Safety

Yes. Here are clean study notes from the chapter, written in a way that’s easier to memorize for class.

Chapter 1: Safety and Quality Management Notes

1. Laboratory Safety Hazards

There are 6 main types of hazards:

CLSI provides guidelines for writing laboratory safety procedures and policies.

2. Chain of Infection

For an infection to spread, all 6 parts of the chain must be present.

1. Infectious Agent

The microorganism causing infection.

Examples:

• Bacteria

• Viruses

• Fungi

• Parasites

Break the chain by detecting and treating the organism.

2. Reservoir

Where the organism lives or multiplies.

Examples:

• Patient

• Blood

• Urine

• Specimen

• Contaminated equipment

A contaminated object is called a fomite.

Break the chain by cleaning and disinfecting.

3. Portal of Exit

How the organism leaves the reservoir.

Examples:

• Blood

• Saliva

• Mucous membranes

• Other body fluids

Break the chain by sealing specimens and using biohazard containers.

4. Means of Transmission

Five methods:

• Direct contact

• Airborne

• Droplet

• Vehicle

• Vector

Direct contact means touching an infected person, specimen, or contaminated object.

Airborne means inhaling very small particles.

Droplet means inhaling droplets from coughing, specimens, spills, or aerosols.

Vehicle means contaminated food, water, or another substance.

Vector means transmission through an insect or animal.

5. Portal of Entry

How the organism enters another person.

Examples:

• Eyes

• Nose

• Mouth

• Broken skin

• Open wounds

6. Susceptible Host

A person who can become infected.

Higher-risk people include:

• Infants

• Elderly people

• Immunocompromised people

• Fatigued or stressed healthcare workers

Important: In the laboratory, patient specimens are the main source of possible infection.

3. Standard Precautions

Standard Precautions assume that blood, body fluids, secretions, and excretions may contain infectious organisms.

They replaced Universal Precautions and Body Substance Isolation.

Important Standard Precautions:

Hand hygiene

Clean hands:

• Before patient contact

• After patient contact

• After touching specimens/body fluids

• After removing gloves

• Before leaving the work area

• Before eating or entering break areas

• Before and after using the bathroom

Gloves

Wear gloves when handling:

• Blood

• Urine

• Body fluids

• Contaminated equipment

• Mucous membranes

• Broken skin

Change gloves between patients.

Remove gloves before touching clean surfaces.

Always clean hands after removing gloves.

Face/Eye Protection

Wear goggles, masks, or face shields when splashing or spraying may occur.

N95 respirators are used for suspected Mycobacterium exposure.

Gowns/Lab Coats

Wear a fluid-resistant coat or gown when working with patient specimens.

Remove it before leaving the work area.

4. OSHA Bloodborne Pathogen Requirements

OSHA requires employers to protect workers from bloodborne pathogens.

Employers must provide:

Engineering controls

• Sharps containers

• Safety needles

• Biohazard labels

Work-practice controls

Employees must:

• Follow Standard Precautions

• Receive annual safety training

• Not eat or drink in laboratory areas

• Not smoke in laboratory areas

• Not apply cosmetics in laboratory areas

• Disinfect work surfaces

PPE

Employer must provide:

• Gloves

• Gowns/lab coats

• Face shields

• Other necessary PPE

Medical protection

Employer must provide:

• Free hepatitis B vaccination

• Medical evaluation after exposure

Documentation

The laboratory must maintain:

• Annual safety training records

• Sharps injury logs

• Safety device evaluations

• Exposure documentation

5. Accidental Blood/Body Fluid Exposure

If accidentally exposed through:

• Needlestick

• Eyes

• Mouth

• Broken skin

Immediately report it to the supervisor.

Evaluation should begin quickly so postexposure prophylaxis, or PEP, can be started when necessary.

Testing may include:

• HIV

• HBV

• HCV

Both the employee and source patient may be tested according to policy.

6. PPE

PPE = Personal Protective Equipment.

