guidelines safety

LABORATORY

SAFETY

GUIDELINES

DEPARTMENT OF HAEMATOLOGY

&

TRANSFUSION MEDICINE UNIT

HOSPITAL UNIVERSITI SAINS MALAYSIA

NO. DOKUMEN : EDISI SEMAKAN : (0)

NAMA T/TANGAN TARIKH

DISEDIAKAN

DISEMAK

DILULUSKAN

REKOD PINDAAN :

NO.

PINDAAN

TARIKH MUKA

SURAT

HURAIAN DISEMAK

OLEH

DILULUSKAN

OLEH

Terkawal ( ) Tidak terkawal ( )

2

LABORATORY SAFETY MANUAL

Contents

Section 1. General Guidelines on Laboratory Safety

1.1 Introduction

1.2 General Guidelines

1.2.1 Access to Laboratories

1.2.2 COSHH Risk Assessment Form

1.2.3 When Entering The Laboratories

1.2.4 When Exiting The Laboratories

1.3 Laboratory Cleaning and Housekeeping

1.4 General Guide to Spill Handling

1.4.1 Safe Handling of Biological Spills

1.4.2 Accident Prevention

1.4.3 The Spill Response Plan

1.4.4 Emergency Spill Response Procedures

Section 2. Safe Handling of Specimens and Disposal of Infectious Waste

2.1 Specimen Containers

2.2 Specimen Transport

2.3 Specimen Reception

2.4 Safety Procedures for the Separation of Serum

2.5 Safety Precautions for Avoiding Ingestion of Infectious Materials and their

Contact with Skin and Eyes.

2.6 Safe Shipment of Specimens and Infectious Materials

2.7 Disposal of Infected Material

2.7.1 Contaminated material for autoclaving and recycling

2.7.2 Contaminated materials for disposal

2.7.3 “Sharps”

2.8 Methods and Procedures for disposal

2.9 Disposal of Solid Medical Waste

3

Section 3. Safe Handling of Laboratory Equipment

3.1 Introduction

3.2 Centrifuges

3.3 Freezing Apparatus

3.4 Pipettes

3.4.1 Safe Use of Pipettes

3.5 Autoclave

3.6 Miscellaneous Equipment

3.6.1 Microscopes

3.6.2 Water Bath

Section 4. Emergency Procedure.

Section 5. Emergency Procedures and First Aid

5.1 Emergency Planning

5.1.1 General Emergency Procedures for Department of Haematology /

Transfusion Medicine Unit

5.2 Emergency Services : Whom to Contact

5.3 Emergency Equipment

5.4 Emergency First-Aid

5.5 First-Aid Measures

Appendix 1: Control of Substances Hazardous to Health (COSHH)

Appendix 2: Laporan Rawatan Mangsa Kemalangan (UKKP RP1)

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GENERAL QUOTES AND REMINDERS CONCERNING

LABORATORY SAFETY

THE ATTITUTES AND ACTIONS OF THOSE WHO WORK IN THE

LABORATORY DETERMINE THEIR OWN SAFETY AND THAT OF THEIR

COLLEAGUES AND OF THE COMMUNITY. LABORATOTY EQUIPMENT

AND DESIGN CAN CONTRIBUTE TO SAFETY ONLY IF THEY ARE USED

PROPERLY BY PEOPLE WHO ARE GENUINELY CONCERNED AND

KNOWLEDGEABLE SAFETY ISSUES.

ALL OCCUPANTS OF A LABORATIRY MUST HAVE REGARD FOR

THEMSELVES, THEIR CO-WORKERS, THE COMMUNITY AND

ENVIROMENT OUTSIDE THE LABORATORY. NEVER ADOPT A CASUAL

ATTITUTE IN THE LABORATORY. ALWAYS PLAN AHEAD AND BE

CONSCIOUS OF POTENTIAL HAZARDS.

ADHERERENCE TO A FEW SIMPLE BIOSAFETY RULES WILL MAKE THE

ALABORATORY AND THE DEPARTMENT A SAFE WORKING AND

LEARNING ENVIROMENTS.

5

1. General Guidelines on Laboratory Safety

1.1 Introduction

It is the policy of the Department of Haematology and Transfusion Medicine

Unit to provide a safe system of work, a safe environment for work and

teaching, and safe equipment. To achieve this goal, it is essential for the staff

and students to follow the guidelines and recommendation that are indicated

herein.

1.2 General Guidelines

1.2.1Access to Laboratories

Entry to any laboratory section is restricted to personnel authorized to

enter by the head of the department or the senior staff in charge of the

respective section. This individual shall ensure that any person given

authority to enter receives/has received appropriate information

regarding safety measures and supervision.

The laboratories in the department will be open from 8.10 a.m. until 4.55

p.m., except the Immunohaematology laboratory and hematology

laboratory which operates for 24 hours.

Children are strictly not permitted in the diagnostic and research

laboratories (The on-call room can be used as a guest room for relatives

or children of the staff).

1.2.2When Entering the Laboratory

All staff must record their attendance and movements in the staff

attendance and movement book.

All students and other visitor must record their attendance in their

respective book.

Place all excess clothing, books, backpacks and other non-essential

items in the personal cabinet that have been provided. Student and

visitors must place their belonging in the on call room student’s cabinet.

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No sitting on laboratory work benches is permitted. Personal articles are

not to be placed on working surfaces; they should be stored in individual

lockers.

No smoking, eating or drinking is permitted in the laboratory. Eating and

drinking are permitted only in the break room, on call room, pantry, and

meeting room.

All clinical materials submitted to the laboratory are to be processed with

appropriate precautions.

