This project has been funded in whole or in part with Federal funds from the Division of AIDS (DAIDS), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, under contract No. HHSN C, entitled NIAID HIV and Other Infectious Diseases Clinical Research Support Services (CRSS). Laboratory Safety Version 8.0, August 2012

 Explain the key elements of laboratory safety related to:  Fire safety  Chemical safety  Blood-borne pathogens  Dangerous goods shipment  Describe the basic safety practice responsibilities for an employer and an employee  Describe basic safety practices related to each type of hazard  Discuss safety incident reporting Objectives 2

Which of the following represents proper portable fire extinguisher maintenance? A.Must be visually inspected every 6 months B.Must be recharged per local standards C.Must document inspection and testing D.A and B only E.B and C only F.All of the above Pre-Assessment Question # 1 3

The laboratory should maintain Material Safety Data Sheets (MSDS) for: A.Test kits B.Reagents C.General-use supplies (e.g., bleach) D.A, B, and C E.A and C only F.A and B only Pre-Assessment Question # 2 4

Which of the following are examples of Personal Protective Equipment (PPE)? A.Gloves B.Face shields C.Gowns D.All of the above Pre-Assessment Question # 3 5

Which of the following is true in terms of dangerous goods? A.Training in dangerous goods must be documented B.Training in dangerous goods must be renewed every four years C.More than one person per laboratory should be trained to ensure proper back up D.A and B only E.B and C only F.A and C only Pre-Assessment Question # 4 6

Which of the following is correct? A.The employer must provide the tools needed for safety B.The employer must create safety policies C.Laboratory safety is the responsibility of the employer D.A and B only E.B and C only F.A and C only Pre-Assessment Question # 5 7

Which of the following statements are true regarding Laboratory Safety? A.Antiretroviral medication may reduce the risk of HIV seroconversion in a laboratory employee who had a needle stick injury B.You should always follow your institution’s policies regarding safety C.Engineering controls include items that isolate or remove the blood-borne pathogen hazard from the workplace D.The prohibition of recapping needles is an example of a work practice control E.All of the above Pre-Assessment Question # 6 8

What are the three components of a safety incident report? A.Documentation, review by laboratory director or designee, quality management program B.Documentation, review by safety training program director or designee, quality management program C.Safety policies, review by safety training program director or designee, quality control program D.None of the above Pre-Assessment Question # 7 9

Responsibilities 10 EmployerEmployee  Provides:  Necessary policies  Engineering and work practice controls  Personal Protective Equipment (PPE)  Ensures compliance with policies  Establishes formal training program  Knows the institution’s health and safety practices  Follows those health and safety practices  Ensures proper use of PPE  Follows engineering and work practices

Four Elements of Laboratory Safety 11 Fire Safety Chemical Safety Blood-borne Pathogens Dangerous Goods

Do you have a fire story? Story Time 12

Fire Prevention  Identify Fire Hazards  Fire Safety Training  Fire Exits and Signage  Electrical Codes  Fire Extinguishers  Storage of Hazardous Materials  Fire Alarm Systems  Fire Audits or Inspections 13

Elements of Fire 14 Oxygen Fuel Fuel Heat

Fire Safety 15 RACE Rescue any people in danger Alarm (activate the fire alarm) Contain the fire by closing the door Extinguish if it is small enough R R A A C C E E

What safety responsibility belongs to the employee? A.Create safety policies B.Wash laboratory coats at home C.Know your institution’s safety policies D.All of the above Skill Check 16

Fire Safety 17 Label Locking pin Carrying handle/ Operating lever Pressure gauge Discharge nozzle or horn

Fire Safety (cont’d) PASS Pull the pin Aim at the base of the fire Squeeze the handle Sweep to cover the fire P P A A S S S S Plan Your Exit Always position yourself with an exit to your back when using an extinguisher 18

Fire Extinguisher Maintenance  Portable fire extinguishers must be:  Visually inspected monthly  Recharged per local standards  Document inspection and testing  Ensure that extinguishers have:  Pin and seals in place  No visual sign of damage  Nozzles that are free of blockage  Pressure gauges that show adequate pressure 19

Additional Safety Equipment 20 What safety equipment does your laboratory have? ??????????????

Safety Equipment  Eye wash (plumbed or portable)  Emergency shower or drench hose  Fire extinguishers  Sharps containers 21 The following safety equipment are required… Do you inspect them? How frequently? Do you document these activities?

