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Bruce Lickey
ID 8841906
Risk Management: Work Practices

University of Vermont - BSL-1 Basic Course
Risk Management: Work Practices

    Content Author

        Benjamin Fontes, MPH, CBSP
        Yale University

Introduction

    Risk management is broken out into the following four sections:

    • Work Practices • Sharp Instruments • Disinfection • Safe Pipetting and Miscellaneous Work Practices

    This module reviews various work practices including labels, transport, biomedical waste, pipetting, and the use of personal protective equipment (PPE). The work practices discussed are applicable to a variety of settings involving biohazards.

    Learning Objectives

    By the end of this module, you should be able to:

        Describe the foundational work practices in biosafety including the do’s and don’ts of laboratory environments.
        Identify best work practices for specialized tasks such as transport, pipetting, and biomedical waste.
        Recognize safe work practices associated with the use of PPE.

Basic Biosafety Work Practices

    This module deals with how biohazards should be handled by those directly working with them and who are at the highest risk of exposure. Work practices are a core component of risk management, which is the next step in the development of a set of standard operating procedures once a risk assessment has been conducted. The goal of this section is to provide an understanding of how work practices are used for biocontainment and the role of work practices in minimizing researcher exposure to biohazards.

    There are seven work practices that serve as the foundation for biosafety; how they are utilized to contain biohazards will be explained. Although specific applications of biological safety will be critically reviewed, this will not cover every possible scenario that may be encountered in a research or clinical laboratory setting. Those working with biohazards and those responsible for biosafety at an organization are responsible for identifying the specific containment mechanisms required to protect employees, as well as implementing the engineering controls necessary for the protection of those employees. It is important to emphasize that biosafety is a team effort, and it starts with the principal investigator (PI) and individuals working with biohazards.

    Prior to beginning work with biohazards, each individual should walk through all of their proposed procedures and identify those steps in the process that have the potential for exposure, including:

    • Generation of splash, splatter, or aerosols • The use of sharps • Transfer of materials from one part of the laboratory to the other, or outside the laboratory to another location • The use of equipment that imparts energy to suspensions of biohazards (such as, infectious microorganisms) • The use of animals typically includes procedures that inherently present risk (animals are unpredictable; they can bite, scratch, or move during an inoculation, and researcher procedures with animals may involve the use of sharps)

    These procedures need careful evaluation to ensure that release and exposure situations are identified, and the appropriate combination of engineering and facility controls, PPE and clothing, and work practices are employed to protect workers and others within and outside the laboratory. This module reviews the work practices that are commonly used to minimize worker exposure to biohazards to effectively manage the risk.

Background

    Work practices are one of the principle controls utilized to control hazards and manage risk. Provided below is the hierarchy of controls with specific examples provided.

    Hierarchy of Controls • Substitution – for example, using an attenuated or defective strain of a pathogen instead of the wild type. • Administrative – for example, only allowing the most experienced personnel to conduct high risk work. • Engineering Controls – for example, requiring that all work be conducted within a biosafety cabinet. • Personal Protective Equipment (PPE) – for example, requiring researchers to wear a respirator for their research. • Work Practices – for example, working safely and consistently to minimize exposure.

    Work practices are among the most critical controls for the containment of biohazards. Aside from performing all work with biohazards within a fully encapsulated glove box, even the most well-constructed laboratory facilities and state of the art containment equipment require trained and proficient operators to ensure that biosafety is followed. Also, work practices are the most inexpensive component of biosafety and can be taught and practiced anywhere.

Seven Basic Work Practices in Biosafety

    Biosafety research through the years has identified the foundational work practices needed to protect workers from exposure to biohazards. Adapted from the National Research Council (1989), these have been reduced to seven basic work practices and serve as the starting point for any risk management biosafety plan to protect workers. The practices are listed below (but are not limited to the seven listed).

        Do not eat, drink, or smoke in the laboratory. Do not store food in the laboratory. Keep your hands away from your face (avoid touching eyes, nose, or mouth with gloved hands).
        Do not pipette liquids by mouth.
        Wear personal protective clothing in the laboratory (such as lab coats, gloves, and face protection when splash or splatter is anticipated).
        Minimize or eliminate (if possible) the use of sharp instruments. If required, work very carefully with sharps.
        Work carefully to minimize the potential for aerosol formation. Confine aerosols as close as possible to their source of generation (in other words, by use of a biosafety cabinet).
        Disinfect work surfaces and equipment after use.
        Wash hands after removing gloves and protective clothing, after contact with contaminated materials, and before leaving the laboratory.

