UNIT 4 synovial fluid, pleural fluid, peritoneal fluid,
pericardial fluid, and amniotic fluid.
SAFETY IN THE
MEDICAL TECHNOLOGY LABORATORY
A. BACKGROUND AND RATIONALE
The Medical Technologr program has established
sectionalized laboratories. Seven (7) laboratories are
furnished with equipment and apparatus that would be
exclusively used for Medical Technologr students. Each
laboratory is designed to include the laboratory safety
precautions, which are geared towards the attainment of
the following objectives;
t. To provide precautions in handling and processing
blood and body fluids,
2. To be awa-re of standard laboratory practices, and
3. To enhance skills in carrying out the techniques
in specimen preparations, handling, processing
and disposal.
B. SAFETY PRECAUTIONS IN IIANDLING BI.OOD
AI{D BODY FLUIDS
Uniuersal Precautions is an approach to infection
control where all human blood and certain human body
fluids are treated as if known to be infectious for HIV,
HBV, and other blood bome pathogens. The following
are highlights of the universal precautions for medical
technologr laboratories as set in the laboratory safety
manual:
1. Universal precautions should appiy to blood and
all body fluids containing visible blood, semen,
vaginal secretions, tissues, cerebrospinal fluid,
44
2. Hands should be washed immediately when
contaminated with blood or other bodily fluids,
after removing gloves, and after completing
laboratory activities.
3. Use of needles and syringes should be limited
to situations in which there is no alternative. If
used, needles should not be recapped, purposely
bent or broken by hand, removed from disposable
syringes, or otherwise manipuiated by hand.
After use, disposable syringes and needles,
scalpel blades, microscope slides, cover slips or
other sharp items should be placed in puncture
resistant containers for disposal; these containers
should be located as close as practical to the use
area. Reusable sharps should be placed in a
puncture-resistant container for safe transport to
the processing area.
4. Laboratory workers should use protective barriers
appropriate for the laboratory procedure and the
type and extent of exposure anticipated.
All specimens of blood should be put in a weli-
constructed container with a secure lid to orevent
leakage during transport.
6. Eating, drinking, smoking, applyrng cosmetics
or lip balm, and handling contact lenses are
prohibited in work a-reas where there is a
reasonable likelihood of occupational exposure.
7. Food and drink should not be kept in refrigerators,
freezers, shelves, cabinets or on countertops
or bench tops where blood or other potentially
infectious materials are present.
 8. Mechanical pipetting devices should be used in
the laboratory. Mouth-pipetting must not be
performed.
9. Laboratory work surfaces should be cleaned of
visible material and then decontaminated with
an appropriate chemical germicide after a blood
or bodily fluid spill and when work activities are
compieted.
10. Contaminated materials used in laboratory tests
should be decontaminated before reprocessing or
be placed in bags and disposed off in accordance
with institutional and regulatory policies for
disposal of infective waste.
11. Contaminated scientific equipment should be
clean and then decontaminated before repair in
the laboratory or transport to the manufacturer.
C. GENERAL LABORATORY PROTOCOL
1. Microbiology and Parasitology
. Universal Precautions shall be observed to
protect employees and students from contact
with potentially infectious blood or other bodv
fluids.
. Universal Precautions are appropriate for
preventing the spread of infectious disease and
shall be used regardless of whether bloodborne
pathogens are known to be present.
. Universal Precautions is an approach to
infection control. All human blood and certain
human body fluids are treated as if known to
be infectious for HIV, Hepatitis B virus (HBV),
Hepatitis C virus (HCV), and other bloodborne
pathogens.
46
Observe the following laboratory safety precautions:
1
I. Disposable gloves should be worn whenever one
expects to come into direct contact with blood,
other body fluids, or contaminated items or
surfaces. This applies to incidents including, but
not limited to, nosebleeds or cuts, or cleaning up
spills including the handling of clothes soiled by
blood or body fluids.
2. Hands and any other contacted skin surface
should be washed thoroughly for 15 to 30 seconds
with soap and warm running water, rinsed
under running water, and thoroughly dried with
disposable paper towels.
3. When running water is not available, antiseptic
hand cleanser and clean towels or antiseptic
towelettes should be used. The use of soap and
running water should be done as soon as feasible.
4. Surfaces and equipment contaminated with
blood shouid be cleaned with soap and water and
disinfected promptly with a fresh solution of bleach
(ten parts.water to one part bleach) prepared daiiy.
While cleaning, disposable gloves and towels
should be used whenever possible. Mops and
other non-disposable items are to be rinsed with a
disinfectant.
5. The Hepatitis B vaccination and vaccination series
shall be made available at no cost to all employees
who have occupational exposure.
6. The use of substitute less hazardous chemicals
like ethyl acetate for ether in ova and parasite