Gloves are to must be worn whenever handling clinical materials. Gloves

may not be used to pick up the telephone, open doors, or enter

information on the computer terminal.

Always wash your hands and wipe off you bench top with bleach and

towels before starting work. (Refer to appendix III for the detail

procedure for cleaning laboratory bench).

Avoid excessive contact between bleach and your skin.

1.2.3When Exiting the Laboratory

Make sure your area is neat and clean.

Wipe down your bench top with bleach and paper towels.

Store and keep any chemicals, reagents and instrument used.

Wash your hands before leaving.

Switch off lights, air-conditioning, PC, analyzer and make sure the area

is safe.

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1.3 Laboratory Cleaning and Housekeeping

1.3.1General

Clean surroundings facilitate clean work. Laboratory workers should

clean and tidy work benches and shelves as they work, and provide a

complete clean-up at the end of the working day.

Work areas to be kept free from physical hazard that might cause

spillages or breakages.

Discarded infectious material, sharps, waste and contaminated

equipment are to be regularly collected for sterilization. This collection

should be independent of the regular collection of uncontaminated

waste.

1.3.2Cleaning Personnel

The laboratory supervisor is to issue special instructions (particularly to

cleaning contractors) necessary for the cleaning of microbiological

laboratories. If cleaning is carried out by cleaning contractors, their work

should be confined to floor, ledges, walls and window cleaning. Only

laboratory workers shall handle infectious materials.

1.3.3Benches and Work Surfaces

Work benches are to be kept tidy and free of materials not being used.

Benches and work surfaces are to be cleared at the end of each working

day and then disinfected. Under-bench cupboards, where used, should

be mobile, to facilitate cleaning of under-bench areas. Unnecessary

items are not to be left on the floor, but placed on the shelves provided.

1.3.4Wall and Shelves

Walls should be cleaned periodically, or when visibly dirty, by washing

with a detergent solution. Unnecessary or too-vigorous cleaning is not

recommended, as it may cause damage to paint surfaces and provide a

surface that is difficult to decontaminate.

8

Open shelves collect dust and should be cleaned weekly. Frequently

used reagent bottles and books collect little dust, but those seldom used

may become dusty, and are better stored in closed cupboards.

1.3.5Floor Cleaning

The time of the day allocated for floor cleaning should be carefully

considered. General floor cleaning should not be carried out during

normal working hours, as it may produce dust and aerosols which

contaminate work.

1.4 General Guide to Spill Handling

1.4.1Safe Handling of Biological Spills

All individuals who work in a lab where pathogens are used must know

how to handle these agents safely and what to do in case of a spill. An

emergency spill response protocol specific for the microorganisms

chemical or hazard in use should be prepared and posted kept in a

visible location within the laboratory.

1.4.2Accident Prevention

An accidents prevention plan should be the first priority. General safety

precautions include:

Wear appropriate protective clothing.

Use plastics rather than breakable glassware to reduce likelihood of

puncture wounds, cuts and generation of aerosols in the event of an

accident.

Transport materials on carts which have lipped shelves, using

secondary containers 9i.e. tubs) to catch possible spills.

Disinfect waste.

1.4.3The Spill Response Plan

Response procedures should be established before a spill occurs.

9

Assessment of the hazards presented by the pathogen(s) in use should

be based upon:

Virulence and infectivity of the agent.

Viability – e.g., does the organism become inactive when dried?

Route of entry – e.g., can the organism enter the body via aerosols or

splash to the eye?

Quantity and location of possible spill.

Immune status of the individuals at risk.

The necessary clean-up materials should be available on site. In

preparing a spill response kit, ascertain that it contains the appropriate

clean-up materials, protective clothing and equipment.

The kit should be stored in a visible and accessible location immediately

outside the facility and should include:

Disposable protective clothing (e.g., long-sleeved coat or gown,

mask, gloves)

Absorbent paper

Autoclave-able container and bags

Disinfectant appropriate for the pathogen(s) handled. Remember to

replace the disinfectant as it expires.

Autoclave-able squeegee or forceps and dustpan.

1.4.4Emergency Spill Response Procedures

Immediate Response Procedures

For small spills

On a work bench or in a biological safety cabinet, cover the spill with a

towel which has been soaked in the appropriate disinfectant. Use of a

spray bottle for distributing the disinfectant will generate aerosols and is

to be avoided.

10

For large spills (500 ml or more)

Evacuate the area immediately to prevent exposure to aerosols.

Close the facility door and allow aerosols to settle for 30 minutes.

Remove and autoclave contaminated clothing.

Disinfect exposed skin; shower if possible.

Treat injuries (this takes precedence over containment of hazard).

Report the spill.

Cleanup Procedures

Before re-entering the area for cleanup, put on the protective clothing

from the spill response kit and proceed as follows:

Pour disinfectant around the perimeter of the spill rather than directly

onto it to minimize creation of aerosols: covering the spill with paper

towels will minimize splashing.

Work the disinfectant towards the centre of the spill and let it sit for at

least 20 minutes.

If the spill has leaked through the grills of a biological safety cabinet,

leave the cabinet running and pour in enough disinfectant (avoid

alcohol due to explosion hazard) to dilute the spill tenfold. Drain the

catch tray after the time interval appropriate for the disinfectant.

Wipe down any adjacent walls, cabinets, furniture and equipment that

may have been splashed.

Use forceps/squeegee and dustpan to pick up and transfer the

contaminated material into an autoclave-able bag or container.

Autoclave the waste and clean-up utensils.

