Safety in the lab: practices and predictions.
Infection with a bloodborne pathogen through the mishandling of a specimen or waste ranks among the gravest of concerns of laboratorians today. Yet not all lab workers are taking basic precautions such as washing their hands or changing their gloves. According to participants in MLO's latest national survey, many of your colleagues still do not take safety seriously. Their failure to comply with safety regulations may result in your needlestick.
While some accidents probably are unavoidable, Bernard E. Statland, M.D., Ph.D., of Statland Laboratory Consulting, Nashville, Tenn., and member of MLO's Editorial Advisory Board, says that what matters most is whether employees know what to do when accidents occur. "I would much rather spend an hour or two with new employees so they know what to be concerned about and know what to do when accidents occur. Without that hour or two in the beginning, they are going to be ill-equipped to deal with the consequences."
BLOODBORNE PATHOGENS: POLICIES AND MONITORING
With bloodborne pathogens such as hepatitis B virus and HIV being of such grave concern in the laboratory, who is responsible for policies and practices preventing exposure? Thirty-seven percent of respondents said infection control practitioners primarily determine the content of policies regarding precautions against exposure to bloodborne pathogens in the lab. Thirty-one percent said lab management is responsible, 25% pointed the finger at a safety/security committee, 3% reported having a task force on bloodborne pathogens, 2% said hospital management is responsible, and 3% said some other person or entity is in charge.
As the size of the hospital increases, so does the likelihood of it having a dedicated safety or security committee that primarily determines the content of policies regarding bloodborne pathogens. The opposite is true with regard to laboratory management: As the size of the hospital increases, the likelihood of having laboratory management determine the content of policies decreases.
Ninety percent of laboratorians said adhering to policies regarding exposure to bloodborne pathogens is part of their laboratory's job performance standards. AS with universal precautions, for most labs (86%), these policies have been in effect for two years or more. Forty-seven percent said such policies have been enacted for two to five years, and 39% reported policies in place for more than five years. As hospital bed size increased, so did the percentage of those mentioning that such policies have been part of their laboratory's job performance standards for more than five years.
In addition, most labs (79%) monitor their employees periodically to ensure they are adhering to the lab's policies regarding exposure to bloodborne pathogens. Thirty-three percent of those surveyed said such monitoring is done daily, 19% said annually, 15% reported monthly, 12% reported quarterly, 7% said every six months, 4% reported weekly, and 1% said biweekly (8% said "other"). Chief technologists/assistants/section heads were least likely of all lab personnel to mention monitoring at all.
THE BOTTOM LINE: WEAR GLOVES
The laboratorians surveyed feel the single most effective precaution one can take to prevent exposure to bloodborne pathogens is wearing gloves (mentioned by 56% of respondents). The next precaution most often mentioned was washing hands (29%), followed by adhering to correct waste disposal procedures (7%), and labeling patient specimens (1%).
Gloves were also the personal protection device (PPD) laboratorians most always had in sufficient supply. Long, heavy gowns were most often lacking. (See "Lab safety - Part 1 ", p. 28 in the August issue of MLO for a breakdown of sufficiently and insufficiently supplied PPD items.)
The importance of gloves was evident because virtually all laboratorians report they routinely wear gloves while performing 12 of the 13 procedures listed in the questionnaire (see Table 1). The next most frequently used PPDs were gowns, protective eye wear, and benchtop hoods. Booties were never routinely used.
Some labs have a policy requiring laboratorians to remove gloves before touching photocopiers (48%), telephones (43%), typewriter/computer keyboards (39%), and doorknobs (33%). Thirty-seven percent, however, have no such policies in place. AS the number of hospital beds increases, so does the likelihood of the lab having a policy requiring laboratorians to remove gloves before touching the above-mentioned items.
MLO asked laboratorians if they routinely wash their hands in a variety of situations (see Table 2). Most laboratorians (98%) wash their hands if a glove breaks, after removing gloves (97%), and just before leaving the lab (99%). Three out of four (75%) do so before regloving between patients, and 79% change gloves and wash their hands after processing a group of specimens.
REMOVING LAB COATS
Only 7% of laboratorians change into a clean lab coat more than once a day. The majority of laboratorians (93%) change into a clean lab coat once a day in a typical shift.
Three out of four laboratorians (76%) always remove their lab coat when going to the employee lounge, 15% usually remove it, 6% occasionally remove it, and 3% never bother. Similarly, three out of five laboratorians (59%) always remove their lab coat when going to the bathroom, 19% usually remove it, 13% occasionally remove it, and 9% never bother.
Employees in larger hospitals (for definitions of hospital size, see Part 1 of this series in the August MLO) were more likely to always remove their lab coat when going to the employee lounge than employees at hospitals with fewer than 200 beds (82% vs. 68%, respectively). Men were more likely to remove their lab coats when going outside the lab than women. Laboratorians in the East were more likely to always remove their lab coats when going to the employee lounge than those in the West (82% vs. 69%, respectively). The more tests performed annually, the higher the likelihood was of laboratorians always removing their lab coats when leaving the lab. Years of experience as an active laboratorian made no significant difference.
HANDLING SPECIMENS AND WASTE
MLO asked laboratorians how specimens are routinely secured before being transported to another location (see Table 3). With the exception of surgical specimens, eight out of 10 laboratories' specimens are bagged. One in three is placed in puncture-proof containers. One in 10 labs double-bags specimens. Para-filming is rarely performed. Small hospitals are more likely to secure specimens in puncture-proof containers [TABULAR DATA FOR TABLE 1 OMITTED] than hospitals with more than 200 beds. As for surgical specimens, 68% of labs bag them, and a little more than half (52%) place them in puncture-proof containers.
