Chapter 2 - Lab Safety

what are two saftey issues that are directly related to the lab

supply chain interruptions

risk of infection from aerosol-generating procedures

98% of lab erros occur in what phase?

preanalytic phase

what are the two main areas of patient safety

communications and mitigating patient risk during IT outages

CDC

center for disease control

WHO

World Healthcare Organization

six goals of US institute of medicine for health care delivery

1. safety

2. timliness

3. effectiveness

4. efficiency

5. equitable treatment (the need to provide consistent quality)

6. patient-centered focus

ASCLS Patient Safety Indicatprs (preanalytical)

Patient identification

phlebotomy-associated negative events

specimen identification

order entry

specimen integrity

effective use of the clinical laboratory

ASCLS Patient Safety Indicatprs (analytical)

verification of the accuracy of anormal results

ASCLS Patient Safety Indicatprs (Postanalytical)

communication of text results

effetive use of test results

outcomes of laboratory testing

ASCLS procedure to evaluate patient safety in the lab

1. determine areas of risk

2. collect data

3. determine the denominator to calculate the error rate

4. capture data

5. data analysis

6. design intervention

7. follow-up

OSHA

Occupational Safety and Health Administration

CLSI

Clinical and Laboratory standard institute

DHHS

US department of Heath and human services

CAP

College of Amercan Pathologist

NHSN

National Health Care Safety Network

(integrates a number of surveillance systems and provides data on devices, patients, and staff)

DHQP

Division of Health Care Quality Promotion

Nosocomial infections are estimated to occur in BLANK% of all acute care hospitalizations

5

The three areas of risk factors for infections are

Iatrogenic risk factors

organizational risk factors

patient risk factors

define Iatrogenic risk factors

pathogens on hands of medical personnel, invasive procedures, antibiotic use

define organizational risk factors

contaminated air-conditioning systems, contaminated water systems

define patient risk factors

severity of illness, underlying immunocompromised state, and lenth of stay

Role of a safety officer

staff orientation and periodic updating

OSHA-mandated Plans

all labs must implement a chemical hygiene plan (CHP) and exposure control plan. Must ahve a copy of the safety data sheet (SDS)

Chemical hygiene plan

Hazard Communication standard

Occupational exposure to bloodborne pathogens

describe the Hazard Communication standard

(OSHA-mandated Plans)

chemical manufacturer, distributor, or importer provide the SDS for each chemical

describe the Occupational Exposure to bloodborne pathogens

(OSHA-mandated Plans)

requires labs to

• develop and implement a plan that protects the staff to bloodorn pathogens

• manage and handle medical waste safety and effectively

Describe the hazard commmunication standard (1988)

• hazard classifiation: provides specifica criteria to address health and physical hazards

• Labels: chemical manufactures and importers must provides a label for each hazard class & category

• Safety Data Sheets: it is requied to be presented in a consistent, user friendly 16-section format

Describe the Exposure Control Plan (OSHA-mandated program)

• Handle medical waste in a safe and effective manner

• develop and implement a plan that portectts from bloodborn pathogens

• All employees who handle hazardous material and waste must be trained on how

• Each lab must evaluate the effectiveness of its plan annually

define standard precautions

handling all patient specimens as if they were infectious

how many biosafety levels are there?

Bioterrorism agents are divided into what categories

4

A, B, C

define occupational exposure

a needlestick or cut with a sharp object or contact by mucous membranes or noninact skin or contact is prolonged

The likelihood of infection after exposure to hepatitis B virus (HBV) or human immunodeficiency virus (HIV) depends on what

• the concentration (viral concentration is higher for HBV)

• the duration of the contract

• The presence of skin lesions or abrasions on the hands or exposed skin

• immune status of the health care worker

what are some safe work practices for infection conrol

• personal protective equipment

• nail care

• shoes

• electronic devices

• handwashing

• decontamination of surfaces, equipment, spills

All devices in contact with blood and capable of

transmitting infection to the donor or recipient must be

BLANK and BLANK

Sterile and nonreusable

Food and drinks should not be consumed in work areas

or stored in BLANK

the same area as specimens

Specimens needing centrifugation should be capped and

placed into a centrifuge with BLANK

a sealed dome

BLANK must be opened slowly and

carefully with a gauze square over the stopper to

minimize aerosol production.

Rubber-stoppered test tubes

Terminal disposal of infectious waste should be

by BLANK an aternative method is terminal

sterilization by BLANK.

incineration

autoclaving

what are ways to prevent disease transmission

screening tests

records of accidental exposure

respirators or masks for tuberculosis

Protection from aerosols (biosafety cabinets, negative-pressure isolation rooms)

lots of addition laboratory hazards

chemical hazards

electrical hazards

fire hazards

labware hazards

infectious waste

define chemical hazards

• hazardous chemical

• carcinogens

define electrical hazards

shock or fire can result from electrical apparatus

• regulatr inspection of electrical equipment decreases the likelihood of electrical accidents

what is the acronym for use of fire extinguishers

P - pull

A - aim

S - squeeze

S - sweep

what is class A fire classification

ordinary combustibles

what is class B fire classification

flammable liquids and gases

what is class C fire classification

Electrical equipment

what is class D fire classification

pwedered metal (combustible) material

what is class E fire classification

cannot be extinguished

Biohazard containers contain what

body fluid specimens, and sharps

Biohazard bags contain what

most infectious waste materials (nothing that can puncture the plastic

What are the three major types of waste streams generated by labs

nonregulated waste

regulated medical wast (RMW)

chemical waste

Regulated medical waste (RMW) is divided into what groups

biohazard waste

biohazard sharps

Biosafety cabinets and hoods need to be certified

BLANK

annually

Eyewash stations and safety shower equipment need to

BLANK from hazardous chemicals

100 feet or no more than a 10-second walk

Chemicals must be BLANK annually.

inventoried

Safety data sheets need to be available as hard copy or

electronically within BLANK

5 minutes of a request.

What to do for Alkali or acid burns on the skin or in the mouth.

Rinse thoroughly with large amounts of running tap

water. If serious, consult a physician.

What to do for Alkali or acid burns in the eye.

Wash out eye thoroughly with running water for a minimum of 15

minutes. An eye fountain is recommended, but any

running water will suffice. A physician should be

notified immediately, while the eye is being washed.

what to do for heat bruns

Apply cold running water (or ice in water) to

relieve pain and stop further tissue damage. Use a wet

dressing of 2 tablespoons of sodium bicarbonate in 1 quart

of warm water. Apply bandage securely but not tightly. For

third-degree burns, consult a physician immediately

what to do for serious cuts

Apply direct pressure to the wound area to

control the bleeding, using a clean compress covering the

wound. Call for a physician immediately.

What to do for minor cuts

Wash the wound carefully and thoroughly with

soap and water. Do not gouge for embedded material.

Apply a clean bandage if necessary.