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2. Safe Handling of Specimens and Disposal of Infectious Waste

Improper collection, internal transport of specimens and eventually disposal of

infectious waste in the laboratory carry a risk of infection to the personnel

involved.

2.1 Specimen Containers

They should be made of glass or plastic.

They should be leak-proof when the cap or stopper is correctly applied.

Containers should be correctly labeled for risk group pathogens 9e.g.

red sticker).

Specimen request forms should not be wrapped around the containers

but places separately.

2.2 Specimen Transport

To avoid accidental leakage or spillage, special secondary containers

such as trays or boxes should be used, filled with racks so that the

specimen containers remain upright.

The secondary containers may be of metal or plastic but should be

autoclave-able or resistant to the action of chemical disinfectants.

They should be regularly decontaminated.

2.3 Specimen Reception

All specimens should be received at the counter located near the main

entrance to the laboratory.

Personnel who receive and unpack specimens should be aware of the

potential health hazards involved, and should seek professional

assistance when in contact with broken or leaking containers.

Specimens should be unpacked preferably on trays and disinfectants

should always be at hand.

Any specimen carrying a ‘highly infectious” label or sticker should ideally

be unpacked in a class II biological safety cabinet.

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2.4 Special Safety Precautions with Blood and other Body Fluids

Specimen tubes and request forms should be labeled with appropriate

warning.

Diagnostics work may be handled according to the risk level of the

suspected microbial agent.

Specimen tubes should be opened in a class I or class II biological

safety cabinet.

To prevent splashing, the stopper should be grasped through a piece of

paper.

Plastics should replace glass wherever possible.

Blood films should be handled with forceps or gloved fingers.

Equipment used for handling blood and body

2.5 Safety Procedures for the Separation of Serum

Only properly instructed staff should be employed for this work.

Splashes and aerosols can be avoided or minimized only by good

technique. Blood and serum should be pipetted carefully, not poured.

Pipetting by mouth should be forbidden.

Pipettes should be completely submerged in hypochlorite (refer to

appendix II for appropriate concentration) or other suitable disinfectant.

They should remain in the disinfectant at least overnight before disposal

or decontamination for reuse.

A solution of hypochlorite, freshly prepared daily, should be available for

dealing with splashes and spillage of blood and serum.

2.6 Safe Shipment of Specimens and Infectious Materials

The safe shipment of diagnostic specimens and infectious materials is

the concern of all who are involved in the process.

Packaging Requirements:

Infectious materials should be packaged in the three layers, two layers of

watertight enclosing and the outer layer to protect the secondary

package from outside influence while transit.

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Package containing infectious material must bear the biohazard label.

One copy of the specimen data form should be taped to the outside of

the secondary container.

If the material is perishable, warnings should appear on accompanying

documents, e.g. “Keep Cool, between + 2O C and + 4O C”.

2.7 Disposal of Infected Material

An identification and separation system for contaminated material should

be established. Categories may be:

2.7.1 Contaminated material for autoclaving and recycling

No pre-cleaning should be attempted - any necessary cleaning or

repair should be done after autoclaving.

Recoverable materials 9e.g. used blood culture bottles, universal

bottles, etc.) should be separated from disposable items and

placed in solid-bottomed containers to prevent spillage and

leakage.

The mouth of the container should allow maximum steam

penetration during autoclaving process.

Discard jars for work benches should be made of autoclave-able

polypylene, not glass.

The disinfectant in discard jars should be refilled every morning

even if unused (refer to appendix II for the appropriate

concentration).

The disinfectant in discard jars can be poured down the sink and

the reusable items should be autoclaved before cleaning.

2.7.2 Contaminated material for disposal

All cultures and contaminated materials 9e.g. disposable agar

plates, pipette tips, micro titer plates, plastic tubes, etc.) should be

collected in a double biohazard bag inside a rigid container. Sharp

items should not be placed in this bag.

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When container is two-third full, close and tie off the inside bag,

and then close and tie off the exterior bag. Remove the bag from

its container and label the location of the lab generating the

waste.

2.7.3 Sharps

Sharp items such as needles and broken glass slides must be

placed in rigid, puncture-resistant, tamper-proof container and

labeled with the same information on biohazard bag.

2.8 Methods and Procedures for Laboratory Wastes Disposal

2.8.1 Autoclave

To ensure adequate sterilization of the contaminated materials

the duration of autoclaving should be increased to 30 minutes.

The autoclaved material should then be sent to washing room

where the wastes are disposed in the sink and the recoverable

containers are soaked in detergent for later cleaning.

2.8.2 Incineration

All contaminated disposables should be double bagged and

placed in the designated area in washing room until pick up for

incineration.

Infectious wastes should only be stored for a minimum amount of

the time to prevent the rapid growth of bacteria and objectionable

odors.

Full infectious waste containers will be removed from the lab and

placed in a designated pick up van to be sent to the incinerator in

the animal house.

The in-lab storage area for your infectious waste should be

cleaned on a regular basis with a suitable hospital approved

disinfectant materials. Any other substitute sterilization technique

may also be used with the approval of bio-safety officer.

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Research animals and sharps containing infectious agents must

also be incinerated following the above procedures.

3. Safe Handling of Laboratory Equipment

3.1 Introduction

An essential element in maintaining personnel safety and environment

protection is the correct selection, use and maintenance of safety equipment

in the laboratory. Every effort should be made to prevent equipment from

becoming contaminated. Item if safety equipment must be well maintained

and regularly serviced. There must also be a regular program of testing and

inspection that could result in leakage, spill or unnecessary generation of

aerosolized pathogens:

Review the manufacturer’s documentation. Keep for future reference,

Use and service equipment according to the manufacturer’s instruction,

Ensure that anyone who uses a specific instrument or piece of equipment

is properly trained in setup, use and cleaning of item.

