Into the Badlands of Safety

During a recent trip to South Dakota, I was able to visit Badlands National Park. I am not a hiker or a camper, so I was not sure I would enjoy the park very much, but it turned out to be the highlight of our vacation. The vastness of the landscape and the unusual beauty of the rock formations cannot be captured in pictures. It is truly something that should be see in person at least once in a lifetime. While walking the trails of the park, it looked and felt like walking in an alien world. It looks strange, and there are hidden dangers- rattlesnakes, potential high heat, and crumbly walkways with sudden drop-offs.

The experience reminded me of how the laboratory must seem to visitors or workers who need to come into the department to perform various duties. The laboratory must seem like a foreign world, and indeed, there are many hidden dangers within. If I had walked blindly into Badlands National Park and not read the warning signs, would I have been bitten by a snake or could I have walked off a cliff? Of course. Do the signs in your lab adequately warn visitors of the dangers? Do visitors pay attention?

The lab staff reported a plugged floor drain under the hematology analyzer, so the facilities plumber arrived to repair it. He asked the staff if the analyzer was running, and because they were not processing any samples, they said it was not. When the plumber bent down to look at the drain, the analyzer cycled waste through the drain line which quickly splashed into the eyes and mouth of the plumber.

Warning signs are required in many labs for many reasons, but they are not sufficient for protection from the hazards in the department. Those who enter the “badlands” of the lab need to be told about the dangers, and they need as much information as possible. If someone is coming in to work on equipment, offer proper personal protective equipment. If someone will be on the floor of a biohazard lab, make sure a lab coat and gloves are in use, and lay a pad on the floor if possible. Make sure people understand proper terminology. An analyzer may not be actively running samples, but it is still “on,” and there are still potential hazards present.

It should not be assumed that people who come to work in the lab department will have general knowledge of the laboratory or of lab safety practices. It is a good practice to use a safety training checklist for vendors or others who enter the department and to go over that checklist at least annually. Couriers can be harmed by pathogens, chemicals, or dry ice. Phlebotomists who are expected to process samples should be trained in centrifuge operations, spill clean up and more. Environmental service workers and biomedical engineering staff need to understand the chemical and biohazards in the department.

Instrument service representatives have training, but not typically much of that training is focused on lab safety. Some representatives keep a reusable lab coat with them, and wear it from lab to lab, washing it at home when visibly dirty. There are some OSHA violations in those behaviors. PPE that is used on a lab cannot be removed from that lab (except for professional laundering). Lab coats used in a laboratory cannot be laundered at home. These are unsafe (and illegal) practices, but until someone notifies the representatives about them, the behaviors will continue.

When someone works in the lab “badlands” every day, it is easy to become complacent about the hazards within, or they may be well-trained and no longer consciously think about the tools they use to mitigate those hazards. That is not true for someone who may enter, someone who does not have the same background, experience, and training. Laboratorians are responsible for their safety as well, and educating those visitors about the potential dangers can keep them safe so they can go into more familiar climates with their health fully intact. 

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.

Lab Safety: It’s Not Monkey Business

The monkeypox virus is poorly named. The actual source of the virus is unknown, although it is possible that African rodents and non-human primates (like monkeys) might harbor the virus and infect people. Either way, the virus has entered the United States again recently and has caused new safety concerns for laboratories around the country.

As with the novel Coronavirus pandemic, the monkeypox outbreak has created new safety concerns among laboratorians. How easily can this be transmitted? How should samples be handled or packaged for transport? Will this create a critical lab staffing shortage? How should waste be treated? It is vital that lab leaders and safety professionals answer these questions for staff and relay as much information as possible to allay unnecessary fears.

First, one of the most important areas of focus for laboratorians potentially working with monkeypox patient samples is to continue to utilize Standard Precautions. As always, all specimens in the lab setting need to be treated as if infectious. When handling standard clinical specimens (blood, body fluids, etc.) from suspected monkeypox patients, no extra safety precautions or PPE should be necessary in the lab. The quantity of pox virus likely to be in clinical specimens is low, although procedures that generate aerosols should always be avoided.

