business of a private motor carrier (such as a private courier). That means that many diagnostic specimens and some hazardous chemicals (under 8 gallons depending on the chemical) may be transported without shipping papers, emergency response plans, and specialized training.

Proper training for those shipping Dangerous Goods takes time, and the information included in the training is much more in-depth than what has been discussed here. Those who are trained should be tested on the information taught, or they can provide a demonstration of proper packaging and paperwork management. Each successful trainee should be given a certificate of completion, and that record needs to be retained for at least 36 months. Training should be repeated every two years in order to satisfy the requirements of all regulatory agencies.

Laboratories across the country package and send diagnostic specimens for testing or for other purposes. Sometimes, depending on how and where those specimens will be transported, very specific regulations will apply, and specialized staff training will be required. Before you get those samples packed and ready for their trip, make sure your lab is following the regulations that will keep your staff (and those who will transport and receive the packages) safe from harm.

 

Scungio 1

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.

Safety Motivation

If you search for top motivational movie speeches, you will see things that might work in real life. The President’s speech from Independence Day (1996), for example, might influence you to never be oppressed by alien tyranny. Freedom will be your rally cry after listening to William Wallace in Braveheart (1995), or Maximus from Gladiator (2000) can speak to your heart about teamwork. Unfortunately, such speeches do to tend to maintain motivation for great lengths of time. Also, none of them will translate to a motivational discussion about safety with your lab staff.

Over many years I have watched what motivates people to do the right thing or take the safe actions in the laboratory, and that motivation varies. Different groups of people are persuaded by different forces, and understanding that can help you move your lab safety culture in the direction you desire. You may not agree with or even like some of the influencers, but learning them can help you be more effective in achieving overall safety compliance.

They say money is a motivator for people in all kinds of circumstances, and that’s true for lab safety as well, although not in the way you might believe (while some businesses may pay a bonus for fewer safety incidents, that is not typical in the lab setting). Lab staff who are concerned about finances are more open to following some lab safety practices if they realize the cost savings. Obviously, lab injuries and exposures cost the department both monetarily and with staff absences. Following proper regulations can reduce costly citations and fines that can be levied by organizations like OSHA, the EPA, or CMS. Some lab team members want funds available for new equipment or more staff. Use that to encourage them to follow proper safety procedures. Make sure staff properly segregates waste in the lab, for example, since doing things like placing paper into a sharps container costs the department extra money. Hospital and lab leadership also respond well to financial motivation. If you need something fixed or replaced because it is unsafe, always explain the financial consequences to the facility if the fix is not approved.

Knowledge can also be a powerful safety stimulator for some staff. Understanding the consequences of poor safety behaviors will discourage some, and education about those consequences needs to be given regularly. Let’s look at waste disposal again- those who are concerned about the environment should know that tossing clean items into a biohazard container could increase the need for biohazard landfills in the area- something we should avoid. Talking about the follow up testing and unpleasant effects of prophylaxis following an exposure from an unknown source can be very eye-opening. It may spur staff to be more careful when potential exposure situations arise.

You might not like to hear that punishment can be a motivator for correct behaviors, but for some staff members it is. Sometimes, explaining that a written corrective counseling or even termination will occur if safety practices are not followed will keep laboratorians working carefully and correctly. No one wants to “threaten” people to do the right things, but there will be those who are only motivated by not wanting to “get in trouble.” Knowing who those employees are can be important to guiding your leadership approach when working with them.

Lastly, some lab staff are inspired to act safely because the environment is designed to make doing so easy. PPE is readily available- lab coats of all sizes are accessible, gloves are out and not in a drawer, and face protection is mounted conveniently. There are hooks for lab coats near exit doors and hand washing sinks so that staff can properly doff and exit. Cleaning supplies and spill kits are readily available and instructions to use them are posted and up to date. Warning signs are there for staff and for visitors not used to the dangers in the department. I know that many labs are older, and the physical layout is not always conducive to making safety easy, but there are always steps that can be taken in order to make safety easier to achieve. You may need to step back and look at your environment with fresh eyes in order to envision what can be done to make improvements.

