Laboratory of Pathology - Staff

Introduction 

It is a goal of each laboratory to ensure that safe work practices are established and followed. All laboratory personnel receive formal training in laboratory safety procedures and are familiar with and annually review the Safety Manual, which specifies practices and techniques designed to minimize hazards. Safety practices and techniques must be supplemented by appropriate facility design and engineering features, safety equipment, and management policies.

Some general laboratory safety rules are outlined below. Since the risk of infection from work done in the clinical and diagnostic facilities in the Laboratory of Pathology is from contact-associated exposures, Biosafety Level 2 (BL2) practices, equipment, and facilities are most applicable. The essential elements of BL2 practices, some general safety rules required by the College of American Pathologists (CAP), and practices related to chemical hygiene are outlined below.

BL2 is suitable for work involving agents of moderate potential hazard to personnel and environment. In particular, laboratory personnel must have specific training in handling pathogenic agents, access to the laboratory should be limited when work is being conducted, appropriate precautions are taken with contaminated sharp items, and certain procedures in which infectious aerosols or splashes may be created are conducted in biological safety cabinets.

Most work, however, is safely performed on the open counter consistent with BL2 work.

The following policies apply to both agents assigned to BL2 and chemical hazards. These polices must be practiced by all laboratory sections. Additional safety policies may be specified within each laboratory section.

Standard Practices 

1. Food is stored outside the work area in cabinets or refrigerators designated for this purpose only.
2. Access to the laboratory is limited when work with infectious agents is in progress.
3. Laboratory personnel receive appropriate immunizations or tests for the agents handled (e.g., hepatitis B vaccine or tuberculosis skin testing) from the  Occupational Medical Service (OMS) and must participate in the Tuberculosis (TB) Surveillance Program if at any risk of exposure to TB. Please refer to Infection Control Policies  for additional information.
4. BL2 laboratory sections must have a BL2 sign (NIH 645-5) posted on the door. This sign designates the type of biohazardous agents used, special procedures or precautions for entry, and emergency contact information. Sections operating under Biosafety Level 1 designation do not require any posting. Refer to Biosafety in Microbiological and Biomedical Laboratories (BMBL), published by the Center for Disease Control, for specific practices, facilities, and equipment for each Biosafety Level designation. Contact the NIH Division of Safety (301-496-5291) to determine Biosafety Level designation and to obtain BL2 signs.
5. The Clinical Chiefs have established policies and procedures whereby persons are advised of all potential hazards in the laboratory. Laboratory personnel are advised of special hazards and required to follow any special procedures.
6. Smoking, eating, drinking, and/or chewing gum is not permitted in the work area.
7. Application of cosmetics and/or lip balm is not permitted in the work area.
8. Handling contact lenses is not permitted in the work area. Persons who wear contact lenses in laboratories should also wear goggles or a face shield.
9. Handle and store brittle plasticware and glassware with care to avoid damage; do not use damaged glassware or plasticware.
10. Recapping, purposeful bending, breaking, removing from syringes, or other manual manipulations of needles are strictly prohibited. Resheathing instruments or self-sheathing needles may be used to prevent recapping of needles by hand.
11. Mouth pipetting is prohibited.
12. Keep work areas clean. Work surfaces are decontaminated daily and after any spill of viable or chemical material.
13. Persons wash their hands after handling chemicals, after removing gloves, and before leaving the laboratory.
14. Instructions for employees' response to exposure to blood, body fluids or infectious material is posted throughout the department, and can be found in the CC Infection Control Guidelines, Response to Exposures. Immediately report all splashes, injuries, and spills to the Clinical Section Head or designate General Supervisor when these occur. Medical evaluation and surveillance are provided as appropriate and written records are maintained. Employees with occupational injuries or illnesses that require medical treatment (more than first aid) must report to OMS. All accidents, spills, and injuries are reported to the Chair of the Safety Committee for evaluation and presentation to the Quality Improvement Committee to avoid recurrence. The following policies and procedures are to be reference by LP staff when managing spills in the laboratories:
    1. DOHS Procedure for Hazardous Chemical Spills
    2. DOHS Procedure for Biological Materials Spills
    3. DOHS Spills with Nanoparticles
    4. Clinical Center Exposure Control Plan for Spills with Infectious Material in the hospital areas and laboratories
15. Explicit instructions are posted, and appropriate supplies are available, for the emergency treatment of chemical splashes and injuries and the control of chemical spills wherever major chemical hazards exist in each section.  

    Note: Spill kits must be handled in accordance with manufacturer's instructions. If no expiration date is assigned, the spill kit must indicate the date it was put into service and the laboratory director or designee must periodically assess its usability.

