Staff working in the hospital laboratories is exposed to chemical and biological hazards.
Depending upon the laboratory and the type of work load, the staff may be exposed to any of the hazards mentioned below:
1. Hazards of infections because of working with potentially infectious samples of blood/ body fluids/tissues, the chances of contamination and the accidental needle pricks.
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2. Exposure to chemicals through direct contact, accidental spills, fumes, ingestion.
3. Fire hazards due to concentration of electrical equipment/loose temporary connections/ overloading of the switches/sockets and explosions due to use of gases.
The environment is also at risk of being contaminated by hazardous materials used and wastes generated in the laboratory.
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Safety in laboratories, therefore, includes protection of both the staff and the environment from hazardous materials.
It is the responsibility of management to take all necessary measures to neutralize all hazards and ensure a safe working environment for the staff.
Some of the important measures that are essential in any laboratory are as discussed below:
1. Safe Facility:
1. The building should be planned as per the special norms for the pathology laboratories and should have washable walls and chemical resistant floors and work benches. There should be adequate ventilation, especially in the microbiology/mycology/virology sections.
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2. Biochemistry work benches should have fume hoods with negative pressure maintained in the exhaust ducts. The exhaust ducts should discharge at least 10 feet above the roof and away from the ventilation intakes.
3. Microbiology labs should have negative pressure inside.
4. Laboratories with floor area more than 200 square feet should have two exits and all the portions of the lab should be within 75 feet of the exit or an exit access door.
2. Safe Storage of Materials:
The chemical containers should be all labeled and adequate shelf space should be provided to prevent the chemicals from being overcrowded and inaccessible.
2. Shelves for storage of chemicals should have safety lips to prevent accidental fall and spillage.
3. Chemicals which react with each other should not be stored in close proximity to each other.
4. Chemicals should not be stored above eye level of the person handling the chemicals.
5. Chemicals should not be stored over, under or near a sink.
6. Flammables and oxidizers cannot be stored near each other.
7. Nitric acid will not be stored with other acids.
8. Do not store heavy items on top shelves.
9. Scissors, knives, pins, razor blades and other sharp instruments must be safely stored and used.
10. Storage of Corrosives:
i. Store corrosive and caustic materials near the floor to minimize danger of bottles falling from shelves
ii. Separate containers to facilitate handling. Organic acids (such as acetic acid) shall be stored separately from strong oxidizing agents (sulfuric, nitric or perchlorate) to prevent interaction of fumes and corrosion of storage cabinets
iii. Use of acid bottle carriers for larger containers.
11. Storage of Inflammables:
i. Inflammables must be stored either in safety cans or in glass containers kept in the bottle carrier to prevent accidental breakage/spillage
ii. Working amounts of inflammables may be stored on open shelves, but bulk storage must be in fireproof safety cabinets in a safe storage area outside the laboratory
iii. Inflammables should never be stored in a closed area such as a refrigerator or in an area exposed to direct sunlight or heat.
3. Personal Protective Measures:
a. The staff should all have periodic medical check-up including blood tests and other investigations indicated.
b. The following items of dress should be avoided in the lab:
i. Open toed/canvas shoes/sandals without protective covering
ii. Hanging jewelry, unrestrained long hair, long or loose neck ties
iii. Loose clothes, short dresses or skirts
iv. Contact lenses.
c. Persons working in the lab should wear a long laboratory coat with long sleeves, plastic gloves of a good quality and safety goggles when working with chemicals.
d. Hands shall be washed after handling the chemicals, before leaving the laboratory and especially before eating and drinking.
e. Protection against infections by vaccination against diseases such as Hepatitis B’.
f. First aid equipment must be available and its location known to every staff member working in the lab.
g. Every chemical laboratory should have an emergency eye wash station for use in situations with exposure to fumes.
h. Immediate wash and disinfection of hands if they become contaminated with blood while taking specimens.
i. After removing gloves and lab coat, wash hands thoroughly. Dispose of gloves in bio hazard bag.
j. The hands of laboratory workers should be kept free of cuts and abrasions, particularly around the fingernails. Hands should be carefully washed with soap and water, followed by immersion in a disinfectant solution after working with infectious materials.
k. Any specimen of blood, urine, sputum, saliva, other body fluid or tissue must be regarded as potentially infectious and all universal precautions must be followed.
Lab. staffs are a high risk group for various infections such as Hepatitis B, tuberculosis, coccidiodomycosis, staphylococcal, streptococcal HIV or other infections, through accidental pricks, contact with skin wounds or mucus membranes, through accidental spills and splashes or inhalation of aerosols.
l. Actions as per the standard protocol in case of accidental exposure to any infections such as needle stick injuries, accidental spills of infectious/chemical materials. This should invariably include reporting to the Safety Management Committee on the prescribed form at the earliest.
