5.

Safety and First Aid

A. Safety in Specimen Collection

1. Goal is to recognize and eliminate hazards and provide information on safety education so
employees can have a healthy, safe environment.

2. OSHA Act of 1991 mandates the provision of a safe working environment.

3. Safety in specimen handling is critical to avoid acquisition of infection.

B. Personal hygiene in the work environment

1. Put nothing in your mouth.

2. Wash hands frequently.

3. Never apply cosmetics.

4. No eating or drinking.

5. Tie back long hair.

6. Button lab coat.

7. No food in lab fridge.

8. No loose, dangling clothing or jewelry.

9. Open toed shoes usually prohibited.

C. Laboratory Safety

1. Correct handling of specimens

a. Specimens should be covered at all times.

b. Centrifuge specimens using appropriate precautions.

c. Dispose of samples in appropriate biohazardous containers.

d. Cover needles by properly utilizing the safety equipment which requires a one-
handed method of permanently covering the end of the needle.

2. Safety advisory has been issued for the use of glass capillary tubes to reduce the risk of
injury due to breakage and include the following:

a. Avoid using capillary tubes made of glass.

b. Use capillary tubes wrapped in puncture-resistant film.

Unit 5—Safety and First Aid (rev Dec 2015) Page 1

 c. Utilize products which do not require manual filling of end with sealant.

d. Utilize products that allow measurement of hematocrit without centrifugation.

3. Correctly dispose of biohazardous waste.

a. Double bag

b. Sharps keeper for sharps and broken glass.

c. When disposing of specimens in sink, turn water on gently.

d. Urine specimens are poured down drain.

e. Blood can be poured down drain if local ordinance permits, most facilities put in
biohazard trash due to high number of samples.

4. Decontaminate work area daily and as needed.

a. Can use a 1:10 dilution of bleach, must be prepared daily.

b. Decontamination of re-usable equipment

1) Decontaminate with bleach solution

2) This would include: tables, tourniquets, chairs, floors, anything with visible
blood or body fluids.

c. Decontamination of blood or body fluid spills must be handled carefully.

1) Place paper towels over spill.

2) Flood with bleach solution.

3) Allow solution to soak into the contaminated material.

4) Glass or sharp objects are not to be removed by hand; if present, they must
be removed by mechanical means (brush and dustpan).

5) Wipe up bleached material with paper towels or absorbent pads and place in
biohazard container.

6) Spray area again with bleach and allow to air dry.

7) Special encapsulating powders are available which gel the liquid.

5. Colored biohazard labels must be placed on all containers used to store, transport or ship
blood or body fluids.

6. If accidental blood or body fluid exposure occurs:

a. Use appropriate safety equipment, i.e., if in eyes go to eye wash station.

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 b. If it is a puncture wound immediately apply first aid, then report.

c. If employee, report to employee health immediately. If student, follow exposure

plan you receive during clinical orientation. Take this packet to clinical EVERY
DAY.

d. Employee and patient (if known) should be evaluated for HIV, HCV and HBV.

e. Employee should receive HBV vaccine and initial dose of anti-retroviral within 1
to 2 hours of exposure.

f. HCW should be counseled and evaluated for HIV infection and periodic intervals.

D. Fire Safety

1. Phlebotomist responsibilities

a. All employees are responsible for safety.

b. Know the location of fire extinguishers and learn how to use them correctly.

c. Know the procedure for reporting a fire.

d. Know where the fire blanket is.

e. It is mandatory to attend periodic safety programs to review.

2. Components of a fire

a. Fuel

b. Oxygen

c. Heat

d. Necessary chain reaction

3. Classification of fires – refer to textbook for illustrations

a. Class A (think Ashes) fire occurs with ordinary combustible material such as
wood, rubbish, paper, cloth and many plastics.

b. Class B (think Barrels) fire occurs in a vapor-air mixture over flammable solvents
such as gasoline, oil, paint, lacquers, grease and flammable gases.

c. Class C (think Current) fire occurs in or near electrical equipment.

d. Class D (think Dangerous) fire occurs with combustible metals such as

magnesium, sodium, and lithium.

4. Fire extinguishers – refer to textbook for illustrations

a. Class A contains soda and acid or water used to cool fire.

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 b. Class B contains foam, dry chemicals or CO2 used on fires composed of vapor, air
mixtures or solvents.

c. Class C contains non-conducting extinguishing agents such as dry chemicals or

CO2 used on fires which occur in or near electrical equipment.

d. Class D used on fires ignited by combustible metals like magnesium, lithium and
sodium. Very rarely encountered.

e. ABC multipurpose extinguisher is very popular and frequently used, reduces

confusion about what type of extinguisher to use.

5. Proper use of fire extinguisher = PASS – refer to textbook for illustrations

a. Pull Pin

b. Aim Nozzle

c. Squeeze Trigger

d. Sweep Nozzle

6. Most healthcare facilities use acronym RACE – refer to textbooks for illustrations

a. Rescue/Remove person(s) from the immediate vicinity of the fire (RESCUE)

b. Immediately pull alarm then call designated number posted on or near phone
(ALERT)

c. Close all doors and windows (CONFINE)

d. If fire is small, use fire extinguisher (EXTINGUISH)

e. If evacuation is necessary, use stairs.

f. If clothing is on fire – stop, drop, and roll.

g. If caught in a fire, crawl to exit, get wet towel if possible to cover mouth and nose.

h. Do not block entrance or try to reenter the building.

i. Do not panic or run.

