IMMUNOLOGY AND SEROLOGY – LAB

PRELIM
SAFETY IN THE LABORATORY
01 PROF. JASON BIRAQUIT

SAFETY IN THE LABORATORY Salmonella typhi for months or even years after
their initial infection
BIOLOGICAL HAZARDS Animal reservoirs
 a biological substance that poses a threat to the  Many of the diseases are transmitted from
health of humans by exposure to harmful animal to animal, with humans as incidental
microorganisms or infectious agents. hosts.
 Sources of Biological hazards in healthcare  Zoonosis is an infectious disease that is
facilities: transmissible under natural conditions from
o Patients vertebrate animals to humans.
o Medical devices and equipment  zoonotic diseases:
o Specimen o Brucellosis (cows and pigs)
o Water sources and irrigations o Anthrax (sheep)
o Vents and air conditioning o plague (rodents)
o Fomites o trichinellosis/trichinosis (swine)
o tularemia (rabbits)
CHAIN OF INFECTION o rabies (bats, raccoons, dogs, and other
 a process by which infection is spread in a mammals
community at a given period which requires
continuous link between source, method of Environmental reservoirs
transmission, and susceptible host.  Plants, soil, and water in the environment are
 More specifically, transmission occurs when the also reservoirs for some infectious agents.
agent leaves its reservoir or host through a  Many fungal agents, such as those that cause
portal of exit, is conveyed by some mode of histoplasmosis, live and multiply in the soil.
transmission, and enters through an appropriate  Outbreaks of Legionnaires disease are often
portal of entry to infect a susceptible host traced to water supplies in cooling towers and
evaporative condensers, reservoirs for the
INFECTIOUS AGENTS causative organism Legionella pneumophilai
 Potentially harmful microbes
o Bacteria (pathogens) PORTAL OF EXIT
o Viruses  is the path by which a pathogen leaves its host.
o Fungi  usually corresponds to the site where the
o Protozoa pathogen is localized. For example:
RESERVOIR o Influenza viruses and Mycobacterium
 habitat in which the infectious agent normally tuberculosis exit the respiratory tract
lives, grows, and multiplies o Schistosomes through urine/ feces
 the reservoir may or may not be the source from o Vibrio cholerae in feces
which an agent is transferred to a host. o Sarcoptes scabiei in scabies skin
o E.g. Clostridium botulinum (botulism) lesions
o Some bloodborne agents can exit by
Human reservoir - may or may not show the effects of crossing the placenta from mother to
illness. fetus (rubella, syphilis, toxoplasmosis),
 Carrier is a person with inapparent infection while others exit through cuts or
who is capable of transmitting the pathogen to needles in the skin (hepatitis B) or
others. o blood-sucking arthropods (malaria)
 Asymptomatic or passive or healthy carriers
are those who never experience symptoms MODES OF TRANSMISSION
despite being infected.  An infectious agent may be transmitted from its
 Incubatory carriers are those who can transmit natural reservoir to a susceptible host in different
the agent during the incubation period before ways. There are different classifications for
clinical illness begins. modes of transmission. Here is one
 Convalescent carriers are those who have classification:
recovered from their illness but remain capable  Direct
of transmitting to others. o Direct contact
 Chronic carriers are those who continue to o Droplet spread
harbor a pathogen such as Hepatitis B virus or  Indirect
o Airborne