concentrates shouid be made when possible.
41
Standard Microbioiogical Practices
1. Access to the laboratory is limited or restricted
at the discretion of the laboratorydirector
when experiments or work with cultures and
specimens are in progress.
2. Laboratory users should wash their hands
after handling viable materials and animais,
after removing gloves, and before leaving the
laboratory.
3. Eating, drinking, smoking, handling contact
lenses, and applying cosmetics are not
permitted in the work areas where there is
reasonable likelihood of exposure to potentially
infectious materials.
4. All procedures are performed carefully to
rninimize the creation of splashes or aerosols.
5. Work surfaces are decontaminated at least
once a day and after any spill of viable materia_l.
6. All cultures, stocks, and other regulated
wastes are decontaminated before disposat by
an approved decontamination method, such as
autoclaving
Hematology
There are various precautions that must be taken
in handling reagents in the hematologr laboratory.
Among the most important items are the following:
Once a portion of a reagent has been removed
from the original container, it should never be
poured back because it can contaminate the
remaining reagent.
48
2. Reagents are preferably stored in alphabetical
order on shelvingprotected from dust, moisture,
and direct sunlight. A reagent that cannot be
clearly identified from the label on its container
should be discarded.
3. The label of the reagent should always be read
before it is dispensed
4. When working with newly prepared reagents,
especially stains, whether or not the desired
results are obtained their accuracy should be
ascertained. Unsatisfactory solutions should
be discarded and replaced.
5. All mixing containers, stirring rods, and
containers used for storage of reagents should
be chemically cleaned prior to use.
6. During mixing and preparation, it is good
practice to prevent reagents from getting in
contact with metals. Many reagents contain
substances that react chemically with metals
and produce changes that will render them
unusable for laboratory work.
7. Inexperienced personnel should not be allowed
to prepare reagents without close supervision.
8. Certain reagents are poisonous, and adequate
precautions shouid be taken to prevent
accidental poisoning. A11 highly toxic reagents
should be conspicuously labeled "POISON" and
should be stored in a separate cabinet in the
laboratory.
9. Commercial reagents should be checked with
standards for purity. All lot numbers must be
recorded in case a reagent is not pure.
10. All new reagents must be tested to assure that
proper results are attainable.
49
 I l. Mersks and protective eyewear or face shields
should be worn if mucous membrane contact
with blood or bodily fluids is anticipated; i.e.
removing tubes from the hematocrit centrifuge.
Histopathology and Cytology
All specimens received must be handred in accordance
with the following guidelines:
1. All specimens are to be received in a closed
container or plastic bag with the appropriate
patient information attached.
2. A11 tissues for a pathological examination,
dissection, sectioning, and gross description
should be placed in one of the four provided
exhausted cutting stations before rimoving
them from the container and before starting an!
of the mentioned procedures.
3. All cytologr specimens are opened and processed
under the histopathologr safety hood.
4. The cryostats used for frozen section should be
cleaned and disinfected with 95% Ethyl Alcohol.
5. The four cutting stations should be rinsed and
cleaned of bloody fluids and tissue debris in
between cases as the need arises.
6. The cutting stations should be cleaned
thoroughly at least once a day with a2O%o bleach
aqueous solution with liquid hand soap added.
7. The comprehensive cleaning, which will
include other possibly contarninated areas of
the laboratories should be performed at the
beginning or at the end of each working day.
Heavily soiled contaminated. areas may requiie
more frequent cleaning.
8. A11 sharps including scalpels tissue blades,
needles and discarded glass slides are to be
disposed off in a suitable bioL-:.azard marked
sharps container,
9. All disposable gloves, paper towels, empty
specimen containers and personal safety
equipment should be disposed
in a biohazard,
red plastic bag for incineration.
10. Al1 linen soiled with blood and body fluids are
washable. Personal safety apparel should be
placed in a biohazard container marked as
"Linens hamper for laundering',.
[1. leaving the laboratories, all
lnon
should remove,
personnel
store and dispose off all
personal safety equipment in the appropriate
fashion. Lightly soiled fluid and impermeable
nylgn surgical gowns may be stored upon exit
and reused upon return to the laboratories.
12. Ali cutting ifistruments, forceps, rulers and
applicable dissecting equipments should be
washed in a 2Ooh aqueous bleach solution with
liquid hand soap, dried and stored in a dry
state until further use. Frequent debridemeht
and rinsing of dissecting equipment is
encouraged throughout the day to prevent cross
contamination of surgical specimens as dictated
by good laboratory personnel practice.
Clinical Chemistry
1. All laboratory workers should take precautions
to prevent injuries caused by needles, scalpels,
and other sharp instruments or devices during
