The Laboratory Safety Challenge

In 2014 there was an internet challenge which exploded in popularity. It was the ALS Ice Bucket Challenge in which people would dump cold water on their heads and post the video on social media. The person getting the ice water dumped on them would challenge others to post a video of their dousing and they would in turn donate to the cause of finding a cure for ALS, a progressive neurodegenerative disease. The challenge became a world-wide sensation and raised $115 million for ALS research. But, like many good things, the challenge had a dark side. Many people were injured while attempting the challenge, and at least two deaths were at least indirectly associated with it.

Another challenge has come to social media lately, and this one involves a technical skill in the laboratory. It, too, has a dark side. The blood smear challenge is the latest rage for lab techs who enjoy posting videos on Facebook, Instagram, and other social media platforms. Lab techs show off their skill by making the perfect blood smear. At first it was about who could make a smear with the most perfect beautiful, feathered edge. Then the challenge evolved into people making smears while holding the top slide with one finger or even a pencil. There are those who were quite proud to show off their skill and work.

When watching videos of people in various labs performing this challenge, I cannot help but cringe. Several of these lab techs are not wearing lab coats. Many are not wearing gloves, and I have not seen any perform the challenge while using face protection or goggles. Ignoring the safety regulations about using basic personal protective equipment is apparently the norm. These people post this online without a second thought to a public display of working in the lab without PPE. It speaks volumes about the safety culture in those laboratories, and what it says is not favorable.

The next, less obvious safety issue with the videos is that they are created using cell phones or other personal electronic devices in the laboratory. People are handling devices sometimes with gloves, sometimes without, or they are setting them on lab counters which are likely contaminated. The use of cell phones and other personal electronic devices is a dangerous infection control issue, but it is unfortunately all too common. Even before this latest challenge, lab staff all over the country pose for pictures for social media posts that are taken by cell phones. Despite the fact that known and reported infections have occurred in labs from cell phones (and other items brought home from work), techs continue to use them.  

Other issues with the blood smear challenge may be less obvious. Unless these smears are being used, valuable lab supplies are being wasted. Slides and blood-dispenser cap piercing devices cost money, and many lab supplies manufacturers have run into supply shortages this year because of the pandemic. To have a lab waste money or run into shortages for the sake of this challenge might seem foolhardy to some.

Another safety issue with the challenge is the blatant act of playing around with human, potentially infectious blood to make the smears. Staff use engineering controls, work practice controls and PPE to separate people from the hazards in the laboratory. To place oneself at risk unnecessarily, especially during the COVID-19 pandemic, borders on reckless.

When the COVID-19 pandemic began affecting labs over a year ago, many laboratorians became concerned for their own personal safety. They were unsure about how they might catch this virus and what effects it might for them and their family. These were valid concerns, and some still have fears today. In conversations with lab staff over the past months I reminded them that they work with bloodborne pathogens every day, and many are as potentially dangerous (or more) than the COVID-19 virus. If Standard Precautions are used on the job, workers will be safe from infections from COVID-19 and other pathogens. The same is true today. Laboratorians may be less worried about the coronavirus, but the risk of infection in labs from this and other pathogens is as real as ever. Using engineering controls, PPE, and safe work practices is the only way to ensure lab staff can go home without bringing something dangerous to our families.

Challenges can be fun. I participated in the ALS Ice Bucket Challenge. I came out unscathed, but I was likely just lucky, not safe. The same is true for those posting pictures and videos online from inside laboratories. You might have been working that way for years and nothing has happened. Again, that is just luck, and it will run out. Make sure you and your staff are doing what is right, and what is safe. The real challenge is how to get laboratorians in all labs to work safely and follow basic safety regulations. Can your lab meet that challenge?

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.

Truth or Consequences: The Wrong Question

It was with sadness that I watched the episode of Jeopardy! which featured Alex Trebek’s final appearance. While I hadn’t watched the game show consistently since 1984 when he first began to host, Alex had certainly become an icon in U.S pop culture and I had enjoyed watching him often. The quiz show has always been different than most- the answer must be given in the form of a question, and it must be the correct question in order to score points. As with most games, contestants don’t always ask the right question. That can happen with lab safety, as well.

I was performing an audit in a laboratory when the manager was bringing a new employee through during her orientation. I was introduced as the Lab Safety Officer, and I described some of my duties like auditing and safety compliance monitoring. The new employee immediately asked, “What happens if you catch someone not doing what they should?” That was the wrong question.