4. General Safety Measures:
i. Defective equipment, unsafe conditions, procedures or safety hazards, if any, shall be reported forthwith by the staff to the HOD through the section in-charge/supervisor
ii. Strict compliance with the warning signs
iii. No unauthorized personnel shall be allowed to enter the laboratory
iv. Prohibition on eating or drinking in the laboratory or storing food or beverages in refrigerators in the laboratory
v. Use of exhaust hoods when working with toxic, inflammable or volatile materials
vi. All laboratory materials, bottles, specimens, etc. shall be properly labeled
vii. Label a container before filling. Never use a container for material other than that called for by the label
viii.Laboratory rooms shall be kept locked at all times when not in use
ix. Should any surface become contaminated with specimens, wash the contaminated area with a 1 to 10 dilution of household bleach
x. Any broken glass pieces must be wiped off counters and table tops to prevent slivers of glass cutting hands, arms and elbows
xi. Implementation of biomedical waste management rules in letter and spirit
xii. Do not touch or recap the used needle. Destroy the used needles and syringes with the help of syringe/needle destroyers, immediately. Empty the container of the needle destroyer into the disinfectant solution at the end of every shift
xiii. Handling of Caustic Materials:
a. While working with acids or alkalies it is advisable to use a barrier of some kind or work in a sink so that the spills, if any, can be controlled
b. Use of aprons, gloves and eye protection devices when handling highly corrosive materials
c. Do not pipette by mouth. Do not sniff reagents.
xiv. Practice of safe techniques such as:
a. While mixing the reagents, mix them slowly
b. Always add acid to water, never water to acid
c. Allow acid to run down the side of the container and mix slowly by gentle rotation.
d. Avoid overheating
e. Eliminate the practice of mouth pipe ting
xv. Receipt of Specimens:
a. Specimens externally contaminated should be accepted only after covering with a clean plastic bag to prevent the spread of infections
b. Wear gloves when processing body fluids, AFB and fungal specimens. Wash hands afterwards
c. Ensure immediate labeling of the specimen. If already labeled, cross check the details with the requisition for investigation.
xvi. Processing of Specimens:
a. Use Test tube racks or trays for tube cultures
b. All sputum, bronchial washing, tuberculosis and fungus specimens shall be handled and processed in the bio-safety cabinet
c. Do not centrifuge the specimens in open tubes. They must be covered by a sealed cap to prevent aerosol formation
d. Work benches should be cleaned and disinfected before beginning and after finishing the work.
xvii. Safe Handling of Glassware:
a. Do not attempt to remove stoppers on glass tubing by force. If they are stuck, cut them off
b. Use asbestos gloves for handling hot glass/containers
c. Check all glass containers and apparatus carefully for cracks if any, before using
d. Immediately after use, rinse all glassware well with soap water so as to clean it internally as well as externally
e. Safe practice of always placing a container (breakable/containing chemicals/infectious material) at a safe and proper place and not just anywhere
f. Use racks or trays to transport small bottles and glassware. Large containers should be transported in suitable jackets or cartons.
xviii. Disposal of Contaminated Materials:
a. Discard specimens and cultures into plastic red bags. If autoclave is available then sterilization by autoclaving and disposal
b. All contaminated sharps materials from Microbiology are to be collected in puncture proof containers for sharps
c. Any breakage of bags or leakage of contaminated materials shall be reported to the Lab. Safety Officer/HOD at once for instructions for safe clean up.
xix. Management of Accidental spills/splashes:
a. All chemical spills, minor or major will be neutralized and cleaned at the earliest as per the SOP on the subject.
5. Fire Precautions:
a. Laboratories and chemical storage rooms should not be allowed to be used as places for preparing/warming/eating the food.
b. Smoking should be strictly prohibited in the laboratories.
c. Measures should be taken to minimize the electrical hazards by eliminating all loose/ temporary connections and providing adequate number of sockets to prevent overloading.
d. Burners or flames must not be left alight in unattended areas or when not in use.
e. Cylinders of compressed and liquefied gases must be turned off at the cylinder valve, when not in use.
f. Gas cylinders must be firmly anchored to the work bench or wall and may be moved only on trolleys.
g. Fire-fighting equipment, effective against all types of fire, must be available and all staff should be well trained to handle the equipment, extinguish the fire and prevent any losses.
h. There should be directional signage (luminous) for evacuation route/exit gates and the route/exit should be free from obstructions of any kind.
i. Following emergency numbers should be displayed prominently next to the phone for quick use in emergency:
a. Hospital Emergency room and reception
b. Fire control room
c. Security control room/security supervisor
d. Chief maintenance engineer
e. Police.
6. Training of Staff:
The staff should be educated about the possible hazards (and their causes) in the area. They should be fully trained in preventive measures and control measures to be taken in handling the accidental situations.
They should know exactly what to do in what kind of a hazard without loss of any precious moments.
7. Responsibility of the HOD Laboratory:
HOD laboratory has an important responsibility of planning and implementing the safety program, training the staff in safe practices and monitoring the safety program to ensure that the staff do seriously follow all the protocols and procedures and do not resort to short cuts even in emergency situations.
8. Appointment of a Laboratory Safety Officer:
One officer, either HOD Path, lab or Microbiologist/Biochemist should be formally appointed as the Laboratory Safety Officer. The officer may be assigned following duties in addition to his/her normal duties:
a. To put in place a laboratory safety manual covering all the safety aspects in the lab, duly approved by the HOD and the MS.
b. To ensure that the safety manual is implemented in every section of the lab by every employee.
c. To monitor the implementation of safety rules by all the employees.
d. To check and ensure safe and correct storage of all hazardous materials in the lab.
e. To investigate and report any breach in the safety rules leading to occurrence of a near- miss/adverse/sentinel event to the HOD.
f. Maintain a record of all the safety violations, incidents and the remedial actions taken.
g. Periodic check of availability and functional status of all personal/general/fire safety equipment in the lab.
h. Regular training of all staff in prevention and control of safety hazards in the lab.
i. Periodic realistic drills of management of safety hazards.
j. Guide and supervise the management of accidental hazards such as spills of hazardous materials in lab/elsewhere in the hospital.