procedures; when cleaning sharp instrumentsl
during disposal of used needles, and when
handling sharp instrument after doing the
procedures.
51
 2. To prevent needlestick injuries, needles
should not be recapped and purposely bent or
broken by hand, and removed from disposable
syringes. Needles, scalpel blades, and other
sharp items should be placed in puncture-
resistant containers for disposal.
3. The puncture resistant containers should be
located as close as practical to the phlebotomy
area. Large bore reusable needles should be
placed in a puncture resistant container before
it can be transported to the reprocessing
area.
A
a. Disposable pipets, swabs, and other disposable
objects should be placed into rigid cardboard
containers before disposal.
5. Broken glasses are placed in thick boxes lined
with plastic biohazard bags, when full, the bag
is incinerated or autoclaved.
6. Analytical balances should not be used for
weighing out Sodium Hydroxide and potassium
Hydroxides.
Blood Banking
This section shall include, but need not be limited to
the following items:
-l
Hand washing protocol should be observed.
2. Require that all items used in blood banking,
which are disposed of and which can cut
or puncture the skin, should be placed in
containers which are impervious to the flow
of liquids, rigid to prevent the container from
collapsing when handled in the blood bank,
and puncture proof to prevent needles from
penetrating the container.
52
3. Require all blood letting and collection devices
to be both sterile and disoosable.
4. A11 laboratory workers should routinely use
appropriate barrier precautions to prevent skin
and mucous membrane exposure when contact
with blood or other body fluids of any patients
are anticipated.
5. Gloves should be worn for touching blood and
body fluids, for handling items or surfaces
soiled with blood and body fluids, and for
performing venipuncture.
Clinical Microscopy
1. Laboratory workers who have exudative lesions
or weeping dermatitis should refrain from all
direct patient care and from handling patient
care equipment until the condition resolves.
2. All specimens of body fluids should be put
in a weli constructed container with a secure
lid to prevent leaking during transport. Care
should be taken when collecting each specimen
to avoid contaminating the container and the
laboratory workers.
3. Recognizable human anatomical remains or
tissues and large tissues must be disposed of
by incineration.
4. Unrecognizable human tissues can be
autociaved and disposed of as described under
"Non-liquid waste and items contaminated with
blood/body fluids". If the tissues have been
chemically preserved, the tissue should be
removed from the chemical prior to autoclaving.
The chemical wouid then be disposed of as
chemical hazardous waste.
53
qF-
5. Homogenizers and blenders must not be used
r
in conjunction with bacterial cultures without
adequate precautions against the spread of air-
borne contamination.
6. Autoclave or otherwise disinfect contaminated
items such as glassware, animal cages and
laboratory equipment before washing, re-using,
or discarding.
7. Nothing containing living micro-organisms or
tissue cultures should be directly poured down
the sink.
B. Microscope slides and cover slips must be
discarded into jars of disinfection solution,
separating the cover slips first from the slides.
D. COLLECTION OF BIOHAZARD WASTE
The methods in collecting biohazard waste are shown
below. Three (3) items to be collected, include the
following:
1. Contaminated Sharps. These contaminated
sharps can be in the form of:
I razor blades
) scalpels
F lancets
) syringes with/without needies
> slide covers, and
> specimen tubes
Sharps are collected directly into one gallon metal cans
available. Metal cans used to collect sharps contaminated
under the definition of biohazard waste must bear the
biohazard syrnbol marked with an ,,x,,, using autoclave
indicator tape. To avoid accidents related to overfilling the
c€ms, remove the cans for decontamination or disposal
54
when they are 213 fuII. Cans of contaminated sherps arc
to be autociaved. After autoclaving, containers of sh:tr1ls
are disposed of in a cardboard box lined with a pl:rsticr
bag, clearly marked with the "GLASS AND SHARPS"
label.
2. Research LablClinic Pipette
For large-scale collection of glass (Pasteur) and plastic:
pipettes contaminated under the definition of biohazarcl
waste, line a puncture, resistant outer container (such
as the package or pipette) bearing the biohazard symbol
marked with a heat sensitive autoclave tape "x'. To
avoid handling a bag full of pipettes, the indicator tapc:
"x" should be placed over the bag's biohazard syrnbol
prior to loading the bag with pipettes.
3. Contaminated Solids
Biohazard soiids consist of:
) culture dishes. flasks.
> Petri dishes,
> solid waste cuitures/stocks from the testing ancl
production of biological, gloves, gowrrs, masks,
and
> other solid material potentially contaminatecl
under the definition of biohaza:rd waste.
Waste bags with universal biohazard syrnbols are to brr
used only forbiohazard waste, which must be autoclave cl
before disposal. Before lining the collection contarners
with an orange biohazard bag, the bag's biohazartl
syrnbol and/or markings must be crisscrossed with
heat sensitive autoclave tape.
55
4. Liquids UNIT 5

