This document discusses various biological, chemical, and radioactive hazards found in healthcare settings like clinical laboratories. It describes the chain of infection and methods to control infections, such as standard precautions, isolation techniques, and waste disposal procedures. Engineering controls, personal protective equipment, and proper chemical handling and labeling are emphasized to reduce exposure risks from biological and chemical threats. Disease-specific isolation practices are outlined for effective patient isolation.
This document discusses various biological, chemical, and radioactive hazards found in healthcare settings like clinical laboratories. It describes the chain of infection and methods to control infections, such as standard precautions, isolation techniques, and waste disposal procedures. Engineering controls, personal protective equipment, and proper chemical handling and labeling are emphasized to reduce exposure risks from biological and chemical threats. Disease-specific isolation practices are outlined for effective patient isolation.
Original Description:
Notes on safety and guidelines inside the laboratory
This document discusses various biological, chemical, and radioactive hazards found in healthcare settings like clinical laboratories. It describes the chain of infection and methods to control infections, such as standard precautions, isolation techniques, and waste disposal procedures. Engineering controls, personal protective equipment, and proper chemical handling and labeling are emphasized to reduce exposure risks from biological and chemical threats. Disease-specific isolation practices are outlined for effective patient isolation.
This document discusses various biological, chemical, and radioactive hazards found in healthcare settings like clinical laboratories. It describes the chain of infection and methods to control infections, such as standard precautions, isolation techniques, and waste disposal procedures. Engineering controls, personal protective equipment, and proper chemical handling and labeling are emphasized to reduce exposure risks from biological and chemical threats. Disease-specific isolation practices are outlined for effective patient isolation.
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Safety and Quality
Assessment Centers for Disease Control and Prevention (CDC)
Occupational Safety and Health Administration (OSHA)
Clinical and Laboratory Standards Institute (CLSI)
Biologic Hazards The health-care setting provides abundant sources of potentially harmful microorganisms. These microorganisms are frequently present in the specimens received in the clinical laboratory.
Chain of infection- Understanding how microorganisms are transmitted
Infection control- procedures to control and monitor infections occurring within their facilities Biologic Hazards Once the infectious agent has left the reservoir, it must have a way to reach a susceptible host. Means of transmission include: 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 Biologic Hazards -Universal Precautions (UP). 1987 , CDC Under UP all patients are considered to be possible carriers of bloodborne pathogens -Body Substance Isolation (BSI) guidelines are not limited to blood-borne pathogens; they consider all body fluids and moist body substances to be potentially infectious. Healthcare Infection Control Practices Advisory Committee (HICPAC) ◦ combined the major features of UP and BSI guidelines and called the new guidelines Biologic Hazards Reducing exposure risk Six major tactics reduce the risk of exposure to BB Pathogens 1. Engineering controls 2. Work practices 3. Housekeeping 4. Hepa B vaccination 5. Private rooms 6. PPEs Biologic Hazards Engineering Controls These are physical and mechanical devices that are available to healthcare workers to reduce or eliminate the potential to transfer infectious diseases. Self sheathing needles Autoclaves Puncture proof sharps containers (80% capacity) Biologic Hazards Workplace Practice Controls -Practices that are incorporated into all health care associates’ work habits to prevent the spread of infection. ◦ Handwashing- the single most important way to prevent the spread of infection ◦ Alcohol based hand cleaners in place of hanwashing ◦ Disinfection- 10% bleach Biologic Hazard Workplace Practice Controls ◦ Antiseptic technique is used on skin surfaces because the solutions are safe to human skin. ◦ Antiseptics ◦ 70% isopropyl alcohon either saturated into gauze or in prepack pads ◦ Tincture of iodine or povidone-iodine ◦ 2% chlorhexidine gluconate and 70% isopropyl alcohol ◦ Benzalkonium chloride, an alternate skin cleanser ◦ Zephrin chloride ◦ Hydrogen peroxide, alternate for people allergic to alcohol Biologic Hazards Workplace Practice Controls ◦ Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas ◦ Food and drink must not be kept in the same room with potentially infectious materials are present ◦ There should be a separate room for food consumption ◦ Before entering the said room, the protective garments should be removed Biologic Hazard Housekeeping ◦ Cleaning up spills and decontaminating soiled areas immediately with a disinfectant such as 10% bleach that has been made up fresh daily. ◦ Broken glass should not be picked up with the hands, a dustpan, brush or tongs should be used Biologic Hazards Hepa B vaccination
◦ Must be available at no charge to the phleb
◦ Effective for 15 or more years in protecting the phlebs ◦ This vaccine does not protect the phleb from all types of hepatitis, only hepa B Biologic Hazard Private room ◦ A private room reduces the possibility of transmission of infection by separating the patient with a disease from other patients and healthcare associates ◦ Anteroom Biologic Hazards PPE used in the laboratory includes gloves, fluid-resistant gowns, eye and face shields, and Plexiglas countertop shields. Biologic Hazards ◦ Hand Hygiene ◦ Hand contact is the primary method of infection transmission
◦ Includes both hand washing and using alcoholbased antiseptic
cleansers. Alcohol-based cleansers can be used when hands are not visibly contaminated. Biologic Hazard ◦ Biologic Waste Disposal ◦ All biologic waste, except urine, must be placed in appropriate containers labeled with the biohazard symbol.
