The laboratory can be a dangerous place. And while accidents can occur in spite of precautions taken, many adverse lab events can be prevented. No truer words were ever spoken than Benjamin Franklin's, "An ounce of prevention is worth a pound of cure." We all know that it is less costly to prevent a problem from happening than fixing it after occurrence.

Annually, news articles and government agencies such as the Center for Disease Control and Prevention (CDC) and the Occupational Safety and Health Act (OSHA) publish a variety of reports on laboratory accidents ranging from needle sticks to death.

While lab risks cannot be totally eliminated through written policies and regulations, reductions in mishaps can occur as a result of ongoing training and practice drills, frequent reminders of safety guidelines, and stringent reporting mechanisms for tracking and trending purposes.

Encourage Reporting for Trends Analysis
All accreditation, certification and government agencies support non-fault reporting of near misses and adverse events for improvement purposes. The CDC especially encourages ongoing reporting of lab accidents and laboratory-acquired infections (LAIs). The data is utilized to compile trend statistics of adverse occurrences for the purpose of updating guidelines and education planning.

There is a universal concern across laboratories and government watchdog agencies that many events go uncovered, underreported or not reported at all. With heightened awareness of potential harm there has been elevated encouragement for administrators to ensure that reporting mechanisms are in place and to encourage no fault reporting of near misses and actual adverse events from employees and research students.

A recent article on laboratory infectious accident exposures covered CDC panel review findings. The panel disclosed that, "Given the shortage of solid data, the number of LAIs is unknown, but laboratory exposures occur more often than is generally suspected." It notes that hepatitis B has been the most frequent lab-acquired viral infection, with a rate of 3.5 to 4.6 cases per 1,000 workers, which is two to four times the rate in the general population.

The five most common ways that lab workers acquire infection on the job, according to the CDC's panel guidelines, are:

1. Parenteral inoculations with syringe needles or other contaminated harps
2. Spills and splashes onto skin and mucous membranes
3. Ingestion or exposure through mouth pipetting or touching mouth or eyes with fingers or contaminated objects
4. Animal bites and scratches (research laboratories or activities)
5. Inhalation of infectious aerosols

The CDC panel goes on to report, "Because of the lack of an official surveillance mechanism for reporting LAIs and because of the fear of punitive action by an oversight agency if injuries are reported, the data needed to determine the extent and cause of LAIs are unavailable."¹

Accidents Vary In Types, Settings and Skill Levels
Tracking and trending lab accidents is important because of the wide variety of accident types (i.e., technician error versus mechanical malfunction). The National Research Council (NRC) reports that while there are several types of accidents attributed to technician error, some mishaps occur due to malfunctioning protective wear, equipment and mechanical failures.²

It should be noted that mishaps occur in a wide variety of diagnostic and research settings. In addition, accidents are occurring in government, private and university and school labs. Finally, over the past few years, news press reveals that accidents resulting in deaths can also occur regardless of the levels or years of experience. Seasoned experienced laboratorians (e.g., scientists and professors) and inexperienced (e.g., research students) individuals have been be involved in lab accidents.^3-6

Attitudes Play Key Role
Accidents will occur even with the greatest of caution. However, intentional and unintentional attitudes with which one approaches his or her work setting are critical. Several undesirable attitudinal traits can play major roles in contributing to lab accidents, such as:

1. Complacency:  This behavior occurs when after performing a technique many times without an accident, you may believe you're experienced enough to skip safety procedures or steps.
2. Distractions: Interruptions do occur. However, not paying close methodical attention to the task at hand can be dangerous.
3. Fatigue: Many laboratorians are not getting adequate rest as a result of today's professional and personal demands. Being tired can slow down your physical and mental reactions, causing your mind to wander.
4. Recklessness: Taking shortcuts on the job is a no-no. For example, taking chances with tools, machinery and chemicals or not wearing proper protective wear (e.g., lab coat, face mask).
5. Skill Deficient: Being afraid to ask questions because you do not want to appear foolish or unskilled is a character trait that has to be crossed off of your list. It is wise to ask questions. It shows you're smart enough to know what you don't know.
6. Memory Deficient: Safety procedures cover a lot of ground, sometimes too much to remember. Always refer to the standard operations procedural (SOP) manual as often as you need to when you're not sure what to do or how to do it.

