You should encourage staff to complete a report on all occurrences which fulfil the definition of an accident. These reports can be analysed during any subsequent review to establish accident trends. For an example of an Accident Investigation Report follow the link.
Accident/Incident Report Form

In the absence of a designated safety officer what can you do to improve your own environment and working conditions?

The baseline is personal knowledge of all equipment and procedures used by you to do your job and the attitude you have to the way you perform your duties. Ignorance is not an excuse when someone dies or is badly hurt as a result of ignorance. For your own protection, as well as the protection of your colleagues, you should develop a thorough knowledge of the following:

• the potential hazards fire and toxicity associated with every chemical used in your laboratory
• the practical applications involved in handling potentially infective material
• the location of and proper use of eye wash equipment, safety shower and fire extinguishers
• the procedure to follow for a chemical splash to the eye or body
• the procedure to follow in case of fire or explosion
• and always use common sense.

The potential hazards, fire and toxicity, associated with EVERY CHEMICAL used in your laboratory
The average histology/cytology laboratory uses about 400 chemicals and dyes so there is no excuse for not learning useful safety information about each. The way to achieve it is to have chemical and dye safety information^8,9 incorporated into methods. If safety data is incorporated into methods it will be read by staff whenever they use the method. And should an accident occur the safety information is readily available. Once staff realise the potential hazard associated with handling chemicals and dyes they often begin to actively seek more information for themselves.

All chemicals contain some degree of danger in their use because of toxicity, irritation or the inflammable nature of the substance.^10-15 Toxicity and irritation can be caused by inhalation, skin contact or ingestion of solid, liquid or vapour. To give you an idea of the sort of complete data you require for each chemical I will give you an example. You can get away with less information incorporated into your methods but somewhere you need to keep full documentation on the associated hazards. The chemical I have chosen for the example is Methanol a chemical commonly used as a dye solvent in Cytology.

Methanol is also known by other names which may not be familiar to all of you. Names such as Methyl alcohol, wood alcohol, methyl hydroxide, carbinol, monohydroxymethane, wood spirit and wood naphtha.

It is a clear, colourless liquid with a pungent odour. It is flammable and should not be handled close to heat or a naked flame. The vapour is heavier than air and can travel along the ground to a source of ignition, like a bunsen burner, then explode into flames. The flames then travel back along the vapour trail to the liquid source and when the two meet there is often a violent explosion.

Methanol is a mutagen and therefore should not be handled by staff who are pregnant especially in the first trimester of pregnancy. Methanol will defat skin and can cause dermatitis. It can also be absorbed through skin in doses sufficient to cause narcosis, which will also affect vision and if the concentration is sufficiently high, blindness. Skin absorption can also cause acidosis, a lowering of blood pH. A splash in the eye or sufficiently high vapour concentrations can cause superficial corneal lesions. Vapour concentrations as low as 5ppm can cause eye irritation. Of course blindness can result from prolonged vapour exposure or brief liquid exposure. It is very toxic by inhalation of the vapour or ingestion of the liquid. Some of the symptoms produced by exposure are headache, anorexia, weakness, fatigue, leg cramps, vertigo, restlessness, nausea, vomiting, diarrhoea, dizziness, severe abdominal pain, back and leg pain, muscular incoordination, sweating, apathy, convulsions, blindness, coma and of course death. It is a flammable so keep it away from heat.

Always use a fume hood when handling methanol but ensure that the fume hood is spark proof. Remember that the vapour is heavier than air so that if you pour it down a sink the vapour will collect in the lowest part of the system and can be an explosion hazard. It should be disposed of into waste drums and placed into the hands of a waste disposal contractor. The usual means of disposal is high temperature incineration.

There are many substances which are incompatible with methanol. The most important ones in the medical laboratory are the oxidising agents with which methanol reacts violently. With chloroform it explodes violently.

There is controversy amongst the chemical companies and health agencies around the world as to what constitutes a safe level of exposure. Those given here are the recommendations of the National Institute of Occupational Health and Safety Administration in the USA. If you always wear protective clothing and use a fume hood and have a respirator handy for a major spill you should not have a problem. But note especially exposure to 800 ppm for prolonged periods, which is not much really, will cause blindness.

