Transcript Basic Clinical & Laboratory Safety Training - Home

Basic Laboratory and Clinical
Safety Training
Environmental Health and Safety
The University of Texas Health Science Center at Houston
Research Environment
In the reserch environment, a person is exposed to various
hazards such as: biological, fire, chemical, and radioactive
EHS Organizational Chart
Robert Emery, DrPH
George Delclos, MD, PhD
Vice President
UT Health Services Medical Director
Clinical
oversight
Bruce J. Brown
Nancy Zamboras
Employee Health
Clinical Services (0.2
FTE)
Director, EH&S
Rachel Gamble,
Biosafety Mgr.
Pamela Phillips
Steve David
Executive
Assistant
Application Sys.
Specialist
William Bryan,
PhD, Chem Mgr.
Janet Gutiérrez,
DrPH, RadiationMgr.
Alan Lucas,
EPP Mgr.
Jason Bible,
OSFP Mgr
Bryan Evans,
Risk Mgr
Mike Gillum
Sondra Faul
Eric Escobedo
Claims &
Insurance
Analyst
Cynthia Quinones
HCPC, Safety
Coordinator
Kristin King
Crystal Giles
Boris Tsenov
Kiamalon
Fletcher
Liang Yu
Eddie Horace
Jr.
Brett
Haltiwanger
Niki Pearce
Travis
Halphen
Kirsztina
Nemeti
Chris
Beckermann
Chris Robb
Cindy
Crosson
Chris Ratliff
vacant
Bryan
Farquhar
Alexis
Hawkins
Service agreement with
UTHealth School of
Nursing
Mike Allen p/t
Environmental Health & Safety
Robin Webb
Risk Management &
Insurance
Employee Health
Clinical Services
Course Objectives
 General Safety
 Chemical Hazards
 Biological Hazards
 Waste Disposal and Storage
General Safety
 Put simply, we exist to help people go home as
healthy and safe as they arrived.
 Occupational Safety Manual
 http://www.uthouston.edu/dotAsset/3344030.pdf
 Hazard reporting
 If you see any hazardous conditions (i.e. uneven walkways,
odors, unsafe work practices) please call and report them to
713-500-8100.
Proper Use of Fire Extinguishers
 P.A.S.S.

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Pull the pin out
Aim the hose at the base of the fire
Squeeze the trigger
Sweep from side to side
at the base of the fire
 Contact the Occupational Safety and Fire Prevention
group at 713-500-8100 to schedule training
Procedure for Responding to a Fire
 Report the fire to UTPD at 500-HELP or 911 (from a safe
location)
 Activate Fire Alarm (pull stations near exits and stairwells)
 Confine the fire to small area by closing the door
 Evacuate the area
High Rise Fire Alarm Notification
• Alarm sounds on affected floor, the
floor immediately above and the
floor immediately below
9
• Be aware that sound might be heard
faintly on other floors, near
speakers, or resonating through
elevator or stairwell shafts
7
• If the alarm is on your floor, you
will know– it’s very loud
• Proceed to the nearest exit; if you
detect the presence of smoke or fire
evacuate the building.
4
8
6
5
3
2
1
Have an Exit Strategy
Area Safety Liason
 Want to be an ASL?
 Want more information?
 Contact EHS at 713-500-
8100
Chemical Hazards
Hazard Communication
 Hazardous Chemicals
 Workplace Chemical List
 Employee Education Program
 Material Safety Data Sheets
 Labeling
 Employee Rights
Texas Hazard Communication Act
 The Texas Hazard Communication Act (revised 1993)
“requires public employers to provide employees with
specific information on the hazards of chemicals to which
employees may be exposed in the workplace.”
Texas Hazard Communication Act
 Under the Act, UTHealth must:
 notify employees of their rights under the Act;
 compile workplace chemical lists (inventories) for the research
and nonresearch areas;
 train all exposed employees regarding the hazards associated
with the chemical they use;
 maintain a file of Material Safety Data Sheets; and
 supply the appropriate emergency personnel with information.