Even though the rules and definitions for liquid biohazard CONCLUDING INFORMATION
waste vary somewhat from solid waste procedures,
autoclaving is the method of choice for disinfection of
the following:
A. BACKGROUND AND RATIONALE

Liquid human blood This section contains added information to conclude

the level of awareness on laboratory safetyprecautions.
Animal blood/body fluids from infected animals It is also aimed to meet the following objectives:

1. To be used as guide to toxicity and

carcinogenicity of chemicals,

2. To identify the flammable materials and

generated biohazard materials, and
tissue cultures
3. To conflrm and testifv the letter of safety
Autoclaved liquid wastes should be discharged directly agreement.
in the sanitary sewer.
B. TOXICITY AND CARCINOGENICITY
OF CHEMICALS

It is not often easy to predict which classes of chemicals

are going to be toxic or carcinogenic, and which are
not. There are some generalizations, however, that are
possible. The following classes of chemicals have been
found to be acute and chronic toxins and extra care
should be taken when working with them.

Acute toxins

Halogens (bromine, chlorine, fluorine, iodine)

are toxic.

Rapid acting toxins such as cyanides and

nitriles (CN groups), hear,y metals (arsenic,
cadmium, mercury, etc.) are well known toxins,
some acute, others chronic.

56 51
 Disinfectants - The following table lists a descriptiorr
Chronic toxins of commonly used disinfectants:

. hear,y metals (arsenic, cadmium, mercury, Table 1

etc.) are weli known toxins, some acute, others Description of Disinfectants
chronic.
Substance Description
Carcinogens
l.Alcohols Ethyl or isopropyl alcohols
. Alkylating agents (alpha-halo ethers; sulfonates;
at 7O-BO'/, concentratiot'l
are good general purpose
epoxides; electrophilic alkenes and alkynes) disinfectants, but are nol
effective against bacterial
. Acylating agents SDOTES

2.Quarternary ammonium Cationic detergents are

. Organohalogencompounds compounds strongly surface-active and
extremely effective against
. Hydrazines lipovirus, but not effective
against gram negative or-
. N-nitroso compounds ganisms and can be neu-
tralized by anionic deter-
. gent soaps.
Aromatic amines
3. Chlorine Low concentrations of
. Aromatichydrocarbons 50-500 ppm are effective
against vegetative bacte-
. ria and most viruses. High
Natural products concentrations of 2500
ppm are required for bacte-
C. DECONTAMINATION OF MATERIAL rial spores. It is corrosiVe to
metal surfaces. It must be
Materials known or suspected to be contaminated freshly prepared. It is used
with an infectious agent must be sterilized by the as disinfectant in laundry
incenerator. In general, autoclaving is the most bleach with a concentration
effective and convenient form of sterilization. of 5.25%o.
4. Iodine It is recommended for
Wet Heat (Steamf - Also known as autoclaving, this general use. It is effective
method requires a chamber temperature of ai least against vegetative bacteri:r
250'F (121'C). The processing time begins when the and viruses. It is not quite
effective against bacterial
materials being sterilized reach the predetermined spores. Betadine, a deriva
temperature. The steam sterilization effectiveness tive form, is used as a goo<l
should be monitored with an approved biological disinfectant for hand wasll
indicator. The sign "Autoclave Usage For Safety and ing.
Quality Control" should be posted near each autoclave
in use.