Decontaminate equipment before it is sent out for repair or discarded.

The following sections outline some of the precautions and procedures to be

observed with some commonly used laboratory equipment.

3.2 Centrifuges

Improperly used and maintained centrifuges can present significant hazard to

users. Failed mechanical parts can result in release of flying objects,

hazardous chemicals and bio hazardous aerosol. The high speed spins

generated by centrifuges can create large amounts of aerosol if a spill, leak or

tube breakage occurs.

To avoid contaminating the centrifuge:

Check glass and plastic centrifuge tubes for streamlines, hairline cracks

and chipped rims before use. Use unbreakable tubes whenever possible.

Avoid filling tube to the rim,

Use caps or stoppers on centrifuges. Avoid using lightweight materials

such as aluminum foils as caps.

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Use sealed centrifuge buckets (safety cups) or rotor which can be loaded

and unloaded in a biological safety cabinet. Decontaminate the outside of

the cups or buckets before and after centrifugation

Inspect o-ring regularly and replace if cracked or dry.

Ensure that the centrifuge is properly balanced.

Do not open the lid during or immediately after operation, attempt to stop a

spinning rotor by hand or with an object or interfere with the interlock

safety device.

Decant supernatants carefully and avoid vigorous shaking when re-

suspending packed cells.

Clear spills promptly.

When using high-speed or ultra centrifuges, additional practices should be

including:

Record each run in the book. Keep record of speed and run time for each

rotor.

Install a HEPA filter between the centrifuge and the vacuum pump.

Never exceed the specified speed limitations of the rotor.

3.3 Freezing apparatus

Spills inside freezing equipment may place laboratory and maintenance

personal at risk; for safe use of such equipment:

Periodically check freezers, liquid nitrogen tanks and dry ice chests for

broken ampoules, tubes, etc.

To minimize breakage and leaks, places primary containers such as test

tubes inside secondary containers prior to storage in freezing units.

For electrical safety, remember to shut down units before proceeding with

decontamination.

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3.4 Pipettes

Improper handling of pipettes can lead to contamination of the user and / or to

generation of hazardous aerosols. Mechanical pipetting aids should be used for

all pipetting procedures: NEVER pipette by mouth.

3.4.1Safe use of pipettes

If infectious aerosols are likely to be generated, perform pipetting operations

in a biological safety cabinet. Handling pipetting as describe below will reduce

splashing and aerosolization:

Plug pipettes with cotton

Check before using; cracked or chipped suction ends may damage the

seals of the pipetting aid.

Keep pipettes upright while in use and between steps of procedure to

prevent contamination of mechanical aid.

Gently expel contents close to the surface of a liquid or allow to flow down

the side of the container.

Avoid forceful ejection of the contents. Use TD (short for “to deliver”, also

referred to as “mark-to-mark”) rather than TC (“to contain”) pipettes, as the

last drop of fluid does not have to be expelled with TD pipettes.

Use easier-to-handle shorter pipettes when working inside biological

safety cabinet.

Submerge used non-disposable pipettes horizontally in disinfectant

solution; dropping them in vertically may force out any liquid remaining in

the pipette.

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3.5 Autoclave

Autoclaves are ideal for decontaminating bio hazardous waste and for

sterilizing surgical dressing, glassware and biological media and liquid. They

must be loaded carefully to allow for steam penetration, since steam must

contact pathogens in order destroy them. Longer times are needed for longer

loads, large volumes of liquid and denser materials.

Proper loading and packing procedures include the following precautions:

Wrap packages to allow for steam penetration. Aluminum foil does not

allow steam penetration, and should be used for wrapping.

Do not overload the chamber.

Avoid over packing of autoclave bags.

Do not seal bag or close bottles and other containers tightly.

Do not stack containers.

The changes which are seen on autoclave indicator tapes following an

autoclave cycle do not guarantee that the contents of containers are sterile;

they indicate only that the tape on the outside of the packages has been

exposed to a certain amount of heat or steam. The time required for effective

sterilization depends on the size of the load, volumes of liquid and density of

materials to be autoclave. Regular use (at least monthly) of either a heat-

resistant biological indicator such as Bacillus streatothemorphilus, or a

chemical indicator should be used to ensure that the cycle in use really

achieves sterilization. The indicator is placed in the area least likely to reach

sterilizing condition, such as in the middle of the largest or densest to the

required conditions for a sufficient length of time.

Safe work practices when using an autoclave include the following:

Read the operating manual and post proper work procedures near the

autoclave.

Never autoclave hazardous chemicals.

Open the door slightly to allow escape of steam before unloading.

Wear insulated gloves or mitts when unloading.

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3.6 Miscellaneous equipment

3.6.1Microscopes

Disinfect the stage, eyepieces, knobs and other contaminated parts. Select a

disinfectant that will be effective on the pathogens and non-corrosive to the

microscope.

3.6.2Water baths

Clear regularly; add disinfectant, such as a phenolic detergent, to the water,

avoid using sodium azide to prevent growth of microorganism; sodium azide

forms explosive compounds with some metals.

Raise the temperature to 90OC or higher for 30 minutes once a week for

contamination purposes.

To prevent electrical shocks, unplug the unit before filling or emptying and

have the continuity-to-ground checked on a regular basis.

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Section 4.

4.1 General Emergency Procedures

All users of radioactive materials should be thoroughly familiar with these

procedures before any emergency arises.