Prevention is everyone's job. In addition, management is ultimately responsible for ensuring that everyone understand his or her role and responsibilities. Laboratories with fewer accidents are those that have learned that the more they participate in safety programs, the safer the laboratory becomes.

Jumpstart Safety Focus 
Safety protocols often get buried in dusty binders on the shelves, only to be retrieved when there is an upcoming inspection or when an accident occurs. To promote safety, the procedures must be visible not only in writing but observable in day-to-day activities.

Taking personal responsibility for your own safety and that of your co-workers is critical. Two ways to accomplish this are to follow every step in every task every time. And equally important is to know exactly what steps to take as an individual should an emergency arise.

The Medical Laboratory Professionals Week (MLPW), which is scheduled this year from April 22-26, is an excellent time to energize your team safety program. The American Society for Clinical Pathology (ASCP), the American Biological Safety Association (ABSA), as well as other professional agencies, offer numerous strategies and tips on fostering safe lab practices. Another excellent resource for tips is the website "The Safety Lady" posted by Terry Jo Gile, MT(ASCP). The information posted on her website is user friendly and covers just about every aspect of laboratory safety there is.⁷

Drills Increase Enthusiasm
Have you ever noticed how energized and refreshed employees are after a drill? Practicing drills on how to handle an accident - from the onset of occurrence up through reporting and follow-up - is an excellent way to inject energy into the safety topic you are discussing. Drills help prepare employees to respond quickly, calmly and safely. It is a good idea to hold practice exercises as often as necessary to keep employees prepared.

Designate a staff member to observe the exercise. Then immediately after each drill everyone should briefly evaluate the effectiveness of the drill, identify the strengths and weaknesses, and discuss action steps to improve performance.

Finally, everyone probably prefers announced drills, and it might be easier for supervisors to plan for the event and minimize workflow disruption. But it has been my experience that having a few unannounced drills during the year measures readiness and response better. Unannounced drills place employees in real-to-life scenarios.

Proactive versus Reactive

Laboratories that conduct ongoing safety activities are generally able to identify vulnerabilities to reduce and even prevent many unwanted accidents. Quality and risk management professionals all agree that waiting until after an adverse event occurs is costly in corrective action repairs and facing potential legalities.

A good safety program with ongoing evaluations and improvement initiatives does not come easily. However, with ongoing safety prevention and an atmosphere that encourages the reporting of incidents, a culture will develop that allows for the sharing of ideas to create a safe work environment.

Resources

1. Roos, Robert. "Unreported Lab Accidents Makes For False Claims of Safety in Labs. Experts say US needs better tracking of lab accidents." www.watchdogonscience.blogspot.com/2012/03/unreported-lab    
2. Hoffmeyer, Evan. "CDC Bio-germ Lab Leak." KATV. www.katv.com/story/18858431/cdc-bio-germ-lab-leak
3. Benderly, Beryl Lieff. "Danger in School Labs: Accidents Haunt Experimental Science." Scientific American. www.scientificamerican.com/article.cfm
4. Kaiser, Jocelyn. "Updated: University of Chicago Microbiologists Infected From Possible Lab Accident." Science Insider. September 12, 2011. www.news.sciencemag.org/scienceinsiderd/2011/09/
5. Noorden, Richard Van. "Death in the Lab." Nature 472, 270-271 November 4, 2011. www.nature.com/news/2011/10418/full/472270a  
6. Parvenn, Shahidah. "Quality Checks in Laboratory Accidents." Interesting Health Facts. November 5, 2009. www.interesting-health-facts.com/2009/11/quality-checks-in-lab
7. The Safety Lady. www.safetylady.com

Eleanor Wolfram is a QA&C Auditor.