MLAB 2401: Clinical Chemistry

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MLAB 2401 Clinical Chemistry

• Laboratory Safety and Regulations

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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.

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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 everyones
  responsibility !!!

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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

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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

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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

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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

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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 )

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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

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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.

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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

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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.

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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
  employees is mandatory

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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 110 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

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Specimen Safety

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

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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

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FIRE SAFETY

• Essential elements for fire
• Fuel
• Heat or ignition source
• Oxygen

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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

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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

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DISPOSAL OF HAZARDOUS MATERIALS

• Chemical Waste
• Know the SOP for the disposal of every substance
• You cant 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(
  gt 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

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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

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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
  .