MLAB 2401: Clinical Chemistry

1. MLAB 2401: Clinical Chemistry Laboratory Safety and Regulations

2. Safety is…… • A combination of common sense, good behavior and housekeeping • Good personal behavior & habits such as professional conduct and appearance, frequent hand washing, no eating, smoking, drinking, or application of makeup, etc. in lab. Should also make yourself aware of emergency procedures / location and proper use of emergency equipment and fire escape route. • Good housekeeping - Laboratory cleanliness, properly labeled containers, immediate appropriate cleanup of any spills, warning signs of potential danger posted, etc. • Good laboratory technique - carefully read all instructions and labels, do not operate equipment until you are instructed and authorized to do so, always respect the power of acids, bases and corrosive chemicals. Protect yourself with PPDs and use proper eyewear protection devices.

3. Safety Awareness • Safety responsibility – shared responsibility • Employer • Provide and supervise safety methods, equipment and policies • Employee • Understand and practice established safety procedures • Notify supervisors of unsafe conditions • Bottom line … Safety is everyone’s responsibility !!!

4. Precautions • No eating, drinking, application of personal products, such as make-up or contact lenses in lab area • Frequent handwashing • Follow Standard precautions at all times, treat all specimens as if infectious • Never pipet by mouth • Properly dispose of wastes • Proper labeling and storage of supplies

5. LABORATORY SAFETY • Lab risks • Electrical: fire and shock • Toxic vapors • Compressed gasses • Flammable liquids • Radioactive materials ( not too common these days ) • Corrosives • Mechanical: moving machinery • Poisons • Biological: microbes, animals, plants and genetically modified agents • Ergonomic: standing, repetitive motion

6. Regulatory Agencies for Safety • OSHA (Occupational Safety and Health Act) 1970 • Federal law that mandates safe working conditions for workers • OSHA may inspect work places for compliance with safety rules • Programs developed by OSHA • Standard 29: occupational exposure to hazardous chemicals • Standard 29: Hazard Communication, including Right to Know • Bloodborne Pathogens Standard • Needlestick Safety and Prevention Act

7. Regulatory Agencies for Safety • CLSI (The Clinical and Laboratory Standards Institute) • Infection control guidelines • JCAHO/ TJC (The Joint Commission) • Hospital accreditation • CAP (College of American Pathologists) • Laboratory accreditation • CDC (Centers for Disease Control) • U.S. Department of Health and Human Service

8. SAFETY EQUIPTMENT • Safety showers • Eyewash stations • Fire blankets • Fire extinguishers • Spill kits • First aid kits • Fume hoods • Biosafety hoods • Chemical storage cabinets • PPEs ( Personal Protective Equipment )

9. CHEMICAL SAFETY • Hazard Communication Standard (Right to Know Law) • The lab, by law, must provide written policies for the safe use of hazardous chemicals ( OSHA regulation ) • Intent to ensure all chemical health hazards are evaluated and information presented to employees. • Safety Data Sheet (SDS ) • A list of all safety information created by the manufacturer for each laboratory reagent (biological or chemical) • The lab is responsible to collect and make available MSDS information for all reagents and chemicals • An SDS lists general information, precautionary measures, and emergency information. • Employees must have ready access to SDS information • Lab must have written Chemical Hygiene Plan that provides specific work practices for hazardous chemicals

10. Storage and Handling of Chemicals • Different storage/handling requirements chemicals based on their differing characteristics: • Flammable/Combustible - classified according to flashpoint, among the most dangerous in the lab. • Corrosives – cause injury to eyes/skin, respiratory tract if contact is made • Reactives – under certain circumstances may react violently - require special knowledge to prevent their contact with reaction causing substances. • Carcinogenic chemicals- been determined to cause cancer. Benzidine is often used as example of lab chemical now classified as carcinogen.

11. Signage and Labeling of Chemicals • Everything must be labeled !!! • Hazardous material must include all necessary safety information • Chemicals transferred • Must be labeled with identification or contents of the chemical

12. Chemical Safety NFPA labeling system for hazardous chemicals • The system uses a diamond-shaped symbol, four colored quadrants, and a hazard rating scale of 0 to 4. • The health hazard is shown in the blue quadrant. • The flammability hazard is shown in the red quadrant. • The instability hazard is indicated in the yellow quadrant. • The specific hazard is shown in the white quadrant.

13. BIOLOGICAL SAFETY • Standard Precautions • All biological specimens must be considered potentially infectious • Always use required PPEs when handling biohazardous material • Cap specimens that are being centrifuged • Mouth pipeting is NEVER permitted under any circumstances • Spills must be cleaned using proper technique • OSHA mandates that labs provide written bloodborne and airborne ( TB ) safety policies. • Annual TB screening ( PPD test ) for hospital employee’s is mandatory

14. Biological Safety Cleaning Specimen Collection Areas and Biological Spills • Wear gloves. • First clean area with visible blood with an absorbant, then disinfect the entire area. • Use 1:10 bleach solution or commercially prepared solution. • Keep the bleach in contact with contaminated area for at least 20 minutes. • Use colored biohazard labels. • Provide accident follow-up report

15. Specimen Safety • Proper Labeling of small samples, dilutions, aliquots • Minimum requirements • Patient Name • Specimen Number • Date • Prevents pre-analytical error

16. Radioactivity Safety • Gamma ray - most penetrating • Beta ray - less penetrating • Must wear badge • Work area monitored frequently The Three Cardinal Principles of Self-protection • Time • Shielding • Distance

17. FIRE SAFETY • Essential elements for fire • Fuel • Heat or ignition source • Oxygen

18. FIRE SAFETY Classification of Fires • Class A: Paper, wood, plastic, fabrics • Class B: Flammable liquids – gases • Class C: Electrical • Class D: Combustible metals • Fire extinguishers are labeled to indicate which type of fire they combat • Most extinguishers utilize a dry chemical that combats A, B and C fires

19. FIRE SAFETY • Know the location of • Fire alarm pull stations • Extinguishers • Fire blankets • Know the telephone number to report fires • RACE • Rescue - Remove patients from immediate harm • Alarm -Pull fire alarm • Contain - Close doors and windows • Extinguish - Extinguish fire

20. DISPOSAL OF HAZARDOUS MATERIALS • Chemical Waste • Know the SOP for the disposal of every substance • You can’t assume that everything goes down the drain ! • Biohazardous Waste • Disposal of biohazardous waste is regulated by law • Waste containers must be clearly labeled • Sharps ( needles, blades, glass ) must be placed in hard containers • Infectious wastes should be autoclaved before disposal • General rules • Tubes and other containers of blood, papers or other materials that contain significant amounts( > 1 inch diameter on paper or ½ mL total) of blood, used culture plates should go into bio-waste • Paper towels, used gloves, KimWipes should go in regular trash

21. ACCIDENT DOCUMENTATION AND INVESTIGATION • All accidents must be immediately reported to a supervisor (AFTER first aid ) • Accident Investigation forms must be completed by the employee and employer • Time and place are documented • Cause documented • Nature of the injury • OSHA regulations require accident records to be kept 30 years

22. References Bishop, M., Fody, E., & Schoeff, l. (2010). Clinical Chemistry: Techniques, principles, Correlations. Baltimore: Wolters Kluwer Lippincott Williams & Wilkins. Sunheimer, R., & Graves, L. (2010). Clinical Laboratory Chemistry. Upper Saddle River: Pearson .