Includes:

• Gloves

• Fluid-resistant lab coat

• Gown

• Goggles

• Face shield

• Masks

• Plexiglas shields

Shoes must:

• Be closed-toed

• Cover the entire foot

Important: Gloves do NOT replace hand washing.

7. Latex Allergy

Possible reactions include:

Irritant dermatitis:

• Dry

• Itchy

• Irritated skin

Delayed hypersensitivity:

• Poison-ivy-like rash

• Appears about 24–48 hours later

Immediate allergy:

• Facial flushing

• Difficulty breathing

• Can become life-threatening

Alternatives include:

• Nitrile gloves

• Vinyl gloves

8. Hand Washing

Wash with soap and water when visibly dirty or after exposure to spore-forming organisms such as C. difficile.

Alcohol hand sanitizer does not reliably kill spores.

Proper hand washing

1. Wet hands with warm water.

2. Apply soap.

3. Rub hands together for at least 20 seconds.

4. Clean between fingers, under nails, thumbs, and wrists.

5. Rinse downward.

6. Dry with paper towel.

7. Use a clean paper towel to turn off the faucet.

9. Biological Waste

Most biological waste goes into leakproof biohazard containers.

Examples:

• Blood tubes

• Used contaminated materials

• Disposable contaminated lab coats

• Materials used to clean biological spills

Urine may usually be poured into the laboratory sink according to facility policy.

Empty urine containers may be discarded as regular waste if they are not considered biologically hazardous under facility policy.

10. Sharps

Sharps include:

• Needles

• Lancets

• Broken glass

Dispose of them in:

• Puncture-resistant

• Leakproof

• Biohazard-labeled containers

Sharps containers should not become more than about 3/4 full.

Never:

• Recap used needles using two hands

• Bend needles

• Break needles

• Remove exposed needles by hand

11. Decontamination

Laboratory counters should be disinfected:

• After each shift

• After spills

The chapter describes sodium hypochlorite, or bleach, as a commonly used disinfectant.

For a spill:

• Absorb the material

• Disinfect the area

• Dispose of cleanup materials in biohazard waste

Know the required contact time of the disinfectant.

12. Chemical Safety

Treat every laboratory chemical as potentially hazardous.

If chemicals contact the skin or eyes:

Flush with lots of water for at least 15 minutes.

Do NOT try to neutralize a chemical directly on the skin.

Know where the:

• Eyewash station

• Emergency shower

• Chemical spill kit

are located.

13. Acid and Water Rule

Very important:

Always add ACID to WATER.

Never add water to concentrated acid because rapid heat production can cause splashing.

Memory trick:

A to W = Acid to Water

14. Chemical Hygiene Plan

CHP = Chemical Hygiene Plan.

OSHA requires laboratories using hazardous chemicals to have one.

It explains:

• Safe work practices

• Standard procedures

• PPE

• Engineering controls

• Fume hoods

• Flammable-storage cabinets

• Employee training

• Medical consultation procedures

A chemical hygiene officer manages the program.

15. Safety Data Sheet

SDS = Safety Data Sheet.

It tells employees important information about chemicals.

Includes:

• Chemical properties

• Fire/explosion risks

• Reactivity

• Health hazards

• First aid

• Safe handling

• Disposal

• Routes of exposure

• Exposure limits

• Carcinogenic potential

Memory tip:

If you need detailed safety information about a chemical → check the SDS.

16. GHS

GHS = Globally Harmonized System.

It standardizes chemical hazard communication.

Chemical labels contain:

• Hazard pictogram

• Signal word

• Hazard statement

The GHS SDS contains 16 standardized sections.

17. NFPA Diamond

NFPA hazard labels help firefighters identify chemical hazards.

Colors:

🔵 Blue = Health

🔴 Red = Flammability

🟡 Yellow = Reactivity/instability

⚪ White = Special hazards

Numbers range from:

0 = little/minimal hazard

to

4 = severe hazard

18. Radioactive Hazards

Radiation exposure depends on:

Time

Less time exposed = safer.

Distance

More distance = safer.

Shielding

More shielding = safer.

