4. Mouth pipetting of specimens is not permitted.
5. Do not create aerosols. Remember, infectious diseases, such as infectious hepatitis, may be transmitted by aerosols produced by centrifuges, stirrers, pipettors, etc. Exercise extreme care when using such equipment. Cool inoculating loops or needles before touching colonies on plates or inserting into liquid material.
6. Develop the habit of keeping your hands away from your mouth, nose, and eyes. Wash hands well with soap before leaving the laboratory.
7. Do not lay personal articles, such as eyeglasses, on the bench in your work area.
8. Laboratory coats or gowns are not to be worn outside the laboratory, particularly not to the employee lounge or cafeteria or out of the building.
9. Wipe off benches in your working area with disinfectant before and after each day’s work. Keep your area clean at all times.
10. In case of injury or unusual incident, however slight, the supervisor in charge must be immediately notified, and a report to occupational health facility is required. Also fill out an accident report form. Major accidents must be documented and reported in detail to the supervisor and chief of microbiology. The report should indicate:
A. Cause of the accident
B. Type of contamination or hazard
C. List of personnel possibly exposed and amount of exposure to possible pathogenic material
D. Decontamination procedures taken if pathogenic material was involved
E. Actions taken to prevent recurrence
F. Actions taken to safeguard or monitor employees
11. Infections may be spread by a number of routes in the laboratory. The actual occurrence of an infection depends on the virulence of the infecting agent, susceptibility of the host, route of entry, inoculating dose, etc. (Table 11.1).
A. Airborne. Droplets and aerosols may be formed by simply removing caps or cotton plugs or swabs from tubes. Heating liquids on needles too rapidly may also create an aerosol. Breakages in centrifuges are serious accidents (Table 11.2).
B. Ingestion. Ingestion can occur through mouth pipetting, failure to wash hands after handling specimens or cultures, or smoking, eating, and drinking in the laboratory.
C. Direct inoculation. Scratches, needlesticks, cuts from broken glass, or animal bites may permit direct inoculation.
D. Skin contact. Some very virulent organisms, and others not so virulent, can enter through small cuts or scratches or through the conjunctiva of the eye.
E. Vectors. Flies, mosquitoes, ticks, fleas, and other ectoparasites can be potential sources of infection in the laboratory, especially if animal work is performed.
12. Personnel who display risk-prone behavior or are pregnant, immunocompromised, or immunosuppressed should be restricted from performing work with highly infectious microorganisms and, in some situations, be restricted to a low-risk laboratory (22).
Handwashing is the most important procedure to reduce the duration of exposure to an infectious agent or chemical, to prevent dissemination of an infectious agent, and to reduce overall infection rates in a health care facility. Hand contamination occurs during manipulation of specimens and during contact with work surfaces, telephones, and equipment. Laboratory personnel should wash their hands immediately after removing gloves, after obvious contamination, after completion of work, before leaving the laboratory, and before hand contact with nonintact skin, eyes, or mucous membranes (8).
Handwashing sinks should be located at each entry/exit door; if possible, the faucet should be operated by a knee/foot control. If these controls are not available, the faucet should be turned on and off using a paper towel. Handwashing should be performed using soap or an antiseptic compound, starting at the wrist area and extending down between the fingers and around and under the fingernails, and rinsed from the wrists downward. Recently, the Centers for Disease Control and Prevention recommended that in addition to traditional soap and water handwashing, health care personnel can use alcohol-based gels (8).
Personal Protective Equipment (OSHA 2001 Blood Borne)
Occupational Safety and Health Administration (OSHA) standards for exposure to blood-borne pathogens require the laboratory to provide personal protective equipment (PPE) for its employees. OSHA standards require that PPE be provided, used, and maintained for all hazards found in the workplace, including biological, environmental, and chemical hazards, radioactive compounds, and mechanical irritants capable of causing injury or illness through absorption, inhalation, or physical contact. Employees must be trained in the appropriate use of PPE for a specific task, the limitations of PPE, and procedures for maintaining, storing, and disposing of PPE.
Gloves
Gloves protect the wearer from exposure to potentially infectious material and other hazardous material and are available in material designed for specific tasks. Gloves must be provided by the employer and must be the proper size and appropriate material for the task. Due to latex hypersensitivity in some workers, only powder-free latex gloves should be used or gloves should be manufactured from nitrile, polyethylene, or other material.
Protective Clothing
Laboratory workers should wear long-sleeved coats or gowns that extend below the level of the workbench, and they should be worn fully closed. The material must be fluid resistant if there is any potential for splashing or spraying. Fluid-proof clothing (plastic or plastic lined) must be worn when there is the potential for soaking by infectious material. Laboratory workers should not wear laboratory clothing outside the laboratory. All protective clothing should be changed immediately when contaminated to prevent the potentially infectious material or chemical from contacting the skin. Coats and gowns should not be taken home for cleaning but should be laundered by the institution.
Face and Eye Protection
Face and eye protection should be used when splashes or sprays of infectious material or chemicals may occur. Equipment includes goggles, face shields, and splashguards. Face shields provide the best protection for the entire face and neck, although splashguards provide an alternative method. If only goggles are worn, the user should also wear an appropriate mask to prevent contamination of mucous membranes.
1. Specimens with gross internal contamination must not be accepted. Place the specimen in a plastic bag to protect subsequent handlers. The test request slips should be bagged separately from the specimen (keep paperwork clean and uncontaminated). Wear gloves when handling the specimen, and wash your hands thoroughly when you finish handling the specimen. Notify the supervisor immediately about a contaminated specimen so that further corrective action may be taken.
2. Specimens to be centrifuged must be placed in a sealed container to prevent aerosols.
3. All specimens