Four Elements of Laboratory Safety 22 Fire Safety Chemical Safety Blood-borne Pathogens Dangerous Goods

Ways chemicals can enter the body:  Inhalation: Breathing in (e.g., powders, fumes)  Absorption: On skin or mucus membranes  Ingestion: Entry through mouth  Injection: Through skin by foreign body Chemical Safety 23

Chemical Safety (cont’d) 24 Examples of Chemical Hazards CarcinogensCancer CorrosivesBurns HepatotoxinsLiver damage MutagensDamage genetic material in cells NephrotoxinsKidney damage NeurotoxinsDamage to the nervous system TeratogensBirth defects

 Product-specific information for chemicals  Name of Chemical  Physical Characteristics and Hazards  Health Related Info  First Aid  Spill and Disposal  Date of most recent change  Name and address of party responsible for MSDS Material Safety Data Sheets (MSDS) 25

 Maintain MSDS for:  Reagents/chemicals  Test kits  General-use supplies (e.g., bleach)  Document staff training  Organize alphabetically or numerically  Update at least every two years  Maintain index of all MSDS; can serve as chemical inventory  Accessible to everyone at all times  Create a hazardous chemicals chart for first aid Material Safety Data Sheets (MSDS) (cont’d) 26

 Flush with plenty of water  At least 15 minutes  Remove contaminated clothing  Seek medical attention  Document First Aid for Chemical Exposure 27

 Characteristics of Nitrogen  78% of Atmosphere  Colorless, Odorless, Tasteless, Nontoxic  Boils at -320  F (-196  C)  Nonflammable  Why be concerned?  It displaces oxygen from the air  Will not support life  Can lead to asphyxiation  It can cause frostbite or worse Liquid Nitrogen 28

 Always wear safety equipment (Personal Protective Equipment [PPE])  Avoid use in small enclosed areas  Avoid prolonged breathing of vapors  Avoid rough handling of containers  Provide adequate ventilation Liquid Nitrogen – Precautions 29

 Full Face Shield with Safety Glasses or Safety Goggles  Cryogenic Gloves  Arm Protection  Laboratory Coat  Cuff-less pants Liquid Nitrogen – PPE 30

 Inhalation – Immediately remove to fresh air  Eyes – Flush with water for 15 minutes  Skin – Soak affected area in tepid water  Seek medical attention  Document incident Liquid Nitrogen – Emergencies 31

Chemical Safety What is wrong with this picture? That is liquid nitrogen they are working with. 32

Chemical Safety (cont’d) What is wrong with this picture?  No cryogenic gloves  No face protection  No arm protection  No laboratory coat  Not an approved container 33 See general guidance above.

Ways chemicals can enter the body include: A.Absorption B.Inhalation C.Injection D.All of the above Skill Check 34

Management of Chemicals in the Laboratory  Standard Operating Procedures (SOPs)  Hazard Communication  Chemical Hygiene  Annual Chemical Inventory/MSDS Updates  Periodic Safety Assessments 35

Story Time Who has a chemical safety story? 36

Four Elements of Laboratory Safety 37 Fire Safety Chemical Safety Blood-borne Pathogens Dangerous Goods

Blood-borne Pathogens (BBP) What are blood-borne pathogens?  Viruses, bacteria, or other micro-organisms that are carried in a person’s blood stream and can cause disease  Common BBPs include:  HIV  HCV  HBV 38

Other body fluids can also spread blood-borne pathogens such as:  Blood Products (Plasma, Platelets, etc.)  Abdominal and Chest Fluids  Amniotic Fluid  Cerebrospinal Fluid (CSF)  Joint Fluids  Vaginal Secretions  Semen Blood-borne Pathogens (cont’d) 39

Treat Everyone’s Blood and Body Fluids as Infectious all of the Time Standard Precautions 40

Use Personal Protective Equipment  Including, but not limited to:  Gloves  Fluid Resistant Gowns or Coats  Goggles and Masks or Face Shields Personal Protective Equipment (PPE) 41

Personal Protective Equipment (PPE) (cont’d) You should wear as much PPE as you anticipate you will need to prevent blood and other infectious materials from contact with your skin, mucus membranes, and clothing. 42

What type of PPE do you recommend for performing the following?  Drawing blood  HIV ELISA  Clerical work (such as a receptionist) What do you think? 43

