Laboratory administration
Laboratory safety
Bloodborne pathogens

Authors: Dan Scungio, MT (ASCP), SLS, CQA (ASQ) (see Authors page)

Revised: 1 June 2016, last major update May 2016

Copyright: (c) 2012-2016, PathologyOutlines.com, Inc.

PubMed Search: Bloodborne pathogens laboratory
Cite this page: Bloodborne Pathogens. PathologyOutlines.com website. http://pathologyoutlines.com/topic/managementlabbloodbornepathogens.html. Accessed November 19th, 2017.
Definition / general
  • The work performed in clinical and anatomical pathology laboratories is often performed while handling infectious patient samples of many types
  • The hazards posed by these samples vary, and proper handling and use of protective equipment is imperative to ensure the safety of laboratory personnel
  • OSHA's Bloodborne Pathogens standard oversees the proper transport, storage and handling of bio-hazardous substances in the laboratory
Regulation
  • Bloodborne pathogens regulatory agencies:
    • Occupational Safety and Health Administration (OSHA)
      • 29 CFR 1910.1030: Bloodborne Pathogens - 1991
    • U.S. Centers for Disease Control (CDC) / The National Institute for Occupational Safety and Health (NIOSH)
      • Information for Employers Complying with OSHA's Bloodborne Pathogens Standard - 2009 (CDC)
    • College of American Pathologists (CAP)
      • Laboratory general inspection checklist
Laboratory
  • Laboratory requirements:
    • Written exposure control plan (ECP)
      • Updated annually
      • Standard operating procedures
      • Six major components:

    • (1) Administration and exposure risk
      • Define responsibilities of employees, supervisors and managers
      • State who is responsible for the implementation and maintenance of the ECP
      • State who is responsible for provision and maintenance of PPE, employee health administration and training
      • Perform risk assessments to determine exposure risk for each employee category (technologist, phlebotomist, pathologist, etc.)
      • Perform task assessments to determine exposure risk for laboratory procedures

    • (2) Exposure control methods
      • Describe the various methods the laboratory will use to prevent occupational exposure
      • Mitigation of risk occurs through a "Hierarchy of Controls"
        • Elimination of risk
          • Preferred, but not usually feasible in the laboratory setting
        • Engineering controls
          • Physical change or application to the workplace to improve safety
          • Ventilation hoods
          • Safety shields
          • Biological safety cabinets
        • Administrative controls
          • Require the employee to take an action to minimize the risk
          • Include work practice controls
          • No eating, drinking, smoking, applying cosmetics or lip balm and handling contact lenses in work areas
          • Do not pick up broken glassware directly with hands
          • Wash hands immediately or as soon as feasible after removal of gloves or other personal protective equipment
        • Personal Protective Equipment (PPE)
          • Considered least effective control in the hierarchy
          • Requires the employee to wear something in order to reduce exposure risk
          • Type of PPE used chosen based on the risk and task assessments
          • Lab coats, gloves, face shields, aprons, respirators, etc.

    • (3) Vaccinations
      • Hepatitis B vaccine must be offered to all potentially exposed employees
      • Employees who refuse should fill out a vaccine declination form
      • Employees who decline may reconsider later

    • (4) Post-exposure follow-up
      • ECP requires a complete exposure follow-up program
        • First aid
          • Clean the wound, flush eyes or other mucous membrane, etc.
        • Incident evaluation
          • Obtain information about how the exposure occurred and the route of entry
          • Identify the source individual, if possible
          • Obtain consent and make arrangements to have the source individual tested to determine HIV, HCV and HBV infectivity
          • Ensure test results are given to the exposed employee
          • Treat high-risk exposures as emergent in order to expedite the treatment or prophylaxis process
        • Medical follow up
          • Provided by licensed medical practitioner
          • Provide employee with written evaluation of exposure and any further necessary treatment options within 15 days of the incident evaluation
          • All involved parties document complete exposure incident evaluation
          • Include review of engineering controls in place, work practices used, employee training, location and procedure being performed and PPE used

    • (5) Communication
      • Provide information to laboratory employees about hazards in the workplace through labels and signage
      • Use biohazard symbol for labeling (see figure 1)
      • Label items that are used to contain or transport blood or OPIM
        • Refrigerators / freezers
        • Incubators
        • Transport coolers
        • regulated waste containers
      • Biohazard symbol at the entryway to HIV and HBV Research Laboratory and Production Facilities required by OSHA
      • CDC requires this entryway signage for all biological laboratories (CDC)

    • (6) Training and records
      • All employees need access to Bloodborne Pathogens standard
      • All employees must be trained on all aspects of the ECP
      • Training should occur upon employment, annually and whenever there is a change made to procedures which involve potential exposure
      • Keep all training records for at least three years
      • Employee medical records are maintained for the duration of employment plus 30 years
      • Maintain a sharps injury log for any percutaneous injury acquired from a contaminated needle or other such device

    Images hosted on other servers:

    Figure 1

Administration
  • Biohazard spill handling:
    • Provide spill response training for all staff that handles blood or body fluids
    • Ensure use of PPE
    • Confine or contain the spill
    • Inspect for broken glass
    • Absorb with towels or spill pillows
    • Use blood / body fluid absorbent if available (see figure 2)
    • Mop or sweep up the spill
    • Dispose of waste in proper receptacles
    • Disinfect spill area with 10% bleach solution

  • Annual review of exposure control plan:
    • Analyze effectiveness of your ECP
      • Review exposure incidents
      • Review training
      • Review blood / body fluid spills
    • Update employee risk exposure documentation
    • Review / update task assessments
    • Provide annual bloodborne pathogens training

    Images hosted on PathOut server:

    Contributed by Dan Scungio, MT (ASCP), SLS, CQA (ASQ): figure 2