The practical applications involved in handling potentially infective material
EVERY SPECIMEN RECEIVED CAN CONTAIN PATHOGENIC ORGANISMS AND VIRUS PARTICLES. So treat ALL human material as having the potential to infect, even if received in fixative.^16-20 Infection from contaminated material can occur from contact with the material and from creating aerosols during the handling of material. Aerosols are created when pouring by splattering, spilling or simply from opening a container which may release retained droplets of moisture to circulate in the air.

The most common disease contracted by health care workers, who handle specimens is to be Hep B.²¹

Therefore all staff who handle fresh biological material should be immunised against Hepatitis B. It can be in any specimen that you handle. And it is no defence thinking to yourself but most of our specimens arrive in fixative. It takes time for a fixative to work. Formalin is not quick in its fixing action. It can take formalin up to 12 hours to penetrate 1 cm into tissue at room temperature. Until it reaches the centre of a piece of tissue any organisms in that tissue will remain viable. There is no cure for Hepatitis B and it can and does kill.

Tuberculosis is another real hazard for staff handling fresh specimens in cytology. Staff should have regular mantoux testing, every five years and be immunised if you lack protection.

If regularly working with a particular infective agent there is a need to be immunised against it. For example staff working with animals are recommended to be immunised against Anthrax which is common in animals. And staff working with chimpanzees are recommended to be immunised against Hepatitis A which is common in chimpanzees.

The best means of personal protection is immunisation and wearing appropriate protective clothing. The first defence against personal contamination is clothing. A laboratory coat or gown which covers the body from neck to calves is essential.

A gown is preferred which ties at the back so that there is nothing protruding at the front to get caught up in anything and which has elasticised wrist bands. Stockings or panty hose are not protective clothing and should not be worn in a laboratory. Some chemicals if spilled on panty hose will melt the synthetic material holding the chemical mixture very close to skin and major skin damage can result.

A face mask is optional but is highly recommended where fresh tissue is handled and where solutions are handled or prepared irrespective of how safe you think that solution might be if it is handled outside of a fume hood.

Apart from dye powders being very toxic substances⁸ many of our dye solutions are wonderful mediums for breeding bacteria, it seems a bit strange but its true. So wear a mask²² anywhere that there is an aerosol hazard and when weighing dry dye or chemical powders.

Although marking glass slides with diamond pencils is disappearing from our laboratories with more widespread use of superfrost slides safety glasses should be worn when inscribing glass slides with a diamond pencil.

Slivers of glass can make a real mess of an eye. The best safety glasses have side protection.

A full face shield should be worn where a splash hazard is known to exist and that is usually where large volumes of solvents are handled.

They are essential pieces of equipment for Mortuary assistants and essential pieces of equipment whenever solutions are changed on an automatic tissue processor.

Wear sensible shoes which protect the feet from spills and heavy items which could be dropped on them.

Although the picture shoes lace up shoes, slip ons are recommended because they can be removed quickly if an acid or solvent is spilled over the feet. Sandals, thongs and the like should all be discouraged.

Wear gloves to protect your hands or a good barrier cream. Beware of the super creams those which even protect against acid contact with unprotected hands and will protect hands from xylene when coverslipping. The creams certainly do offer substantial protection from chemical substances because they do form a complete barrier over the skin but it is that barrier which is unsafe trapping bacteria underneath and anything else which hasn't been thoroughly removed before applying the cream which is effective for four or more hours. They also completely block pores not allowing skin to breath which ultimately will cause serious dermatitis and in addition they contain propylene glycol a highly toxic substance found in anti freeze and weed killers. Its absorbed through the skin and in high concentrations like you find in antifreeze and weed killers it can cause death. The concentrations in hand creams are low but there is still a risk attached their use.

The location of, and proper use of, eye wash equipment, safety shower, fire extinguishers and safety blankets
Following an accident, panic is often the first reaction to trauma, especially when staff have not received education in the correct procedure. Staff who receive appropriate, regular instruction, they know what to do, they tend not to panic.

SAFETY SHOWER - A safety shower should be provided within any laboratory where dangerous chemical substances are handled regularly, especially if strong oxidising or reducing substances are handled. The location of the safety shower should be clearly marked and ALL staff made aware of its location and instructed in its use. It must be regularly checked to determine that it is working correctly. It is recommended that the safety showers provides a minimum of 135 litres of water per minute at low velocity to avoid further damage to body tissues. Valves should require a positive action to shut them off. If a safety shower is not available in the immediate vicinity as is the case in most histology labs staff should be made aware of the location of the nearest shower facility that is available for emergency use. If a safety shower or shower facility is not available to staff in an emergency a hose, fitted with a spray nozzle and which will fit at least one tap in the laboratory, can provide an alternative means of emergency shower facility.

