Safety, health and the environment

A slogan in Section 16: Quality is ‘Quality is everybody's responsibility’, and in much the same way it can be said that ‘Safety is everybody's responsibility’. The management of the organization is responsible for providing a safe environment for personnel, but if they do not apply themselves to basic safety rules and use their common sense when applying themselves to their work, the risk of accidents and injury will be increased. Transfusion service personnel are at risk of all the usual hazards to be found in any working environment, such as electrical and fire hazards, and risk of accidental injury, but in addition are at risk of exposure to contaminated blood or blood products; to needlestick injuries and cuts from other sharp objects; to hazardous chemicals and for some personnel, to the extremely low temperatures found in cold rooms and freezer rooms. In order to protect themselves from these additional hazards, personnel should know and understand the importance of hand-washing, using protective equipment such as gloves, face masks and eye protection, and wearing protective clothing when appropriate. By the end of this section, the student should be able to describe the general safety requirements of the blood transfusion service, and should be able to give a clear account of details related to the following: Organizational safety policy Requirements of the safety programme: safety committee work areas training personal protective equipment identification of risks work practices reporting accidents blood-borne pathogens handling of blood spills electrical hazards decontamination of work surfaces and equipment waste management The senior management of the organization has the overall responsibility for safety, health and the environment, and this should be documented in the formal safety policy that defines the organization's overall approach to health, safety and the environment. In addition, there should be a dedicated safety budget to ensure that the requirements of the policy can be achieved and maintained. Many countries have legislation in place that lists the basic requirements that must be met in providing a safe work environment, and management should regard compliance with these legal requirements as the lowest acceptable standard for the organization. The aim should be to ensure that the organization is moving towards ‘best working practices’ in health and safety, and to regard the health and safety of personnel as a core management function. The safety policy should be compulsory reading for all personnel and some organizations require, as a condition of employment, that employees sign a statement that they have read, understood and will abide by the requirements of the safety policy. This policy should include: Details of the safety programme of the organization, which should include each of the elements dealt with later in this section The need for compulsory training on the safety policy, particularly during the orientation period for new personnel The fact that all personnel are responsible to some extent for their own safety and that their co-operation is critical to the provision of a safe working environment An explanation of the roles and responsibilities of the safety committee An explanation of risk communication; how risks, such as that of fire, will be communicated to personnel in their work areas The use of protective clothing, such as gloves, eye protection and masks Information on blood-borne pathogens Information on radiation hazards Information on chemical hazards. Common sense and each individual's personal interest in his/her own safety are the greatest guarantees of safety at work. The organization should take the safety of all personnel seriously and any wilful violation of safety rules should be considered a cause for disciplinary action. Safety hazards (defined as any objects or events that may cause injury or damage) are many and varied, and include the following: Biological hazards, including pathogenic organisms such as bacteria and viruses that may be present in blood Chemical hazards, including corrosive acids and alkalis and flammable agents such as alcohol Environmental hazards, including noise, heat and cold Electrical and mechanical hazards, including electrical equipment with moving parts such as centrifuges. Warning signs should be displayed in work areas to alert personnel and visitors of any specific hazard that may be peculiar to that area, such as a slippery floor in a freezer room. An organization-wide safety programme should embrace all of the foregoing, and should include at least the elements that follow in this section. The organization should have an elected safety committee comprised of representatives from each work area. This committee should be chaired by a safety officer appointed by and acting on behalf of the chief executive officer (CEO), and the committee should be responsible for routine safety inspections and for making recommendations regarding safety issues to senior management. These recommendations should be made in writing, and the members of the committee should monitor the effectiveness of the corrective or preventive action. Each member of the safety committee should be required to make formal inspections of the work area that they represent, using an approved checklist, to ensure that all hazards are reported and appropriately dealt with. These inspections are usually conducted once a month. All accidents and incidents, or ‘near misses’ that do not result in accidents but could have, if the circumstances had been slightly different, should also be reported and evaluated by the safety committee which should then