58 59
 -F
D. DEFINING LABORATORY-GENERATED
BIOI{AZARD WASTE heat retained from production, or which, if ignitccl,
produces a serious transportation hazard.
A11 biohazard waste inciudes:
These deflnitions are based on the flammabilty
. Materials contaminated or potentially contami_ characteristics of the material, specifically the flash
nated during the manipulation or clean-up of point.
material generated during research md/or
teaching Table 2
Flash and Boiling Points of Liquid Chemicals
. Human blood and body fluids
Classification Term Flash Point Examples
Human tissue and anatomical remains and Boiling
Point {O F)

Materials contaminated with human tissue or Class 1A Flammable Below 73 but Ethyl ether,
boils below Acetaldehyde,
tissue cultures 100 F Methyl
fnrma te
Animal carcasses, body parts, blood, fluids and Pentane
bedding from anima_ls infected Class I B Flammable Below 73 but Acetone,
boils above Benzene,
E. CLASSES OF FLAMMABLE MATERIALS 100 F Carbon
disulflde,
Ethanol, and
Any substance that can burn is considered Toluene
combustible. This includes common materials found
Class I C Flammable Below 73 but Xylene, Butyl
in the laboratory, which are not often thought of as boils below alcohol, and
hazards, such as paper towels, stacks ofjournals and 100 F Amyl acetate
notebooks, as well as chemicals that are stored. Efforts Class II Combustible At or above Glacial acetic
must be exerted to avoid situations where these items 100 F acid, Formal-
might become involved in or contribute to a fire. dehyde, and
Hydrazine
C_ombustible liquid is any liquid having a flash point
above 1000F (3s0c) and below 2000F (93nC). Class III A Combustible At or above Naphthalene
140 F and Octyl
alcohol
Flammable gas is a compressed gas that satisfies the
Class IIIB Combustibie At or above Glycerine,
criteria for flame projection, lower flammabilitv lir.nit and Propylent:
2oo F (930 C)
and flammability range. glycol

Flammabts liquid is any liquid having a flash point

below 1000F (3BoC).

Flammable solid is a non-explosive material that

is capable of producing fire ." r ,."rrlt of friction.

60
61
<
Cierreral Chemistry (2OOg). Chemistry Laboratory
Regulation and" safetg precautions. Retrieved APPENDIX A
from
Chemistry laboratory safety website: http:
l,lnvw. PROTOCOL FOR LABORATORY WORKERS
sciencebyjone com. / safety rules. htm.
PROTECTION
General Laboratory Safety (2OOg). Resea"rch
Safetg at
Northwestern [Jniuerslfy. Retrieved from
Nortfr."[r., PART 1: HEPATITIS B EXPOSURE
University web site : wwwrs / lab safe cb sl cb
/ / sl5. htm
Hepatitis B immune Globulin is now available to thosc
High School Chemistry Laboratory Safety Guide laboratory employees and students, who accidentally
QOO9), Infectious Disesase. Retrieved from Center come into contact with a patient's biood confirmctl
for Disease Control website: http:/ www: maexam. positive with Hepatitis B Virus' Examples of common
com/clin_skills.htm laboratory accidents which may qualify one for
protection with Hepatitis B Immune Globulin include:
Laboratory Safety (2OOg) Biotogg Laboratory
Safety
Guide line s. Retrieved fr om
swe eidri* c oll e ge"weu . Accidentai needle stick
www. biolo gr. sb c. e du h an db o ok I ab "ite, . Direct mucous membrane contact (mouth/nose/
/ / s afety. il tm