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 o Vehicle borne o “fecal-oral” route – gastroenteritis,
o Vector borne (mechanical or biologic) intestinal infections
o skin (hookworm)
Direct Contact o mucous membranes (syphilis)
 occurs through skin-to-skin contact, kissing, and o blood (hepatitis B, human
sexual intercourse. immunodeficiency virus)
 contact with soil or vegetation harboring
infectious organisms. SUSCEPTIBLE HOST
 Infectious mononucleosis (“kissing disease”) and  The final link in the chain of infection
gonorrhea are spread from person to person by  Susceptibility of a host depends on genetic or
direct contact. constitutional factors, specific immunity, and
 Hookworm is spread by direct contact with nonspecific factors that affect an individual’s
contaminated soil. ability to resist infection or to limit pathogenicity
 Droplet spread  An individual’s genetic makeup may either
o refers to spray with relatively large, increase or decrease susceptibility
short-range aerosols produced by  immunocompromised patients, newborn and
sneezing, coughing, or even talking. infants, and the elderly are often more
o Droplet spread is classified as direct susceptible host
because transmission is by direct spray
over a few feet, before the droplets fall TYPES OF SAFETY HAZARD IN LABORATORY
to the ground.
o E.g: Pertussis, meningococcal infection, TYPE SOURCE POSSIBLE
SARS and SARS-COV2 infections INJURY
Biologic Infectious Bacterial,
Indirect transmission agents Fungal, Viral, or
 the transfer of an infectious agent from a Parasitic
reservoir to a host by suspended air particles, infections
inanimate objects (vehicles), or animate Sharps Needles, Cuts, punctures,
intermediaries (vectors) lancets, broken blood-borne
 Airborne transmission occurs when infectious glass pathogen
agents are carried by dust or droplet nuclei(5 exposure
microns) suspended in air and may be blown
over great distances. (E.g: Measles, Chemical Preservatives Exposure to
tuberculosis, influenza, colds, chickenpox) and reagents toxic,
 Vehicles- may indirectly transmit an infectious carcinogenic, or
agent include food, water, biologic products caustic/corrosive
(blood), and fomites (inanimate object agents
 Vectors such as mosquitoes, fleas, and ticks
may carry an infectious agent through purely Radioactive Equipment and Radiation
mechanical means or may support growth or radioisotopes exposure
changes in the agent.
o Mechanical transmission - flies Electrical Ungrounded or Burns or shock
carrying Shigella on their appendages wet equipment,
and fleas carrying Yersinia pestis, in frayed cords
their gut
o Biologic transmission - the causative Fire/Explosive Open flames, Burns or
agent of malaria or guinea worm organic dismemberments
disease undergoes maturation in an chemicals
intermediate host before it can be
transmitted to human Physical Wet floors, Falls, sprains, or
heavy boxes, strain
THE PORTAL OF ENTRY patients
 refers to the manner in which a pathogen enters
a susceptible host.
 must provide access to tissues in which the STANDARD PRECAUTIONS
pathogen can multiply or a toxin can act. 1. Handwashing
 Often, infectious agents use the same portal to 2. Wearing of Gloves
enter a new host that they used to exit the 3. PPE – Mask, Eye protection (goggles) and Face
source host. shield
o respiratory tract – influenza, 4. Gown
5. Patient Care equipment
tuberculosis, COVID 19

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 6. Environmental Control  The amount of radioactivity present in the
7. Linen clinical laboratory is very small and represents
8. Occupational Health and Blood Borne little danger; however, the effects of radiation
Pathogens are cumulative related to the amount of
a. Eg. Sharps Container exposure.
b. Proper disposable of sharps  The amount of radiation exposure is related to a
9. Patient Placement combination of time, distance, and shielding.
a. Eg. Isolation  Persons working in a radioactive environment
are required to wear measuring devices to
OCCUPATIONAL EXPOSURE TO BLOOD BORNE determine the amount of radiation they are
PATHOGENS STANDARD accumulating
1. Requiring all employees to practice UP/Standard
Precautions ELECTRICAL HAZARDS
2. Providing laboratory coats, gowns, face and  The danger of water or fluid coming in contact
respiratory protection, and gloves to employees with equipment is greater in the laboratory
and laundry facilities for no disposable protective setting.
clothing  Equipment should not be operated with wet
3. Providing sharps disposal containers and hands.
prohibiting recapping of needles  Designated hospital personnel monitor electrical
4. Prohibiting eating, drinking, smoking, and equipment closely
applying cosmetics, lip balm, and contact lens in
 Laboratory personnel should continually observe
the work area
for any dangerous conditions, such as frayed
5. Labelling all biohazardous material and
cords and overloaded circuits, and report them
containers
to the appropriate persons.
6. Providing free immunization for HBV
 Equipment that has become wet should be
7. Establishing a daily disinfection protocol for work
unplugged and allowed to dry completely before
surfaces; an appropriate disinfectant for blood-
reusing.
borne pathogens is sodium hypochlorite
(household bleach diluted 1:10)  Equipment also should be unplugged before
8. Providing medical follow-up for employees who cleaning.
have been accidentally exposed to blood-borne  All electrical equipment must be grounded with
pathogens three pronged
9. Documenting regular training in safety standards  When an accident involving electrical shock
for employees occurs, the electrical source must be removed
immediately.
CHEMICAL HANDLING  This must be done without touching the person
 Acid should always be added to water to avoid or the equipment involved
the possibility of sudden splashing caused by
the rapid generation of heat in some chemical FIRES AND FIRE EXTINGUISHERS
reactions. The acronym PASS can be used to remember the steps
 Wearing goggles and preparing reagents under in the operation:
a fume hood are recommended safety 1. P ull the pin
precautions 2. A im at the base of the fire
 Chemicals should be used from containers that 3. S queeze handles
are of an easily manageable size. 4. S weep nozzle side to side
 Pipetting by mouth is unacceptable in the
GENERAL SAFETY PRACTICES THAT WILL
laboratory
REDUCE THE RISK OF INADVERTENT
CONTAMINATION WITH BLOOD OR BODY FLUIDS:
MATERIAL SAFETY DATA SHEET
1. 1.Staff must wear laboratory coats and be
MSDS includes the following:
additionally protected from contamination by
1. Physical and chemical characteristics
infectious agents.
2. Fire and explosion potential
2. Food and drinks should not be consumed in
3. Reactivity potential
work areas or stored in the same area as
4. Health hazards and emergency first aid
specimens. Containers, refrigerators, or freezers
procedures
used for specimens
5. Methods for safe handling and disposal
3. should be marked as containing a biohazard
4. Specimens needing centrifugation are capped
RADIOACTIVE HAZARDS
and placed into a centrifuge with a sealed dome.
 Radioactivity is encountered in the clinical
5. A gauze square is used when opening rubber-
laboratory when procedures using radioisotopes
stoppered test tubes to minimize aerosol
are performed.