make recommendations regarding corrective and preventive action. If senior management does not act on these recommendations, the reasons for this inaction should be recorded by the safety committee for future reference. The design and maintenance of work areas and also of the premises in general is important in ensuring that the overall environment is safe for personnel or visitors to the area. The first step in an effective safety programme is the provision of a workplace that is designed to eliminate, as far as possible, all risks to health and safety. This design should include the provision of adequate fire control equipment, chemical fume cupboards and safe storage areas for flammable liquids and hazardous chemicals, adequate storage areas to avoid clutter, proper signage, fire exits, the provision of adequate electrical outlets and wash stations for hand-washing. Thereafter, good housekeeping should be practised in all work areas to maintain high levels of safety and cleanliness. Emergency telephone numbers, including those of the fire department, ambulance service, the police, and medical director should be prominently displayed in each work area to avoid unnecessary delay in an emergency. Work areas should be kept free of clutter. Exits should be kept clear of obstruction. Access to fire control equipment should be kept clear at all times. Fire control and other safety equipment should be provided, serviced and checked regularly. This includes fire extinguishers, safety drench showers, eye-wash fountains, first aid kits, fire blankets and fume cabinets. Personnel should familiarize themselves with the location of fire extinguishers and fire hoses (and know how to use them), and also with the closest exits. Work surfaces should be regularly cleaned and disinfected to avoid the risk of contamination. Compressed gas cylinders should be stored in accordance with the supplier's recommendations and secured so that they cannot be accidentally knocked over. Hazardous chemicals and flammable liquids should be stored in an appropriately constructed fire store and only minimal amounts kept in the work area. Laboratories in which hazardous chemicals are used should be equipped with eye-wash facilities (fountains) and personnel trained in their use. Depending on the nature of the work carried out in the work area, it may be necessary to provide drench showers for the rapid decontamination or treatment of personnel. Drench showers may be required in areas where caustic, corrosive or toxic chemicals are used. Biohazardous waste containers and sharps containers should be available where required, and properly labelled. Entry to any work area should be restricted to those personnel authorized to enter. Those entering the area should receive appropriate information regarding safety measures to be observed, depending on the nature of the work, and be provided with the necessary protective clothing even if they plan to remain in the area for a limited time. Children should not be allowed to enter any laboratory even if they are under the supervision of an adult. All personnel should be trained to protect themselves from injury in the workplace. This means that each individual should clearly understand potential hazards to which they may be exposed, and the precautions that should be taken to manage risks. After the provision of health and safety training, a clear understanding should be demonstrated, before the individual is assigned to a task or work area where the risks are present. Personnel should be advised of organizational standards for personal hygiene, and given training in the correct hand-washing technique, with emphasis being placed on the need to work clean in a clean environment, especially when handling donors and donated blood units during processing and testing. Training should also be provided for fire safety, and should include the location and use of fire control equipment such as hoses and extinguishers; emergency fire alarms and smoke detectors and evacuation procedures and fire exits. Fire drills should be practiced at least annually, and plans should be developed, and appropriate training conducted for dealing with emergencies such as fire, explosion, chemical spills, electric shock, and personal contamination. Personal protective equipment (PPE) may be defined as any specialized clothing worn, either in place of or over personal clothing for protection against hazards such as exposure to blood, extreme heat or cold, and noxious fumes, and includes items such as gloves, boots, warm clothing, eye protection and laboratory coats. Appropriate PPE should be worn whenever its use will provide additional safety to the wearer. In general, the use of PPE should not be optional, nor left to the discretion of the individual involved, but should be compulsory under defined conditions. For example, the wearing of disposable gloves and closed laboratory coats or aprons should be compulsory when working with blood specimens from patients. By the nature of the work in which they are involved, personnel in many areas of the blood transfusion service are exposed to blood in various ways, necessitating the use of PPE. Personal clothing worn to work should also be in compliance with the standards of the organization. For example, the wearing of shoes should be mandatory and in some instances, closed shoes should be worn rather than sandals. Exposure to blood during collecting donor specimens Exposure to blood during testing patient and donor specimens Accidental injury with sharps (needles, lancets and contaminated glassware) Splashes of blood onto mucous membranes, such as the eyes. Personal protective equipment should be removed at