eye)
Laboratory safety (2oog) Heatth Hazard Data . Oral ingestion (pipetting accident)
and.
Precaution's. Retrieved from Fire and . Open wound contact (accidental splash)
safety precautions
web sit. www. ivis. org/ advances feldman . Cut fi.nger (from blood contaminated tube)
/ / ch ap 4 / htrnl.
Laboratory Safetl for Schools (2OOg) Laboratory
Prouides Time and, Gui.ance if one has such an accident involving blood, plasma or
for Siud,e;"7;-;r;;;';"
the Safetg precautions. Retrieved from School serum from a SPECIFIC IDENTIFIABLE PATIENT, he
Website: http: /ww.carnegieinstitution.
Safety should report immediately to his supervisor. If testing
org/fi.st_hghi_ for HBV has not been done on this patient, a bloocl
case/horn/labsafety.htm.
specimen is to be obtained from the patient and sent
Phlebotomy (Online Course) (2OOg). Appropriate to the SeroloS' Laboratory to be tested. If the results
Precautions, includ.ing the lieed.testick are negative, no further action will be taken except
S"y"ti i"a
Retrieved from the laboratory panels or profiles to inform the employee or student and to send thc
website: http:/www.medialabinc.net/phlebotomy. report to Human Resource or department concerncd
aspx.html. as the case may be. If the result is positive, tl-tt:
Laboratory Director will consult the Employee Heerltl-r
WHO Laboratory BloslfetV Manua_l (2OOg). or University Medical Clinic so that arrangements cittr
Laboratory
Biosafetg Manual. Retrieved from IggT be made for the employee or student to receive two
Publication Safety in Health_Care website: WHO injections of Hepatitis B Immune Globulin; the first
http:/
:y* yho . int I csr / re sourc es / publicatiorr" 7 bio safeiy/ within 7 days of exposure, the second within 2tJ-ll0
BiosafetyT.pdf days of exposure