Laboratory staff should also be trained to package and ship Category B specimens. The current West African strain (clade) of monkeypox in the U.S. is not considered Category A under the Hazardous Materials Regulations (HMR), so monkeypox swab specimens for virus testing should be shipped similarly to other clinical specimens. Use the packaging kit and follow the instructions from the receiving testing lab.

There may be concerns about the spread of monkeypox infection among employees in the laboratory. Any infected employee should be using PPE when working in the department, and the monkeypox virus is only spread by close physical contact, direct contact with the infectious rash, scabs, or body fluids, and touching items (such as clothing or linens) that previously touched the infectious rash or body fluids. If there was contact with infected PPE or if an employee had prolonged face-to-face contact with an infected co-worker, that should be reported. The CDC states that monkeypox can spread from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. The illness typically lasts 2-4 weeks. People who do not have monkeypox symptoms cannot spread the virus to others. Direct any concerns to the employee health practitioners.

Laboratories should have an emergency management plan in place which includes how to handle staffing shortages. That plan may include sending routine testing to an alternate location, using point-of-care testing or reducing services to a limited test menu. In most laboratories, however, this monkeypox outbreak is unlikely to create a massive staffing outage. The virus does not spread quickly or in public, and a pandemic of monkeypox is not expected.

Handling monkeypox waste is another consideration for laboratories. Normally, the waste associated with monkeypox virus is considered a Category A waste (waste contaminated with a known highly infectious substance). However, waste from patients infected with the current West African strain of monkeypox is considered exempt from the category A Infectious Substance Regulations according to the Department of Transportation. It can be managed as regulated medical waste. Soiled laundry, including lab coats, should never be shaken or handled in manner that may disperse infectious particles. Laundry should be contained (bagged) at the point of use. Organizations should contact their local public health authority for more information if needed. As the past few years have shown, new threats will continue to emerge, and they will raise safety questions in the laboratory. As always, laboratorians should stay vigilant, pay attention to the work they do every day to avoid injuries and exposures when handling any specimens. Communicate with the hospital departments to ensure proper internal specimen transport of clinical and diagnostic (swab) specimens. Handling laboratory specimens has never been monkey business- the use of Standard Precautions and safe work practices will keep employees safe through this outbreak, and for whatever comes next.

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 Ergonomics: Safe Today, Healthy Tomorrow

Ergonomics is a safety topic that gets little respect in the laboratory, but it can become very important over time. The effects of poor ergonomics are cumulative, and they can appear suddenly. When they arise, the pain and treatment are often difficult, and as people age, healing is slower as well. Because the consequences of repetitive motion injuries are slow to appear, it can be a challenge to raise concerns and create solutions regarding ergonomics. Education and action today can prevent a great deal of future injuries and staff shortages.

There are several areas in the lab where a focus on ergonomics can create benefits, and creating healthy movement and comfort does not need to be expensive or difficult. Laboratory workstations have a primary and secondary work zone.  Keep the most frequently used objects in the primary zone (within 18 inches of reach) and less frequently used in the secondary zone (within three feet).  Every employee is a different size. Teach staff to take a minute before beginning work to adjust the chair and other work items to make the workstation more comfortable.  Eliminate clutter beneath the workstation to allows room to stand or sit allowing for foot and leg comfort.

Chairs should have 4-way and preferably 6-way adjustability and come in a variety of sizes to fit the employees who work in the lab.  Chairs should have five legs with casters that are appropriate for the surface being used (e.g.: hard casters on carpet and soft casters on tile).  The backrest should flex between 90 and 113 degrees with arm rests removed on chairs in the technical area to allow the chair to get closer to the benchtop. 

The tops of computer monitors should be at eye level.  Since many employees may use the same monitor, having it on a movable arm will help each user move the monitor to an acceptable level.  Any glare on the monitor screen can be reduced with a glare screen or by reducing the light in the department.  Keyboards should lay flat to allow the hands and wrist to work in a neutral position and the arms to work at a 90 degree level for comfort.