When an accident involving radiation occurs, address the greatest hazard first;

lifesaving measures always take precedence over decontamination or other

concerns. Advise personnel working nearby of any hazard or accident as soon as

possible, and prevent them from entering the hazardous area. Always notify the

RSO (Radiation Safety Officer) (Dr Ahmad Zakaria ext: 1201/1207).

4.2 Specific Emergency Procedure for Spills

Inform the occupants of the laboratory about any spill.

Put on protective clothing such as shoe covers, gloves before starting

containment and clean up of the spills.

Cover the spill with absorbent material as quickly and as completely as possible

to prevent spreading. To localize the contamination, wipe inward toward the

center of the spill. DO not wipe back and forth or in a random fashion.

Have someone who is not contaminated call the OHS immediately.

If a biological agent is involved, soak the area with a disinfectant for 30 minutes

to inactivate the agent, and wash your hands and arms thoroughly with soap or

an appropriate disinfectant. Scrub your hands for several minutes and rinse

them thoroughly.

If you leave the contaminated area, remove your gloves, shoes and laboratory

coat; segregate them as radioactive waste before leaving the laboratory.

After removing protective clothing wash and rinse your hands and thoroughly

without breaking skin.

Monitor all personnel before allowing them to leave the area.

Do not restart work in the laboratory without the approval of the RSO.

Monitor all personnel involved in incident before allowing them to leave the

area. Follow up monitoring will also be required.

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Section 5. Emergency Procedures and First Aid

5.1 Emergency Planning

An emergency occurs when safety controls fail and unforeseen circumstances

occur. Damage and injury can be limited if emergency procedures are practiced

regularly, updated, and if adequate emergency equipment as well as trained

personnel is available for warning, rescue and damage control. Every laboratory

must have a comprehensive, widely distributed and approved emergency plan.

Laboratory working with infective biological agents should determine and institute

the safety precautions appropriate to the hazard of the agents in use.

5.1.1 General Emergency Procedure for Haematology and Transfusion

Medicine Unit Laboratories

A written emergency plan for laboratory accidents is a necessity which should be

posted in a conspicuous place in the laboratory for immediate reference.

The following components should be included in the procedure:

Accidental injections, cuts and abrasions.

Accidental ingestion of potentially hazardous material.

Potentially hazardous aerosol release other than in a safety cabinet.

Broken and spilled blood component..

Breakage of tubes containing hazardous material in a centrifuge.

Emergency evacuation procedure (fire, flood and natural disaster).

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5.2 Emergency Services : Whom to Contact

The telephone numbers and addresses of the following should be prominently

displayed near all telephones.

The laboratory itself

o (Unit Perubatan Transfusi, UPT) (3343)

o (Makmal Hematologi) (4020)

Safety officer

o (Unit Perubatan Transfusi, UPT) (3335)

o (Makmal Hematologi) (4019)

Accident & Emergency (ambulance service) (ext: 1227/1217)

Head of Department (ext: 6191)

Fire service (ext: 994)

Police (ext: 999)

Water, gas and electricity services (ext: 3113)

5.3 Emergency Equipment

5.3.1First Aid Kit

Antiseptic solution (Acriflavin for wounds and Savlon for washing)

Antiseptic cream (Burnol)

Ammonia salt (smelling salt); Eye Mo

Gauze, Bandages, Cotton wool, Plaster

Forceps and scissors

Instruction manual; accident report form / book

5.3.2Eye Wash Kit

Eye wash bottle; Eye cup

Sterile distilled water

Instruction manual, accident report form / book

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5.3.3Biological Spill Clean-up Kit

Latex gloves, protective clothing and safety glasses

Tape/ marking pencil; Forceps

Biohazard spill notice (keep out signs); Biohazard bags

Disinfectant 5% - 10% Chlorox / Lysol

Absorbent materials (cloth rags or paper towels)

accident report form / book; Spill clean-up procedure

5.3.4Fire Extinguisher

Ordinary combustion (Foam; loaded stream; dry chemicals).

Flammable liquids and gases (Carbon dioxide; dry chemical sodium

bicarbonate; foam; loaded stream; Halon 1301/1211).

Energized (live) electrical equipment (ABC-type dry chemical; Carbon

dioxide; Halon 1301/1211).

Combustible and reactive metals (Sand; dry powder media).

5.3.5Fire Blanket

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5.3.6Location of the emergency equipment in the Transfusion Medicine Unit

laboratory.

EQUIPMENT LOCATION1. First Aid Kit UPT - Bilik menderma darah

Hematologi - Makmal Hematologi

2. Eye Wash kit UPT - Makmal Komponen

Hematologi - Tepi Pintu Masuk Makmal

3. Biological Spill Kit UPT - Makmal Immunohematologi

Hematologi - Stor Kimia Hematologi

4. Shower UPT - Makmal Komponen

Hematologi - Tepi Pintu Masuk Makmal

5. Fire Extinguisher UPT

1. Ruang Kaunter UPT

2. Bilik Menderma darah

3. Makmal Komponen

4. Laluan di hadapan makmal Stem Cells

5. Pintu keluar kecemasan

Hematologi

1. Tepi Pintu Masuk Makmal Hematologi

2. Sebelah Seksyen Koagulasi

3. Tepi Pintu Pantri

6. Fire Blanket -

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5.4 Emergency First-Aid

It is essential that the laboratory staff should have some knowledge of basics first

aid because the minute immediately following an accident, first aid should be

performed to minimize the injury or even save a life. All accidents, incidents

involving injuries and ‘near misses’ should be reported to and recorded by the

departmental safety officer

The following procedures should observe in any serious accident:

Check for danger

Summon for a first aider to take charge of the casually until medical aid arrives.

