CM and PARA - Laboratory Safety and Etc (Day 1) PDF

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I. Clinical Microscopy and Parasitology Day 1: July 6, 2020 Topics:  Laboratory Safety  Preparation and Storage of Chemicals  Proper hand hygiene  Proper Donning and DoffingReferences: Video Labster AUBF 6thGen by Strasinger (Chapter 1)Laboratory Safety and HazardsSafety  Safety procedure manua...

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CLINICAL INTERNSHIP 1 Day 1: July 6, 2020

I. Clinical Microscopy and Parasitology Topics:  Laboratory Safety  Preparation and Storage of Chemicals  Proper hand hygiene  Proper Donning and Doffing

References: Video Labster AUBF 6th Gen by Strasinger (Chapter 1) 

Laboratory Safety and Hazards Safety  Safety procedure manuals must be readily available in the laboratory that describe the safety policies mandated by the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA), and strict adherence to these guidelines by laboratory personnel is essential.  Clinical and Laboratory Standards Institute (CLSI) provides the guidelines for writing these procedures and policies. Table 1-1

Types of Safety Hazards

Type Biologic

Source Infectious agents

Sharps

Needles, lancets, broken glass

Chemical

Preservatives and reagents

Radioactive

Equipment and radioisotopes Open flames, organic chemicals Wet floors, heavy boxes, patients

Fire/explosive Physical

Means of Transmission - a way to reach a susceptible host 1. Direct contact: the unprotected host touches the patient, specimen, or a contaminated object (reservoir) 2. Airborne: inhalation of dried aerosol particles circulating on air currents or attached to dust particles 3. Droplet: the host inhales material from the reservoir (e.g. aerosol droplets from a patient or an uncapped centrifuge tube, or when specimens are aliquoted or spilled. 4. Vehicle: ingestion of a contaminated substance (e.g., food, water, specimen) 5. Vector: from an animal or insect bite Portal of Entry - can be same as the portal of exit, which includes the mucous membranes of the nose, mouth, and eyes, breaks in the skin, and open wounds.

Possible Injury Bacterial, fungal, viral, or parasitic infections Cuts, punctures, or blood-borne pathogen exposure Exposure to toxic, carcinogenic, or caustic agents Burns or shock

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Burns or dismemberment Falls, sprains, or strains

Any accidental exposure to a possible blood-borne pathogen must be immediately reported to a supervisor. Evaluation of the incident must begin right away to ensure appropriate postexposure prophylaxis (PEP).

Biologic Hazards  Healthcare setting provides abundant sources of potentially harmful microorganisms which are frequently present in the specimens received in the clinical laboratory.  Chain of Infection - How organisms are transmitted is essential to preventing infection. → Infectious agent - reservoir - portal of exit - means of transmission - portal of entry - susceptible host  Infection Control - Procedures to control and monitor infections occurring within the facilities.  Infectious Agents - consists of bacteria, fungi, parasites, and viruses. It must have a way of exit the reservoir to continue the chain of infection (can be through mucous membranes of nose, mouth, eyes, and in the blood or other body fluids)  Reservoir - the location of potentially harmful microorganisms, such as a contaminated clinical specimen or an infected patient. The place where the infectious agent can live and possible multiply.  Fomites - Equipment and other soiled inanimate objects, it can serve as reservoirs particularly if it contain blood, urine, or other body fluids.

Proper hand hygiene, correct disposal of contaminated materials, and wearing personal protective equipment (PPE) are major importance in the laboratory. 

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Standard Precautions (1996 CDC and the Healthcare Infection Infection Control Practices Advisory Committee (HICPAC) The Occupational Exposore to Blood-Borne Pathogens Standard is a law monitored and enforced by OSHA

Personal Protective Equipment (PPE)  PPE used in the laboratory includes gloves, fluidresistant gowns, eye and face shields, and Plexiglas countertop shields.

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Gloves - sterile and nonsterile, and powdered and unpowdered, and latex and nonlatex.

CLINICAL INTERNSHIP 1 Day 1: July 6, 2020

I. Clinical Microscopy and Parasitology Topics:  Laboratory Safety  Preparation and Storage of Chemicals  Proper hand hygiene  Proper Donning and Doffing

References: Video Labster AUBF 6th Gen by Strasinger (Chapter 1)

→ Important when combining acid and water. → Acid should always be added to water to avoid the possibility of sudden splashing caused by rapid generation of heat in some chemical reactions. → Wearing goggles and preparing reagents under a fume hood are recommended safety precautions. → Chemicals should be used from containers that are of an easily manageable size. → Pipetting by mouth in unaccepatable in the laboratory

Biologic Waste Disposal 

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All biologic waste, except urine, must be placed in appropriate containers labeled with the biohazard symbol. → This includes both specimens and the materials with which the specimens come in contact. → The waste is then decontaminated following institutional policy: incineration, autoclaving, or pickup by certified hazardous waste company. Urine - it may be discarded by pouring it into a laboratory sink under a Plexiglas countertop shield. Care must be taken to avoid splashing, and the sink should be flushed with water after specimens are discarded. Disinfection of the sink - using 1:5 or 1:10 dilution of sodium hypochlorite dilutions stored in plastic bottles are effective for 1 month. → The same solution also can be used for routinely disinfecting countertops and accidental spills. → The solution should be allowed to air-dry on the contaminated area. Absorbent materials - used for cleaning countertops and removing spills must be discarded in biohazard containers. Empty urine containers - discarded as nonbiologically hazardous waste.