When using a centrifuge, stand directly in front and work over the top when loading and unloading, and use two hands to close the lid.  Centrifuges should be placed low enough so that employees can see into the body of the machine easily. Place antifatigue mats in front of laboratory equipment that requires standing for long periods of time. These mats relieve lower back and leg discomfort.  When bending and lifting, employees should lift using their thighs and not the back. Teach staff to hold objects close to the body when lifting.  Never lift more than 50 pounds without assistance from other employees or an assistive device such as a hand truck.

Capping and uncapping tubes for an extended period, phlebotomy, and transcription are laboratory tasks that require the use of the same muscle groups in the hands.  When working in these areas, it is important to vary the tasks every 2-3 hours per day and take mini-breaks to stretch fingers and arms in order to prevent carpal tunnel issues.

Breaks are an important part of overall ergonomic health.  It is better to take a five minute break every hour than to take a 15 minute break every four hours.  It is especially important if you are using a microscope or a computer for an extended period of time.  Remember the 20-20-20 rule: Every 20 minutes look up to focus on something 20 feet away and blink your eyes 20 times.  This will allow you to moisturize your eyes and give them a short rest. This can help to prevent ergonomics issues such as Computer Vision Syndrome which can result in neck pain, vision problems, and headaches.

Ergonomics safety is important on all areas of the laboratory, and the best way to ensure good work practices is to perform an ergonomics assessment. An ergonomic assessment should include identifying physical work activities or conditions of the job that are associated with work-related musculoskeletal disorders (MSDs) and how to eliminate these hazards.  For additional information, review the Occupational Safety and Health (OSHA) laboratory ergonomics fact sheet (https://www.osha.gov/sites/default/files/publications/OSHAfactsheet-laboratory-safety-ergonomics.pdf).

Over one third of all U.S. worker injuries are related to MSDs caused by poor ergonomics. Laboratory employees are valuable resources, now more than ever, and preventing time away from work, surgeries and medical bills for laboratorians should be a priority. The results of poor ergonomic practices in the lab do not show up today, but they will have effects tomorrow if we don’t pay attention to them. Those effects can be career-altering, career-ending, and they can interfere with the happy and healthy retirement that we all want to enjoy. Take steps today to prevent that future- provide training, raise awareness, and perform ergonomics assessments to make sure staff remains comfortable and healthy for all of their tomorrows.

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.

Three Rules to Manage Chemical Waste- It’s Complicated!

The lab technologist approached the Lab Safety Officer to ask what should be done with a collection of liquid wastes that were collected from the chemistry analyzers. The LSO had worked with multiple labs for years helping to determine how to dispose of their liquid chemical wastes according to the regulations. He thought he was pretty well aware of the hazardous chemical wastes coming from the labs, but he had no idea this chemistry analyzer waste existed. He dug a bit deeper. As he called around to the different labs in the system, he learned not all sites were handling the waste the same way. Some sites saved the excess waste and poured it into other containers to use on the analyzers. Some labs threw the containers in the trash with liquid inside, and other sites simply poured the excess chemicals down the sink drain.

Some laboratories and lab systems are very large, and there are probably many practices, some newer, some older, that have developed over time, because “someone said so,” or because a vendor said it was acceptable. The LSO may not always be able to know about every practice in each lab. Staff should always escalate questions about waste processes when there is a concern.

Managing hazardous (chemical) wastes is a complicated process, and training and education is needed in all laboratories. The regulations surrounding waste are numerous and complicated, and it would be unlikely that every lab employee would aware of all of them. Here are some basics that are true for all laboratories:

Pouring Bulk Wastes Down the Drain is (Usually) Incorrect and Possibly Illegal

In general, manually pouring bulk amounts of chemical waste down the drain is not permitted by the EPA. What is a bulk waste? It is defined as 200 mL or more. That means if you have >200 mL of a reagent left over in a container, you cannot pour it down a drain for disposal. That chemical is now waste and must be properly collected, labeled, and stored until a waste contractor can pick it up.