As an experienced lab safety professional, I often see people fail to follow certain lab safety regulations. Unfortunately, you do not have to look far to find lapses in lab safety practices. Vendors and service representatives and other visitors walk into labs across the country and lab staff ignore them. The visitors are not given information about the hazards in the department and they are not offered PPE. A look on social media will reveal multiple pictures of lab workers not wearing PPE as well. Oh- and they are taking those pictures with cell phones they shouldn’t be using (sometimes the hand holding the phone is gloved, other times it is not). While I am concerned about these unsafe behaviors, I am equally concerned about those that witness them and say nothing.

The COVID-19 pandemic has raised the public awareness of an important aspect of personal safety: the unsafe behavior of others can have a direct affect on your own safety. People who refuse to wear masks or who are sick and do not isolate themselves may create situations where the virus is spread to others. In the past year, many people have realized this and have felt empowered to say something to those who are not exhibiting safe behaviors. That realization that they may be in danger has made people feel comfortable speaking up for their safety and that of others around them. Perhaps that is what is needed in the lab setting as well.

Unsafe behaviors in the laboratory can easily have consequences that may affect many in the department. Spills and exposures are just some incidents that may occur. Messy lab areas can create trips or falls, and improper storage of chemicals or hazardous wastes can be dangerous as well. Perhaps laboratory staff don’t think enough about the dangerous consequences because there isn’t enough training about them. Perhaps they don’t think about the potential consequences to others because they haven’t been told about the possible physical, environmental, or financial consequences. When the new lab employee asked the question, “What happens if you catch someone not doing what they should,” I should have had an immediate answer. I should have said that she asked the wrong question. The real question is, “More importantly, what happens to you if you’re not doing what you should?” Teaching staff about the consequences of unsafe lab practices is something that should start on day one, and the awareness of these issues should be raised often and continuously. The truth is, it is important to correct your own unsafe behaviors, but it is also important to feel empowered to correct unsafe issues that are witnessed. The truth is, we all have a responsibility for our safety and that of everyone else who may be in the laboratory. If we own that responsibility, then no one’s safety has to be in…jeopardy.

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.

2020: Lessons Learned in Lab Safety

2020 will be a year for many to remember, no matter your profession. If you worked in a laboratory, though, you know many things happened along the way which were both difficult and unexpected, and much of the year was consumed with work surrounding the COVID-19 pandemic. Changes and challenges came along which would test the resiliency of any lab safety professional. With luck, though, there were good lessons learned and new ideas about how to face certain lab safety issues in the future.

The Fear of Biohazards

One of the earliest challenges many lab leaders faced this year was dealing with the fears of staff who would have to work with COVID-19 patients and specimens. With the news reporting daily death tolls and unscientific data (like mortality rates when the total number of cases could not be determined), the amount of fear that was generated for some people became obvious at work. Staff members became afraid of handling any specimens, and people began unnecessary practices like double-bagging swabs or wearing gloves when transporting specimens.

Getting employees to deal with those fears and to continue to work became a priority for many very quickly. Many lab leaders conducted meetings and educational sessions. It was important to remind staff that they usually handled specimens every day which contain bacteria and other viruses that could be as harmful to them. They had to remember that if they used Standard Precautions with all samples, they could remain safe. In some locations COVID-19 FAQ newsletters were used to address hot-button issues and answer common questions about PPE, high-touch surfaces, and aerosol generating procedures. It was a good lesson to learn, lab staff need regular information about the proper handling of the hazards they work with and knowledge about how to remain safe on the job.

PPE Changes

Another challenge that arose was trying to keep up with the changes in recommendations for PPE use in the lab and for those who collected COVID-19 swab specimens. In the beginning of the year, masks were not required in the workplace, but that changed. Then cloth masks were not allowed in some organizations. The use of face shields or goggles was mandated, in some locations they were even required in break rooms and hallways. Phlebotomists who once wore only gloves now had to wear gowns, masks and face shields, and in some instances N95 respirators were used. These changes required education, training and an explanation for staff as to why the extra PPE was necessary.

Changes also came to how laboratorians would utilize PPE. Because of international shortages of supplies, the CDC provided information about extended use and re-use of the equipment. Organizations moved from using disposable lab coats and gowns to reusable ones. Hospitals had to set up methods for reprocessing and disinfecting gowns and N95 respirators for reuse using UV lighting or a hydrogen peroxide vapor treatment. Laboratorians and other healthcare workers learned how to extend the normal wear time of N95 respirators, masks, and other disposable PPE and how to store items rather than toss them out. While PPE supply issues seem to have calmed down, labs learned many lessons about how to handle such shortages in the future.

