Standard Precautions

The clinical laboratory presents an environment with many potential risks from biological hazards to chemical or fire hazards. Safety training has become a mandatory part of responsible employee practice, not only for employees themselves but also for their colleagues. Safety training sessions are an essential part of employee training. These sessions represent a lifeline toward optimal behavior should an employee encounter an unexpected hazard. Biological hazards constitute one of the more major risk areas, and this section focuses specifically on this area. Chemical and environmental hazards are briefly summarized. Most of the patient samples used in the hematology laboratory are derived from human body fluids (blood, organ or joint fluids, stools, urine, semen, etc.). Each of these is a potential source of bacterial, fungal, or viral infection; consequently, each sample is potentially hazardous. Laboratorians must protect themselves from contamination by observing practices that prevent direct contact with body fluids or a contaminated surface, contamination, or inhalation. In 1996, the Centers for Disease Control and Prevention issued a set of standard precautions aimed at creating a safe working environment for laboratory practice. These standard precautions combine principles of body substance isolation and universal precautions. The main features of standard precautions that relate to safe hema-tology laboratory practice include personal protective equipment (PPE) and safety features other than PPE.6

Personal Protective Equipment

PPE includes gloves, eye and face shields, countertop shields, and fluid-resistant gowns or laboratory coats.

Gloves

Gloves must be worn during any activity with potential for contact with bodily fluids. Gloves must be changed immediately if contaminated or damaged. When patient contact is initiated, gloves must be changed with each patient. Gloves are removed before exiting the laboratory for any purpose (Fig. 1.2).

Gowns and Laboratory Coats

Gowns and laboratory coats must be fluid resistant with long sleeves or wrist cuffs. They may not be worn outside of the laboratory and must be changed if con-

Figure 1.2 Gloves.

taminated or torn. Disposable coats are treated as bio-hazardous material and discarded, whereas cloth coats are laundered by the hospital service.

Splash Shields (Face, Eye, Surface)

Goggles, face shields, masks, and Plexiglas countertop shields are used to minimize the risks of aerosol and specimen splashes. Although most automated instrumentation is cap piercing, there are many laboratory operations in which these precautions are vital to employee safety (Figs. 1.3 through 1.5; Table 1.1).

Safety Features Other Than Personal Protective Equipment

1. Handwashing is a basic yet most effective tool to prevent contamination. Soap and water

Figure 1.3 Face shield.

Figure 1.3 Face shield.

Figure 1.4 Eye protection.

must be used, and the handwashing procedure should include the wrists and at least a 10- to 15-second soap application. This soap application represents significantly more time than most individuals spend in handwashing. It cannot be stressed enough that proper hand-washing using the recommended times is the first step in the decontamination protocol. Germicidal soaps are suggested. Hands must be washed with every patient contact, after gloves are removed, and if gloved or ungloved hands have been contaminated with a bodily fluid sample.

2. Care must be taken with contaminated sharps; needles, blades, pipettes, syringes, and glass

Figure 1.5 Biohazard shield with flexible arm.
8 Part I • Basic Hematology Principles

Table 1.1

Personal Protective

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