Laboratory Facilities and Physical Safety 

1. Each lab contains a sink for hand washing.
2. Vacuum breakers (anti-siphon devices) must be provided on water outlets if the spigot or an extension extends below sink level, or if the outlet has a suction apparatus attached.
3. The laboratory is designed so that it can be easily cleaned. Work surfaces should be protected from contamination through the use of disposable, absorbent, plastic-backed paper. Replace contaminated paper as necessary and handle as hazardous waste.
4. There must be unrestricted access to an eyewash station and emergency shower. Eyewash stations are tested on a regular basis and documented in each laboratory on an Emergency Eyewash Check Sheet. Emergency showers are tested and documented by maintenance on an annual basis.
5. Laboratory airflow (negative pressure relative to corridor) may be checked through maintenance if requested.
6. The laboratory is equipped with a zoned automatic fire detection system, an overhead sprinkler system and alarm systems. The fire alarm is audible in all parts of the laboratory, including storage areas, lavatories, and darkrooms. Fire alarm pull stations are located throughout the hallway corridors. ABC fire extinguishers are in the corridors. Corridors and stairwells have adequate emergency lighting for safe evacuation of the laboratory.
7. Rooms larger than 1000 ft 2, or in which major fire hazards exist, have at least 2 exit access doors remote from each other, one of which opens directly into a means of egress.

Security and Access Control 

1. Security access to the NIH, and subsequently Laboratory of Pathology (LP) laboratories and offices, is controlled by the NIH Division of Personnel Security and Access Control (DPSAC) in accordance with NIH Physical Access Control Policy 1405.
2. The NIH utilizes Physical Access Control Systems (PACS) to facilitate timely access to NIH facilities while meeting regulatory security requirements. These systems allow for automated entry based on access rights which are granted on an individual basis using an NIH personal identity verification (PIV) card.
3. The Office of Research Services (ORS), Office of Security and Emergency Response (SER), Division of Personnel Security and Access Control (DPSAC) maintains overall responsibility for managing physical access to NIH facilities.
4. All access doors to LP's clinical laboratories, faculty offices, and common clinical areas are secured by PIV card readers, and PIV card access is granted only by authorization of the Clinical Manager. 
   1. Access to LP's doors are granted only to staff or ancillary personnel who have a need to access the particular room or corridor as determined by the Clinical Manager. 
   2. NIH Access Control will not authorize individuals' requests for access to any LP door without authorization of the LP Clinical Manager.
5. Vendor or Visitor Access:
   1. Two main doors to LP's clinical laboratories and two main faculty office suites are unlocked during normal duty hours between 09:00 and 17:00 for Clinical Center staff or vendors who present with an NIH identification card and have authorized business with LP's staff.
   2. No vendor or visitor will be allowed access to patient identified records or material, and they must be accompanied by an LP staff at all times.
6. NIH Physical Access Control Policy 1405 mandates all individuals leaving NIH is out-processed prior to their departure date, at which time the Administrative Officers or Office of the Chief Staff will collect the individual’s ID badge as part of the departure process. The ID badge must be returned to the local/satellite security/badge issuance office. Failure to surrender a badge will be reported to the Division of Police as possessing unauthorized property.

Noise Protection Policy - Hearing Conservation

Employees are entitled to protection from excessive noise when sound levels equal or exceed an 8-hour time-weighted average of 85 decibels. As a practical measure, when the background noise level exceeds 85 decibels, one must shout in order to be heard. If employees or supervisors feel that the noise in their work area meets this standard, the noise level should be monitored and protective equipment will be provided. Please refer to the NIH Hearing Conservation Program for additional information and resources.

Mercury Abatement

NIH Mercury Abatement Program

• The NIH Department of Occupational Health and Safety (DOHS) has developed a mercury policy that aims to replace mercury-containing equipment with “greener” products where possible. 
• Although the Laboratory of Pathology has been deemed mercury-free, staff should be knowledgeable of the NIH Chemical Hygiene Plan, Mercury Spills. 
• Additionally, the NIH Waste Disposal Guide provides instructions on how to discard thermometers and other items that might contain mercury on the NIH campus.

Gas Cylinders

LP staff adhere to the NIH Clinical Center's S-007 Policy on Compressed and Liquified Gas Cylinder Safety. The following guidelines relate to LP laboratories:

• No more than one extra cylinder of compressed, flammable gas (other than those actually connected for use) should be stored at any one workstation.
• All compressed gas cylinders must be secured to prevent accidental falling and damage to the valve or regulator.
• Only non-flammable gas cylinders are currently used in the LP. If flammable gas cylinders are used in the future, the flammable gas cylinders must be stored in a separate, ventilated room or enclosure, reserved exclusively for that purpose, and which has a fire-resistance classification of at least 2 hours.