New Testing

As the pandemic progressed, many labs were asked to bring on board new COVID-19 testing. This testing typically had to be brought on board quickly, and in some cases new laboratory space had to be found. Many considerations had to be discussed such as room ventilation, safety equipment (BSCs, eyewash stations, spill kits, etc.), and proper specimen transport.

The best approach for this (as with any new process in the lab) is to conduct a complete risk assessment. One method is to identify the risks associated with the new testing, rate the likelihood and consequences of potential hazards in the process, and then implement steps to mitigate those hazards. Performing these assessments routinely and reviewing them will help to keep your staff safe as work continues in the department all year.

The COVID-19 pandemic affected other areas of work in the laboratory. Accreditation agencies delayed inspections, and now they are trying virtual auditing. Staffing levels are affected by virus exposures in the community or within the department, and while organizations do their best to follow national safety guidance, many have different approaches. The pandemic is not over, and soon healthcare workers will be offered a vaccine. What new lessons will we continue to learn as the situation continues to develop? Time will tell. The important thing for lab leadership is to stand for what keeps those in their department safe. Continue to follow standard precautions, and escalate issues when the unusual occurs. Remember, we will get through this, but as we do, take the opportunity to learn from the experience this year and when moving ahead!

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.

The Lab Safety Professional: How to Grow Your Role

In any professional career path, there are people who want to learn, to grow, and to advance professionally. That’s no different in the world of laboratory safety, and there are good opportunities to make that happen. If you’ve been in your position for a while, you might be asking what the purpose is for growing in your role. There are good reasons, and there are easy ways to go about it as well.

One reason to advance yourself professionally in the role of lab safety is that it can help you to stay on top of the latest regulations. That, in turn, will help you do a better job with keeping your lab safe and up to date, a goal we should all have. Advancement in the role can also keep you excited and motivated about your career which may make you a stronger safety leader. That motivation can lead to involvement with other laboratorians and professional organizations which creates advocacy for lab medicine (and safety) as a whole. Those interactions have the potential to bring positive changes to the overall field of lab safety. Embarking on the road to professional growth in lab safety also has personal benefits. It keeps you from becoming stagnant in your job. Armed with the latest information and making positive changes to keep your safety program running strong, the professional growth may lead to new and exciting career opportunities that did not previously exist.

Staying on top of changes and news in the world of lab safety is important to keeping your safety program up to date and in compliance with the latest regulations. It can be difficult sometimes to find the time to read professional articles or newsletters, but if you learn to skim headlines and read the relevant material, you can remain aware of new or updated safety regulations. There is an abundance of free literature available, and there are even safety and occupational health resources that are not specific for labs, but which contain valuable safety information on topics like PPE, the physical environment, ergonomics, or waste management. Request free newsletters from important safety resources such as OSHA, the CDC and NIOSH. These organizations have a major impact on lab safety guidelines and regulations.

Knowing your written and published laboratory safety resources is important as well. The Laboratory Biosafety Manual is a free book available from the World Health Organization (WHO) website. The latest version is the 3rd edition, and it was published in 2004, but an updated version will be released soon. The CDC’s Biosafety in Microbiological and Biomedical Laboratories (BMBL) 5th Edition is an excellent resource for biosafety information, and its next edition is also due to be published soon. OSHA offers a Laboratory Safety Guidance book on line as well, and the information withing aids in obtaining compliance with safety regulations that are required in all labs.

Another way to become more actively involved in lab safety is to volunteer to write or edit CLSI lab safety guidelines. The Clinical & Laboratory Standards Institute (CLSI) accepts volunteers from government, industry, and clinical labs to assist with guideline development, editing, and approval. Through their process, you can work on teams to create best safety practices that are viewed around the world. The experience of working with other lab safety professionals will broaden your knowledge and expand the resources you now access. Being a part of the CLSI document development process is a worthwhile and professionally rewarding experience.

Lastly, a lab safety professional can grow their role through certification. There are some general safety certifications that can be achieved, but there is only one in the United States that is specific to clinical lab safety: The Qualification in Laboratory Safety (QLS) offered by ASCP. The process of applying, studying, and testing for this certification can take you to that next level of lab-specific safety knowledge and expertise. The certification also bestows upon you increased credibility as an expert. If you have some experience in your role and are looking for the next step, getting that ASCP QLS is for you.