EYE WASH EQUIPMENT^23,24 - Eye wash equipment should be provided, in the form of an eye wash bottle or continuous flow facility which is far superior to an eye wash bottle, which will only give a continuous flow for about 15 seconds at most.

An eye needs constant washing. Having to stop washing an eye to refill an eye wash bottle could result in eye damage. Learn the location of eye wash equipment and how to use it- it could save YOUR eyesight.

The procedure to follow for a chemical splash to the eye or body
First the affected eye should be washed immediately in gently flowing, cold water (wash bottle or eye wash continuous flow facility) for a minimum of 15 minutes. Cold water because warm water can cause absorption of chemicals into the body by dilating pores and increasing absorption surfaces. 15 minutes because it can take that long to remove a chemical which is readily absorbed. The eye must be kept open during the flushing. Whilst the eye is flushed a colleague should seek medical advice about the possible hazard to the eye from the contaminating chemical.

Speed is very important, 30 seconds delay between the splash and the initial flush can make the difference between permanent eye damage or saving the sight, especially if the victim is wearing contact lenses.²⁵ Avoid wearing contact lenses in laboratories - chemicals or bacterial and viral aerosols can dissolve in tears and become trapped beneath the contact lens causing a variety of eye disorders. Conjunctivitis id the most common eye disorder encountered in laboratory workers who wear their contact lenses to work. Also some corrosive chemicals can damage the surface of a contact lens which in turn can seriously damage an eye.

NEVER flush an eye with dilute acid or dilute alkali to 'neutralise' a chemical, they can cause more severe damage. NEVER wear contact lenses in a preparation area or where an eye splash is a possibility. Should irritation or pain persist, seek immediate medical advice.

For a chemical splash to the body flush the area of the splash for a minimum of 15 minutes, with cold water. Like with the eye it might seem like a long time but many chemicals are also absorbed through the skin and into the bloodstream. It does take time to get these substances out. Warm or hot water opens pores which allows more readily, the absorption of chemical substances. Vapour from hot water can also carry chemical particles which can be inhaled. For a large splash wash the victim with a safety shower or hose for a minimum of 15 minutes. Do not wait to remove clothes before beginning to shower. While the victim is being flushed with water all clothing should be removed. Contaminated clothing should be washed before re-use.

The procedure to follow in case of fire or explosion

Responsible Institutions have a plan of procedure to follow when a fire breaks out.

Staff should familiarise themselves with the contents of the fire plan for their area. If a fire plan does not exist it becomes the responsibility of the safety officer or the laboratory manager to prepare one. A drawing of a Department layout accompanied by documentation on evacuation should be placed somewhere highly visible close to the laboratory exit. It quickly shows an individual where they are and the quickest and safest routes to evacuate the building and the location of fire fighting equipment.

If you have the misfortune to be present when a fire starts a sensible procedure to follow is:

• close the door leading to the fire if you think about it turn out the lights on your way out but at this stage don't worry about other electrical equipment which might be on your prime concern must be to.
• raise the alarm by notifying the switchboard of the Institution that a fire exists, be calm and state its exact location.
• then Select the correct type of fire extinguisher for the class of fire.
• return and attempt to put out the fire using the fire extinguisher.

If the fire has developed beyond the stage where it can be controlled with an extinguisher and time allows, turn off all electrical appliances, close the door, ensure that the area is evacuated and wait for your fire team, safety officer or fire brigade to direct them to the fire. At this point your responsibility should end unless you are directed to perform some action by the fire team controller, safety officer or a member of the fire brigade.

A pre­designated area of the Institutions grounds, away from likely areas of congestion by fire fighters, should be used for staff to assemble. All staff should remain in the pre-designated area until their names have been checked off against a master list of staff members. One member of the staff, and a deputy, should have the responsibility for this procedure. Evacuation should be done quickly so that if anyone is unaccounted for they can be found quickly.

In order to make staff aware of their responsibilities and the procedure to follow in the event of a fire, and to prevent panic there should be at least two practice fire safety evacuations of buildings each year.