There are, of course, exceptions to every rule. If a waste drain line is connected to a drain, for example, that is not considered “pouring,” and it is acceptable provided a lab has informed the local wastewater treatment center about what is going down the drain. Performing a gram stain in microbiology and letting the residual chemicals go down the drain is allowed also. That is considered part of the gram stain process, and it is not viewed as “pouring” chemicals down the drain. Also, the wastewater facility is aware that these chemicals are going down the drain.

Another exception exists in some laboratories that have an external “chemical pit” which is tied to certain sinks and drains in the lab. That means that all wastes poured down these drains go straight to a collection tank which neutralizes the chemicals. The tank is emptied periodically by a contracted vendor. Since there is no waste going to the local wastewater system, the local authority does not need to be contacted about what goes down the lab drains.

Hazardous Waste Must be Properly Stored

Anytime a lab collects chemical waste, it must be properly stored. There are two types of waste storage areas, Satellite Accumulation Areas (SAA) and Central Accumulation Areas (CAA). A Satellite Accumulation Area is a storage area near to where the waste is generated. The SAA must be within the line of sight of where the waste is made, it cannot be in another room or around the corner. You must store the waste where it can be seen from where it was generated. You cannot move waste from one SAA to another SAA. You can. However, move waste from a SAA to a Central Accumulation Area (like a hazardous waste shed outside, for example).

SAAs can store up to 55 gallons of waste. Waste must be stored inside of a flammable cabinet if it is flammable, and acid wastes cannot be stored next to bases. SAAs and CAAs must have a specific emergency contact poster hung nearby which indicates the location of the nearest fire extinguisher as well as an emergency contact in case of a spill or accident. CAAs must be checked weekly for proper labeling, open containers, and leaking, and these checks must be documented.

Hazardous Waste Must be Properly Labeled

Anytime a lab collects chemical waste, it must be properly labeled per EPA regulations. All waste containers must be labeled with the identity of the contents and the words “Hazardous Waste.” There must also be an indication of the waste hazard(s), such as a pictogram or an NFPA diamond. If waste is collected into an empty reagent jug, you may not use the wording or warning label from the original jug.

Dates should never be placed on chemical waste labels when stored in a Satellite Accumulation Area, but dates always need to be on containers once moved to the Central Accumulation Area. If the waste vendor picks up containers directly from your SAA, you never need to place dates on the containers.

Again, the proper management of the laboratory hazardous wastes is complicated. There is a great deal to learn and to put in practice. Many regulations have exceptions, and some of them depend on the facility’s waste generator status. If you have questions, reach out to your EPA (or state branch) representative, or ask an available safety expert. Make sure your lab is handling chemical wastes appropriately and safely.

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 Succession

In many laboratories, managing safety is rarely a full- time job. Many have to oversee the safety program while also managing day-to-day operations, and overseeing the quality or point of care programs. Some are lucky enough to be able to spend all of their time on the lab safety program. Either way, the role can include managing safety policies and procedures, performing audits, providing education and training, and consistently working to improve the overall culture.

But what happens when the lab safety officer has a job change, a promotion or is ready for retirement? What happens to all of that safety knowledge and experience? Wouldn’t a gap like that be a detriment to the lab’s safety program? Yes, and laboratories should always be preparing for such an event.

One way to get prepared for a transition of lab safety duties is to identify a potential replacement while you are still working in your role. Look for someone who has shown interest in your work or has asked good questions about safety issues. Ask them to shadow you as you perform your safety tasks. Ask them to review safety procedures that are due to be revised. Have them watch a lab safety audit and describe how it should be performed. Ask them to create and possibly present safety education for the staff.

This may seem more difficult if you are the lab manager with safety responsibilities. However, there can be a benefit to identifying someone among the staff to perform some of the safety tasks as they can eventually come off of your plate. Leaders should also always have an active succession plan, so if safety must remain under your purview, make sure it is part of your discussions with your potential leadership replacement(s).