68 69
 *f
PART 2: HEPATITIS C EXPOSURE
Health-care professionals who provide care to persons
exposed to HCV in the occupational setting should be
knowledgeable regarding the risk for HCV infection
and appropriate counseling, testing, and medical
follow-up
UNIVERSAL (STANDARD) BLOOD AND BODY FLUIDS
PRECAUTIONS are to be used in the care of ALL
patients, especially including those in emergency-care
settings where the risk of blood exposure is increased
and the infection status of the patient is usually
unknown.
IG and antiviral agents are not recommended for
previously exposed patients after exposure to HCV-
positive blood. In addition, no guidelines exist for
administration of therapy during the acute phase of
HCV infection. However, limited data indicate that
antiviral therapy might be beneflcial when started early
in the course of HCV infection. When HCV infection
is identifled early, the person should be referred for
medical management to a specialist in this area.
Testing for HCV
. For the source, testing for anti-HCV should be
performed.
. For the person exposed to an HCV-positive
source, the baseline testing for anti-HCV and
ALT activity should be performed, and follow-
up testing, e.9., at 4--6 months) for anti-HCV
and ALT, should be performed.
. If earlier diagnosis of HCV infection is desired,
testing for HCV RNA may be performed at 4--6
weeks.
10
. All anti-HCV results rep<lrtcrl Posttttrt'ttttt:ll
be confirmed by enzymc illltttttll()ilsi:i;lv
using supplemental anti-HCV testrrrg, ('lf, '
Ml)'
recombinant immunoblot assay IRIBAI
Counseling for Health Care Professionals Exposed
to Viral Hepatitis
Health Care Professionals exposed to HBV- or
HCV-infected blood do not need to take any special
precautions to prevent secondary transmission during
the follow-up period; however, they should refrain
from donating blood, plasma, organs, tissue, or
semen. The exposed person does not need to modify
sexual practices or refrain from becoming pregnant'
If an exposed woman is breast feeding, she does not
need to discontinue.
No modiflcations to an exposed person's patient-care
responsibilities are necessary to prevent transmission
to patients based solely on exposure to HBV- or
HCV- positive blood. If exposed persons become
acutely infected with HBV, they should be evaluated
according to published recommendations for
infected. HCV. No recommendations exist regarding
restricting the professional activities of Health Care
Practitioners with HCV infection. As recommended
for all HCP, those who are chronically infected with
HBV or HCV should follow all recommended infection-
control practices, including standard precautions and
appropriate use of hand washing, protective barriers,
and care in the use and disposal of needles and other
sharp instruments.
1l
 PART 3: ACQUIRED
TMMUNODEFICIENCY SYNDROME (ArDS)
Human immunodeficiency virus (HIV), the virus that
causes acquired immunodeficiency syndrome, is
transmitted through sexual contact and exposure to
infected blood or blood components and perinatally
from mother to neonate. Epidemiologic evidence has
implicated only blood, semen, vaginal secretions, and
possible breast milk in transmission.
The increasing prevalence of HIV increases the risk
that laboratory workers will be exposed to blood from
patients infected with HIV, especially when blood and
body fluid precautions are not followed for all patients.
An increasing emphasis for health-care workers tr_r
consider ALL patients as potentially infected with
HIV and/or other blood-borne pathogens and to
adhere vigorously to infection-control precautions for
minimizing the risk of exposure to blood and body
fluids of all patients.
MANAGEMENT OF POSSIBLE EXPOSURE TO HTV.
If a laboratory worker has a parenteral or mucous_
membrane exposure to blood or other body fluids or
has a cutaneous exposure involving large amounts
of blood, the laboratory worker should be counseled
regarding the risk of infection and evaluated clinically
and serologically for evidence of HIV infection as
soon as possible after the exposure. The laboratory
worker should seek medical evaluation for any acute
febrile illness that occurs within 12 weeks after the
exposure, particularly one characterized by fever,
rash, or lymphadenopathy. Seronegative persons
should be retested 6 weeks post exposure and on a
periodic basis thereafter (e.g.,12 weeks and 6 months
after exposure) to determine whether transmission
has occurred.
72
PART 4z TUBERCULOSIS EXPOSURE CONTROL
PLAN (Pathology and Clinical Laboratory Services)
I. Objective
To reduce the risk of infection (especially to personnel)
in an area where all specimens are potentially
infectious (Mycobacterium tuberculosis (TB) and
fungal specimens, through the proper use of equipment
and techniques designed for that purpose.
II. Personnel Requirements
A. Health:
1. Laboratory personnel must fulfill all pre-
employment and annual health requirements
of the University Health Service. This includes
required testing and I or immunizations.
2. Tuberculin skin Test (PPD): A11 iaboratory
personnel employees) are required to have
(a11
an annual tuberculin skin test. Employees with
a history of a positive PPD are required to be
screened annually by University Health Services.
Individuals who have a "positive" screening will be
referred to University Health Services for further
evaluation and treatment, if necessary.
. If an exposed empioyee has had a negative
skin test in the past, it should be recheck
immediately and again B weeks after exposure.
If an employee has ahistoryof Bacillus Calmette-
Guerin (BCG) immunization or positive skin
test, chest x-ray may be done in B weeks.
-a
IJ
T
B. Orientation and Instruction
Standard precautions include:
All new employees are required to have a post a. B:rrrier techniques should be used to prevent
empioyment examination to include a tuberculin
skin test. A11 employees with a positive reaction will
skin or mucous membrane exposure.
depending upon the procedure: gloves,
be referred to the University Health Services.
gowns, masks, andf or protective eyewear may
be required
III. General Infection Control Measures

A. Hand hygiene b. Hands should be cleaned with an antimicrobial

agent immediately if contamination with blood
or body fluids occurs.
Wearing of gloves does not replace the need for
hand hygiene. Hand hygiene is considered the 2. For personnel performing invasive procedures,
most important single procedure for preventing
speciflc recommendations call for routine use of
and controlling the spread of infection. proper appropriate barrier techniques to prevent skin and
hand hygiene has been shown to eliminate or mucous membrane contact with blood or other
greatly reduce hand carriage of pathogens. It
body fluids. Minimum precautions for invasive
therefore represents an important means of procedures include:
preventing cross infection between patients.
a. Gloves and surgica_l masks for all procedures
Healthcare workers must clean their hands which pose potential exposure.
with soap and water if they are visibly dirty or
contaminated with blood or other body fluids. b. Protective eyewear or face shields for procedures
if hands are not visibly soiled, an alcohol based that commonly result in the generation* of
hand cleaner may be used to decontaminate droplets and/or spiashing of blood or other
hands.
body fluids.
B. Universal (Standardf precautions
c. Household bleach (1 : 10 dilution) or a disinfect-
ant
STANDARD PRECAUTIONS (previously known
as Universal Precautions, The Exposure Control
Plan, should be used when caring for ALL patients,
especially in settings where the risk of blood exposure
is increased and the patient's antibody (HIV,HCV,
andf or HBV) status is unknown. All specimens are
handled with standard precautions.

