Unit 1 lecture 3

Chapter 2: Safety - Patient and Clinical Laboratory Practices

Overview of Copyright

  • Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

  • Further editions from: 2012, 2007, 1999, 1992, 1979, 1970, by Mosby, Inc., an affiliate of Elsevier Inc.

Patient Safety

  • A recent study of laboratory errors indicates that 98% of errors in the diagnostic process occur during the preanalytical phase.

  • Understanding preanalytical errors led to the development of specific goal areas by the Joint Commission National Patient Safety Goals for clinical laboratories.

Joint Commission National Patient Safety Goals (Effective January 1, 2014)

Goal 1: Improve Patient Identification

  • Use at least two patient identifiers when providing laboratory services.

Goal 2: Improve Communication Effectiveness

  • Report critical test results and diagnostic procedures in a timely manner.

Goal 7: Reduce Healthcare-Associated Infections

  • Comply with the current CDC or WHO hand hygiene guidelines.

Goals of U.S. Health Care Delivery

  • Safety

  • Timeliness

  • Effectiveness

  • Efficiency

  • Equitable Treatment

  • Patient-Centered Focus

Patient Safety Communications

  • Refer to table 2-3 for details.

  • Mitigating Patient Risk:

    • Prepare for information technology downtimes

      • Schedule downtime during routine maintenance of instruments.

    • Importance of communication is emphasized.

Laboratory Safety

  • Most laboratory accidents can be prevented through:

    • Good technique

    • Remaining alert

    • Using common sense

  • Laboratory safety is governed by

    • Occupational Safety and Health Administration (OSHA) standards

    • CDC guidelines.

Safety Standards and Governing Agencies

  • UST Department of Labor’s OSHA

  • Clinical and Laboratory Standards Institute (CLSI)

  • Centers for Disease Control and Prevention (CDC), part of the U.S. Department of Health and Human Services (DHHS), Public Health Service

  • College of American Pathologists (CAP)

  • The Joint Commission

National Health Care Safety Network (NHSN)

  • A voluntary system integrating multiple surveillance systems.

  • Provides data on devices, patients, and staff.

  • Enhances legacy patient and healthcare personnel safety surveillance managed by the Division of Healthcare Quality Promotion (DHQP) at CDC.

OSHA-Mandated Plans

Occupational Safety and Health Act 1970

  • Hazard Communication Standard

    • Establishes required plans and procedures for workplace safety.

Chemical Hygiene Plan

  • Mandates that manufacturers provide Safety Data Sheets (SDS) for hazardous chemicals.

  • Helps employers communicate hazards to employees in case of exposure.

Occupational Exposure to Bloodborne Pathogens

  • Became law in 1992.

  • Requirements for laboratories include:

    • Develop and implement plans ensuring protective safety for lab personnel

    • Manage medical waste safely.

    • Training for employees handling these materials is mandatory.

Biohazards

  • Defines infectious materials or agents posing a risk to humans or animals.

  • Public Health Service (PHS) Biosafety Levels are categorized as:

    • Level 1: Minimal risk

    • Level 2: Moderate risk

    • Level 3: Higher risk

Avoiding Transmission of Infectious Diseases

Laboratory-Acquired Infections
Bloodborne Pathogens

  • Defined as an occupational exposure through

    • Percutaneous injuries (e.g. needlestick, cuts)

    • Contact with mucous membranes or non-intact skin.

  • Includes exposure to:

    • Blood

    • Tissues

    • Blood-stained body fluids

Safe Work Practices for Infection Control

  • Personal Protective Equipment (PPE):

    • Selection and use of gloves

    • Facial barrier protection

    • Use of occlusive bandages

    • Laboratory coats or gowns for barrier protection

    • Handwashing practices

    • Decontamination of work surfaces, equipment, and spills.

General Infection Control Safety Practices

Pipetting Safeguards

  • Use automatic devices for pipetting to reduce risk.

  • Follow the safety manual for sharps safety and needlestick prevention.

Specimen Processing Protection

  • Requirements for specimen handling and shipping.

Prevention of Disease Transmission

Immunizations

  • Recommended vaccines include:

    • Hepatitis B

    • Influenza

    • Measles

    • Mumps

    • Rubella

    • Varicella

    • Covid-19

Screening Tests

  • Tests include:

    • Tuberculosis: Purified Protein Derivative (PPD, Mantoux) Skin Test

    • Rubella

    • Hepatitis B Surface Antigen

    • Covid-19 antigen testing or PCR

Prophylaxis and Medical Follow-up

  • Address exposure to:

    • Hepatitis B Virus

    • Hepatitis C Virus

    • Human Immunodeficiency Virus (HIV)

Additional Laboratory Hazards

Chemical Hazards

  • Specific hazardous chemicals include:

    • Select carcinogens with hazard warnings.

Protective Measures for Chemical Handling

  • Follow these safety precautions when handling chemicals:

    • Always read the label to identify potential hazards

    • Use appropriate Personal Protective Equipment (PPE)

    • Use special carriers for transportation

    • Never store chemicals above eye level.

    • Flammables should be stored in designated cabinets and all chemicals must have proper hazard communication labels.

Electrical Hazards

  • Major concern in healthcare facilities

  • Always report damage or suspicion of electrical hazards.

  • Turn off power if a coworker has been electrically shocked.

Fire Safety

  • Fire safety applies to all employees:

    • Familiarize oneself with the use and location of fire extinguishers

    • Know fire procedures and participate in training for safety equipment.

Classification of Fires

  1. Class A: Involves ordinary combustible materials (wood, paper, cloth).

  2. Class B: Involves flammable solvents (gasoline, oil).

  3. Class C: Involves electrical equipment.

Fire Extinguisher Classification

  • A fires: Use an ABC or pressurized water extinguisher

  • B fires: Use an ABC or CO2 extinguisher

  • C fires: Use CO2, halon, or ABC extinguisher

Emergency Response Protocol (RACE)

  • Rescue: Remove patients from danger

  • Alert: Pull the nearest fire alarm

  • Confine: Close windows and doors

  • Extinguish: Use a suitable fire extinguisher.

Hazards with Glassware

  • Follow facility protocols when dealing with broken glass.

Infectious Waste

  • Classified as:

    • Blood and blood products

    • Contaminated sharps

    • Pathology waste products

    • Microbial waste

Containers for Waste

  • Must use biohazard containers and biohazard bags.

  • Ensure signage in areas with infectious waste.

Final Decontamination of Waste Materials

Infectious Waste

  • Requires adherence to OSHA definitions and training for management.

Radioactive Waste

  • Less common in routine labs today, however:

    • Workers must wear exposure badges

    • Utilize shielding measures, follow procedures for disposal and decontamination.

Safety Audit: Basic First-Aid Procedures

  • Institutions should develop disaster plans.

  • Mandatory employee training and participation in drills.

  • Importance of CPR training emphasized for personnel.

References

  • Copyright © 2016 by Mosby, an imprint of Elsevier Inc.