There are those who might think a career in safety sounds boring, and a narrower focus on clinical lab safety may even appear to be limiting as a career choice. That is not the case – there are a wide variety of methods to grow in such a career and truly become an experienced professional who is well-respected. That respect can take your career down an amazing path you never thought possible, and such a path can only be a benefit lab professional everywhere.

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.

Blood Splatter Does Matter

As a patient, when I go in to get my blood drawn, I have the anxieties and fears that most normally feel. Even as someone who understands the collection process and subsequent testing, it’s human nature to be nervous when having any type of medical procedure performed. Something most do not consider, however, is the fear and anxiety that the phlebotomist, nurse or laboratory technician who is drawing the blood may be feeling. Healthcare workers are at risk of biohazardous exposure daily and, in the wake of infectious diseases that can result in global pandemics, protection from this exposure is even more important. In the worst case, unanticipated patient movement or a combative patient may cause a needlestick injury to the person collecting. But what about the much less obvious risk of blood splatter? It’s important to understand all risks in order to put the appropriate protection in place. So, what exactly are the risks of blood splatter and how is the healthcare system working to minimize it?

Over the years, legislation such as the Needlestick Safety & Prevention Act and the Bloodborne Pathogen Standard has been put into place to decrease exposure risk, resulting in safety-engineered collection devices becoming mainstream. Prior to these changes, it was not uncommon for needles to carry no additional safety measures to protect healthcare workers and ensure the used needle was shielded when collection was completed. The rates of infection reflected this and, thankfully, have been significantly reduced with the introduction of safety devices.

While there have been several studies focused on needlestick injuries and the efficacy of safety engineered devices, there have been few on the potential for exposure through splatter when using these devices, though equally important. Splatter presents a real danger since it is known that infection can occur if mucous membranes are exposed to even minute amounts of blood. Most users may not even be aware that splatter or aerosolization has occurred and would not seek prophylaxis to prevent potential infection as a result. This would mean that they may not even be aware of a deadly infection taking hold in their body.

Though methods for assessing splatter may differ slightly, there have been studies that demonstrate visible and/or measurable splatter from use and activation of safety devices. One such study looked at retractable phlebotomy and intravascular devices and showed both measurable and visible splatter with a winged collection device.1 Studies since have taken this type of evaluation further looking at specific devices and the mechanism of activation.2

So, what does this tell us about the risks that phlebotomists and lab techs face every day from this potential for exposure that is often unrecognized? Because healthcare personnel must be aware of all avenues of exposure in order to take the necessary precautions, it is extremely important that use of safety devices meant to protect them does not create an additional risk of infection. Picking the safest device for use should not only include consideration of reduction in needlestick injuries but also assessment of splatter and review of studies such as those cited here to properly evaluate performance. Additionally, especially with devices associated with greater incidence of splatter, the appropriate protective equipment, e.g. face shields or googles, gowns, etc., should be utilized to prevent exposure and potential infection from bloodborne pathogens.

In summary, it is crucial that healthcare employees are equipped with the appropriate safety equipment when dealing with the potential for biohazardous exposure, that they understand the impact of the products being used and how these products can either help or hinder protection from bloodborne pathogens.

References

  1. Haiduven DJ, Applegarth SP, Shroff MP. (2009). An experimental method for detecting blood splatter from retractable phlebotomy and intravascular devices. Am J Infect Control 37(2); 127-130.
  2. Haiduven DJ, McGuire-Wolfe C, Applegarth SP. (2012). Contribution of a winged phlebotomy device design to blood splatter. Infect Control Hosp Epidemiol 33(11); 1069-1076.

-Michelle McLean, MS, MT(ASCP), BS is currently the Scientific Affairs Manager for Greiner Bio-One Preanalytics in North America. In this role, she is responsible for new product development and associated clinical studies, defining appropriate device application and developing technical and educational materials to support the preanalytic product portfolio. She is a Medical Technologist with an additional Bachelor of Science Degree in Biology and a Master of Science Degree in Pharmacology & Physiology. 

-Mackenzie Farone is a Senior Manager of Corporate Communications, Greiner Bio-One North America

Safety Checklists and High Reliability in the Lab

A High Reliability Organization (HRO) is one that works with complex and hazardous systems every day and yet retains a high level of safety and an error free environment. The first recognized HRO industries were the United States Navy nuclear aircraft carriers , the Federal Aviation Administration’s Air Traffic Control systems, and nuclear power plant operations. These industries operate using highly complicated and dangerous processes, yet they have the fewest safety incidents.