◦ The waste is then decontaminated following institutional policy:
incineration, autoclaving, or pickup by a certified hazardous waste company
◦ Urine may be discarded by pouring it into a laboratory sink under a Plexiglas
countertop shield. Biologic Hazards Isolation Techniques ◦ Isolating a patient- help the healthcare team break the chain of infection ◦ Was first published in 1887. ◦ Isolation but still allowed nosocomial transmission because of aseptic technique ◦ 1910- cubical system- septic technique ◦ 1960- private rooms or ordinary rooms ◦ 1970- CDC recommended use of 7 isolation categories, a practice called category-specific isolation Biologic Hazards Category Specific Isolation ◦ Required knowing that a patient needed to be isolated ◦ Often, patient would come to the hospital with an illness that was later determined to be a disease requiring patient isolation. This would occur after many patient had already been eposed. Biologic Hazards ◦ Category Specific Isolation ◦ Strict isolation ◦ With contagious dse- chickenpox, DPT, Pneumonia ◦ Contact Isolation ◦ Dse that is transmitted by direct contact- scabies, ◦ Respiratory Isolation ◦ Dse transmitted through the air- mumps, pertussis or rubella ◦ TB Isolation ◦ Similar to respiratory trans ◦ Tb is an opportunistic disease Biologic Hazards Category Specific Isolation ◦ Drainage/Secretion Isolation ◦ Patients with open wounds (wound and skin precautions) ◦ Enteric Precautions ◦ Severe diarrhea due to contagious bacteria- Salmonella, Shigella or Vibrio cholerae ◦ Transmission by contact with infected feces ◦ Protective or Reverse Isolation ◦ Protecting the patient from healthworkers Biologic Hazards Disease Specific Isolation ◦ Established in 1983 to overcome the shortcomings of CSI ◦ Category of blood and other body fluids are added ◦ Protective or reverse Isolation was eliminated because it was proven to be inefficient ◦ TB isolation was improved ◦ Private room with negative air pressure and the use of High-efficiency particulate air(HEPA) filter respirators instead of surgical masks Biologic Hazards Transmission-based Precautions ◦ 1996 revised ◦ Two tiers ◦ 1st tier- Standard precautions ◦ 2nd tier- TBP ◦ Intended for patients diagnosed with or suspected of having a specific transmissible disease AIRBORNE DROPLET PRECAUTIONS CONTACT PRECAUTIONS PRECAUTIONS EX OF Rubeola, varicella, TB DPT, Mycoplasma, Clostridium difficile, E. DISEASES pneumonia, pertussis, coli, Shigella, hepatitis A, influenza, mumps, herpes simplex, scabies, rubella Staphylococcus( open wounds)
PRIVATE YES YES YES
ROOM RESPIRATORY YES, with TB NO NO PROTECTION MASK Persons susceptible to YES, if working within 3 NO measles or varicella feet or 1 meter of should avoid contact patient Sharp Hazards ◦ including needles, lancets, and broken glassware, present a serious biologic hazard, particularly for the transmission of blood-borne pathogens.
◦ disposed in puncture-resistant, leak-proof container with the biohazard
symbol. Chemical Hazards ◦ same general rules for handling biohazardous materials apply to chemically hazardous materials
◦ Chemical Spills and Exposure
◦ Skin contact> flush with water for 15 mins ◦ Never attempt to neutralize XXXXXXXX ◦ Emergency showers and eye wash stations Chemical Hazards ◦ Chemical Handling ◦ never be mixed together unless specific instructions are followed(added in order specified) ◦ Wear goggles and mix reagents in fume hoods Chemical Hygiene Plan chemical Hygiene Officer 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 Chemical Hazard Chemical Labeling ◦ should be labeled with a description of their particular hazard, such as poisonous, corrosive, flammable, explosive, teratogenic, or carcinogenic ◦ National Fire Protection Association (NFPA)—ID of Fire Hazard Chemical Hazard Material Safety Data Sheets (MSDS) ◦ 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 Radioactive Hazards -Radioactivity may be encountered in the clinical laboratory when procedures using radioisotopes are performed.
-amount of radioactivity present in the clinical laboratory is very small> cumulative
exposure
-amount of radiation exposure is related to a combination of time, distance, and
shielding Electrical Hazards ◦ same general rules of electrical safety observed outside the workplace apply ◦ Equipment should not be operated with wet hands. ◦ 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. 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. (RACE) ◦ Rescue—rescue anyone in immediate danger ◦ Alarm—activate the institutional fire alarm system ◦ Contain—close all doors to potentially affected areas ◦ Extinguish/Evacuate—attempt to extinguish the fire, if possible or evacuate, closing the door
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