Hazardous Locations
 Laboratories
 Animal care facilities
 Hazardous waste accumulation areas
 Hazardous waste processing areas
 Housekeeping storage areas
 Maintenance shops
 Clinics
 Others
Door Postings
Employee Rights
 You have the right to:
 information on your exposures
 receive training on chemical hazards
 access to MSDSs
 receive protective equipment (free of charge)
 file complaints, assist inspectors, or testify against your
employer
Labeling
 Mandated
 Chemical name
 Brief description of hazards
 Manufacturer name & address
 When transferring chemical,
label new bottle
Material Safety Data Sheets
Available to all UTHealth
employees
 Can be accessed through EH&S
MSDS link
 Can be obtained from the
manufacturer
 Can be obtained by calling Chemical
Safety at 713-500-5832
Safety Handling of Chemicals
 Chemical Segregation
 Common hazardous
categories
 Hazardous chemical
spill clean up
Segregation of Chemicals
 Store chemical according to category first (acid, base, etc.), then
in alphabetical order within category
 Flammables should be stored in flammable cabinets and/or
explosion-proof refrigerators – not in regular refrigerators!
 Label all chemicals
Common Hazardous Categories
Chemical Exposure
 Types of Exposure
 Acute (immediate)
 Chronic (months or years
later)
 Routes of Entry
 Inhalation
 Absorption
 Ingestion
Hazardous Chemical Spill Clean-Up
 Minor Spill: Alert people in immediate area; Avoid breathing
vapors from spill; Wear protective equipment; Use appropriate
spill kit; Clean spill area. Call 713-500-5832 for assistance
 Major Spill: Call UTPB Office at 44890 or 911; Alert people
to evacuate; Close doors to affected area; Attend to injured
personnel.
Call Safety at 713-500-5832
Engineering Controls: Chemical Fume
Hoods
 Procedure and equipment at least 6
inches inside hood
 Sash kept at proper level and
lowered when not performing work
 Power failure – stop work, cover or
close chemicals, close hood, notify
supervisor
 Hood is NOT a storage area
Administrative Controls: Good Work
Practices
 Follow established Standard Operating Procedures (SOPs)
 No eating or drinking in laboratories
 Receive training for proper use of chemicals
 Keep compressed gas cylinders secured
Personal Protective Equipment
 Keep body covered
 Pants
 Lab coat
 Eye/face protection
 Closed-toe shoes
 Proper gloves – latex examination
gloves are rarely appropriate for
chemicals (see glove compatibility
guide for proper glove selection)
 Always wash hands before
leaving lab area
Biological Hazards and Bloodborne
Pathogens
Bloodborne Pathogens
•OSHA
 29 CFR 1910.1030 - OSHA Bloodborne Pathogen Standard issued originally in 1991
 http://www.osha.gov/SLTC/bloodbornepathogens/index.html
 In 2001 the Standard was revised with the Needlestick Reduction Act which includes:
 Education and selection of sharps injury reduction devices (e.g., self-sheathing
needles)
 Maintenance of a contaminated sharps injury log
Texas Department of State Health Services
Bloodborne Pathogen Control
 Prevention of contaminated sharps injuries, needlesticks
 Exposure control plan designed to minimize exposure of governmental entity employees
to bloodborne pathogens
 http://www.dshs.state.tx.us/idcu/health/infection_control/bloodborne_pathogens/
Bloodborne Pathogens (BBP)
 Definition:

Pathogenic microorganisms that are present in human blood or other
potentially infectious material (OPIM), and can infect and cause
disease in humans. These pathogens include, but are not limited to,
hepatitis B virus (HBV) and human immunodeficiency virus (HIV).