the time of leaving the work area and should never be worn in rest areas or tearooms. Visibly contaminated clothing should be removed promptly and placed in a container reserved for soiled clothing. Personnel should not take soiled clothing home for laundering as this may spread the contamination and the home laundering may not be effective in decontaminating the garments. The safety of the workplace can only be maintained if personnel are trained to recognize and report hazards as soon as they are noticed. Faulty electrical equipment, for example, with a risk of electrical shock or of fire, should be labelled ‘out of order’, taken out of use and reported immediately to the responsible member of the safety committee. Standard operating procedures (SOPs) should be available that define how various hazards (such as blood spills, exposure to hazardous chemicals) should be handled. Part of the validation procedure for SOPs should be an evaluation of the risks to which personnel could be exposed when following the procedure. If hazardous chemicals are used in the procedure, personnel should know how to handle and dispose of these chemicals to reduce personal risk or risk to others, before being asked to perform the procedure. The same applies to any other risks to which personnel may be exposed while using the procedure. When conducting procedures that involve hazards or potential hazards, the following questions should be asked when designing the procedure and writing the SOP: What are the hazards and the potential hazards? What could go wrong during the procedure, and how must the individual deal with these problems? What good laboratory or clinical practices, protective clothing and equipment are necessary to minimize the risks? Mouth pipetting should be prohibited. The following should be prohibited in the laboratory or when attending to blood donors: smoking eating and drinking application of cosmetics insertion or manipulation of contact lenses placing any objects, such as pencils, in the mouth. The storage of food and drink should not be allowed in the laboratory or blood collection area, or in a refrigerator belonging to either area. Laboratory glassware should never be used for food or drink. Eating or drinking utensils should not be washed in the workstation sink. Water for filling a kettle should never be drawn from the workstation sink. When an accident occurs it is important that it is reported to the designated member of the safety committee or the safety officer as soon as possible. Reporting procedures and report forms should be available to ensure that as much information as possible is recorded soon after the event. This is necessary for a full root (primary) cause investigation into the incident with the purpose of introducing preventive measures, if necessary, to prevent a recurrence. In addition, accidents, and particularly those that result in personal injury, may result in insurance and/or workman's compensation claims and the insurers will require full details if the claims are to be honoured. The organization should have measures in place that minimize the risk of exposure to blood-borne pathogens. These measures should include the following work practices: All blood specimens should be treated as if they are infectious. This is a necessary precaution, as very often it is not known in advance which specimens may be contaminated with bacteria or viruses. The wearing of gloves, masks, eye protection and laboratory coats as appropriate when carrying out tasks that may result in blood splashes. Frequent hand-washing, but particularly after blood or any items that may be contaminated with decontamination of work surfaces and should be of the of for by blood specimens or the of the before it has for the proper of of with all necessary items and for the of blood and chemical precautions may be required if the specimens from with such as or as the viruses responsible for these are very spread by blood and other may require that all such and the working with the be in it is clear that the is under specimens for should not be the clinical on the has been In the of it is to use blood in order to avoid the risks of the Many blood transfusion to those are exposed to blood during the of their routine Depending on the of exposure in the general may be for as an and the to those do not have the or have only at a very low in this programme should be but if an individual the this should be If an individual is exposed to blood a needlestick or should be for and after being provided with appropriate If possible, the should also be and procedures should be in place for such as or should this be is important that of understanding is by the individual before any are carried If an individual the testing or the this should also be spills in a blood transfusion service are and can as a result of specimens being or blood during being for example, and the should be for such an event. the to prevent it the area This is particularly important if the is in a place such as a blood collection area. appropriate PPE for the including If the is to include such as precautions will be necessary to avoid possible such as to as much of the as possible and then clean the area with the area, using an approved to the of all contaminated to the organization's on the of contaminated to have the The of should be checked to that they are not The proper use of electrical equipment such as and with proper maintenance and the of hazards, is in accidents that could result in electric shock or even Personnel should be trained in the proper use of such Personnel should report electrical and other potential hazards promptly to the safety officer and should from