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 production (introduction of substances into the
air).
6. Auto dilutors or safety bulbs are used for Handwashing Techniques
pipetting.
 Pipetting of any clinical material by
mouth is strictly forbidden

PROTECTIVE TECHNIQUES FOR INFECTION

CONTROL

Selection and Use of Gloves

 Gloves for medical use are sterile surgical or
nonsterile examination gloves made of vinyl or
latex.
 Latex gloves provides more tactile sensitivity;
however, either type is usually satisfactory for 1. Palm to palm
phlebotomy and as a protective barrier during 2. Between fingers
technical procedures. 3. Back of Hands
 Latex-free gloves should be available for 4. Base of thumbs
personnel with sensitivity to usual glove 5. Back of finger
material. 6. Fingernails
 Rubber household gloves may be used for 7. Wrists
cleaning procedure 8. Rinse and wipe dry

Guidelines Related to The Selection and General Use Donning of PPE

of Gloves: 1. Sanitize or wash hands
1. Use sterile gloves for procedures involving 2. Wear the protective gown
contact with normally sterile areas of the body or 3. Wear the mask. Ensuring that no air leakage at
during procedures in which sterility has been the upper part and lower chin.
established and must be maintained. 4. Wear the eye goggle or face shield.
2. Use nonsterile examination gloves for 5. Wear the shoe cover if needed.
procedures that do not require the use of sterile 6. Wear the gloves.
gloves. Gloves must be worn when receiving
phlebotomy training. Doffing of PPE
 The National Institute of Occupational 1. Remove gloves. Using one hand, grasp the
Safety and Health (OSHA) mandates palm of the other hand and peel off the first
the use of gloves for phlebotomy. glove.
3. Gloves should be changed between each 2. Perform hand hygiene.
patient contact. 3. Remove gown.
4. Wear gloves when processing blood specimens, 4. Perform hand hygiene.
reagents, or blood products, including reagent 5. Exit the patient's room and close the door
red blood cells. 6. Remove goggles/face shield
5. Gloves should be changed frequently and 7. Perform hand hygiene
immediately if they become visibly contaminate 8. Remove mask/respirator.
6. 6. Do not wash or disinfect latex or vinyl gloves
for reuse. Decontamination of the Working Area
 Rubber gloves may be decontaminated  all work surfaces should be
and reused, but disinfectants may cause cleaned and sanitized at the
deterioration. Rubber gloves should be beginning and end of the
discarded if they have punctures, tears, shift with a 1:10 dilution of
or evidence of deterioration or if they household bleach.
peel, crack, or become discolored.  instruments such as
7. Using items potentially contaminated with scissors or centrifuge
human blood or certain body fluids (e.g., carriages should be
specimen containers, lab instruments, sanitized daily with a diluted
countertops solution of bleach
8. Gloves should be properly removed or covered  Diluted household blea ch prepared daily
with an uncontaminated glove or paper towel inactivates HBV in 10 minutes and HIV in 2
before answering the telephone, handling minutes
laboratory equipment, or touching doorknob

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  Disposable materials contaminated with blood
must be placed in containers marked
“Biohazard” and properly discarded

Disposal Of Infectious Waste

 Infectious waste (e.g.,
contaminated gauze squares
and test tubes) must be
discarded into proper
biohazard containers with the
following features:
1. Conspicuously marked
“Biohazard” with the universal
biohazard symbol
2. Universal color—orange, orange and black, or
red
3. Rigid, leakproof, and puncture resistant.
4. Used for blood and other potentially infectious
body fluids, as well as disposable materials
contaminated with blood or fluid

BIOHAZARD CONTAINER

PUNCTURE-PROOF CONTAINERS FOR SHARPS

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