 Ex: HIV, HBV, HCV, T. pallidum,
Herpes Virus, M. tuberculosis
(aerosol hazard), Human
T-Lymphotropic Virus Type I (HTLV-I)
 Human cell lines also apply.
Where can you find a BBP?
 Body fluids that can harbor BBP:
• Blood
• Semen and vaginal secretions
• Saliva involved in dental procedures
• Synovial fluid
• Cerebrospinal fluid
• Any cell line
• All body fluids containing blood
Signs and Symptoms of TB
 Cough
 Chest pain
 Coughing up blood
 Weakness
 Fever and/or night sweats
 Weight loss
TB Surveillance
 Purified Protein Derivative (PPD) or Montaux skin test
 BCG vaccine-false positive
 Positive test
 High risk group >5mm (HIV, recent TB infection)
 Medium risk group >10mm (IV drug users, TB lab personnel)
 Low risk group >15mm
 PPD test reading
 Poor test follow up-2 visits necessary
 Each HCW may read the test slightly different
 QuantiFERON-TB Gold
 Interferon Gamma Release Assay (IGRA)
 Better test follow up-only 1 visit
 Ease of reading
 Fewer false positives
TB in the Clinical Setting
• Routinely ask all patients:
• History of TB disease?
• Symptoms suggestive of TB?
• Patients with history or symptoms of undiagnosed
TB:
• Refer promptly for medical evaluation of possible active
infection
• Wear surgical mask
• Provide urgent care in TB isolation areas (i.e., negative
pressure rooms)
How can you be exposed?
 Mucous membrane contact - splash to the eyes, nose or
mouth
 Percutaneous inoculation - misuse of sharps (broken glass,
needles, scalpels)
 Exposure to broken/damaged skin - risk increases if contact
involves a large area of broken/damaged skin or if contact is
prolonged

* Risk increases with high
titer levels in the source
Preventative Measures
 Risk of exposure can be minimized or eliminated by
using the following controls:
 Engineering controls
 Personal protective equipment (PPE)
 Administrative controls
 Work place practices
Engineering Controls
 Leakproof containers
 Use for storage & transport of
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

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
bloodborne pathogen material
Sharps containers
 Fill no greater then ¾ full
Needleless devices
 Use retractable syringes, self-sheathing
needles
Directional air flow
Biosafety cabinet (BSC)
High efficiency particulate air (HEPA)
filtration
Access control
Personal Protective Equipment
 Face protection
 Goggles or safety glasses with side shields
 Clothing
 Lab coats, scrubs, disposable gowns (long pants only and no
open toed shoes!)
 Replace immediately if contaminated & restrict to work area
 Gloves
 Replace immediately if torn
 Do not wear outside the lab area
Administrative Controls
 Medical surveillance
 TB skin test (PPD), baseline serum
 Immunizations
 Hepatitis B series
 Training
 Management of staff (SOP compliance)
 Background checks, security clearance
Hepatitis B Vaccination Series
 For personnel who have routine exposure to BBP
 Vaccine provides protection in 90-95% of healthy adults
 Offered at no cost to employees with potential exposure
 Vaccine process:
- Three shot series
- Second shot given one month after the first
- Third shot six months after the first
- Immunity builds gradually
 Reported to provide lifetime immunity
Good Work Practices
 DO NOT eat, drink or apply cosmetics in work area
 Decontaminate work surfaces
• At start and end of procedures, immediately after spill, and
before removal of equipment
 Dispose of waste properly
 Label containers/hazard communication
 Wash hands frequently & always before leaving work
area!
Good Work Practices (cont.)
 Develop and follow SOPs
 Use standard precautions
 Treat all human blood and body fluids as if
known to be infectious for HIV, HBV or
other potentially infectious material
 Familiarize yourself with the work
area
 Note locations of all necessary
equipment, waste containers,
disinfectants, soaps
 Establish and maintain clean and
dirty zones
 NEVER recap needles!!!
