First Aid in Medical Lab Technology

 INTRODUCTION

The first step towards safety regulations

for clinical laboratories was initiated by

OSHA(Occupational Safety and Health

Administration) and CDC(Centre for

Disease Control and prevention) in 1970

when they published numerous safety

standards in a clinical set up (1). Later in

1988, OSHA expanded the hazard

communication standard to apply to

hospital workers, which is frequently

referred to as the “lab right to know

standard” (1). They insisted that

management should be committed to

safety of its employees and it should

increase health and safety awareness

among employees through proper

educational programs.

HAZARDS

Hazards in a clinical laboratory can be

broadly classified into chemical hazards,

electrical hazards, fire hazards & bio-

hazards.

CHEMICAL HAZARDS AND ITS

MANAGEMENT

Common chemical hazards found in a lab

are Explosives, Compressed gases,

Flammables, Oxidizers, Toxic materials,

and Corrosive materials (4).

FLAMMABLES: Substances which have

a flash point or ignition point below room

temperature. E.g. Oil and Gasoline, Ether

etc. Storage rooms, cabinets and containers

should be specially designed for such

flammable liquids.

COMBUSTIBLES: Flash point at or above

room temperature. It is better to choose a

combustible product over a flammable

product if all other considerations are

equal. Clearing agents offer this choice.

EXPLOSIVES: Picric acid forms

dangerous salts with certain metals which

explode when wet (5). Avoid them

altogether. Certain silver solutions, on

ageing, explode by shaking. So never

store these solutions after use.

OXIDATIVES: Oxidatives promote

combustion in other materials, but are

harmless themselves. They have a risk of

fire hazard when in contact with suitable

material. E.g. Sodium iodate , Mercuric

oxides , Organic peroxides.

TOXIC MATERIALS: Causes death by

ingestion, skin contact or inhalation, at

certain specific concentration. E.g.

Methanol- toxic, Formalin- toxic by

ingestion and inhalation, Chromic acid,

Osmium tetroxide and Uranyl nitrate-

highly toxic.

COMPRESSED GAS: Gas at room

temperature (20°C) and pressure, packaged

as a pressurized gas by compression or

refrigeration and is usually quite heavy.

The potential hazard of compressed gases

occurs when sudden rupturing of the

container causes it to become a dangerous

projectile. E.g. Propane & Acetylene

bottles.

CORROSIVE MATERIALS: Causes

destruction of living tissue or irreversible

alteration and destroy materials e.g.

Bleach, Battery Acid, Ammonia &

Hydrochloric Acid.

IRRITANTS: Reversible inflammatory

effects at the site of contact. Eyes, skin and

respiratory passages are affected. Formalin

is a skin and respiratory irritant.

SENSITIZER: Causes allergic reaction.

Sensitization lasts for life & gets worse

with subsequent exposure. Formalin is a

prime example (5).

CARCINOGENS: Chloroform, chromic

acid, Dioxane, Formaldehyde, Nickel

chloride, potassium dichromate, certain

dyes etc.

CHEMICALS CAUSING TARGET

ORGAN EFFECTS: Cause specific harm

to selected anatomical or physiological

systems. Xylene and toluene are

neurotoxins. Benzene affects blood.

Chloroform, Methanol, Xylene, Toluene

are reproductive toxins (5).

MANAGEMENT OF CHEMICAL

HAZARDS

Use cart to transport heavy or multiple

number of containers from one area to

another. A bottle should never be held by

its neck, but instead firmly around its

body, with one or both hands, depending

on the size of the bottle to avoid spills.

Acids must be diluted by slowly adding

them to water while mixing; water should

never be added to concentrated acid to

avoid splattering. Acids, caustic materials

and strong oxidizing agents should be

mixed in the sink. This provides water for

cooling as well as for confinement of the

reagent in the event the flask or bottle

breaks. Label the container before adding

the reagent, and dispose off when proper

expiry date is reached (6).

No eating, drinking or smoking in the lab.

Application of cosmetics is prohibited.

Wash hands frequently but hydrate with a

good lotion. Keep finger nails short. At the

end of the day clean all working benches

with a disinfectant. Wear closed-toed

shoes.Tie back long hair. Do not wear

sandals, jewelry, loose or baggy clothing

(4,7).

FIRST AID

Injuries caused by broken glass: Wash

the wound immediately to remove any

glass pieces. Apply mercurochrome or

acriflavine ointment to the wound. Cover

with gauze and adhesive tape (8).

Acid/Alkali splashes on the skin: Wash

thoroughly; bath the affected skin with

cotton wool soaked in 5% aqueous sodium

carbonate if acid and 5% acetic acid or

undiluted vinegar, if alkali(8).

Acid/Alkali splashes in the eye: Water

spray from a wash bottle or rubber bulb

into the medial corner of the eye . Put 4

drops of 2% Aqueous Sodium bicarbonate

into the eye, if acid, and saturated solution

of boric acid, if alkali.

Swallowing acid: Make the patient drink

some 5% soap solution immediately. Make

him gargle with the soap solution. Give

him 3 or 4 glasses of ordinary water. If the

lips and tongue are burned by the acid,

rinse thoroughly with water. Bathe with

2% aqueous sodium bicarbonate (8).

Swallowing alkalies: Make the patient

drink 5% solution of acetic acid or lemon

juice or dilute vinegar. Make him gargle

with the same acid solution. Give him 3 or

4 glasses of ordinary water. If the lips and

tongue are burned by the alkali, rinse

thoroughly with water; bathe with 5%

acetic acid.

Poisoning

Send for a physician or qualified nurse,

specifying the toxic substance involved.

Place the victim in the open air while

waiting for the physician.