Liquid Nitrogen (LN2) Safety

Liquid nitrogen is nitrogen in a liquid state at a very low temperature. It is a cryogenic fluid that causes rapid freezing on contact with living tissue. Due to its extremely low temperature, careless handling of liquid nitrogen may result in cold burns. As liquid nitrogen evaporates, it also reduces the oxygen concentration in the air and can act like an asphyxiant. Since nitrogen is odorless, colorless and tasteless, it can produce asphyxia without any sensation or prior warning.

• Store liquid nitrogen containers in a dry ventilated area. Do not store in a confined space area.

• Handling of liquid nitrogen is dangerous – it causes burns and asphyxia. The low temperatures associated with liquid nitrogen can cause cryogenic burns. Use of protective clothing is an essential safeguard against this.

• Never allow any unprotected part of the body to touch exposed pipes/vessels containing cryogenic liquids; skin coming in contact with cold metal may adhere to it and tear when attempting to withdraw.

• Exercise caution when adding a cryogenic liquid to a Dewar flask at room temperature to a cryogenic liquid. Both will cause the liquid to boil and splash vigorously.

• Only use containers or equipment specified for cryogenic use.

• Never place liquid nitrogen in a sealed container or object that could cause entrapment of the gas.

• Never plug containers holding cryogenic liquid; cover them when not in use to prevent an accumulation of moisture and ice.

• Inspect pressure relief valves on equipment (e.g., 150 Liter Dewar flask) for ice build-up.

Personal Protective Equipment for using LN2

Eye Protection
Safety glasses/goggles and face shields should be worn during operations where liquid nitrogen is being poured from a large container to a Dewar or another smaller container.

Hand Protection
Loose fitting thermal insulated (cryogloves) or leather gloves are recommended. Check glove manufacturer for recommendations on a suitable glove.

Body Protection
Long sleeve shirt, lab coat, pants without cuffs and closed toed shoes.
An impervious full length apron should be worn when transferring liquid nitrogen.

Laser Safety Program

Laser use at the NIH for research and medical treatments has grown dramatically over the last decade. With increased use there is potential for increased risk; it is imperative to ensure safe laser use so that researchers can continue scientific and medical breakthroughs here at NIH. Within the LP, internal lasers might be found in clinical instruments, such as flow cytometers.  The NIH Policy Manual 3036: NIH Laser Safety Program provides guidance and oversight for the safe use of Class 3b and Class 4 lasers and laser systems at the NIH.

Ultraviolet Light

Ultraviolet light (UV) is defined as electromagnetic radiation in the spectral region between 180 and 400 nanometers (nm). UV light may cause corneal or skin burns from direct or deflected light sources. Immediate or prolonged exposure to UV light can result in painful eye injury, skin burn, premature skin aging, or skin cancer. Wherever UV light sources are used, suitable and adequate personal protective equipment must be provided, and appropriate approved signage displayed. Laboratories may obtain information on safety from manufacturers of devices that emit UV light.

Typical laboratory equipment with the capacity to emit non-ionizing UV wavelengths includes biological safety cabinets (BSCs), transilluminator boxes and UV crosslinkers.

UV exposure is not immediately felt and the user may not realize a hazard until after the damage is done. Diagnosis of exposure may vary but is commonly set into two categories, photokeratitis (eye injury) and erythema (sunburn).  

General Safety

• Never allow your eyes or skin to be exposed to UV light in the laboratory. This laboratory UV light is heavily concentrated and can cause severe damage with very short exposure periods.

• The UV lamp must never be on while an operator is working in the cabinet or cryostat. Equipment must not to be used if the door safety interlocking mechanism is not working properly. Always lower sash and keep away from escaping rays.

• Wear UV safety glasses when performing routine lamp maintenance or when potential exists for direct or indirect (reflected light) exposure. Not all protective eyewear will protect laboratory workers from deleterious UV light exposure. Make sure the protective eyewear is rated for UVC protection.

• Always wear personal protective equipment (PPE) such as gloves, face shields, and lab coats (long sleeves) when using UV light. Thick nitrile gloves are recommended, but latex gloves can be doubled for use. Biological Safety Cabinets (BSCs) are never to be occupied while the UV lamp is activated. 
• Mechanical safety devices should be standard on most new cabinets. If there is no safety shield or safety switch, these must be retro-installed in such a way as to prevent exposure and not interfere with the operation of the apparatus.
• Transilluminators are never to be used without the protective shield in place. A face shield, thick nitrile or double latex gloves, along with a lab coat are the recommended PPE.

LABEL EQUIPMENT PROPERLY: Overexposure of UV radiation almost always occurs because of inadequate education with regard to hazards when using UV-emitting equipment. All equipment should be obviously and specifically labeled pertaining to UV emission. Properly labeled equipment will decrease the likeliness of an accident involving exposure to the eyes and/or skin.