Think about what incentives are important to you when it comes to lab safety. Is it simply self-preservation? That’s good, but for many who are complacent about safety, their motivation may be different. Finding their reasons to be safe is a worthwhile task. It helps you understand better who your staff is as a people, and it will help you gain expertise for providing the stimuli they need to continue to work safely today and every day.

 

Scungio 1

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.

Safety in the Pre-analytic Phase

The courier suddenly became sleepy in the middle of his daily driving route. It was cold outside and he had all of the windows in the vehicle closed. He also had filled his cooler with four pounds of dry ice, and it was sitting in his back seat.

There was no education at the hospital for specimen collection staff regarding proper label placement on collection tubes. Since the CBC analyzer would not accept tubes with labels that were too long, the lab techs kept a razor blade handy to slice off extra label paper. It wasn’t long before someone cut their finger.

The phlebotomist completed the outpatient collection, but the large elderly patient was unable to stand up from the chair without assistance. The phlebotomist bent at the waist and attempted to lift the patient to standing. The back muscle pull that followed kept the phlebotomist out of work for two weeks.

Every laboratory professional understands the value of quality in the pre-analytic phase of laboratory testing. If you have ever worked where phlebotomy has been decentralized and is no longer overseen by the laboratory, you may have experienced the many pitfalls due to inadequate specimen collection techniques. Laboratory professional by nature want to provide good diagnostic results, and compromised specimens hinder that resolve. Sometimes, however, the aspects of safety that are important during the pre-analytic phase of lab testing get overlooked.

Needle safety and ergonomics should be considered during blood collection from patients. Using a needle with an attached safety device and activating it as soon as possible are important steps in needle stick prevention. Make sure there is a sharps disposal container near the point of collection or wherever needles are used so that the potential hazard can be eliminated quickly. When collecting blood, be sure to raise the bed height (or the arm height if in a chair) so that excessive bending is avoided. Use a chair or a task stool to sit on while performing the collection to maintain a better posture throughout the procedure. Never attempt to lift patients by yourself, always ask for help. Thousands of back injuries occur every year in healthcare due to avoidable patient lifting errors.

For many laboratories, couriers are a vital part of the pre-analytic process. They bring specimens from clients and other labs, and their safety should be considered as well. Teaching dry ice safety is vital if it is used, and both couriers and lab staff need to be taught how to handle it appropriately. Dry ice sublimates (or changes to gas from a solid state), so it should never be placed into a sealed container, or the building pressure from expansion will cause the container to explode. Couriers should never place more than one pound of dry ice inside a vehicle, and the windows should be opened when transporting it to create good ventilation. The gas created from dry ice quickly reduces the oxygen content in the air, and the elevated Carbon Dioxide levels can quickly cause unconsciousness or even death. Never place dry ice leftovers in the sink for disposal. While it might be fun to run water on it to see movie special effects, the cold temperatures can burst sink pipes and even make the entire sink fall out of place.

If specimens for analysis arrive in the testing area, and they frequently aren’t ready for analysis- for instance the labels aren’t placed properly- go to the source of the error to make corrections. If inappropriate labeling is a constant problem, staff will create work-arounds to get the work done, and some of these work-arounds may not be safe. Poorly-labeled samples may prompt a lab tech to remove gloves in order to adjust the sticky labels, and that should never occur. The use of sharp blades may be another work-around, and staff injuries can occur. Be sure to explain to specimen collection staff the importance of proper labeling. Turnaround times are delayed, but staff safety is also a concern.

Lab Quality and Safety are often related, and rarely is it more so than during the pre-analytical phase of testing. Proper collection, labeling, and processing are all vital in order to provide high quality lab results, and that is the crux of what laboratorians wish to do. The same can be said for laboratory safety: that pre-analytical process can’t be done well without proper safety considerations. Safety events here will create staff injury, turnaround time delays, and potential errors with test results. Make sure staff understand the impact of good quality as well as safety in the pre-analytical phase.

