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Urgent need to reassess lab safety policies.

Urgent need to reassess lab safety policies

Laboratorians have always been safety-conscious. They are used to daily exposure to infectious materials and toxic chemicals. With detailed safety policies to guide them, they are taught how to work with isolated patients and safely handle hazardous substances. But is this enough to minimize risks and protect laboratory employees?

Recent articles have reported about employee infections from virulent blood specimens.1, 2 This news has raised the level of concern in laboratories, and all lab managers should now be asking critical questions: Are current precautions suitable for the increased risks of infection that lab employees face? Do hospital, medical staff, and laboratory safety policies in general adequately protect employees and guard against an employer's liability? What new safety policies should be instituted to optimize protection of employees?

Let's consider these questions from three angles:

Patient information. With the advent of computers, patient-specific information became harder to get. Laboratorians tended to adapt to meet computer program specifications and eventually accepted the omission of admitting or possible diagnosis. They are often denied this information because a software program cannot provide it or because they are not counted among those who have a "need to know.'

I have been in laboratories where policy dictates that "possible diagnosis' should not appear on test order forms. I also know of an emergency room staff that was reluctant to answer when someone from the laboratory asked whether a patient's symptoms led to an abnormal white count. The patient had AIDS.

Laboratories should not tolerate incidents of this kind. Any suspected communicable disease should be announced to all departments that have direct patient contact or handle patient speciments. Doing so won't jeopardize patient privacy policies.

Such information would bring benefits other than safety. Knowledge of patient conditions could improve the quality of test results, reduce unnecessary repeat testing, enhance the integration and correlation of test results, and better enable laboratories to help clinicians reach diagnostic and therapeutic decisions.

Laboratory directors and managers must insist on receiving patient data essential to accurate results and employee protection. The lab is definitely a "need to know' department, and as such, should be well informed.

Internal safety. Because it is not always possible to know the actual diagnosis, laboratories should handle every specimen as if it were infectious. Guidelines for health care workers have been issued and updated by the Centers for Disease Control and other health organizations, published extensively, and adapted for use in laboratories.1, 3, 4 Both the Centers for Disease Control and the American Hospital Association have issued AIDS safety guidelines.

It's safe practice to wear rubber gloves, wear mask and gown when handling known infectious specimens or entering isolation rooms, and remove or exchange one's laboratory coat when leaving the lab. Other precautions include prompt placement of used needles in puncture-resistant containers designed solely for disposal, without trying to reinsert the needles in their original sheaths; immediate reporting of spills, tube breakage, or employee skin puncture; and strictly adhering to a policy of no smoking, drinking, or eating in lab testing areas.

Some of the recommended precautions may seem excessive and costly. But avoiding just one misfortune resulting in a hefty compensation award justifies the cost of safety.

Laboratory managers have to look at their own operation and evaluate the level of their safety policies and practices. It may only take a good in-service or retraining program to strengthen compliance. Then again, the entire safety program may need an overhaul.

Personnel policies. Many employees are beginning to refuse to draw blood from known or even suspected AIDS patients. One hospital fired an employee for this, and the dismissal was upheld after a union grievance hearing.

In other laboratories, managers say employees are beginning to ask if they can refuse to work with AIDS patients. If your institution has not developed a way to deal with this problem, you need to discuss it with policymakers. Each institution will have to make its own decision. But AIDS is a growing personnel problem and cannot be ignored.

Whatever your approach to these concerns, the objective must be to insure employee safety and avoid legal problems for your institution. You are also charged with providing a responsible, non-hysterical atmosphere for employees. They should understand the reasons for all precautions, but they should not have to work in fear.

Technologists and technicians should set an example for other hospital support personnel. They have the knowledge and experience it takes to remain reasonable. Back these employees with a realistic laboratory action plan.

1. Pinckney, D.S. AHA urges wider use of AIDS protective gear. Am. Med. News 30: 3, 51, July 17, 1987.

2. Scott, B. 3 AIDS cases will not change CDC guidelines. Clin. Chem. News 13: 1, 18-19, 1987.

3. AIDS guidelines reinforced. Clin. Chem. News 13: 19, 1987.

4. Baldwin M.F. Labor department may require health care providers to comply with strict AIDS guidelines set by CDC. Mod. Healthcare 17: 64, July 31, 1987.
COPYRIGHT 1987 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1987 Gale, Cengage Learning. All rights reserved.

Article Details
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Author:Barros, Annamarie
Publication:Medical Laboratory Observer
Article Type:column
Date:Oct 1, 1987
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