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Sharp Hazards  Sharp objects in the laboratory, including needles, lancets, and broken glassware, present a serious biologic hazard, particularly for the transmission of blood-borne pathogens.  All sharp objects must be disposed in puncture-resistant, leak-proof container with the biohazard symbol.  Puncture-resistant containers - should be conveniently located within the work area.  Biohazard sharp containers - should not be overfilled and must always be replaced when the safe capacity mark is reached. Chemical Hazards  Chemical Spills and Exposure → When skin contact occurs, the best first aid is to flush the area with large amounts of water for atleast 15 minutes, then seek medical attention. → Proper use of emergency showers and eye wash station. → Contaminated clothing should be removed as soon as possible. → No attempt should be made to neutralize chemicals that come in contact with the skin.  Chemical Handling → Chemicals should never mixed together unless specific instructions are followed, and they must be added in the order specified.

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Chemical Hygiene Plan → OSHA also requires all facilities that use hazardous chemicals to have written chemical hygiene plan (CHP) available to employees. The purpose of the plan is to detail the following: 1. Appropriate work practices 2. Standard operating procedures 3. PPE 4. Engineering controls, such as fume hoods and flammables safety cabinets 5. Employee training requirements 6. Medical consultation guidelines → Each facility must appoint a chemical hygiene officer, who is responsible for implementing and documenting compliance with the plan. Chemical Labeling → Hazardous chemicals should be labeled with a description of their particular hazard, such as poisonous, corrosive, flammable, explosive, teratogenic, or carcinogenic. → National Fire Protection Association (NFPA) has developed the Standard System for the Identification of the Fire Hazards of Materials, NFPA 704. → The diamond-shaped, color-coded symbol contains information relating to health, flammability, reactivity, and personal protection/special precautions. → Each category is graded on a scale of 0 to 4, based on the extent of concern. → These symbols are placed on doors, cabinets, and containers. Material Safety Data Sheets Information contained in an MSDS includes the following: 1. Physical and chemical characteristics 2. Fire and explosion potential 3. Reactivity potential 4. Health hazards and emergency first aid procedures 5. Methods for safe handling and disposal 6. Primary routes of entry 7. Exposure limits and carcinogenic potential

CLINICAL INTERNSHIP 1 Day 1: July 6, 2020

I. Clinical Microscopy and Parasitology Topics:  Laboratory Safety  Preparation and Storage of Chemicals  Proper hand hygiene  Proper Donning and Doffing

Radioactive Hazards  Radioactivity may be encountered in the clinical laboratory when procedures using radioisotopes are performed.  The amount of radiation exposure is related to a combination of time, distance, and shielding.  Persons working in a radioactive environment are required to wear measuring devices to determine the amount of radiation they are accumulating. Electrical Hazards  Equipment also should be unplugged before cleaning.  All electrical equipment must be grounded with threepronged plugs.  When an accident involving electrical shock occurs, the electrical source must be removed immediately. This must be done without touching the person or the equipment involved to avoid transferring the current.  Turning off the circuit breaker, unplugging the equipment, or moving the equipment using a nonconductive glass or wood object are safe procedures to follow.  Cardiopulmonary resuscitation (CPR) may be necessary. Fire/Explosive Hazards  Joint Commission (JC) requires that all health-care institutions post evacuation routes and detailed plans to follow in the event of a fire.  When a fire is discovered, all employees are expected to take the actions in acronym RACE: → Rescue - Alarm - Contain - Extinguish/Evacuate  Flammable chemicals should be stored in safety cabinets and explosion-proof refrigerators, and cylinders of compressed gas should be located away from heat and securely fastened to a stationary device to prevent accidental capsizing.  Fire blankets may be present in the laboratory.  NFPA classifies fires with regard to the type of burning material.