Radiation exposure is cumulative.

Workers may wear radiation monitoring devices.

Pregnant workers should avoid radioactive areas according to laboratory safety procedures.

19. Electrical Safety

Never operate electrical equipment with wet hands.

Watch for:

• Frayed cords

• Wet equipment

• Overloaded circuits

Electrical equipment should be grounded with 3-prong plugs.

Unplug equipment before cleaning.

If someone is being shocked:

Do NOT grab the person.

Instead:

• Shut off the circuit breaker

• Unplug the equipment

• Use a nonconductive object when necessary

20. Fire Safety — RACE

RACE tells you what to do when discovering a fire.

R — Rescue

Rescue anyone in immediate danger.

A — Alarm

Activate the alarm.

C — Contain

Close doors.

E — Extinguish/Evacuate

Extinguish the fire if safe, otherwise evacuate.

21. Fire Extinguisher — PASS

PASS explains how to use the extinguisher.

P — Pull

Pull the pin.

A — Aim

Aim at the base of the fire.

S — Squeeze

Squeeze the handle.

S — Sweep

Sweep side to side.

22. Fire Classes

ABC extinguishers commonly contain dry chemicals.

Water can be used for Class A fires.

23. Quality Management

QM = Quality Management.

QM monitors the entire testing process to make sure patients receive accurate, reliable results.

QMS = Quality Management System.

It includes:

• Policies

• Procedures

• QC

• Equipment maintenance

• Training

• Safety

• Record keeping

• Proficiency testing

• Personnel competency

24. Three Phases of Laboratory Testing

This is VERY important.

Preexamination / Preanalytical

Everything BEFORE testing.

Examples:

• Test ordered

• Patient identification

• Patient preparation

• Specimen collection

• Specimen labeling

• Transportation

• Storage

• Specimen rejection

Memory trick:

PRE = before testing.

Examination / Analytical

The actual testing process.

Examples:

• Reagents

• Instruments

• Calibration

• QC

• Testing technique

• Preventive maintenance

• Personnel competency

Memory trick:

ANALYTICAL = analyzer/testing.

Postexamination / Postanalytical

Everything AFTER testing.

Examples:

• Reporting results

• Calling critical results

• Correcting reports

• Interpreting results

• Transcription

• Delta checks

Memory trick:

POST = after testing.

25. Urine Specimen Rejection

Possible reasons to reject a urine specimen:

• Unlabeled container

• Label does not match requisition

• Feces/toilet paper contamination

• Contaminated container exterior

• Insufficient volume

• Improper storage

• Improper preservation

• Excessive delay in transport

Do NOT automatically relabel mislabeled specimens.

Investigate and document the problem.

26. Urine Timing

Urine should generally be examined within:

2 hours

If testing will be delayed, proper preservation or refrigeration instructions must be followed.

27. Quality Control

QC = Quality Control.

QC checks:

Accuracy

How close the result is to the correct/expected result.

Precision

Ability to get the same result repeatedly.

Reliability

Maintaining both accuracy AND precision.

Easy memory:

Accurate = correct.

Precise = repeatable.

Reliable = correct + repeatable.

28. External Quality Control

External controls are actual control materials run similarly to patient specimens.

Usually at least two levels are tested.

They help check:

• Accuracy

• Precision

QC results must be acceptable BEFORE patient results are released.

29. Internal Quality Control

Internal controls are built into the testing system.

They may confirm:

• Enough patient specimen was added

• Reagent was added properly

• Sample migrated correctly

• Test system reacted appropriately

Example:

A color line showing enough specimen was added.

30. Electronic QC

Electronic QC uses a mechanical or electronic system instead of liquid control material.

It checks whether the instrument functions properly.

However, it may not check the actual test supplies/reagents.

31. Proficiency Testing

PT = Proficiency Testing.

Also called:

External Quality Assessment or EQA.

An outside organization sends an unknown specimen to the laboratory.

The laboratory tests it like a patient specimen.

Results are returned and compared with results from other laboratories.

PT provides an outside check of laboratory accuracy.