Hand Hygiene
 On average only 40% of health care workers regularly
wash their hands
 Hospital acquired infections result in transmission of:
• MRSA – Methicillin resistant S. aureus
• 1.2 million infections; 48,000 patient deaths yearly
• VRE –Vancomycin resistant Enterococci
• $4.5 billion yearly cost for treatment
 Methods for contamination
• Moving patients
• Taking blood pressure
• Touching bedrails
Source: Hand Hygiene Resource Center http://www.handhygiene.org/
Environment Can Facilitate
Transmission
Contaminated surfaces
increase crosstransmission
Abstract: The Risk of
Hand and Glove
Contamination after
Contact with a VRE (+)
Patient Environment
.
Hayden M, ICAAC,
2001, Chicago, IL.
X represents
VRE culture positive
sites
Proper Handwashing
 Always done between patients and procedures!
 Wet hands with warm (not hot) water
 Apply soap on hands
• Liquid soap is better because germs can live on wet soap bars
 Rub hands together for at least 15 seconds
• Wash longer if there is visible dirt on hands
• Cover all surfaces of hands and fingers - including between fingers,
backs of hands, thumbs, under fingernails
 Rinse hands thoroughly with warm water
 Dry hands thoroughly
• If using blow dryer, push button with elbow
• If available, use towel to turn off water
 What song is about 15 seconds long….
Source: Hand Hygiene Resource Center http://www.handhygiene.org/
Where Do We Miss?
Alcohol Sanitizers
 Alcohol Sanitizers
• 62% alcohol
• Accepted as effective under certain conditions
• Should not be used for visible dirt, grime or blood
Needlestick/Possible Exposure
Procedure
 Apply routine first aid immediately
 Clean site of injury with soap and flush with warm water for at
least 15 minutes
 antiseptics may be used if available
 Flush mucous membranes with water or saline for at least 15
minutes
 Notify supervisor
 Complete First Report of Injury
 Used to process insurance claims, helps identify trends
 Seek medical attention
 Needlestick Hotline (24hr): 1-800-770-9206
 Employee Health: 713-500-3267
Potential Medical Surveillance
 All treatment will be determined in conjunction with
Employee Health Clinical Services.
 Baseline Labs
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HIV antibody (with consent)
RPR (Syphilis)
Hepatitis B surface antibody
HCV antibody
 If source is known to be Hepatitis C+, also obtain liver function & HCV RNA tests
 CBC with differential and platelets, chemistry profile, urine pregnancy test if
source is known HIV+ and if exposed personnel chooses to utilize post-exposure
prophylaxis
 Hepatitis B Vaccination
 Tuberculosis skin test, Quantiferon test (blood test), Chest
X-rays
Most Commonly Reported Injury at
UTHealth-Needlesticks
Primarily occur in clinical setting
 Improper sharps disposal
• Overfilled sharps containers
• Recapping
 Improper handling
• Improper passing of sharps to other personnel
• Improper suture technique
 Uncooperative patients
 Not familiar with device (i.e. self sheathing needle)
 Improper lighting
Exposure Risk
 If you were exposed to a BBP, what is the “chance” you’ll
experience a transmission?
 Percutaneous injury transmission rates with blood or blood
products:
• HBV
• HCV
• HIV
6-30%
~1.8%
0.1- 0.3%
 Source: CDC Bloodborne Pathogens-Occupational Exposure
http://www.cdc.gov/oralhealth/infectioncontrol/faq/bloodborn
e_exposures.htm
Employee Rights in the Event of an
Exposure
 In the event of a possible exposure to bloodborne
pathogens, the employee is entitled to:
• Confidential medical evaluation and follow-up
• Documentation of routes of exposure
• Identification, documentation, testing and results of the
source individual
• Counseling
• Evaluation of reported illness
Total No. of
Individuals
No. of Injury
Reports
31%
89%
94%
Blood Spill Clean-up Procedure
 All blood spills should be cleaned up using a 10% dilution of
household bleach or any other approved disinfectant.