    These basic work practices serve as a platform from which to build a solid set of precautions (or risk management plan) to protect workers. They are discussed as independent categories, but in reality, work practices are intertwined with each other for effective biocontainment. For example, protective clothing is put on to protect workers from contamination; biohazards are handled with care to avoid spills, contamination, and exposures; work surfaces and equipment are disinfected after use and at the end of experiments to ensure that the work area is clean for the next person; and individuals remove their protective clothing and wash their hands when work has been completed. The remainder of this module provides an overview of each of these important work practices and how collectively they manage the risk to those handling biohazards.

Good Biosafety and Microbiological Work Practices (General)

    The rationale for each work practice is provided below.

    • Do not eat, drink, or smoke in the laboratory. • Do not pipette liquids by mouth. • Wash hands after removing PPE, before leaving the laboratory, and before leaving the restroom.

    Eating, drinking, or smoking in the laboratory must be prohibited for obvious reasons. Food and drink can become contaminated in numerous ways by multiple hazards. Mouth pipetting also can lead to exposure via ingestion, contamination of the hands and indirect transfer to the eyes, nose, or mouth; direct contamination of the eyes, nose, or mouth with droplets; and inhalation of aerosols. As such, mouth pipetting should not be allowed in the laboratory under any circumstance.

    • Never apply cosmetics, handle contact lenses, or store food in the laboratory. • Keep hands away from your face while working in the laboratory.

    As mentioned above, it is important to practice good hygiene while working with biohazards in the laboratory. Workers must have constant awareness of what they are working with, what is contaminated, and avoid situations that may involve direct or indirect transfer of contaminants into their body via the eyes, nose, or mouth. Strict adherence to wearing safety glasses or other forms of face protection can aid in this effort, serving as a stop sign against inadvertent glove to face contact.

    A recent research study (Johnston et al. 2014) counted the number of times that microbiologists touched their face, specifically their eyes, nose, and mouth while working. The study identified that researchers touched their face an average of 2.6 times per observation period. These researchers were working with human pathogens that could enter their bodies through the eyes, nose, and mouth. None of the researchers were wearing safety glasses or other face protection during the course of the study.

    • Keep pets out of the laboratory. • Report insect and pest problems.

    Animals and plants not associated with the research must not be allowed in the laboratory. Pets can serve as a source of contamination within the laboratory and disrupt research. Pets may also be harmed from other hazards present in the laboratory. Promptly report the presence or evidence of any pests within the laboratory to have professionals investigate and eliminate the source.

    Decontaminate work surfaces and equipment after use with an appropriate disinfectant.

    Ensure that equipment is decontaminated before moving it out of the laboratory, discarding, and prior to repair or service. Service vendors who are not familiar with biohazards may be placed at risk if equipment is not appropriately disinfected prior to handling.

    Work surfaces can be protected with plastic-backed absorbent matting. These bench pads should be discarded following contamination and changed between experiments. The work surface below the bench pad should also be disinfected after use and removal.

    Researchers must know which disinfectants inactivate the specific biohazards used in their laboratory. Solutions of the effective disinfectant should be present in the laboratory at the bench and also within the biosafety cabinet in the concentrations that are effective against the biohazards used. Researchers must be aware of the shelf-life of disinfectant solutions and change them periodically to ensure sufficient concentration.

Tragic Breakdown of Good Work Practices
Hand Washing

    Hand washing is the single most important personal hygiene measure in the laboratory. Hands should be washed well with soap and water for 25 to 30 seconds (ten seconds each of rinse, lather, and rinse) at each of the following times (at a minimum):

    o After removing gloves and PPE o Before leaving the laboratory o Before eating, drinking, smoking, or applying cosmetics o After using the restroom

    Ensure that all hand washing stations are equipped with an adequate supply of soap and disposable paper towels. Never use food-preparation areas or kitchens to wash your hands. Always use a laboratory, utility, or bathroom sink. In areas that do not have running water, antiseptic wipes or gels can be used to pre-wash hands. Employees must follow-up by washing their hands at a sink with running water as soon as feasible after using the antiseptic wipes or gels.