The use of checklists is an important part of keeping safety incidents to a minimum. They can help employees avoid safety issues, avert disasters, and even aid in incident response. In aviation, a pre-flight safety checklist is a list of tasks that must be performed by pilots and crew before a take-off. Pilots also use checklists for both normal and non-normal operations, for landings, take-offs, and also for malfunctions, and emergencies. Checklists are usually printed on a card, and one card may be divided into as many as a dozen of separate checklists, each of which will be read aloud depending on the phase of a flight. Nuclear power plant operations also involve the use of many safety checklists.

A functional safety checklist features specific characteristics that aid the user in avoiding safety mishaps. Checklists should have defined pause points so users can determine when the list should be used and when new tasks should begin. Checklists types are also important, and the style used may vary depending on the task and the experience of the user. For example, a “do-confirm” list is generally used when users are experienced with the process and have gone through the necessary steps on the list and simply run through it to ensure the process is complete. A “read-do” checklist means employees perform the tasks as they read through each list item.

Most checklists should not be lengthy as it may tempt experienced users to take shortcuts or to ‘pencil-whip’ responses. Make sure the list includes crucial and potentially overlooked steps. These may be the things that can cause the greatest harm if not checked. Use language that is simple, precise, and use terminology that is familiar to the lab staff using the list. Lastly. Test the checklist to see that it fits the criteria above, and that it accomplishes the task set for it. The real goal of using a safety checklist is to create a cultural change by enhancing teamwork, increasing safety communication and changing the understanding of responsibility for safety within the department.

There are quite a few published lab safety checklists available for use. Here are just a few:

  • CLSI’s Clinical Laboratory Safety (GP-17) – Lab Safety Checklist (Appendix C)
  • World Health Organization Biosafety Manual (2004)– Ch. 22 Safety Checklist
  • ISO 15190 Medical laboratories: Requirements for Safety (2019) – Annex B
  • EPA website: Waste Generator Inspection Checklists

Your lab may have its own specific needs, and these checklists may not cover them, or they may be too much for your current issues. If that is the case, create a checklist that focuses on an issue or issues you’d like changed. For example, if PPE compliance is on the rise, create a list that can be used daily or weekly. Walk around and look for proper footwear, lab coat use, and face protection for example. Home made checklists can be scored and used as a quality monitor in order to show improvement in lab safety over time. Make sure people are trained to use the checklists properly, and that people are consistent in how they answer individual items. It’s always a good idea to alter who uses the safety checklists as well. Make sure everyone can use them, and that will create a broader understanding of the safety needs of the department. That can go a long way toward improving the overall safety culture. A review of checklists is always key. If there is a problem with a response for a particular item, it should never be ignored. In fact, it should be addressed quickly.

Many labs today do not fall into the category of a High Reliability Organization. Complex and dangerous tasks do occur in the field, but safety incidents are not uncommon. It may be because lab employees are not educated enough about the consequences. There are definite hazards when working in the lab setting, but often they are not in the forefront of the lab techs’ minds, safety is not made a priority. It needs to be discussed more. Or maybe the reason is that many of the hazards in the lab do not always have more immediate consequences. Organisms involved with exposures have incubation periods, and disease states (like cancer) can take years to develop after a safety incident.

In the airline and nuclear industries, if a safety error is made, the consequence is usually immediate, and deadly for many. Is that it? Is that why people don’t have the same reaction to safety issues in the lab? What can we do as safety professionals to change that? I believe we can change it- and it will take checklists, training and safety awareness.

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.

From Panic to Pandemic: Laboratory Emergency Response Plans

In 2018, Hurricane Florence ripped through the Carolinas causing an immense amount of destruction and taking a record amount of lives in the area. Superstorm Sandy had a devastating impact on New York and New Jersey in October 2012. In Joplin, Missouri, an EF-5 tornado cut a damaging path through town in May 2011, directly hitting the hospital. Severe storms, flooding, and even blizzards are regular events throughout large areas of the United States every year, disrupting normal life and the delivery of services, including healthcare services.