E. Electrical Safety

1. Potential major hazard is the possibility of electric current passing through a person.

2. Know the location of circuit breakers to assure fast response during electrical fire or shock.

3. Preventive maintenance on equipment.

a. Periodically inspect cords for fraying.

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 b. Control switches and thermostats should be in good working order.

c. Unplug equipment when performing preventive maintenance and when cleaning up

spills in equipment.

d. Use a 3-prong plug.

e. Do not touch electrical equipment while drawing blood on patient.

f. Avoid the use of extension cords.

4. Procedure to follow when coworker has contact with electrical current.

a. Unplug equipment first or turn off power.

b. Do not touch the victim.

c. To remove electrical contact, use asbestos gloves, which cannot conduct electricity
or place hand in glass beaker to push power supply away from the victim.

d. Call for medical assistance and start CPR immediately if needed.

e. Do not move the victim.

f. Place fire blanket or other warm clothing over victim.

F. Radiation safety

1. Three principles to protect yourself

a. Time – radiation is cumulative and length of exposure should be minimal.

b. Shielding – lead apron or behind lead shield.

c. Distance – to reduce amount of exposure.

2. Know radiation sign and use appropriate precautions – colors may be different, but symbol
will be the same.

a. Areas where radioactive materials or reagents are stored must be labeled with
radiation hazards sign.

b. Exposure for phlebotomists may be collection of specimens in nuclear medicine or

x-ray department or taking specimens to RIA department in lab.
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 c. In clinic settings, phlebotomist may be asked to assist with proper placement of
patient for an x-ray.

d. Unacceptable exposure may lead to diseases such as cancer.

e. If routine exposure is expected may be required to wear dosimeter badge to

monitor.

3. Be knowledgeable about institution’s policy pertaining to radiation safety, especially if

pregnant.

G. Mechanical Safety

1. Correct use of equipment is critical.

2. Centrifuge is the most common piece of equipment used by phlebotomists.

a. Centrifuge carrier must be in correct position and swing freely.

b. Must use correct head or cups specifically designed for centrifuge used.

c. Unbalanced load can lead to dangerous problems.

3. Schedule preventive maintenance on a regular basis.

H. Chemical Safety

1. Injury in the laboratory can occur due to exposure to poisonous, volatile, caustic or
corrosive agents such as strong acids or bases.

2. Different chemicals and reagents can present different types of hazards.

a. Inhalation of fumes can damage lungs (sulfuric acid).

b. Some are corrosive to the skin (phenol).

c. Some are caustic (acetic acid).

d. Some are volatile (some solvents).

e. Some present a combination of hazards.

3. All chemicals and reagents should be stored in original container, tightly closed and in an
appropriate, well ventilated storage area, i.e., flammable cabinet.

4. Hazard communication manual, mandated by OSHA in 1986 and known as the “Right
to Know Act”, requires that employers maintain documentation related to all hazardous
substances and must include the following:

a. Written communication program.

b. Documented training of employees.

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 c. Sophisticated tracking and documentation of hazardous substances and Safety
Data Sheets (MSDS).

5. Occupational Safety and Health Administration (OSHA) hazard communication standard

(Right to Know) is designed to ensure that laboratory workers are fully aware of hazards
associated with chemicals in the workplace.

a. Each site must have a comprehensive chemical hygiene plan to implement the
practice of safety measures throughout the lab.

b. A chemical hygiene plan for each lab must include:

1) Outline the specific work practices and procedures necessary to protect

worker from any health hazards associated with hazardous chemicals.

2) Provide information and training regarding hazardous chemicals to all lab

workers.

c. All hazardous chemical labels must contain the following:

1) Appropriate warning, i.e., corrosive.

2) Explain the nature of hazard, i.e., flammable.

3) Special precautions to eliminate risks.

4) Explain first-aid treatment for exposure.

6. Information about signs and symptoms associated with exposure to hazardous chemicals
used in the lab must be communicated to all.

a. Reference materials for this information are included in the Safety Data Sheets
(SDS) provided by all chemical manufacturers and suppliers.

b. This information concerns hazards, safe handling, storage, and disposal of

hazardous chemicals used in the lab.

7. Safety Data Sheets (SDS)

a. Previously called Material Safety Data Sheets (MSDS), modified to SDS to be in

line with Global Harmonization System (GHS).

b. GHS developed consistent hazardous material classification and transportation

regulations in all countries and standardized the order and format of the SDS.

c. Information is provided by chemical manufacturers about each chemical.

d. Each lab must have on file all SDSs for the hazardous chemicals used in the lab.

e. Use of SDSs is a common way that potential product hazard information is made
available and OSHA requires this provision by all chemical manufacturers.

f. The healthcare facility is required to provide this information to its workers.

