Doing what we've always done
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February 1, 2019
Editor’s note: In this guest column, Dan Scungio, MT(ASCP), SLS, laboratory safety officer for Sentara Healthcare, a multihospital system in Virginia, and otherwise known as “Dan, the Lab Safety Man,” discusses the important issues that affect your job every day.
The reference cytology lab has always had limited storage space for supplies and specimens. It uses tall wire racks to store the many liquid-based cytology specimen vials. The vials contain small amounts of flammable chemicals, and the shelves are 7 feet high. The lab staff have followed this storage procedure for 10 years.
It has taken Jan four years to get her clinical lab staff to a decent point of compliance with regard to PPE use. They are pretty good about donning lab coats and gloves, and they’ve greatly improved their use of face protection while handling open specimens. However, many of the lab’s staff members still refuse to give up wearing mesh sneakers while at work. Given the amount of work she’s put in already to get them this far, Jan feels that battling the shoe issue would not be worth her time or energy.
The safety officer in the hospital lab has a clinical background and doesn’t really understand anatomic pathology safety issues, so he usually stays out of that area. The staff has nice ventilated cabinets for specimen storage, which help decrease the formaldehyde vapors in the area. Because there is no chemical fume hood, staff have opted to store the formaldehyde reagent cube inside the cabinet. The doors to the cabinet won’t close, but they feel safer about pouring off formaldehyde there rather than doing it on the open counter. The safety officer agrees with this arrangement.
It is said that if we do what we have always done and expect different results, we might be insane. That’s a strong statement, but there may be some dangerous truth to it. In scenarios like the ones described above, there is a lack of knowledge about safety regulations, some complacency, and even a lack of a questioning attitude. Each of these situations represents a ticking safety time bomb waiting to create havoc.
In the first case of the cytology specimens, there is no written laboratory regulation that states liquid specimens or chemicals cannot be stored on a high shelf. However, best safety practices dictate that all chemicals should be stored below eye level in the laboratory. Any time people have to reach above their head to bring down a chemical, there is a risk for a splash to the face. Lids on vials may become damaged or loose, and a chemical exposure to the eyes or mouth can occur easily. The other issue here is the amount of flammable material being stored in the laboratory. NFPA 45, Standard on Fire Protection for Laboratories Using Chemicals, requires that labs with or without an automated sprinkler system limit their flammable storage. In a lab with sprinklers, up to 2 gallons of flammable liquids may be stored in each 100 square feet of lab space. If there is more than that stored, the specimens or chemicals must be placed inside of a flammable cabinet.
In the second situation described above, Jan is happy about her progress in the department regarding PPE compliance, but she should not stop there. While it is a common issue in labs nationwide, mesh shoes are simply unacceptable in the lab setting. Mesh absorbs chemicals or blood and body fluids, which can all be easily spilled in the lab setting. Needles and other sharps can easily penetrate mesh as well. Having the correct footwear is an important issue in the lab, and it should be dealt with to protect staff.
The last scenario describes an issue in which staff may not understand how engineering controls function. It also highlights the need for staff to consult the lab safety professional when making certain decisions. A vented cabinet is a wonderful tool for storing specimens or chemicals in the histology area, but it only works well if the cabinets are closed. If the doors are opened, it is unlikely the fumes from the bottom of the cabinet will be drawn up and out, and lab staff will become exposed. It would be a much better idea to purchase a small chemical fume hood for the pouring of formaldehyde in the department. That way, all staff are minimally exposed to the carcinogenic chemical.
Allowing the lab to function as it always has—and letting safety issues go—is never a good idea. Eventually, although it may not occur right away, someone will be hurt. Changing your approach to lab safety is the best way to make a difference. Don’t ignore safety issues; ask questions when something doesn’t seem quite right, and continue to learn safety regulations through research and education. By making these changes, you will begin to see results, and they will take your laboratory to new heights of safety.