Handle sharps with care  Do not recap needles or other sharps  Do not bend, shear, or break off needles  Dispose of sharps in puncture resistant container Biohazardous Sharps 44

Remember… Things that should not be done in areas where you are working with blood or body fluids  Eat or drink  Smoke  Apply cosmetics  Handle contact lenses 45

Hand Washing MOST IMPORTANT! Reduce your risk of infection: the sooner you wash infectious material off your hands, the less your chance of infection. 46 Wash Hands

Four Elements of Laboratory Safety 47 Fire Safety Chemical Safety Blood-borne Pathogens Dangerous Goods

IATA International Air Transport Association Regulates international air transport, including the transport of Dangerous Goods Dangerous Goods 48

Who can name some? Dangerous Goods (cont’d) 49

Includes:  Dry Ice  Infectious Substances  Poisons  Firearms  Ammunition  Paint To name a few! Dangerous Goods (cont’d) 50

(In accordance with IATA 1.5, 49 CFR Sec ) “No person shall handle, offer for transport, or transport Dangerous Goods...unless they are trained.” Dangerous Goods Regulations 51

 Saf-T-Pak Compliance Training  IATA website Dangerous Goods Training Sources 52

What do you think happens if you do not follow the regulations for Dangerous Goods transportation? What do you think? 53

 Individual civil penalty between $250 and $25,000 per violation  Willful individual violators may be fined up to $250,000 and/or receive up to 5 years in prison  Business entities or institutions may be fined up to $500,000 per violation Fines for Violations 54

Safety Policies 55 Standard/Universal Precautions Chemical Hygiene Hazard Communication Waste Management General Safety Safety Equipment

 Blood-borne pathogens  Personal protective equipment  Chemical hygiene  Hazard communication  Use of safety equipment Safety Training 56

 Handling of cryogenic materials  Shipping of dangerous goods (IATA)  Waste management  Biohazard containment  General safety  Local regulations Safety Training (cont’d) 57

Safety Training (cont’d) 58  Orientation of new employee  Annually thereafter Frequency Documentation of training

Safety Incident Reporting 59 Documentation Review by laboratory director or designee Quality Management Program

Lucia works as a Laboratory Technician within the Specimen Processing Laboratory. You are the Manager of the laboratory. You report to work early this morning to find that Lucia experienced a potential exposure from a participant specimen. The preliminary information would indicate that Lucia received a laceration to her finger or hand, as well as a splash to her face.  What immediate steps do you take?  What additional measures do you undertake? Safety Case Study 60

Which of the following represents proper portable fire extinguisher maintenance? A.Must be visually inspected every 6 months B.Must be recharged per local standards C.Must document inspection and testing D.A and B only E.B and C only F.All of the above Post-Assessment Question # 1 61

The laboratory should maintain MSDS for: A.Test kits B.Reagents C.General-use supplies (e.g., bleach) D.A, B, and C E.A and C only F.A and B only Post-Assessment Question # 2 62

Which of the following are examples of PPE? A.Gloves B.Face shields C.Gowns D.All of the above Post-Assessment Question # 3 63

Which of the following is true in terms of dangerous goods? A.Training in dangerous goods must be documented B.Training in dangerous goods must be renewed every four years C.More than one person per laboratory should be trained to ensure proper back up D.A and B only E.B and C only F.A and C only Post-Assessment Question # 4 64

Which of the following is correct? A.The employer must provide the tools needed for safety B.The employer must create safety policies C.Laboratory safety is the responsibility of the employer D.A and B only E.B and C only F.A and C only Post-Assessment Question # 5 65

Which of the following statements are true regarding Laboratory Safety? A.Antiretroviral medication may reduce the risk of HIV seroconversion in a laboratory employee who had a needle stick injury B.You should always follow your institution’s policies regarding safety C.Engineering controls include items that isolate or remove the blood-borne pathogen hazard from the workplace D.The prohibition of recapping needles is an example of a work practice control E.All of the above Post-Assessment Question # 6 66

What are the three components of a safety incident report? A.Documentation, review by laboratory director or designee, quality management program B.Documentation, review by safety training program director or designee, quality management program C.Safety policies, review by safety training program director or designee, quality control program D.None of the above Post-Assessment Question # 7 67

“Safety isn’t expensive, it’s priceless.” 68 - Anonymous

Wrap Up 69