Natural disasters occur frequently, and labs must consider them in their Emergency Response plans. These disasters have consequences for hospitals and laboratories and their operations. Given the wide variety of possible disasters that can affect a laboratory, it may seem impossible to be prepared for every type of event that could occur. Some labs take a reactive approach and create individual plans for different disaster types. For example, a lab manager may decide to create a blizzard response plan after a major winter storm—a plan that is separate from any previously existing lab emergency response plan. That may not work well, and it many plans may become cumbersome for lab staff when the event occurs.

As 2020 has shown us, other types of disasters that are not normally considered can also affect laboratory operations. The COVID-19 pandemic situation has created issues like the reduction of the availability of staff, a need to quickly alter testing platforms, and even major supply acquisition issues. Clearly, pandemic issues need to be considered when looking at lab disaster responses.

The best type of laboratory emergency response plan is a single plan that will enable the laboratory to continue to provide services in a variety of disaster scenarios, including pandemics. The College of American Pathologists (CAP) requires labs to develop an emergency plan which is based on the overall facility’s Hazard Vulnerability Analysis (HVA). The HVA is a risk assessment tool that lists types of disasters that can affect the facility, and it ranks which disaster types are most likely. If you work in an independent lab, you must perform your own HVA and update it every year. In 2020, it would be prudent to quickly add “pandemic” to the list.

There is no need to panic, however. In your plan which has been designed to have an “all hazards” approach, you may find some aspects of pandemic response are already addressed. Fluctuating staffing levels should already be addressed. Be sure the plan discusses how to best utilize staff when fewer people are available. That process may include a reduction in testing or utilizing a reference lab if necessary. In some instances during the pandemic, labs were left with too many staff members once an overall reduction in lab volumes occurred. How can extra staff be used? Can they go to other departments or facilities where needs may exist? There should be a section in the response plan regarding how to handle supply issues. If it is known there is going to be a problem obtaining PPE, reagents, and other supplies, decide what procedures will occur. Stockpiling, finding alternative vendors, and changing the type of supplies purchased are some options.

Once all of the pieces of the updated lab emergency operations procedure is complete, it is important to test the plan for flaws or needed improvements. One thorough method of testing includes the use of a table-top drill or exercise. Present a step-wise disaster scenario to key lab stakeholders and discuss possible responses as the imagined situation unfolds. Be sure to discuss important aspects such as staffing, supplies, communications, and relocation of testing. If the COVID-19 pandemic has led your lab to utilize its emergency response plan, be sure to take the opportunity to review how it is working for your department. Ask lab leaders and staff members if the current plan works- what went well and what needs improvement? This current disaster can help us all to improve our current procedures and keep us ready for the next event.

Is your laboratory emergency operations plan up to date? Does your staff know how to use it or will they panic when a disaster occurs? Has the plan been tested? Now is the time to review what you have and make sure it works for pandemics as well as a wide variety of disaster scenarios.

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.

Unwritten Safety Rules Every Lab Professional Should Know

Many years ago a woman purchased a cup of coffee in a restaurant drive-through. Not having a cup holder available in her car, she placed the cup between her legs to hold the coffee while she reached for money to pay for it. She burned her legs, sued the restaurant, and actually won her court case. Now such restaurants are required to warn customers with signs stating the obvious; “coffee served hot.” Before this regulation came to be, however, many people were aware of the possible danger of placing a hot cup near their skin. Does having a posted sign make customers safer? What about the lab environment? There isn’t an explicit safety regulation written for every action that could create an unsafe situation. So what are a few of the hidden and maybe no-so-obvious things might your staff need to know in order to keep safe?

You can’t chew gum in the laboratory. It’s true, but sadly, it’s not written down anywhere as a regulation. OSHA’s Bloodborne Pathogen standard says that “eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited (in the lab).” It says nothing abut gum, throat lozenges, hard candy, or even chewing tobacco. The unwritten rule is that OSHA is trying to prevent hand-to-face contact while working in an area where infections can be acquired easily this way. There are multiple routes of entry via mucous membranes- a major source of pathogen exposure- your mouth, nose, and eyes. Laboratorians should always keep their hands away from their face when working in the department. These activities are just another opportunity for hand- to-mouth contact. While you might be able to show the safety officer you are putting these things in your mouth outside of the lab, you would not be able to prove that to an inspector, and they will rightly cite you for it. If you need help enforcing this, be on the lookout- by the end of the year there will most likely be a regulatory body that addresses gum chewing directly.