If, as a safety leader you run a laboratory safety committee, look for potential future safety leaders in that group. There may be one or more good candidates for future lab safety leadership. You can assess their readiness by delegating projects and tasks. Again, things like creating safety education, working on policies, and performing audits are great “auditions” for a future job. You can also ask the committee to create a safety fair, or to develop a safety poster contest or other projects which help to raise safety awareness in the department.

Provide resources for potential leaders such as safety documents and regulations. Involve them in lab safety inspections. If the EPA, the local fire department, or even the wastewater authority arrives for an audit, allow those staff members to be involved in the process. Getting a taste of these typical lab safety events can help people discern whether or not they want a future in the field. Preparing the lab for an upcoming accreditation inspection is also great experience.

Another way to help someone on their path if they are interested in safety is to help them get certified. ASCP offers a Qualification in Lab Safety (QLS). Preparing for the certification will help someone learn more about specific safety topics like Bloodborne Pathogens, Chemical Hygiene, and Waste Management among others. The suggested study resources and references will remain important in the hands of a future lab safety leader.

Given the growing shortage of laboratorians, it is clear that it will become more difficult to fill job openings as the years pass. Labs cannot operate without specific people, however. Leaders are vital, bench staff are key, and safety professionals will always be necessary. Planning for succession is something that should be inherent in the department for most positions. The organizational chart should be designed with succession in mind and a staffing plan that goes beyond today. Lab Safety should always be a key piece in the lab’s overall succession process. 

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 Moment

Often I am asked how one who is responsible for laboratory safety (yet has other duties as well) can get the job done well. In today’s labs there is tight staffing, tight budgeting, and a score of regulatory duties that must be accomplished, and not all of these things revolve around safety. Many who oversee the lab safety program also must run the point of care program, the lab quality program, or even manage all of the day to day operations of the department. It’s a great deal to juggle, but there are methods you can use to make sure that laboratory safety doesn’t take a back seat.

One way to incorporate safety into your multiple roles each day is to start every meeting or huddle with a safety moment or story. Ask for a team member to discuss a safety story they witnessed or in which they were involved. Placing safety first lets the team members know it has priority, and relating an issue or incident has benefits as well. The safety moment may be as brief as reporting on how an employee provided PPE to a vendor that came into the department. That is a safety success worth mentioning, and there are doubtless others that can be mentioned. These safety stories may also be those that do not necessarily illustrate a success. Telling people about an incident and asking how it could have been avoided is a fast yet educational plus for your safety culture. Reviewing safety incidents is also beneficial so that others know what happened and they can be thinking of how to avoid the same thing from happening to others or themselves. Talking about safety in these ways takes little time, but if safety is incorporated into the language of the department, the culture will remain improved, and it is easy to fit this habit into your schedule.

Acting as a consistent role model is another way to incorporate safety into your multiple roles. Make sure you wear the correct clothing and shoes. If you walk in and out of the department, you should dress the part. Open-toed shoes or mesh sneakers should not be worn. Wear PPE when performing any work in the lab, including huddles or team meetings. It doesn’t take any extra time to model the safety behaviors you expect from the staff, and doing this shows the staff where safety stands in the department.

A third way to insert safety into your busy day is to make sure you are able to quickly spot safety issues and address them immediately. Developing your “Safety Eyes” is a vital tool – learn how to notice safety problems as you work in the lab. Train yourself to be able to do this by looking for one thing each week. For instance, look for PPE and dress code issues on week one. Purposely notice what people are wearing on their feet, look for proper PPR like lab coats and gloves. Check to see that they are worn properly. If you do this for one week, you will become much better at noticing issues with just a glance. The next week look for proper chemical labels, then fire safety issues, etc. Once your Safety Eyes are enabled, you will be able to easily see issues and manage to rectify them while performing your other lab duties.

No matter your role in the laboratory, part of the job involves talking to other people. Make safety a part of those conversations when the opportunity arises. You might speak to your lead technologist about an instrument installation. Ask about new reagents that might need to be added to the chemical inventory.  Find out if there will be new waste streams generated. Was a risk assessment performed to look for other possible dangers?