Laboratories cannot communicate with one another about PT results.

32. Levy-Jennings Chart

Used to visually monitor QC values over time.

It can identify:

Shift

A sudden change in the QC mean.

Trend

A gradual movement in one direction.

Scatter

May indicate poor precision.

Control limits are often based on standard deviations around the mean.

33. What If QC Is Out of Range?

Do NOT report patient results.

Possible corrective actions:

• Check expiration dates

• Check lot numbers

• Repeat QC

• Use new controls

• Open new reagent strips

• Check technique

• Check instrument function

Document corrective action.

Patient testing/results can continue only after QC is acceptable.

34. Preventive Maintenance

PM = Preventive Maintenance.

Regular maintenance helps prevent equipment failure.

Examples:

• Refrigerator temperature checks

• Water bath temperature checks

• Centrifuge calibration

• Microscope cleaning

• Pipette accuracy checks

• Instrument maintenance

All maintenance should be documented.

35. Postexamination Results

Laboratory reports should include things such as:

• Patient name

• Patient ID

• Collection date/time

• Specimen source when needed

• Tests performed

• Results

• Reference ranges

• Final result time

• Testing facility

36. Critical Values

Critical values can represent potentially life-threatening results.

They must be communicated immediately according to laboratory policy.

Document:

• Result

• Time called

• Person receiving result

37. Delta Check

A delta check compares the patient’s new results with previous results.

A large unexpected difference may indicate:

• Testing error

• Wrong patient

• Specimen identification problem

38. Autoverification

Autoverification means the computer automatically compares laboratory results with predetermined criteria before results are released.

39. Sensitivity vs Specificity

Sensitivity

Lowest level of an analyte that the test can detect.

Think:

Sensitivity = can it detect it?

Specificity

Ability/likelihood of measuring the analyte you actually want.

Think:

Specificity = is it specific to the right thing?

Answers to the Study Questions

1. C — CLSI

2. C — Chemical

3. C — Specimens

4. A — Hand sanitizing

5. D — Standard Precautions

6. A — Report to a supervisor

7. B — Fluid-resistant

8. A — Urine specimen containers

9. C — OSHA

10. D — Sodium hypochlorite

11. D — Turning on the water with a paper towel

12. C — Aerosols

13. B — Hold under running water for 15 minutes

14. A — Acid is added to water

15. B — Safety Data Sheet

16. D — Pregnant

17. A — Pulling the person away

18. B — Operation of a fire extinguisher

19. C — NFPA

20. C — Dry chemicals

21. A — Rescue people in danger

22. B — May have developed a latex allergy

23. D — Not acceptable in the laboratory

24. B — Biohazards

25. B — Hazard pictogram, signal words, hazard statement

26. A — Class A

27. C — HBV

28. D — Running to answer the telephone

29. D — Quality of specimens and patient care

30. D — All of the above

31. B — Put a complete, referenced procedure in the manual

Question 32

• Reagent expiration date → 2 Examination

• Rejecting contaminated specimen → 1 Preexamination

• Constructing a Levy-Jennings chart → 2 Examination

• Telephoning positive Clinitest newborn result → 3 Postexamination

• Calibrating centrifuge → 2 Examination

• Collecting timed urine specimen → 1 Preexamination

33. D — Proficiency testing

34. C — Internal QC

35. D — All of the above

36. C — Date and laboratory worker’s initials

37. D — All of the above

Most Important Things to Memorize

If you’re studying for a test, focus especially on:

• Chain of infection = agent → reservoir → exit → transmission → entry → susceptible host

• Standard Precautions

• OSHA bloodborne pathogen rules

• PPE

• Hand washing = 20 seconds

• Chemical exposure = flush 15 minutes

• Acid goes into water

• SDS = chemical safety information

• NFPA colors

• RACE

• PASS

• Preexamination vs examination vs postexamination

• Accuracy vs precision

• Internal vs external vs electronic QC

• PT/EQA

• Never release patient results when QC is unacceptable

• Urine should generally be tested within 2 hours