References: Video Labster AUBF 6th Gen by Strasinger (Chapter 1)

Table 1-2 Fire Type

Class A

Class B

Class C

Class D

Class K

Types of Fires and Fire Extinguishers Extinguishi Type/Compositio Extinguisher ng n of Fire Material Wood, Class A Water paper, clothing Flammable Class B Dry organic chemicals, chemicals carbon dioxide, foam, or halon Electrical Class C Dry chemicals, carbon dioxide, or halon Combustib None Sand or dry le metals powder Class ABC Dry chemicals Grease, Class K Liquid oils, fatss designed to prevent splashing and cool the fire Proper Hand Hygiene

Hand Hygiene  Hand contact is the primary method os infection transmission.  Hand hygiene includes both hand washing and using alcohol-based antiseptic cleaners.  Alcohol-based cleansers - can be used when hands are not visibly contaminated. → They are not recommended after contact with spore-forming bacteria, including Clostridium difficile and Bacillus sp. → When using alcohol-based cleansers, apply the cleanser to the palm of one hand. Rub your hands together and over the entire cleansing area, including between the fingers and thumbs. Continue rubbing until the alcohol dries.  CDC has developed hand washing guidelines to be followed for correct hand washing. Hand Washing Procedure  Should be 1 minute or count 10 seconds in each steps  Equipment: Antimicrobial soap, Paper towels, Running water, and Waste container  Procedure: 1. Wet hands with warm water, Do not allow parts of body to touch the sink.

CLINICAL INTERNSHIP 1 Day 1: July 6, 2020

I. Clinical Microscopy and Parasitology Topics:  Laboratory Safety  Preparation and Storage of Chemicals  Proper hand hygiene  Proper Donning and Doffing

2. Apply soap, preferably antimicrobial. 3. Rub to form a lather, create friction, and loosen debris.Rub Thoroughly clean between the fingers and under the fingernails for atleast 20 seconds; include thumbs and wrists in the cleaning. → Rub hands palm to palm to obtain good quantity of foam. → Then rub right palm over the back of left hand with interlaced fingers (repeat vice versa) → Rub again palm to palm with fingers interlaced → Rub back of the fingers to oposing palms with fingers interlocked (repeat this action in each hands) → Rub rotationally the left thumb in right palm and vice versa → To clean tip of the fingers. Rub rotationally backwards and forwards with clasped fingers of right fingers and left palm and vice versa 4. Rinse hands in a downward position to prevent recontamination of hands and wrists. 5. Obtain paper towel from the dispenser. 6. Dry hands with paper towel. 7. Turn off faucets with a clean paper towel to prevent contamination.

References: Video Labster AUBF 6th Gen by Strasinger (Chapter 1)

respirator does not interfere with the correct positioning of the eye protection, and the eye protection does not affect the fit or seal of the respirator. Face shields provide full face coverage. Goggles also provide excellent protection for eyes, but fogging is common. 6. Put on gloves. Gloves should cover the cuff (wrist) of gown. 7. Healthcare personnel may now enter patient room. Doffing More than one doffing method may be acceptable. Training and practice using your healthcare facility’s procedure is critical. Below is one example of doffing. 1.

2.

Proper Donning and Doffing Donning 1. Identify and gather the proper PPE to don. Ensure choice of gown size is correct (based on training). 2. Perform hand hygiene using hand sanitizer. (atleast 20 seconds) 3. Put on isolation gown. Tie all of the ties on the gown. Assistance may be needed by other healthcare personnel. 4. Put on NIOSH-approved N95 filtering facepiece respirator or higher (use a facemask if a respirator is not available). If the respirator has a nosepiece, it should be fitted to the nose with both hands, not bent or tented. Do not pinch the nosepiece with one hand. Respirator/facemask should be extended under chin. Both your mouth and nose should be protected. Do not wear respirator/facemask under your chin or store in scrubs pocket between patients.*  Respirator: Respirator straps should be placed on crown of head (top strap) and base of neck (bottom strap). Perform a user seal check each time you put on the respirator.  Facemask: Mask ties should be secured on crown of head (top tie) and base of neck (bottom tie). If mask has loops, hook them appropriately around your ears. 5. Put on face shield or goggles. When wearing an N95 respirator or half facepiece elastomeric respirator, select the proper eye protection to ensure that the

3. 4. 5.

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Remove gloves. Ensure glove removal does not cause additional contamination of hands. Gloves can be removed using more than one technique (e.g., glove-in-glove or bird beak). Remove gown. Untie all ties (or unsnap all buttons). Some gown ties can be broken rather than untied. Do so in gentle manner, avoiding a forceful movement. Reach up to the shoulders and carefully pull gown down and away from the body. Rolling the gown down is an acceptable approach. Dispose in trash receptacle. * Healthcare personnel may now exit patient room. Perform hand hygiene. Remove face shield or goggles. Carefully remove face shield or goggles by grabbing the strap and pulling upwards and away from head. Do not touch the front of face shield or goggles. Remove and discard respirator (or facemask if used instead of respirator). Do not touch the front of the respirator or facemask.*  Respirator: Remove the bottom strap by touching only the strap and bring it carefully over the head. Grasp the top strap and bring it carefully over the head, and then pull the respirator away from the face without touching the front of the respirator.  Facemask: Carefully untie (or unhook from the ears) and pull away from face without touching the front. Perform hand hygiene after removing the respirator/facemask and before putting it on again if your workplace is practicing reuse.*...