Incorporating safety into your already busy day might seem like an impossibility, but it can be done. It is important that it is done. You are managing different parts of the lab, but if people are getting injured and exposed because there is no focus on safety, there won’t be much left to manage! Try these few ways to blend safety into your schedule- add one at a time and see how it works. In time you will notice that these small tasks make a big improvement on your lab safety culture.

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 Anatomy of Lab Safety Design: Handling a Flood

Most laboratories are designed with eyewash stations and at least one safety shower depending on the size of the department. The use of these safety showers is not common, but it does happen, and the staff needs to be prepared for such an event. That preparation not only involves testing and training on equipment use, but also in making sure the physical space is ready for a potential deluge of water that can pour down into the department for potentially up to fifteen minutes. Other flooding incidents may occur as well. A floor drain can back up, a water line connected to an analyzer might break, or water might even come through the ceiling from a pipe above the department. Being prepared and responding efficiently to these types of flooding events should be part of the overall lab safety program.

One reason safety specialists and some regulatory agencies require that items in the lab not be stored directly on the floor is so they will not be damaged in the event of a departmental flood. It is generally acceptable to store plastic items (waste bins, etc.) on the floor since they cannot be damaged by water. Cardboard, computer hard drives, and other like items should be stored on palettes or shelves. Securing electrical wires and raising multi-plug adaptors off the floor is also a best practice.

When designing or remodeling a laboratory, consider the possibility of floods when choosing the type of flooring to be installed. The best laboratory flooring is monolithic, like a sheet vinyl that has few seams. It should bend up to the walls to create a coved base that is integral with the floor. This design (recommended by the CDC and CLSI) keeps liquids from going under tiles or through walls which will create more problems (like mold) down the road.

Floor drains where safety showers exist are not required, and many labs have showers where there is no drain at all. Remember that in a typical situation where a shower would be used, hazardous chemicals are involved. Any hazardous waste that might go into the sanitary sewer should be routed through a neutralization station or into a hazardous waste collection tank. The ANSI requirements for a safety shower include the ability to deliver 20 gallons of water per minute for 15-20 minutes. That’s a total of 400 gallons. The requirements also state that the water pattern must be at least 20” in diameter and 60” above the floor. Therefore, a majority of the water will not even travel to the drain. It will go to the lowest point of the floor in the department. The bottom line is, if the safety shower must be used, a flood should be expected.

In order for the lab to be prepared for a flood emergency, materials should be on hand that will help contain large amounts of water. Those materials may include large volume spill kits with booms or dikes that are capable of holding water back. Staff should be trained how to use these materials as spill training is provided, and drills should be conducted so they can use the supplies comfortably. Make sure these spill materials are easily accessible and that signage clearly indicates where they are stored.

What does the physical anatomy of your lab look like? Is it designed for safety in the event of a hazardous material spill or exposure? Is the department set up to handle a sudden flood situation, and can staff identify the steps to take to respond efficiently and safely? Take a look around your lab today, and make any necessary corrections so that all will be ready should a laboratory flood occur for any reason.

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.

Lab Safety Whiplash

The world seemed like a brighter place just a few short weeks ago. The pandemic seemed to be nearing an end, and life was returning to normal. In laboratories, the COVID-19 testing volumes decreased, wearing surgical masks all day long at work was no longer the norm, and the workday had that old feeling of familiarity again. Then, suddenly, it all came roaring back. The COVID-19 Delta Variant, loading its victims with over 1000 times more viral particles than the original could, came to visit. Now masking and social distancing are back with a vengeance, and everyone holds their collective breath as we wait to see what other cancellations and restrictions will come our way. It is almost worse this time because we know what the future will bring, and it isn’t pretty.

So how do we deal with it in the laboratory? How do we manage our lab safety program as our staff deals with this physical and mental whiplash? Many labs already saw the fatigue workers exhibited in the past 18 months. People stopped distancing from each other, they became less diligent about hand hygiene in the department, and PPE use became a bigger compliance issue than it had been when the pandemic began.