Know where the nearest fire extinguisher is, its type and learn what other fire and safety equipment is nearby. The life it saved could be yours. NATA inspectors often pick staff at random and ask them Where is your nearest fire extinguisher? What sort is it? What type of fire can it be used upon? Where is your nearest fire escape? Is it readily accessible? Is any operation of mechanics required? Do you know how to operate the fire escape?

Encourage staff to use a fire extinguisher so that they can become familiar with how to use one. Its pointless waiting until there is a fire before trying to learn what to do. Seconds wasted can cause someones death.

COMMON SENSE
Never smoke, eat or drink in a laboratory. There are many documented cases where staff have been poisoned and contracted contagious diseases from smoking, eating or drinking in laboratories. Smoking also provides a fire and explosion hazard apart from social and personal hazards. Never store food or drink in a refrigerator used for the storage of chemicals or body fluids - they just don't mix.

Never cover up safety signs. They are put in place for a very good reason.

Appearance of refrigerator door with safety signs covered

Appearance of refrigerator door after notices were removed

Never apply cosmetics in the laboratory. A cosmetic is also a chemical and it can react with laboratory chemicals and damage eyes and skin. And if you have not washed your hands before applying a cosmetic you could be carrying a contaminant on your hands that can contaminate a cosmetic particularly if the cometic is a cream applied by hand.

Do not chew the ends of pencils or pens left on a bench. Who knows what might have contaminated them?

Use proper methods for lifting and carrying reagents.
Carrier for winchesters

Carry winchesters containing acids in acid carriers - which can confine spills if a breakage occurs.

Use two hands for handling winchesters.

Never lift winchesters by the neck alone.

Store incompatible chemicals in separate areas of the laboratory.

Keep flammable liquids only in small amounts in the laboratory.

Handle volatile liquids in a fume hood that has all electrical connections spark proofed.

Never pipette liquids by mouth.

Handle all material as though it is infectious, even what you consider to be fixed.

Wash hands thoroughly after any procedure using chemicals, dyes or human or animal tissues.

Wash hands often with disinfectant soap and always before leaving the laboratory.

Protect your hands when cleaning, handling or re-sharpening instruments which are sharp, have sharp points or sharp edges.

Never stretch or reach above eye level for a reagent bottle containing a concentrated chemical or solution if it slips from your grasp you could be in serious trouble.

Stain and coverslip in a well ventilated area preferably using fume extraction by downdraft.

When using a bunsen burner ignite the match before turning on the gas. if you turn on the gas first and then can't get a match to fire, eventually there could be a big bang when the match does light.

When working with known carcinogens always wear protective clothing and always use a fume hood. And that means when weighing any dry dye powder because almost all dye powders are carcinogens.

Dilute concentrated acids by pouring the concentrated acid into water. Heat is generated by the reaction which can be very violent. Always pour slowly. Some acids weigh quite heavily and a small drop can cause quite a splash.

Wear sensible shoes that offer feet some protection.

Walk carefully in or near the histology laboratory as paraffin wax can make floors very slippery.

Confine long hair.

Never wear contact lenses in fact if you do have poor eyesight wearing spectacles can give a degree of protection against splashes whereas the wearing of a contact lens in a similar situation could result in eye damage.

Never wear panty hose for reasons we have already discussed.

Do not sniff at the top of bottles to determine the contents unless you have someone in the laboratory who is very good at artificial respiration - you might need their services one day.

Never clutter up fume hoods. They should not be used for storage. They should be used for handling toxic substances.

Use a pathogen handling cabinet for handling all fresh tissues irrespective of what clinical details are provided. The clinician may not know that what he has just removed contains TB or Creutzfeldt Jakob.

Use an explosion proof cabinet for storing small quantities of volatile solvents in the laboratory. ensure that the solvents stored together are compatible.

Have a variety of spill kits readily available or have a universal spill compound available in bulk. You should also have a respirator handy with a cartridge for any chemical which is handled in large amounts - that means formaldehyde and xylene at the very least.

And finally the universal panacea for any Cytology laboratory - downdraft ventilation. The fumes from all volatile liquids quickly sink after the initial explosion upwards after release as do the fumes associated with formaldehyde. So its no good having fume extraction at high levels - which is how most standard fume hoods work. They draw fumes backwards and up but some of the heavy fumes just will not go and tend to spill over the front of the fume hood which defeats the object of having one in the first place. Fumes can be totally eliminated with downdraft ventilation. Bench surfaces contain many small holes through which fumes are sucked away.

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