Vol. 24 • Issue 3
• Page 6
Lab safety is never a done deal. It's a work in progress, predicated on understanding the latest challenges and solutions, knowing regulations, and taming behavioral "non-compliance." That latter term lumbers through all levels of healthcare and, like a persistent "elephant in the room," it also rears its head right in the lab.
Case in point: needlesticks. In 2000 President Bill Clinton signed the Needlestick Safety and Prevention Act into law. Since then accidental needlesticks have been reduced by about 34 percent industry-wide. But what's wrong with that picture? Those silent elephants.
"There's still 66 percent of needlesticks remaining, still way too many," bemoans Dennis Ernst, MT(ASCP), executive director of the Center for Phlebotomy Education Inc., Corydon, IN. "We have made great strides reducing sticks by putting safer devices into peoples' hands. Yet clearly that's not the only answer, or we would have eliminated them."
Needlestick Safety Lag
It's a great irony, considering manufacturers are developing a new generation of safety devices that are user passive. "They don't require the user to do anything," explains Ernst. "There's nothing to swivel into place, no buttons to push; a shield automatically conceals the needle. They've been out for a while, and prices will start coming down as more labs use them. That is a promising development."
So why the safety lag? It's due in some part to the fact that not all facilities stock safety devices. "Even though it is law, and a lab can be fined and given a citation by OSHA if not using safety devices, we only have a 90 percent compliance rate in the United States. Ten percent of facilities still are not using the required safety devices," notes Ernst.
Ernst, along with other lab safety experts, is clear on the next step to safety. "The focus now needs to be on behaviors," he says, of both individual laboratorians and facilities. And the best conduit to behavior change is education. But it can't be one-and-done.
"It has to be ongoing; it has to be diligent; it has to be from a multitude of directions, from a multitude of sources," says Ernst. "Laboratorians constantly must be aware of behaviors that put them at risk before they can start modifying behaviors. There needs to be a culture of safety in every facility exemplified by constant in-services, reporting, educational material in front of people, workshops and training sessions. Everyone should know the goal is zero needlesticks per year."
Lessons in Ergonomics
That rhetoric is music to the ears of self-proclaimed "ergonomics safety geek" Dan Scungio, MT(ASCP)SLS, CQA, laboratory safety officer for Sentara Healthcare, comprised of eight hospitals in Tidewater, VA.
What are ergonomic challenges in a lab? "There are so many," answers Scungio. "Much has to do with the chairs, the computer keyboards and mice. People need to flatten their keyboards and rip those feet off of them . We just discovered this year that [persistent use of] keyboards does not cause carpal tunnel syndrome as previously thought, but not keeping your wrist straight does cause other wrist and arm injuries, tendon problems, hand problems."
Ergonomic indiscretions also carry a fiscal blow to facilities. "There are so many dollar amounts you could tie to ergonomics," explains Scungio. "A $500 lab chair is so much cheaper than physical therapy for back/leg issues. A cut-out area at a work bench is cheaper than rotator cuff repair, not to mention replacing an absent employee. A disposable face shield is cheap compared to the priceless gift of vision."
Coaching is Key
Scungio's solution to lacking safety vigilance, ergonomic or otherwise, is education. At Sentara, Scungio implemented a peer coaching program, which he calls key to a safe lab. "I teach a volunteer from every one of our labs to peer coach. These safety coaches become the eyes and ears of a lab," he explains.
Usually, says Scungio, people are reluctant to correct a co-worker when they see someone doing something in an unsafe manner - whether it's neglecting to close a lab coat, wearing the wrong shoes or uncapping specimens with no face protection. And often co-workers do not respond well to unofficial "coaching." But when there is a designated, trained safety coach, well-delivered advice can go long way. "A coach with a gentle touch can explain to others that this individualized ongoing education is to help them. It's a case of never leaving your wing man," says the safety officer.
Just as important as individual safety coaching is national industry-wide coaching. Scungio is working on a committee to update a segment of general practice guidelines for Clinical and Laboratories Standard Institute (CLSI), with committee chair Terry Jo Gile, MT(ASCP), MA Ed, a laboratorian for 45 years with a quarter century specialization in lab safety.
Revisions Under Construction
"We use those guidelines as a basis for how to properly and safely operate a laboratory and to help us meet the organization's accrediting requirements," says Gile, who is author of Complete Guide to Laboratory Safety (HCPro), now in its third edition, and is the educational voice behind her all-safety-all-the-time website, www.safetylady.com.
Gile says the "still under-construction" GP (general practice) 17 revision to best practices is the first update to that section since 2004.
"The biggest and most controversial recommendation revolves around personal protective equipment (PPE); in the past that has been glossed over," she says, noting GP17 will be more specific about what type of PPE is acceptable or needed in various laboratory settings.
"In particular we're concerned about the style of shoes that are worn in the lab. Clogs are unsafe because of their open back. We hear laboratorians say, '. but nurses can wear them.' Well, nurses aren't under the same regulations . we have to consider chemical spill risk."
Gile also says the best practice for a lab coat or cover gown is to cover from the collarbone to the waist, and tips of fingers to the elbows. "That's why gloves should go over the outside of a knitted cuff of a lab coat -- so there is no gap in skin," says Gile underscoring particular GP17 interest in glove use. "And lab coats need to be knee-length; they can't be cut off. We're seeing a lot of people cutting them off, especially the disposable ones. That's an absolute 'no-no.' About 90 percent of chemicals spill from top down; three-quarters of your body must be covered. And we encourage people to wear scrubs under their lab coats because if you get a splash or spray of chemicals, blood or body fluids you have to leave your personal clothing to be cleaned by the hospital. And I assure you if you're wearing an angora sweater, it'll be ruined."
Other discussions stirring concern include the wearing of long pants that touch the floor (not appropriate) and capris, as well as the use of personal cell phones in the technical work area. Gile says she expects the revised guidelines -- which are now under review - to be published by late 2012 or early 2013.
Valerie Neff Newitt (firstname.lastname@example.org) is a managing editor.