 

Scungio 1

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! OSHA is in My Lab!

Hospitals and other healthcare facilities have been on OSHA’s “high-risk” workplace list for a few years. That means the regulatory agency has noticed an increased number of employee injuries there, and therefore OSHA inspections have increased in hospitals and labs as well. If an OSHA inspector arrives at your facility, you should not panic, but you should know some very specific steps to follow.

If inspectors come directly to your department and you belong to a hospital or larger facility, be sure to contact your administration and accreditation departments immediately. This is a government agency on site, and the facility representatives need to be aware and involved. Verify the identity of the inspector(s). Sadly, there are imposters who pose as inspectors for the purpose of collecting money. OSHA inspectors will never talk about fine amounts during an inspection, and they certainly would not collect money on site. To prove the inspectors’ identity contact the state or federal OSHA office and verify that an inspector is scheduled to be on site. Twenty seven U.S. states and territories operate OSHA-approved State Plans, and if that is true in your area, it will be the state inspector on site rather than someone from the federal government.

OSHA is legally authorized to conduct workplace inspections to enforce health and safety standards, so it is usually best to allow them to inspect if requested. That said, you do have the right to require the inspector to obtain a search warrant before allowing them into your lab. However, as you can imagine, this will give an inspector the wrong idea about what you may or may not be hiding. They may dig deeper when they do return with that warrant, so it may not be the best course of action to turn them away.

An OSHA inspection begins with an opening conference which details the scope and purpose of the inspection. In the initial meeting, it is acceptable to ask the purpose of the inspection and its anticipated length. Ask what documents the inspector will want to see, and ask if there are any specific employees he or she will need to interview. If the inspection was triggered by an employee complaint, ask for a copy of the written report. The inspector may review certain lab documents pertinent to the investigation, and these may include the chemical hygiene plan, exposure control plan, or other policies and procedures.

While on site, the OSHA inspector should always be accompanied by a representative of your employer, an escort, and their next steps will usually be a walk-through of the inspected areas to look for safety hazards and to talk to employees. The inspector may talk to staff, take notes, and take pictures. The lab escort should take copious notes while this is happening, and it is advisable to take pictures of whatever the inspector documents with photographs.

If the inspector asks to interview an employee, he may do so in private so long as the employee agrees to that. Train staff to never volunteer information during an OSHA inspection; they should answer only what is asked. An OSHA inspector may ask if the employee familiar with lab safety policies and procedures, and whether or not the employee follows those procedures. They will try to determine if staff is aware of hazards in the workplace. If the inspector points out safety violations he notes, do not agree to them; it may be taken as an admission of wrong-doing and could incur a fine. If you are able to correct the violation on site, do so immediately, but understand that you could still be cited. However, this goes a long way toward showing the inspector that your interest truly is in cooperating and keeping employees safe.

Once the investigation is complete, the inspector will hold a closing session on site. During that time the lab will be notified about citations that will appear in the written report. The inspector will explain your right to appeal noted violations and give information on how and by when to appeal. They will answer any questions you may have. If on-site corrections were allowed during the inspection, be sure the inspector states that the follow up was completed.

If a citation will be incurred, start right away to prepare your response while the information is fresh in your mind. An OSHA report can take up to six months to be sent to the facility. Post OSHA citations at or near the site of the violation in the department.  If the correction of the violation takes longer than three days, the posting must remain until the correction is completed. After correcting a hazard, notify OSHA in writing. Employers have up to 25 days to submit OSHA an abatement of the safety issue or issues. If the abatement will take a long time (greater than 90 days), the first abatement progress report is due to OSHA within 55 days.

OSHA fines increased in 2016 for the first time in over 30 years. A single fine amount can range from $12,500 up to $125,000 depending on the seriousness of the violation. That’s just one reason to make sure your lab is following OSHA safety regulations. Keep your staff safe, but if OSHA knocks on your door, remain calm, and follow the steps to ensure a smooth inspection and follow-up process.