If no response is obtained, call for the Accident/Emergency Unit (A/E):

State your location in detail

Nature of emergency

Your name and other essential information

5.4.1The Most Common and Expected Laboratory Emergency Injuries

Eye injuries from explosion, chemical burns or particles from shattered glass

or equipment.

Thermal and chemical burns.

Cuts and wounds from glass or metal with chemical contamination.

Poisoning through the skin or by ingestion or inhalation.

Chemical or electric asphyxiation.

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5.4.2General rules for administering First Aid

DO

Act quickly

Immediately alleviate respiratory arrest and severe bleeding, then focus on

other injuries, wounds, fractures, burns.

Send for medical assistance.

Calm and reassure them victim.

If possible, find out from the victim and witness what actually occurred.

Keep the victim breathing and stop the bleeding with direct pressure.

Use artificial resuscitation to keep the victim breathing

Know where emergency supplies are kept and where eye washes, fire

blankets and emergency showers are located.

Move the victim away from a life-threatening situation.

DO NOT

Panic

Move the victim, unless it is necessary for his safety or your own.

Leave the victim unattended.

Give the victim food, liquids or medications until you determine the nature of

the injury or illness.

Administer oxygen unless you are trained in the use of the equipment.

Attempt to straighten joints or bones.

Remove an object from the victim’s eye with your finger.

Remove embedded objects from open wounds.

Break blisters on burns.

Tie a bandage or tourniquet around the victim’s neck.

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5.5 First Aid Measures

5.5.1Respiratory Emergencies are emergencies in which normal breathing is

reduced or stopped and oxygen intake is insufficient to support life.

Laboratory causes of respiratory emergencies can be physical accident,

circulatory failure due to shock, electric shock and poisoning.

Signs of breathing impaired by a foreign object in the throat are as

follows:

Gasping for air

Violent fits of coughing

Turning blue

Inability to talk or breathe

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First-Aid Treatment:

Open the victim’s mouth and grasp to remove the object.

Place the head lower than the body or roll the victim onto his side and

slap him on the back.

Stand behind the victim and place your arms above the victim’s navel

and below his rib.

Lean the victim forward in a hanging position. Grasp your own wrist and

exert sudden strong pressure against the victim’s abdomen to expel the

obstruction.

Signs when breathing are impaired from other cause:

No detectable rise and fall of chest or abdomen.

No detectable expulsion of air from the nose or mouth.

First Aid Treatment:

Mouth-mouth (mouth-to-nose) resuscitation

Work quickly and continues until the victim breathes normally.

Place the victim on his back, chin up.

Use your fingers to remove any possible obstruction, making sure that

the victim’s tongue is not blocking the airway.

Pinch the nose to form an airtight seal and breathe into the mouth until

the chest expands. Breathe three times. Repeat the process. If no air

exchange begins, turn the victim onto his side and slap him between his

shoulder blades.

Check the mouth for any obstruction and repeat the whole breathing

procedure. Do not forget to remove your mouth after each breath to

allow the air to escape.

5.5.2Circulatory Failure

Circulatory failure is a result of the lack of pumping action by the heart. It

can occur as a consequence of other emergency conditions such as electric

shock, respiratory obstruction or heart attack.

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Signs :

No breathing

No pulse

First Aid Treatment :

Work quickly – cardiac arrest may mean death to the victim.

Check for responsiveness, airways and breathing.

If the victim is not breathing, give mouth-to-mouth resuscitation.

Check a major artery to find a pulse, if none begin the Cardiac-

compression procedure.

Cardiac – compression procedure

Kneel at the victim’s side. The pressure point for cardiac compression is

two finger’s distance above the tip of the sternum. Place the heel of the

hand at this point and the other hand over the first one.

Positioning your shoulders over the victim’s sternum, rock your weight

downward depressing the sternum 1.5 inches to 2 inches, making the

depressing and releasing of equal length of time.

Compressions should be continued at rate of approximately 60

compressions per minute, with an artificial resuscitation breath every 15th

compression.

5.5.3Bleeding

Bleeding results from a wound or break in the body tissue and may be

internal or external. In the laboratory, bleeding usually results from

mishandling of sharp objects, failing or being struck by glass fragments.

Signs of external bleeding :

Blood will be spurting, flowing or oozing from an artery, vein or capillary.

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Cover the wound with the cleanest cloth available and apply direct

pressure to the wound.

If there is no fracture, elevate the limb as pressure is applied.

Digital pressure may also be applied if the wound is an arterial wound

and the bleeding is severe. Pressure should be applied where the main

artery supplies the wound as close possible to the wound and between

the wound and the heart.

Hold the pressure point tightly for approximately 5 minutes. If there is a

skull injury and direct pressure cannot be applied, use the pressure

points.

A tourniquet should be used as a last resort and should be applied near

the wound, between the wound and the point at which the limb is

attached to the body. Do not tie it too tightly; tie it just tightly enough to

stop the bleeding. Never apply a tourniquet directly over a wound.

Open wounds should be protected from infection by covering them with

a clean fabric.

5.5.4Internal Bleeding

Sign :

Cold, clammy skin, weak

Rapid pulse, eyes dull and pupils enlarged

Thirst, nausea, vomiting and pain.


Treat for shock

Give nothing by mouth

Get medical help quickly

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5.5.5Shock

Shock is a condition resulting from depression of vital body functions, it may

be life threatening and may result from a loss of blood, reduced blood flow

or insufficient oxygen supply. Traumatic shock results from an injury;

anaphylactic shock results from an allergic reaction to a foreign substance.