using any equipment it has been Electrical are for use and should not be used as a for electrical should not be allowed to the should be from accidental and secured in a way that will prevent over Faulty or equipment should be labelled as such and removed from the work area. Personnel should not or any electrical equipment if their are Personnel should not with any while it is into the should be taken not to many electrical items into the same as may a fire training should be provided to all personnel on the treatment of electrical Laboratory and other work surfaces such as that may contaminated with blood should be cleaned and at least once a spills that during the should be cleaned and the area a standard usually the end of the all work surfaces should be cleaned before being with an approved equipment that may be exposed to blood should also be each and should be before being or The of the used for decontamination of work surfaces will the contact time that is required for effective decontamination and the of the and this information should be available to personnel in the of an that the decontamination of the blood collection area or laboratory should also be carried out to a to ensure that all areas of the remain clean and The management of and of waste in is an important of the safety should be stored in a that members of the in from with the Many organizations have waste that of the of waste effective often to for such as and should not only on such as for the unnecessary of but should include to minimize the use of and such as and important of waste management that is by other elements of the programme is the of work that has to be it not carried out properly in the first or the equipment used not properly maintained or This to a waste of time as as and other and under some circumstances can result in in the of and regard to the of it is important to in that many of the that require will including laboratory and the waste management should be designed to ensure that this information is not to any that may be in the such as the personnel of the or waste for such as lists of should be so that they are in a that to any should be to the of or such as and and or contaminated waste at the where the waste is this is using using for waste and for This may be to ensure the of items for by providing containers for and should be to waste containers that Biohazardous waste The should ensure that handling the during the of the will not be exposed to the contaminated and this may require of or the of the into a If the waste is not removed from the work area to the it should be stored in a area that is not to any individual the Depending on the nature of the the may require while Biohazardous waste should never be to of the risk of personnel to the should also be taken to store waste where it will not such as and of waste that is and other items that can or if A should be in place for the safe of and this usually that the sharps are placed in a container immediately after use. This container should have a which the sharps can be be to the sharps once and and closed when The container should also be clearly labelled as These sharps will be contaminated with blood and the sharps container should be of in a waste The of hazardous chemicals can be and is to in that can also provide information on the storage of the to as this will depending on the of chemicals waste should be of to and should be kept in such a while that and other are not able to Biohazardous waste should be of by a that has the of the for this of This is usually by or by by at an approved The for the of medical waste is to or This will result in of the with a of and will also the of such as a of that can be and into the by the of at low a A of should be provided by the waste management to the organization as a that the waste carried The senior management of the organization have the overall responsibility for safety, health and the environment. policy on safety should be documented and should be compulsory reading for all personnel. Each individual's personal interest in his/her own safety is the greatest of safety at work. The organization should have an elected safety committee responsible for a high of safety in the workplace. Personnel should be trained on all of the safety programme and on how to themselves safe in the work environment. PPE includes any specialized clothing that is worn for protection against hazards such as exposure to blood, extreme heat or cold and noxious should be used whenever its use will reduce the risk of The safety of the workplace will be maintained if personnel are trained to recognize and report hazards as soon as they are noticed. The validation procedure for SOPs should include an evaluation of the risks to which personnel will be exposed when following the procedure. When an accident occurs it should be reported to the designated member of the safety committee or the safety officer as soon as possible. The organization should have measures in place that minimize the risk of exposure to blood-borne pathogens. should be available for the decontamination of blood for the management of and of waste in an important of the safety is that use a medical and/or the to the of and and to to the information provided in this section. A of that may be in this regard is provided Personal protective equipment Safety policy Safety risk risk of waste there a programme for the of waste in the If how could it be of accidents at work recorded and communicated regularly to If could this be to of the importance of workplace If are accidents in the and to prevent their The of this section on health and the environment has not from any the This has potential