 

 

Scungio 1

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.

A Chemical Conundrum

In 1983, OSHA established its first version of the Hazard Communication standard. These regulations were made law in response to a lack of hazard information given to over 30 million United States employees working with chemicals. OSHA estimates that 650,000 chemicals are used in over three million work places across the country. Recognizing that the work performed in laboratories is unique—relatively small quantities of hazardous chemicals are used on a non-production basis—OSHA promulgated the Chemical Hygiene standard (more simply known as the Laboratory standard) in 1990.

The Chemical Hygiene standard regulations supersede HazCom standard regulations in the laboratory setting. However, there are still several HazCom rules that affect labs such as those involving hazard determination, chemical labeling, and Safety Data Sheets. The Chemical Hygiene standard brings another layer of exposure protection to the lab employee through the required establishment of a series of chemical safe work practices. Understanding how both sets of laboratory regulations work together is important in creating an overall lab chemical management program.

The regulations for creating a chemical inventory are expressed in the HazCom standard. OSHA requires a list of hazardous chemicals in every work place where they are manufactured, stored, or used. This inventory can be a useful tool for many reasons. Use the list to document the required chemical risk analysis. Review the chemicals in the lab for their hazards, and indicate on the inventory list any applicable hazard warnings such as the signal word and pictograms. CAP requires that you determine which chemicals in the lab are carcinogenic or reproductively and acutely toxic. Once that analysis is complete, it can also be documented on the inventory list. Record average volumes of the chemicals stored in the lab as well. This information may be helpful in a fire situation so that the fire department or other rescue workers will be aware of what they may encounter.

Laboratories must designate a Chemical Hygiene Officer, a point person who is qualified and responsible for providing technical guidance for the implementation and operation of the entire lab chemical management program. The Lab Standard even mentions the establishment of a Chemical Hygiene Committee if the lab or chemical program is larger. Details of this lab chemical safety structure should be spelled out in the lab’s required Chemical Hygiene Plan.

If you read the actual Chemical Hygiene Standard on OSHA’s web site, you can see it is not very long (unlike the HazCom standard or others). Because of the volume of chemicals used in labs, the standard’s main focus is protecting employees from those chemicals via written procedures, physical barriers (such as PPE and engineering controls), and health monitoring. A model Chemical Hygiene Plan must include exposure control methods, a chemical fume hood maintenance process, a detailed training program, and medical consultation and follow-up when chemical exposure limits are exceeded. Appendix A of the standard (called National Research Council Recommendations Concerning Chemical Hygiene in Laboratories) was created to assist laboratories with the development of a complete and compliant Chemical Hygiene Plan.

A third set of OSHA regulations that affects labs and chemical safety is the Formaldehyde standard. The exposure monitoring section gives instructions on how to perform vapor monitoring for this carcinogenic chemical. The laboratory has an option to monitor each employee individually, or it may set up a representative sampling strategy and measure exposures within each job classification and for each work shift. The purpose of this strategy is to properly characterize the exposure of every employee without having to monitor each one. Simply stated, that means if Jane and John perform the same duties and are equally exposed to formaldehyde in their work day or for a specific task, you may monitor only Jane’s exposure and share the results with both employees. That said, the CAP standard on the Anatomic Pathology inspection checklist states that each new employee should have formaldehyde vapor monitors performed. While it references the OSHA formaldehyde regulations, the standard fails to include OSHA’s wording about representative monitoring. That can be an issue if a CAP inspector follows strict adherence to those standards and does not subscribe to OSHA’s intent. Clearly representative vapor monitors make sense and are safe, but you may have to challenge the case with certain inspectors.

Chemical management in the laboratory can certainly seem daunting, and there are many regulations (federal and otherwise) that affect how the lab program may be run. The basic safety strategies exist for the purposes of protecting the employee from chemical exposure, but so many details are involved with the process. Proper storage of flammables and corrosives, labeling, and waste handling are just some of the topics not even touched upon in this article, but they also must be considered for safety purposes. If operating the chemical management program is your duty, be sure to understand the regulations, and build a team of staff who will work together to ensure safe chemical processes in the laboratory.