Electric Shock – results from the passage of an electric current through

any part of the body.

Signs of external bleeding:

Unconsciousness

Visible burns where contact occurred

Shallow breathing, as in shock

Irregular heart rate, fibrillation


Shut off the current or cautiously, using an insulator 9e.g. hand inside a

glass beaker), separate the victim from the victim from the current.

Begin artificial respiration

Keep the victim warm.

5.5.6Poisoning

Poisoning id sue to any substance that impairs health or causes death when

introduced into the body or onto the skin surface. In the laboratory,

poisoning is due to ingestion, inhalation or absorption through the skin.

Signs of external bleeding :

Telltale odour on breath, burns around the mouth

Wide variety of signs depending on the poison and the mode o ingestion

or intoxication (e.g. dilated pupils, nausea, impaired breathing).

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Poisoning through ingestion of toxic substance

Diluted or neutralize the poison.

If the poison is ingested and is noncorrosive, dilute it with milk or water

by mouth.

Induce vomiting unless the poison is a petroleum product.

If feasible, administer the correct antidote.

For corrosive poisons, do not induce vomiting; give milk or water

If necessary, treat for shock


Remove the victim from the area.

Loosen clothing.

Clear the airways.

Initiate artificial respiration.

Keep the victim warm.


Remove the victim’s clothing and drench the victim.

Wash contaminated skin with soap and water for a minimum of 5

minutes if tissues have not been baby destroyed.

Administer artificial respiration if required.

5.5.7Bone and Joint Injuries

Broken bones or fractures are either simple 9no open wound) or compound

(associated with an open wound and protruding bone). Injuries to the

skeletal system and joints, ligaments and soft tissues are common in major

accidents.

Signs :

Broken bones, with no open wound.

Open fracture, deformity, swelling, discoloration.

Separation of two bones – deformity, pain, loss of function.

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Leave the injury alone – do not attempt to straighten the limb.

Try to immobilize the victim in a comfortable position.

Obtain assistance.

Stop the bleeding..

5.5.8Burns

A burn is an injury resulting from contact with heat, chemicals or radiation.

The goals are to reduce pain, prevent contamination and treat for shock.

Signs :

Red skin – first degree

Red skin, blisters – second degree.

Skin destroyed, tissues charred and damaged – third degree.


First degree burns

Immerse the burn in cold water and apply ice.

Second degree burns

Cut away the clothing, cover the burn with cold, moist dressings and

treat for shock. Do not disturb blisters

Third degree burns

Cut away loose clothing that is not attached to the wound.

Cover the wound with sterile, cold, moist dressings, taking care to keep

burned areas from contact with each other.

Do not apply ointments, ice or salves on open blisters.

For chemical burns, remove clothing and flood the area for at least 15 to

20 minutes.

5.5.9Eye Injuries

Eye Injuries are a common laboratory emergency. All personnel should

know where eye washes are located. Contact lenses should not be allowed

when there is a chemical-splash hazard. Protective eye glasses should be

used in the laboratory.

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Signs of injury due to a foreign object or chemical in the eye:

Redness

Burning

Tearing

Blinking


Do not rub the eye.

Remove contact lenses at once because they may retain the chemical or

object and prevent adequate flushing.

Have the victim flush eyes well for at least 15 minutes with assistance,

holding eyelids open and apart.

If possible, remove the foreign object with sterile gauze. If you are

unable to do so, cover the eye (but not with cotton) and obtain medical

assistance.

Signs due to Impaled object in the eye:

Object may be visible protruding from eye.

Blinking, tearing.

Bleeding and pain.


Do not attempt to remove the object.

Cover the injury eye lightly with a gauze bandage.

Place covering over both eyes (because both eyes move synchronously

to stop movement).

Calm the victim and obtain medical assistance.

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APPENDIX 1

Control of Substances Hazardous to Health (COSHH) Assessment Form

Department of Haematology and Transfusion Medicine Unit

School of Medical Sciences

General Notice to Undergraduate, Postgraduate Students, Research

Diagnostic and all attachment personal.

The laboratories in the department will be opened from 8.10 a.m. until 4.55 p.m.,

SUNDAY to WEDNESDAY and for THURSDAY is until 4.40 p.m. However, the

routine diagnostic laboratory operates 24 hours.

After 4.55 p.m. on weekday and during weekends and public holydays all doors will

be locked except the main entrance. Entry to the laboratory during this period must

be recorded in the log book provided at the main entrance.

No unauthorized (i.e. medical student and MLT student), will be allowed into the

laboratories unless there is a member of staff or postgraduate student present to

supervise them.

Universal precautions must be observed at all times; these include selection and

appropriate use and wearing of personal protective equipment (e.g. gloves, lab

coats, face shields, mask, etc.)

Before commencing practical work you must fill in a COSHH (Control of Substance

Hazardous to Health) form.

Under no circumstances must equipment be used unless proper instruction has

been given.

36

COSHH ASSESSMENT FORM(CONTROL OF SUBSTANCES HAZARDOUS TO HEALTH)

It is essential to monitor each of the laboratory activity involving bio hazardous agent to ensure that the laboratory personal, student, the laboratory environment, the public and the natural environment are protected from hazard associated with laboratory operation. Usual hazards associated with laboratory practice can be categorized as follows: biological hazards, chemical hazards, ultraviolet hazards, electrical hazards, and physical and equipment hazards. To efficiently and effectively discharge the department’s responsibilities, individual undertaking research activities must complete this form. Please return the completed form to the Biosafety Officers.