How long should staff wear PPE? During the COVID-19 pandemic, many have asked about the effectiveness of various PPE and have looked for written guidance discussing how long it should be worn. In general, studies show that gloves lose barrier effectiveness in about two hours. Wear them that long if they are not visibly soiled while in use in the lab. Lab coats- disposable or reusable- can be worn for one week in the general lab setting unless something is spilled on them. Once a new coat is worn, the outside is considered contaminated, but that does not mean it cannot be re-used. It is wasteful to change coats every day unless there is a reason to do that (i.e. in a specialty lab where cross-contamination will be an issue). Face shields worn by staff can be reused as well, and they can be cleaned with alcohol-based products for disinfection. Rarely should a wearable face shield or goggles be used only once before disposal.

Mesh shoes are not allowed to be worn by lab personnel. Again, other than in CLSI guidelines, it will be difficult to find that written clearly in lab safety regulations. Laboratory footwear should “be comfortable and cover the entire foot, including the instep and the heel. Because canvas shoes will absorb chemicals or infectious fluids, they are not recommended. Leather or a synthetic, fluid-impermeable material is suggested. OSHA’s PPE standard does insist that employers take measures to protect the feet of employees. In the lab and specimen collection setting, that means footwear needs to protect from biohazard materials, chemicals, and even sharps. Mesh or canvas shoes do not fit the bill, and neither do clog-style shoes (even if they have a heel strap). If you need to, set your lab’s footwear policy through the dress code or maybe the Chemical Hygiene Plan. If staff tells you they can’t find this type of footwear, tell them to look harder. All across this country, hundreds of laboratory employees are wearing the appropriate shoes, and they are available at several different stores.

Often, because these safety rules are “unwritten,” staff will challenge you on them. It can be difficult to try to enforce these important safety measures if you can’t properly educate the staff about why they exist. Be sure to know your regulatory resources, and don’t be afraid to dig deeply into the references to find the answers you seek. Lab leaders can write their own policy, and it can go above and beyond what the regulations state if needed. The safety standard may not be clear and direct, but it these are still important measures to take. Just like that lady may have needed a sign to prevent her from putting hot coffee in her lap, your staff needs clear safety guidance to keep them safe from a lab-acquired injury or exposure. Provide the tools they need to remain happy and healthy members of your lab team.

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.

Laboratory Safety and COVID-19: References You Need to Know

Three months ago, life in the laboratories in these United States carried on as usual, and no one could probably have predicted where we stand today. The COVID-19 pandemic has changed the way laboratorians work everywhere. Some staff have had hours cut because of decreased workloads, other labs worked around the clock to bring new testing on board, and others dealt with staffing shortages due to illness. It has been a wild ride, and through it all, a great many safety issues have arisen. Common lab practices are now viewed through a new lens- is it acceptable to bring hematology slides for review into a clean pathologist’s office? Can we wear surgical masks worn in the lab into the break room? There are many good questions, but some of the answers can be found using references offered from reliable sources. Not everything you read online can be believed, but here are some references that may be necessary and that provide important information.

The pandemic has created a world-wide shortage of PPE, and some have wondered what can be done as resources diminish. The CDC has some good information about calculating how long PPE can be used and how long it can last. There are good guidelines about re-use and extended use of PPE.

PPE Burn Rate Calculator:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/burn-calculator.html

Strategies to Optimize the Supply of PPE and Equipment:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html

There are specific references regarding respirators and how they should be used.

Respiratory Protection During Outbreaks: Respirators versus Surgical Masks

Understanding the Use of Imported Non-NIOSH-Approved Respirators

Proper N95 Respirator Use for Respiratory Protection Preparedness

Some laboratory disinfectants have become more difficult to purchase. The gold standard for disinfection remains a 10% bleach solution, but there are many other options that can be used as well.

Disinfectants for Use Against SARS-CoV-2 (EPA List N):

https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2

EPA’s Registered Antimicrobial Products Effective Against Human HIV-1 and Hepatitis B Virus:

https://www.epa.gov/pesticide-registration/list-d-epas-registered-antimicrobial-products-effective-against-human-hiv-1

The CDC also offers laboratories a set of COVID-19 guidelines for performing testing, biosafety issues, waste management, and protection against aerosols. These guidelines are thorough, and they can be very helpful should safety challenges arise.

Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with Coronavirus Disease 2019 (COVID-19):

https://www.cdc.gov/coronavirus/2019-nCoV/lab/lab-biosafety-guidelines.html

Many of these references are updated regularly, so be sure you go to go to the source when making safety policy about COVID-19 tasks.