74
75
 APPENDIX B
DEFINITION OF TERMS
Acid. This is a substance, which can dissociate into
one or more hydrogen ions and one or more negative
ions.
Aerobes. This is a minute organism, which may require
oxygen for growth.
AirborneTransmisslon. This is the process of spreading
pathogens farther than one meter in air from reservoii
to susceptible host.
Alcohol. This is an organic morecure with functionar
group, hydroxyl group (-OH).
Antimicrobial drug. This is a chemicar that destroys a
pathogen without damaging the body tissues.
Antiseptic. This is a chemical used as disinfectant of
the skin, mucous membrane or other living tissues.
Antitoxin. This is a specific antibody produced by the
body in response to a bacterial exotoxin or its toxoids.
Asepsls. This is a condition without contamination bv
unwanted organisms.
Attenuation. This is a process of lessening virulence of
a microbe.
Autoclaue. This is equipment used for steriiization
employing steam under pressure usually operated at
15 psi and 121 degree Celsius.
Bacteremia. This is a condition in which there are
bacteria in the blood.
76
Bacteria. This refers to all living organisms \Mith
prokaryotic ce1ls.
Bactericidal. This is an agent capable of killing bacteria.
Bacteriostatic. This is an agent capable of inhibiting
bacterial growth.
Base. This is a substance that dissociates into one or
more hydroxide ions and one or more cations.
Biohazards. This refers to biological haza;rdous waste
materials commonly encounter in the laboratory.
Biology. This is a field of study about living organisms.
Biological Transmission. This is the condition of
transmitting a pathogen from one host to another when
the pathogen reproduces in the vector.
Blood Borne pathogens. This refers to pathogens present
in the blood that usually cause diseases or infections.
Chemicals. This refers to substances commonly used
in the laboratory experiments which are either liquids
or solids, which may be toxic or non-toxic ingredients.
Chemical reactions. This refers to a process of making
or breaking bonds between atoms.
Contact Transmisslon. This is a condition of spreading
diseases by direct or indirect contact or via air droplets.
Contagious Dlsease. This is a disease that is easily
spread from one person to another.
Decontamination. This is a process of rendering an
object or area safe for unprotected people by removing
or making harmless by the use of biologic or chemical
agents.
77
Detergent This is any substance that reduces the
surface tension of water. As used in this manual, the
term refers to laundrv soaps.
Direct Contact. This term is a method of spreading
infection from one host to another through some kind
of close association of the hosts.
Disease. This is any change from a state of health.
Disinfectanf. This is aly substance used on inanimate
objects to kill or inhibit the growth of microbes
Electrical Safetg. This refers to the electrical safety
precautions that must be observed by the laboratory
workers.
Enteroinuasiue. This is an organism capable of invading
the human body's mucosal surface and sometimes
the deeper tissues of the bowel.
Fire Safety. This is the set of laboratory precautions
that must be observed by iaboratory workers to protect
themselves in case of fire.
species and other individuals of the sarne species.
Inuasiueness. This is the ability of microbes to establish
residence in a host.
Mechanical Transmission. This is a process by which
arthropods transmit infection by carrying pathogens
on their feet and other bodv parts.
Parasites. This is an organism that derives nutrients
from a living host .
Quaternary Ammonium Compound. This is a cation
detergent with four organic groups attached to central
nitrogen atoms used as a disinfectant.
Standard Precautions. This refers to infection control
guidelines that should be carried out in the University-
based laboratories..
Sterile. This is a condition free of microorganisms
Tincture of lodine. This is an alcoholic solution of
iodine.

FlashPoinf. This is the minimum temperature at which Toxigenicitg. This is the capacity of a microbe to
a liquid gives off vapor in sufficient concentrations to produce toxins.
allow the substance to ignite.

Fomites. This is a group of non-living objects that can

spread infection.

Gerrnicidal. This is an agent that destroys germs using

chemica-l disinfectant.

Infection. This is a condition where there is an

increasing number of microbes in the body.

Innate Resistance. This is a condition where an

individual is resistant to diseases that affect other

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