 

Scungio 1

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.

Bringing it Home

A recent report from the Centers for Disease Control (CDC) found that twenty-four laboratory workers were infected with a strain of Salmonella typhimurium, an enteric pathogen. The infections were reported in sixteen states across the country. Of those infected, six were hospitalized with symptoms such as diarrhea, fever, and severe abdominal cramps. Luckily, there were no deaths reported. These infections occurred in various teaching and clinical laboratories. The worst part? This could have been avoided.

When interviewed, some of those who became ill said they remembered specific exposure events. Many others who were unsure of how they became exposed described unsafe behaviors in the laboratory. Those victims admitted to working in the lab setting without lab coats or gloves, and many reported not washing their hands before leaving the department.

If you’re a laboratory leader, you very likely work during the day shift. Hopefully, when management is on site, staff is compliant with safety. If not, you may need to examine your safety program and leadership style. Do you enforce safety regulations in the lab? Do you lead by example? Do you don PPE when you pick up the phone or use a computer in the lab?

If safety seems to be good during the day, you may want to make a visit during the off-shifts. Depending on the level of safety culture, there may be anything happening from solid safe practices to open eating and drinking in the department. I know that was the norm in many labs 25 years ago, but those unsafe practices and safety violations should now be ancient history. Unfortunately, that is not the case, and that is one reason we have bacterial infection outbreaks in our laboratories.

An experienced lab auditor will tell you it is not difficult to assess the lab safety culture in a department, even on inspection day. I once entered a lab as part of an accreditation inspection team, and I watched as the lab staff struggled to find gloves. Even though they knew the inspection was imminent, they could not hide the fact that glove use was not the norm for them in that lab. A complete lab safety audit can reveal a number of inappropriate practices such as improper PPE use, gum chewing, cell phone use, and many others.

The National Institute for Occupational Safety and Health (NIOSH) has educated workers for years about hazard and exposure control. The “Hierarchy of Controls” is an excellent model to use in the laboratory setting, although certain facts about it may be surprising. The first and best two controls to remove hazards are elimination and substitution. Of course, these are not always possible in the lab setting. While there are substitutes for hazardous chemicals, the inherently dangerous specimens that are handled cannot be replaced or removed.

Engineering controls create physical barriers between the hazard and the employee. Biological Safety Cabinets (BSCs) and Chemical Fume Hoods are powerful engineering controls. Administrative and Work Practice controls are the safety policies and actual practices that help prevent infection. Written safety procedures are designed to change the way people work, and standard work practices include not eating or drinking in the lab setting and practicing hand hygiene when necessary.

The final control for infection prevention is Personal Protective Equipment (PPE). In the hierarchy, PPE is considered the last resort for staff protection. Since the lab hazard cannot be eliminated, and since humans commit errors with procedures, that final method of protection must be utilized. Lab coats, gloves and face protection need to be used at all times when working in the laboratory. Without it, the worker is at great risk for exposure- and that is what happened in the labs where the Salmonella infections occurred. Each of the controls that should be in effect in the lab were bypassed, and there were consequences.

It is always better to read about incidents that occur in other laboratories rather than have to report them about your own. When I hear of such stories, I always look at my own labs to see if such an event could occur there. What opportunities exist in my lab safety program? What about yours? Be sure to learn from these unfortunate events and keep your own staff safe.

The personal (and probably painful) part of the infection outbreak was that these laboratory workers were infected on the job, and then they brought it home. The CDC report says nothing about infections being spread to family members or friends, but it certainly could have happened. If there are weaknesses in your lab safety program, what could your staff be bringing home? What infections or diseases could be spread because of unsafe work practices? Now is the time to take the lead for your safety program before such an event can occur. Bring safety home for your staff. Teach them and lead them so that the unsafe practices of the past turn into practices that keep everyone healthy into the future.

 

Scungio 1

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.