The Case of the Contaminated Sink
Personal Protective Equipment (Wear Protective Clothing in the Laboratory)

    PPE is the last line of defense between the biohazard and the individual worker. Work practices are again interrelated with PPE, as workers must be trained in the proper selection, fit, use, donning, and removal of all protective clothing assigned to them. PPE used in the research laboratory includes, but is not limited to, gloves, lab coats or gowns, face and eye protection, and where applicable, respiratory protection for high risk experiments (such as work with Risk Group 3 and higher biohazards). Basic work practices associated with PPE include:

        Wear PPE inside the laboratory to block potential exposure to biohazards.
        Never wear PPE outside the laboratory; never wear PPE to non-laboratory areas (such as libraries, cafeterias and office areas).
        Use gloves to prevent contamination of hands.
        Wear a full face shield or safety glasses and mask to protect the eyes, nose, and mouth when the potential for splash or splatter of biohazards or other hazardous materials exists.
        Wear lab coats or gowns to cover personal clothing.
        Ensure that the wrists are adequately covered with gloves that fit over the cuff of the lab coat or use a lab coat with a banded cuff to minimize wrist contamination.
        Change gloves and protective clothing as soon as feasible or after they are contaminated to prevent spread of biohazards, or to prevent cross-contamination within the laboratory.
        Change gloves often as glove membrane integrity diminishes with use and time (regular use of gloves stretches the membranes, which can increase the leak rate).
        Remove gloves in a manner that does not contaminate bare skin (by grabbing the glove near the base and removing it inside out, then with the now bare hand, slide one finger under the glove opening and lift to remove inside out also).
        Always wash hands with soap and water after removing PPE and before leaving the laboratory.

    PPE is covered in detail within the CITI Program module Risk Management: Personal Protective Equipment.

Safe Pipetting Work Practices

    Although not considered to be associated with the same potential release of aerosols as some of the high-speed equipment used in the laboratory, improper pipetting can lead to aerosol formation and dissemination. As this practice is routinely utilized in the laboratory and performed multiple times daily, it is important for all researchers to understand the basic principles associated with containment of aerosols during pipetting. These are detailed below.

        Perform pipetting operations inside a biological safety cabinet when working with biohazards.
        Never mouth pipette.
        Use "mark to mark" pipettes that do not require the forcible expulsion of the final drop from the pipette, which can generate more aerosols.
        Never blow out the last drop from a pipette as this practice can generate a significant amount of smaller aerosols that can create an inhalation risk.
        Use filtered pipettes and pipette tips to protect mechanical pipettes from contamination with aerosols.
        Avoid mixing liquids by alternate suction and expulsion from the pipette as this procedure generates more aerosols.
        If practical, work above a plastic-backed absorbent pad to minimize aerosol formation from any liquid dropped from the pipette during work.
        When transferring liquids into a container, discharge the contents as close as possible to the side wall or fluid level to minimize the potential formation of aerosols. (Dropping liquids from a height to a surface or to another liquid is associated with the formation of aerosols, droplets, and splatter).
        If using a vacuum source for aspiration of liquids, protect the vacuum source from contamination by using a collection and overflow flask, protected by a HEPA or hydrophobic filter to block aerosols from contaminating the vacuum source.
        Collect used contaminated pipettes within the biological safety cabinet inside a horizontal collection tray that allows total immersion of the pipette within disinfectant. In order to "decontaminate" the interior of the pipette, researchers may have to draw disinfectant up the interior of the pipette and then release into the horizontal collection tray. Waste should sit inside an appropriate disinfectant for at least ten minutes to be considered inactivated.

Miscellaneous Biosafety Work Practices
Labels

        Post a biohazard sign at the entry to the laboratory when biohazards are stored or used inside.
        Ensure that the specific entry requirements (such as vaccination and PPE requirements), name of the agent, biosafety Level, and name of an emergency contact person are posted on the biohazard sign.
        Label equipment housing the agent (incubators, freezers) with the universal biohazard symbol and biohazard identity (where applicable).
        Ensure that all transport containers used to safely move biohazards from one location to another are labeled with the universal biohazard label, the identity of the biohazard, and contact information for the laboratory.