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 g. Each SDS contains basic information about the specific chemical or product
including:

1) Trade name, chemical name, and synonyms

2) Chemical family

3) Manufacturer’s name, address and phone number for further information

4) Hazardous ingredients

5) Physical data, fire and explosion data.

6) Health hazard and protection information

h. The SDS DOES NOT include instructions on how to use the chemical, as this may
vary with each lab’s use of the chemical.

8. Hazard Warning

a. The NFPA 704 marking system is a hazard identification system developed by the
National Fire Protection Association that is frequently used in health care facilities.

b. This system provides at a glance, in words, symbols, and pictures, information on

the presence of potential hazards and the level of hazard.

1) Health – blue

2) Flammability – red

3) Reactivity or stability – yellow

4) Special hazards information – white

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 c. The hazard identification system consists of four small, diamond-shaped symbols
grouped into a larger diamond. MEMORIZE!

1) Top diamond is red and indicates a flammability hazard.

2) Diamond on right is yellow and indicates a reactivity-stability hazard; these

materials are capable of explosion or violent chemical reactions.

3) Diamond on the left is blue and indicates a possible health hazard.

4) Diamond on the bottom is white and indicates special hazard information

such as radioactivity, special biohazard, and other dangerous elements.

5) The system indicates the severity of the hazard using numerical

designations from 0 to 4, with 0 being no hazard and 4 being extremely
hazardous.

9. Routine safety precautions when handling chemicals.

a. Read labels for potential hazards prior to use.

b. Use appropriate PPE when handling.

c. Use special carriers for transport.

d. Rooms or cabinets used for storage must be labeled with caution sign at entrance
specifying chemicals present.

e. Never store chemicals above eye level.

f. Explosives or flammables stored in specially designed cabinet.

g. If chemical is transferred from original container, the new container must be

labeled with chemical name and hazard identification diamond.

10. Chemical spill or exposure

a. Know the location and proper use of the eye wash station and safety shower.

b. If clothing involved, go to safety shower, remove clothing, rinse for 15 minutes.

c. If eyes are splashed, go to eye wash station, remove contact lenses, rinse 15
minutes.

d. For spills on surfaces obtain chemical clean up kit from clinical chemistry
department.

1) Special supplies which absorbs or neutralizes acid, alkali, mercury and

other chemicals.

2) Type used will depend on type of chemical involved.

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 3) Has indicator system that identified when spill has been neutralized and can
be cleaned up.

11. Disposal of chemicals

a. Acids and alkalis that are soluble in water can be flushed down sink with lots of
cold water.

b. Pour alkalis into large amount of water first.

c. ALWAYS add acid to water, NEVER add water to acid, may result in explosion.

I. Equipment and Safety in Patient Rooms

1. Properly dispose of all specimen collection supplies.

2. Leave bed rails in position they were in when you entered.

3. Report unusual odors.

4. Check and report spills on floor.

5. During blood collection, do not touch electrical instruments, patient may become grounded
and receive a shock.

6. If patient has an IV, report to the nurse if the site is red and swollen, if blood is backing up,
the IV container is empty or the IV alarm is sounding.

7. If the patient is in unusual pain, or is unresponsive, notify the nursing station immediately.

8. Be aware of signs and symptoms of latex allergies in patients which may include skin rash,
hives, respiratory problems or shock.

J. Patient Safety Outside the Room

1. Travel with care as trays, carts, ladders may be placed in unusual places.

2. Pick up items on the floor to prevent individuals from slipping.

3. Avoid running, as others may become alarmed and run also, or you may run into someone.

K. Disaster emergency plan

1. Most institutions have developed procedures to follow in case of: hurricane, flooding,
earthquake, bomb threat and local major disasters.

2. Must become knowledgeable about your role in disaster plan procedures.

3. Many places have annual or semi-annual city wide disaster drills involving all emergency
service departments and appropriate health care facilities.

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L. Emergency Procedures

1. Detach yourself from the situation to the degree necessary to perform well and deliver best
possible care.

a. Be prepared to act if an accident occurs in your presence.

b. Prevent severe bleeding, maintain airway, prevent shock and further injury.

c. Get assistance immediately, but do not leave patient.

2. Bleeding aid

a. Place a clean cloth over the site and apply pressure.

b. If none available, use your gloved hand until one is available.

c. Elevate the extremity to decrease blood flow, raise above the heart.

d. Do not use a tourniquet unless limb is mangled, crushed or amputated to the extent
that there is profuse bleeding.

3. Breathing aid

a. When breathing stops—lips tongue and fingernails become blue.

b. This is an indication for immediate mouth to mouth resuscitation.

c. Delay in artificial respiration may result in brain damage or death.

4. Circulation aid can only be achieved by proper training in a CPR class.

a. Most large institutions offer classes and refresher courses periodically.

b. TAKE ONE.

5. Preventing shock

a. May be the result of excessive bleeding, extensive burns, lack of oxygen or other
traumatic events.

b. Signs include: pale, cold, clammy skin, weakness, rapid pulse, increased shallow
breathing and frequently nausea and vomiting.

c. Main objectives are to improve circulation, get sufficient oxygen to the brain and
maintain body temperature.

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