 Bleach mixture should be fresh
 Materials used to clean up the spill, like towels, should also be
disposed in a biohazard bag.
 Apply the approved disinfectant to the perimeter of the spill and
slowly proceed inwards.
 The disinfectant should be allowed to soak for at least 15 minutes.
Infectious Substance Shipping
 Training required for all persons
wanting to ship infectious or diagnostic
substances
 Refresher training required every two
years or as regulations change
 For additional help or training
information please contact Biological
Safety at 713-500-8161
Hazardous Waste Disposal
Waste Minimization
 Plan experiments to limit waste
 Reduce wastes through use of microscale protocols
 Segregate hazardous and non-hazardous materials
 Prevent orphaned chemicals through proper labeling
 Avoid spills and leaks
 Take advantage of free chemical reuse and alcohol
thermometer replacement programs
 Get rid of old or unwanted chemicals
Biological Waste DisposalAutoclave Use
 Steam Sterilization (Autoclave)
• Training required for all persons who
will be using autoclave for waste disposal
• For treatment of solid and liquid wastes
(Autoclave not used for nano-particles,
radioactive materials, fecal material or
chemicals)
• Utilize the nearest autoclave for
biological waste disposal (For locations,
contact E.P.P. at 713-500-5835)
• Perform quality control on a routine
basis and record activities in log book
Biological Waste Disposal (cont.)
 Off Site Disposal
• Utilize a biological waste box or reusable red
•
•
•
•
•
tub with a red liner
Close red liner bag loosely with a single knot
Securely close the box using the self locking tabs
Attach completed biological waste label
(designate incineration only by attaching a
yellow shipping label)
SRB, DBB, DAC, BBS, RAS, SCRB3 please place
in the regional biological waste storage room
MSB, MSE, or SONSCC please call the
hazardous waste line (713-500-5837) select
option #3, Include building, room number, and
number of containers ready for pickup
* Place sharps in an appropriate sharps container. Call
the hazardous waste line (713-500-5837) to
request collection.
Chemical Waste Disposal
 Call the Waste Line (713-500-5837) select
option #2, Include building, room number,
and number of containers ready for pickup
 Waste Line is checked and wastes are collected
on Monday, Wednesday, and Friday
*Note:
Empty containers which held acute hazardous
materials (e.g. sodium azide, epinephrine,
osmium tetroxide, warfarin) are considered
hazardous wastes and must be collected by EHS
(a complete list of acute hazardous wastes
may be obtained by contacting EHS
Chemical Waste Storage
• Utilize original container or safety cans provided by
EHS
• Label all wastes with the chemical name including
components - include the word “WASTE” or
“Hazardous Waste” in the description
• Keep waste container closed and utilize secondary
containment
Controlled Substance Disposal
 Call hazardous waste line 713-500-5837
 Press 2 for chemical waste disposal, leave a message with drugs
ready for pickup, contact information, building, and room
number.
 EHS will contact the registrant and schedule the CS
pickup and destruction.
 The registrant and UTPD must accompany EHS to and
witness the blending with hazardous waste.
 EHS will send a record of the disposal to the local DEA
office.
 Keep records of disposal for at least three years.
Surplus Transfer Form
 To transfer items to surplus fill out and submit e-transfer
form available at
http://www.uth.tmc.edu/safety/index.html
 EH&S will inspect equipment within three business days,
affix a green tag, and forward request to Capital Assets
Management.
 Surplus request for items that are non hazardous such as
office equipment will be forwarded to Capital Assets
Management upon receipt.
 Please do NOT store equipment awaiting surplus
removal in hallways or egress corridors.
Want to use Radioactive Material?
 Training required for all
persons working with
radioactive materials
 Training from previous
institutions MAY fulfill
requirement
 For additional help or
training information please
contact Radiation Safety
at:713-500-5840
Training Certificate