The majority of labs (94%) dispose of glassware in rigid containers, which are then primarily disposed by incineration (58%). Other methods of disposing rigid containers include inactivation of etiologic agents before disposal in a landfill or sanitary sewer (13%), steam sterilization (9%), dry-heat sterilization (2%), chemical treatment plus wet grinding (2%), and other methods (18%).
For those who do not dispose of glassware in rigid containers, 89% dispose of glassware in sharps containers. Six percent do nothing to prevent accidental cuts, 3% have housekeepers wear impermeable or metal mesh gloves, and 9% use other methods.
A BIRD'S-EYE VIEW ON THE FUTURE
In terms of the future, safety considerations will continue to be an integral part of a career in the lab, but opinions are mixed as to whether safety issues actually deter individuals from entering the field.
Lynn Schwaby, MT(ASCP), manager of quality improvement and safety and assistant microbiologist at Evanston Hospital in Evanston, Ill., says, for example, "I think safety concerns play a minor role in determining whether or not people pursue a career in the lab. People who investigate find the lab can be a very safe environment, more safe than some public situations."
And Statland remarks, "In the beginning, people were concerned about AIDS, but now the issues are job security, being laid off, and [TABULAR DATA FOR TABLE 3 OMITTED] longer hours. Concerns about safety would be a real issue if they didn't pale in comparison to some of these other issues."
Table 2 Do you routinely ... Yes No Base Wash your hands ... If a glove breaks? 98% 2% (736) After removing gloves? 97 3 (735) Before regloving between patients? 75 25 (674) Just before leaving the lab? 99 1 (729) Change gloves and wash hands after processing a group of specimens? 79 21 (721)
Approximately one-third (31%) of participants in the survey, however, felt safety considerations do deter some people from entering the field (on a scale of 1 to 5 with 1 = "not at all a deterrent" and 5 = "a tremendous deterrent", they answered "4" or "5"), while 32% did not (they answered "1" or "2"). Thirty-six percent were ambivalent (see Figure 1). Those with fewer than 10 years' experience as active laboratorians were less likely to say that safety considerations deter individuals from entering a career in the lab than those with more than a decade as an active laboratorian.
Among those already working in the lab, one out of four laboratorians (27%) knows someone who has quit the profession because of safety considerations. As the size of the hospital increases, so does the likelihood that laboratorians know someone who has quit because of safety issues. The more years of experience laboratorians have, the more likely they are to know someone who has quit due to safety reasons.
But the majority of laboratorians (83%) do not consider safety considerations a valid reason to leave the field. Laboratorians employed in the East and in urban settings were least likely to have considered leaving the profession because of safety.
DOES DEREGULATION THREATEN SAFETY?
When asked to what extent the efforts of Congress to repeal government regulation in the laboratory threaten the safety of health care workers, 40% said such efforts probably would not threaten safety, while 30% believed those efforts would. More men believed this than women.
As one lab manager at a small hospital in Florida says, "Most laboratories and other health care providers were active in employee safety before the Feds made it a bureaucratic nightmare, and this will continue. The quickest route to a safe environment is informed thinking and empowered employees."
And as a section supervisor at a medium-size government hospital in Louisiana says, "My safety is ultimately under my control. I must follow proper procedures. I must be careful and take my time. The only effect decreased regulation would have might be the institution would feel it no longer had to provide personal protective equipment (PPE) and I don't think that will happen."
But as a lab manager in a small non-for-profit hospital says, "Safety is expensive. Money won't be spent if it doesn't have to be."
A lab manager in a small, private hospital adds, "Employers will not provide PPE without a law telling them to do so."
DOES MANAGED CARE THREATEN SAFETY?
When asked whether managed health care will threaten the safety of health care workers, 39% said "not at all" or "only slightly", while 37% felt it would to some degree [ILLUSTRATION FOR FIGURE 2 OMITTED].
A safety officer at a large government hospital in California says, "Smart managed care organizations will see that the cost of one large damage award exceeds the cost of safety equipment. Plus, if you do not provide a safe work environment, lab workers will migrate to those jobs that do."
But as a safety officer at a large urban nonprofit hospital says, "Safety for employees and patients costs money. Managed care is primarily for cutting costs regardless of outcomes."
"Managed care is going to have a chilling effect on everything in the lab because the bottom line is now the bottom line," says Statland. "I think education is going to be hit more than safety. It's not so much that there will be a few less gowns or gloves, but so much of safety is instruction, education, and orientation, and if these programs are minimized because of budgetary concerns, this will greatly impact safety."
Daniel M. Baer, M.D., chief of pathology at Veterans Affairs Medical Center, professor of pathology at Oregon Health Sciences University, Portland, and member of MLO's Editorial Advisory Board, comments, "Any time work needs to speed up in any setting, people will take short cuts that might threaten their safety, and managed care, competition, downsizing, and lack of money are all things that drive our people to do more work with less staff. To that extent, managed care might have an adverse effect, but it's not managed care alone; it's many pressures that threaten safety."
"Managed care will encourage laboratories to reduce costs and be more productive, and perhaps safety does incur extra costs and cause some slowdown of work, so there will have to be some reconciliation or adjustment," Schwaby adds.
Laboratorians indicated increased overall safety, government regulations, and the use of PPDs were some of the greatest improvements in the past five years. But, according to respondents, some of the greatest safety problems yet to be overcome are getting fellow laboratorians to take safety seriously, getting all colleagues to comply with safety regulations, and needlesticks.
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|Title Annotation:||medical laboratories|
|Publication:||Medical Laboratory Observer|
|Date:||Sep 1, 1996|
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