Laboratorians are now literally on the front lines during this novel coronavirus pandemic. While many public and commercial services have been scaled back, restaurants are closing, and many people are staying or working at home, lab staff are doing their level best to keep coming to work despite the extremely unusual circumstances and hardships.

I am here to serve as well. If you have questions about how to safely navigate this national (and global) emergency while working in the lab, ask me (info@danthelabsafetyman.com). I will do my best to provide any lab safety resources you may need. Make sure the decisions you make during these days are safe, sound, and based on the most recent resources available to you.

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.

COVID-19 Laboratory Safety: The Wrong Conclusion?

In the classic Barry Manilow song, Copa Cabana, the singer admonishes his audience at the end not to fall in love. We are told to avoid love because some guy named Rico might exterminate our loved one and we will end up a drunken barfly like Lola in did in the song. It’s a pretty funny conclusion when you think about it. If you were the victim in the story though, you might draw the same conclusion, however flawed. As the COVID-19 pandemic continues, laboratorians are seeing people draw incorrect conclusions as well, and some of those assumptions are leading to some potentially unsafe practices in some laboratories.

It’s easy to understand and even to forgive any misconceptions. The COVID-19 pandemic is unprecedented in our lifetime. The virus is new, it has spread very quickly, and there are unknowns about its make-up and mode of transmission. The situation has changed rapidly, and agencies like the CDC have had to change safety recommendations almost daily at times. Couple that with a media that by its nature uses fear and drama to ensure continued viewership, and people everywhere are going to make some fast decisions, and not all of them will be good.

One example of a change in guidance came from the CDC. At first, they were very careful not to give out any more information for lab safety than what was posted on their COVID-19 web page. When asked if typical lab specimens (blood and urine) from COVID-19 patients could be transported via a pneumatic tube system, they said that all specimens should be hand-carried to the lab. Since many patients were asymptomatic and many more could not be tested because of kit shortages, that would basically mean that all specimens in all hospitals would be carried to the lab. Before hospitals could react or even find the information, the CDC changed its recommendations. Only respiratory specimens from these patients should be carried directly to the lab (https://www.cdc.gov/csels/dls/locs/2020/transport_recommendations_for_covid-19_specimens.html), blood and urine can safely be transported. Given what is known about viruses and other pathogens in blood, walking all specimens to the lab doesn’t sound like a necessary guideline, does it? But this judgement in guidance simply illustrates what can happen when a situation changes rapidly.

With the push for the need for COVID-19 testing, news has come out about specimen collection kits and new and faster testing platforms. Not everything that has been reported has been factual. Every night we see numbers of cases and mortality rates reported in the media. Mathematically, one cannot determine a mortality rate without knowing the total number of patients’ cases. If there aren’t enough test swabs and reagents, and if we don’t test those who are asymptomatic (estimated to be about 25% of cases), how can we calculate any kind of accurate rate? Some laboratories have been pushed to bring on testing, and with little experience with brand new instruments, there has been work performed in some locations without adequate PPE or other safety measures. Look at your testing platform. Review the steps to see if there are any potential aerosol-creating steps. Are the correct PPE or engineering controls in place? Now more than ever it is vital to adhere to lab safety regulations while paying attention to the latest COVID-19 safety guidance. If you feel there is work being performed without adequate safety protection, escalate the situation as soon as possible. There will be no one to run teste if all of the laboratory staff becomes sick.

In many locations, hospitals have responded to the shortage of N95 respirators and surgical masks by developing methods to decontaminate and reuse them. While that is an innovative idea, make sure the system in place has physical and biological checks in place to ensure the reprocessing is effective. Spot test disinfected N95 respirators by performing fit-testing with them as batches are reprocessed. Use a biological indicator to ensure the COVID-19 virus particles have been eradicated. Do not reprocess N95 respirators used for protection against tuberculosis unless it is certain the disinfection process is known to effectively destroy TB bacteria.

Sometimes we come to the wrong conclusion, and sometimes mistakes are made, even in the world of science. But we are human, and we have to come to terms with that or we might end up alone in a disco like the aforementioned Lola. That’s why it’s important that we stop for a moment and pause, especially when an event occurs rapidly and transforms the very environment where we work. Take the time to ensure safety measures are in place for everyone involved. If something doesn’t make sense, question it. Examine it, and work with your staff as a team to make sure we can do what we are called to do- to safely perform lab work in order to provide quality results for the patients we serve.

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.