Most clinical or hospital laboratories are rated as Biosafety Level 2. That designation means that employees in those labs work with pathogens that pose moderate hazards to humans and the environment, and therefore specific measures must be in place in order to adequately contain those infectious microbes. Common clinical hazardous organisms include Hepatitis B, HIV, Salmonella, and Staphylococcus aureus. Laboratorians work with such bio-hazardous material every day, and ensuring a lab safety program that prevents exposures and infections is vital.
Many who lead lab safety programs struggle to keep staff safe. There are those employees who have become complacent and no longer wear gloves or lab coats, or those who engage in unsafe work practices such as eating in the lab or using cell phones. If you look on social media, there are several examples of these unsafe acts posted for all to see. These are not new issues.
In 2020, the COVID-19 pandemic came home to labs across the country. Suddenly US clinical labs were on the front lines of this battle, providing specimen collection, coordinating supplies, and even offering testing. So many questions have been asked by lab staff about how to remain safe when handling COVID-19 specimens, whether processing them to send to a reference lab, or testing in house. What PPE is needed? Can I work with the sample outside of a biological safety cabinet? Do I need extra gloves? What if there is a spill?
The heightened fear regarding COVID-19 is a result of many things. It’s a new pathogen with some unknown characteristics, and fear generation and misinformation is all over the news and social media. It is known that most healthy adults below a certain age and with no co-morbidity would easily survive an exposure to this virus. Given this hard science, it may not make sense for laboratorians to be more afraid of the coronavirus than of the HIV or Hepatitis that they handle every day. However, now is the time to use this heightened safety awareness to help sustain a stronger long-term lab safety culture. There are several ways to make this happen.
Often, laboratorians use unsafe practices because it is how they were trained, or it’s what they see lab leadership doing. If the manager walks through and meets with staff every day and conducts huddles in the lab while wearing sandals or holding a cup of coffee, the message the lab manager tells his/her staff about how they prioritize safety is a strongly negative one. It is extremely important to have leaders in the lab set the proper example, and to do it consistently. Setting the wrong example will cause damage to the safety culture that can be spread far and wide in the department.
Setting the right example
A Dutch psychologist named Geert Hofstede wrote two groundbreaking books on the subject of “Power Distance.” Power distance is a description of how people belonging to a specific culture view superior-subordinate relationships. In some cultures, those in authority openly demonstrate their rank and subordinates are not given permission to speak up unless asked. In the lab setting, a power distance relationship may exist between lab staff and medical directors or between lab staff and management. If the lab personnel are afraid to speak up about safety to someone they view as in authority, an unsafe situation may be allowed to continue. Creating a culture in the lab where everyone can speak up about safety issues is vital, and working with lab leadership and physicians to make it happen is important.
Some laboratorians continue unsafe behaviors because they have never faced any consequences for them. For instance, a microbiologist never wore gloves when reading culture plates, but has never knowingly been infected with bacteria. The trick here is explaining that this person has been lucky; they haven’t been doing the right thing just because there haven’t been any bad outcomes...yet. Educating staff about the potential outcomes of poor safety behaviors is an important aspect of an ongoing safety program.
Daily safety inspections
To improve safety in the environment, laboratorians should be trained in the use of their “Safety Eyes.” It’s the ability to easily see an unsafe issue, and this super power improves with use. Once trained, a person can walk through the lab and quickly and easily recognize unsafe situations. The ability is honed by practice—simply take the time to walk through the lab and begin looking for specific safety items like PPE use, trip hazards, waste handling, or anything that can be seen while walking through the area. It can be valuable to learn to be able to spot unsafe behaviors and situations, and to always take immediate action on them. If staff are situationally aware more often, the overall safety culture is better and will be sustained.
Lastly, measuring the lab safety culture regularly can be a valuable tool to making long-term improvements. Create a safety culture survey or use safety audit results and safety meeting data to make an assessment. Ask staff and leadership how they feel about the current culture and discuss what could be improved. Keeping a pulse on the lab safety culture lets others know safety is a priority in the department as well.
When questions arise about lab safety when handling COVID-19 specimens, the first reaction might be to ask “why now?” Ultimately, it doesn’t matter. If there is something happening that raises awareness of lab safety issues, take advantage of it. Use the questions to provide solid answers, and apply those answers to all pathogens handled in the department. Take this opportunity to educate about important safety practices that prevent injuries and exposures every day in the department. This pandemic will pass, but the lessons learned and the opportunities to improve lab safety can continue for years to come.