Fortunately, this is not a new challenge for lab safety professionals. Even without a pandemic, maintaining an awareness for the importance of lab safety has been a consistent need. Those who have been in the field for years and have never had a chemical exposure or a needle stick become complacent about the hazards where they work. Formaldehyde is treated like it was water, and contaminated blood tubes are handled with no gloves. This “disease” spreads also, when new employees observe these poor safety behaviors and emulate them. A poor safety culture does not have to become a pandemic, however, there is a cure, even in times such as these.

First, determine where your lab safety culture lies on the spectrum- is it very broken, or does it just need a little boost? Make an assessment of the overall culture using surveys or by talking to lab staff and leadership directly. Review your findings with the staff so that they are clear about why you are tackling the issues. That act alone raises awareness in the department. If possible, obtain a commitment from staff to improve the overall safety culture. Find safety champions who will work with you on the on-going project. Be sure safety is being discussed daily and is placed in front of the staff. Use huddles, e-mails and safety boards to promote a positive culture.

Unsafe behaviors in the laboratory can easily have consequences that may affect others 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. Maintaining awareness of these issues is always key.

The COVID-19 pandemic and its apparent rebound has made for some very long months for employees in healthcare, and the struggles do not appear to be ending anytime soon. As safety leaders, it is important for us to do what we can to help staff build resilience against the whiplash and to reinvigorate them to continue with good safety practices. We must remind them that despite all of the changes in safety guidelines in the recent past that the basics – PPE use, using engineering controls and work practice controls- are there to help us get safely through the day so that we can still go home healthy and to be able to enjoy our lives so that we can see the end of these unusual times.

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.

Win, Lose, or Draw?

In the 1962 Japanese release of King Kong vs. Godzilla, it was pretty easy to determine who the winner of the epic battle was (it was Kong, if you’re keeping track). Almost 60 years later, the two famous giant behemoths met again on the big screen, this time in an American version. This second battle, while fun to watch, had a less-obvious outcome. Those who sided with either monster had moments to cheer during the movie, but in the end, (spoiler alert!) a secondary issue overshadowed the much-hyped monster match. It seemed obvious to me that the script writers tried their best to satisfy audiences on both sides of the aisle. In doing this, however, the movie lost a little bit of its punch. That can happen in lab safety as well. If the message isn’t strong or clear, safety issues will ensue.

The lab manager noticed an increase in employee injuries on the job. Someone cut their finger on a microtome blade. Two different specimen processors splashed serum into their eyes. A night shift tech kneeled onto the floor to pick up a box, and her knee landed on broken glass that hadn’t been swept up. It was clear people were not paying close attention while they were performing their duties. The manager held a meeting in the lab to raise safety awareness. He delivered his message, but staff noticed he was chewing gum and that he did not put on a lab coat even though he was in the lab for over 20 minutes. The message was not clear. He said he was for a safer lab, but he didn’t look to anyone like he meant it.

Jake was new to the histology lab and he was excited to make a good impression as he began his career. During his departmental orientation, the supervisor stressed the importance of chemical safety. Formaldehyde and xylene were in use in the department, and they were potentially dangerous. Jake got the message and was ready to show the department he could work there safely. After orientation was done, Jake came to work to begin cutting tissue. When he sat down at his station, he opened the drawer for supplies and saw a packet of oatmeal a spoon, and a coffee cup. The medical director came in to the lab to welcome Jake, and he noticed she was drinking tea. The message Jake received about safety was no longer clear. The supervisor spoke about safety, but it was clear no one enforced it.

When the message we send to staff about lab safety is mixed, we really can’t blame them when the culture is bad. The problem is that many leaders are not aware they are sending this confusing communication. If you’re not sure if you are one of those leaders, take a step back and look in the mirror. What kind of message do you send? Do you support safety? Do you do it with your words AND your actions? What sort of example do you set?

If you’re not in lab leadership, you still have a responsibility to represent safety with your lab practices as well. Everyone has an impact on the overall safety culture, not just leaders. What do you do to promote safety in your department?