PRINCIPAL INVESTIGATOR :________________________ Tel. No. __________CP-INVESTIGATOR: _______________________________ Tel. no. __________LAB PERSONAL (List only those involved in this research) : ______________________________________________________________________________________________________________________________________________________SECTION: ________________________________________ Tel. No. __________PROJECT TITLE: _______________________________________________________________________________________________________________________PERIOD OF REQUEST: From: ______________________ to: ________________SITE WHERE RESEARCH WILL BE DONE: Bulding: ________ Room No. (s) ____

PLEASE FILL OUT THE REST OF THIS FORM BY ANSWERING ALL SECTIONS APPLICABLE TO THE PROJECT. Please check all that apply, and attach separate comment page if necessary.

A. Chemicals1. Toxic chemicals including toxins, cyto-toxic/antineoplastic a Yes No heavy metals.

2. Flammable/Explosive/Unstable chemical Yes No 3. Carcinogen/Mutagenic/Teratogenic chemical Yes No

4. Toxic Compressed gases Yes No

5. Acetylcholinesterase Inhibitors/Neurotoxins Yes No

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For each of chemical classes checked above, please state below how much you expect to purchase, how you will store it, what precaution, if any, will you take in handling it, and how you propose to dispose of it. Be sure to include substances that ten to form explosive by-products (i.e., ether)_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

B. Ionizing Radiation Will you use ionizing radiation? Yes No

Isotope: ____________________ Authorization Number:______________

Note: If you have not been approved for radioisotope, you must submit an“Application for procurement of Radioactive Materials” to Safety Office

Do you label any organism , tissue , or other materials Yes No

Radio isotope?Where is the labeling done? Building __________ Room No. ___________

Do you work with radiolabeled organisms? Yes No.

List isotope(s)/ organism(s) ___________________

C. Infectious AgentWill you conduct experiments involving infectious agent or number which may be capable of encoding an agent that can infect human Yes No.If yes, please specify__________________________________________________________________

D. Human Subject/VolunteersWill you work with human subjects? Yes No

E. Organ or Tissue CultureWill you work with organ or tissue culture? Yes No.

If yes, specify human or Species __________________________________________

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F. AnimalsWill you be using animals? Yes NoIf yesSpecies __________________________________________________________

G. Microbial Agent.

Do you use microbial agents? Yes NoIf yes, complete the following section for each microorganism to be use in the lab.

Is the microbial agent infectious or potentially pathogenic to humanYes No

a)Location(s) where organism will be used/handled?_______________________ Name of organism: _____________________ Specific strain(s): ____________

b) Is antibiotic resistance expressed? Yes No Other makers ____________________________________________________

c) Largest volume of organism used is __________________________________

d) Is a toxin produced? Yes No

e)Do you work with toxins? Yes No

f) Is the organism inactivated prior to other lab manipulations? Yes No

g) Specify method of inactivation heat Chemical Radiation

h) Do you concentrate the organism? Yes No

I) Specify method of concentration

Centrifugation Precipitation Filtration Other _________

H. Human Blood, Organ, Or Body Fluids

Will you work with human blood, organs, or body fluid Yes NoIf Yes, complete following section – please check or list all that apply.

Human Sample Manipulated: Blood Serum Feces Urine Semen Tissue Spinal fluid Other _____________________

Frequency of Manipulation Daily Weekly Others ______________

Type of Manipulation? Centrifugation Pipetting Dissection

Blending/mixing Sonicating Other______

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I. What containment equipment is available? – Check all that apply:

Biological Safety Cabinet Class I Class II Class III

Chemical Fume Hood Containment Centrifuge Others

J. Risk Assessment: Does this project constitute any other hazards to humans or the environment which is not stated above? Yes No If yes, explains:

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

40

I understand and am fully aware of the possible hazards associated with my research activity and am fully informed about their specific danger, proper action for safe use, steps to take in case of accidents and have been provided with all necessary safety equipment and instructions in its use.

Date: ________________ Research Student: ______________________

Biosafety Acknowledgement Sheet

Subject: ______________________________

Name of Student: _______________________________________

Student No.: ________________

I have received biosafety instruction relating to the subject nominated above in the following form:

Lectures/Department Safety Manual/Supervisor

I have read and understood data sheet in the front of the practical manual for the subject nominated above.

I have read copy of the department Laboratory Safety Manual and I understand the concepts of

. Levels of physical containment including safety Cabinet

. Risk group of infectious organism including group 1 to 4.

I understand that failure to adhere to the biosafety rule may result in exclusion from one or more practical and repeated failure to adhere to the biosafety rules my lead to further disciplinary action at the discretion of the head of department or dean of school of medical sciences.

I have been shown the laboratory spill kit. I am familiar with its contents and I understand how to deal with spills of infectious organism.

Signed: _____________________

Date: _______________________

41

RISK ASSESSMENT – PREPARATION PROCEDURES

Emergency Procedures:To be filled in where contamination, spillage or fire would pose a hazards beyond that covered Laboratory Practice

Contamination of personal (by fume, ingestion, skin or eye contact):

Spillage/uncontrolled released:

Fire:

Assessor (subject leader) Head of Department

Signed: Signed:

Date: Date:

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Infectious Agent Decontamination Form

Complete one for each surface or piece of equipment. Please print.

Lab Contact: __________________ Building: ______________ Room(s): ________

Infectious Agent(s)/Other Potentially Material(s) used:________________________

Equipment/surface: ___________________________________________________

Disinfectant and dilution used: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Name of Person Performing Decontamination and survey: ____________________

Date Of Survey: ____________

Comment:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Continue on reverse if necessary.

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