Transport of Biohazards

    The following information only applies to the transport of biohazards within laboratories at one organization (within the building or hand carried between buildings). It does not apply to transport of biohazards in commerce. More information regarding shipping regulated biohazards is provided in CITI Program’s Research and HIPAA Privacy Protections module. Follow these procedures when transporting biohazards between laboratories within an organization:

        Use two leak proof containers, including a sealed primary container and a sealed secondary container.
        Absorbent (paper towels) between the primary and secondary containers suitable for the volume transported.
        A biohazard sticker on outside of the secondary container with agent name, laboratory address, and phone number.
        Utilize plastic containers whenever feasible and avoid glass.
        Sealed plastic (not glass) primary vials can be transported within sealed, labeled plastic bags.
        If glass primary containers must be used, place containers within a sealed rigid plastic container with absorbent and padding to cushion vials during transport.
        Before transporting biohazards outside the organization, ensure that the appropriate classification has been conducted according to the Department of Transportation (DOT) and/or the International Air Transport Association (IATA). The individual who packages and ships biohazards must also be appropriately trained. State regulations govern how biomedical waste must be transported. Follow organizational rules to ensure compliance.

Biomedical Waste

        Ensure that all waste containers are labeled with the biohazard symbol, or are red or orange in color.
        Keep biological waste bags off the floor; use stands to hold biological waste bags when possible.
        Replace waste containers when they are two-thirds (2/3) to three-quarters (3/4) full (do not allow containers to overflow).
        Transport biomedical waste to autoclaves or waste collection locations in covered leak-proof containers.
        Treat liquid waste with ten percent household bleach or other applicable disinfectant for at least 30 minutes. Ensure that your method of inactivation is in conformity with state and local regulations. Some states require 15 to 20 percent or higher concentrations for the inactivation of liquid wastes. Follow the requirements assigned by the state or municipality.

Administrative Control Practices in Biosafety

        Establish safety policies (such as a written set of standard operating procedures or a site-specific biosafety manual).
        Restrict access to laboratory to those involved with the research protocol.
        Ensure training for all who work with hazards.
        Advise all workers of any special hazards.
        Provide initial biosafety training to workers before they handle biohazards and ensure that periodic updates are provided while they are working in the laboratory.
        Ensure that all workers demonstrate proficiency with procedures before allowing them to work independently with biohazards.
        Remind workers to report all incidents, accidents, or inappropriate procedures identified in the laboratory to the PI, laboratory supervisor, and biosafety office.
        Remind workers to report immunosuppressive condition, compromised skin, and any changes in their health status to the employee health office and PI.
        Ensure that workers report any signs and symptoms related to the biohazard under study to the employee health office and PI.
        Remind staff that any new procedures involving biohazards must be evaluated for risk and approved by the biosafety office before initiation. These new experiments must never be initiated without authorization.

Summary

    This module reviewed foundational biosafety work practices along with more extensive biosafety work practices in a wide variety of settings and applications. Very detailed descriptions of these applications, such as safe transport, pipetting, and work practices associated with the use of PPE were provided.

References

        Johnston, James, Dennis Eggett, Michele J. Johnson, and James C. Reading. 2014. “The Influence of Risk Perception on Biosafety Level-2 Laboratory Workers’ Hand-To-Face Contact Behaviors.” Journal of Occupational and Environmental Hygiene 11(9):625-32.

        National Cancer Institute (NCI) Office of Research Safety, National Institutes of Health (NIH) Special Committee of Safety and Health Experts, and National Institutes of Health (NIH). 1978. Laboratory Safety Monograph: A Supplement to the NIH Guidelines for Recombinant DNA Research. Bethesda, MD: National Institutes of Health.

        National Research Council, Committee on Hazardous Biological Substances in the Laboratory. 1989. Biosafety in the Laboratory: Prudent Practices for the Handling and Disposal of Infectious Materials. Washington, D.C.: National Academy Press.

        Wilson, Deborah E., and L. Casey Chosewood, eds. 2009. Biosafety in Microbiological and Biomedical Laboratories, 5th Edition. Washington, D.C.: U.S. Government Printing Office.

Original Release: February 2010
Last Updated: December 2018

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