Maybe you are an employee and it’s your leader who is sending mixed messages. First, make sure you’re choosing the side of safety in your work no matter what others are doing. Second, it may be time to “manage up” and ask leadership why certain unsafe practices occur. If the leader is part of the problem, it is acceptable to point that out, provided you do so with purpose, tact and professionalism.

Leading by example for safety is vitally important no matter your role in the department. Choose your side, stick to it in all circumstances, and over time you will be able to be declared the decisive winner. Those mixed safety messages usually lead to a draw, or worse, a loss for the team. 

Because I have been a Godzilla fan for decades, I thoroughly enjoyed this latest film entry. In truth, I was able to discern a clear winner of his fight with Kong despite the writer’s intentions, but that may be because I had support for my favorite going in. That might be your way to victory as well. Root for “Team Safety,” and your support will be noticed and followed for the win!

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.

Anticipating Sublimating

Many years ago I worked in a lab that often received dry ice in boxes with our blood product deliveries. The habit in the lab was to dump the excess frozen carbon dioxide into one of our stainless steel sinks. The staff would get excited each time there was a delivery because they liked to run tap water onto the ice to make a “waterfall” of smoke flow onto the floor when they were bored. Before too long, this repeated incorrect placement of dry ice resulted in severe damage to the sink and pipes below. The stainless steel basin cracked and the sink fell down onto the broken pipes below. That particular plumbing is not designed to handle such a low temperature, and the repair was not cheap. Luckily, no one was injured. I thought this was a long-dead practice in labs, but even today I get questions about proper dry ice disposal and am asked whether or not the sink is a good spot for that.

Dry ice sublimates at room temperature. That means it transforms from a solid state directly into a gas. Too much of this gas in a small space will reduce the normal oxygen levels in the area, potentially causing dizziness and asphyxiation. Letting dry ice sublimate in the work place can be a dangerous practice. If you have dry ice to dispose of, the best practice is to set it outside (where other could not have access to it) so it can dissipate into the open air.

Dry ice is often used in the transport of specimens, blood products, and certain lab reagents. The Department of Transportation considers it a dangerous good, and it must be used and labeled specifically if it is to be shipped by land or by air. If dry ice is used in shipping, an additional Class 9 miscellaneous hazard label also must go to the right of the Class 6.2 infectious substance label. In addition to the Class 9 label, the outer box must be labeled with the net quantity of dry ice used.

Another common use of dry ice is with the transport of outreach or clinic lab samples in courier vehicles. Certain samples must be kept frozen for testing, and the use of dry ice provides a convenient method for maintaining the necessary temperatures. Dry ice is placed in a cooler in the courier vehicle, and samples are placed until delivery to the reference laboratory. With that, there are specific safety practices that should be adhered to when using dry ice for this purpose. Couriers are often overlooked when considering safety training, but they are an important piece of the lab sample and testing process. Be sure couriers have complete safety training, including training for the proper handling of dry ice.

Couriers should limit the amount of dry ice placed inside the cooler that will rest in the vehicle. No more than three pounds of dry ice should ever be placed in that cooler. The cooler should never be completely sealed (remember the ice sublimates to gas, and the volume of the gas in the cooler will expand). Also, if dry ice is kept inside of a vehicle, the windows should be left opened, even a tiny bit. There have been incidents where too much dry ice in a closed vehicle has caused a driver to become dizzy or even become unconscious. Obviously, this is a potentially dangerous or even deadly situation and should be avoided completely.

In recent years, the College of American Pathologists (CAP) added new regulations for labs that handle dry ice. These safety rules include the use of appropriate (insulated or cryogenic) gloves and a face shield when handling dry ice. Safety Data Sheets should be available and staff who use dry ice must have documented training. CAP also discusses the need for using dry ice only in well-ventilated areas.

In the laboratory or outreach settings, employees are asked to work with many dangerous substances, bloodborne pathogens, chemicals, and sometimes dry ice. Inherently, these departments are not safe, but OSHA requires that employees be able to work safely in those places, and it can be done. Proper training and oversight of safety are the keys to ensuring your employees can collect, transport, and process lab samples in such a way in which all involved in these processes are kept safe.

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.