Burns caused by heat: They fall into two

categories

Severe burns: If the victim is on fire, roll

him in a blanket or overall to smoothen the

flames. Inform the physician. Lay the

victim on the ground. Do not remove his

clothing. Cover him if he is cold. Do not

apply any treatment to the burns. This

must be left to the physician.

Minor burns: Plunge the affected part into

cold water or ice-water to soothe the pain.

Apply Mercurochrome or Acriflavine

ointment to the burn. Apply dry gauze

dressing loosely. If the burn becomes

infected or does not heal, refer the patient

to a physician. Never tear off the blisters

that form over the burns.

ELECTRICAL HAZARD AND ITS

MANAGEMENT

Electrical equipment should not be

handled with wet hands, nor should

electrical equipment be used after liquid

has been spilled on it. The equipment must

be turned off immediately and dried

thoroughly. In case of a wet or

malfunctioning electrical instrument the

plug should be pulled and a note of

cautioning should be left on the

instrument. Use of extension cords is

prohibited (1).

Bodily damage by electric shock: The

symptoms are fainting and asphyxia.

Before doing anything else, put off the

main switch. Send for a physician. Begin

giving mouth to mouth respiration

immediately.

FIRE HAZARD AND ITS

MANAGEMENT

Fire in the laboratory may occur due to

spirit lamps, electrical appliances or other

inflammable reagents used in a laboratory.

All laboratories should have a fire

extinguisher (1, 2, 4), and easy access to

safety showers and fire blankets. For

putting off the flames from the

inflammable liquids, smoothen the fire by

throwing sand over it.

BIOHAZARDS

Can be infectious agents themselves or

items (solutions, specimens or objects)

contaminated with anything that can cause

disease in humans regardless of its source.

To operate a clinical laboratory safely, it is

essential to prevent the exposure of

laboratory workers to infectious agents such

as the hepatitis B virus (HBV) and the

human immunodeficiency virus (HIV).

Universal Precautions (1, 2) specify how

U.S. clinical laboratories handle infectious

agents. In general, they mandate that

clinical laboratories treat all human blood

and other potentially infectious materials

as if they were known to contain infectious

pathogens. The specifications apply to all

specimens of blood, serum, plasma, blood

products, vaginal secretions, semen,

cerebrospinal fluid, synovial fluid and

concentrated HBV or HIV viruses. In

addition, any specimen that contains

visible traces of blood should be handled

using these Universal Precautions.

Universal Precautions also specifies that

barrier protection must be used by

laboratory workers to prevent skin and

mucous membrane contamination from

specimens. These barriers, also known as

personal protective equipment

(PPE)(1,2,6,7,9), include gloves, gowns,

laboratory coats, face shields or mask and

eye protection, mouth pieces, resuscitation

bags, pocket masks, or other ventilator

devices.

PRECAUTIONS FOR BIOLOGICAL

HAZARDS

 Never perform mouth pipetting and

never blow out pipettes that contain

potentially infectious material.

 Barrier protections such as gloves,

masks, and protective eye wear and

gowns are to be worn.

 Wash hands whenever gloves are

changed .Facial barrier protection

should be used if there is a sig-

nificant potential for the spattering

of blood or body fluids.

 Dispose off needles in rigid

containers; use the "one-handed”

technique.

 Dispose of all sharps appropriately.

 Encourage frequent hand washing in the

laboratory; employees must wash their

hands whenever they leave the

laboratory.

 Make a habit of keeping hands away

from your mouth, nose, eyes, and any

other mucous membranes. This

reduces the possibility of self-

inoculation.

 Decontaminate all surfaces and

reusable devices after use with

appropriate hospital disinfectants.

 Use proper biohazard disposal

techniques (e.g., Red Bag) .

 Never leave a discarded tube or

infected material unattended or

unlabeled.

 Periodically clean out freezer and

dry-ice chests to remove broken

ampules and tubes of biological

specimens.

 OSHA requires that Hepatitis B

vaccine be offered to all employees

at risk of potential exposure as a

regular or occasional part of their

duties.

SPECIAL NOTE FOR HISTOLOGY

LABS

Fresh specimens of human origin must

always be considered potentially

infectious. Grossing an unfixed specimen

is the most risk activity that can be

undertaken in a histology lab (5). Fixed

specimens have a much reduced risk;

nearly all infectious agents are readily

deactivated by fixation provided the

specimen is thoroughly fixed for proper

time. Tissue in the first several stations of

a tissue processor may remain bio

hazardous. Complete penetration by

alcohol will kill all infectious agents

except prions. So properly processed

specimens can be handled without special

precautions (5). Cryotomy carries special

risk because tissue is always fresh & small

dust-like particles generated from

sectioning may become air borne (5).

CONTAMINATION BY INFECTED

MATERIAL

In case of wounds caused by broken

glassware containing stools, pus, etc.,

wash the wound immediately with

antiseptic lotion. Check whether the cut is

bleeding. If not, squeeze hard to make it

bleed for several minutes. Refer the patient

to a physician if the material involved is

known to be very infective, e.g. pus. If

infected material is accidentally sucked

into the mouth spit it out immediately. Use

a disinfectant (e.g. Diluted Dettol) for

mouth washing (8). If the infected material

has been swallowed accidentally, forced

vomiting is to be done. Ascertain the kind

of infection and take advice from a

medical person.

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https://ehs.uconn.edu/emergency/lab-accidentfirst-aid-information/

https://lab-training.com/essentials-laboratory-first-aid/

https://www.mltwala.com/first-aid-procedures-in-laboratory/

https://www.slideshare.net/slideshow/first-aid-for-lab-studentspptx/260198732#6

https://www.ompj.org/files/109d39648f3274f2c61006cbbb1e3a5c-Dhanalaxmi.pdf

https://egyankosh.ac.in/bitstream/123456789/97736/1/Unit-13.pdf

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