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Hematology

Emergency Procedures

The Hematology laboratory environment presents several potential safety emergencies, ranging from percutaneous injuries (needlesticks), mucous membrane exposures (splashes), chemical spills and exposures, to fires. Rapid and decisive action is crucial to minimize the potential harm to laboratory personnel and to contain the emergency before it escalates. All laboratory staff must be thoroughly trained in the proper response protocols and the location of emergency equipment

Percutaneous Injuries (Needlesticks & Cuts)

A percutaneous injury, involving a needle or sharp object breaking the skin, presents the most direct route for transmission of bloodborne pathogens like HIV, HBV, and HCV. Every laboratory must have a clearly defined protocol for immediate management and follow-up

  • Immediate First Aid: The initial response is the same regardless of the source patient’s known infection status
    1. Do not panic or squeeze the wound. This may increase exposure
    2. Wash the Wound: Immediately wash the wound thoroughly with soap and water. Antiseptic solutions (iodine, chlorhexidine) can be used but are secondary to mechanical washing
    3. Apply Gentle Pressure: If bleeding continues, apply gentle pressure with a clean gauze pad
  • Reporting the Incident: The incident must be reported to the supervisor immediately, even if the injury seems minor. This triggers the formal evaluation and documentation process
  • Documentation: An incident report must be completed. This will include:
    • Date, time, and location of the incident
    • Description of the device involved (needle type, lancet, broken glass)
    • Details of how the injury occurred
    • Depth of the injury
    • Source patient information (if known)
    • Vaccination status of the exposed employee
  • Source Patient Evaluation: Unless the source patient is known to be negative for HIV, HBV, and HCV, efforts must be made to test the source patient’s blood. Testing the source patient is crucial for determining the need for post-exposure prophylaxis (PEP) for the exposed employee. Note that in many jurisdictions, testing the source patient requires informed consent
  • Employee Evaluation and Treatment
    • Baseline Blood Draw: The exposed employee has blood drawn for baseline testing of HIV, HBV, and HCV antibodies. This establishes the employee’s pre-exposure status
    • Medical Consultation: The employee must be referred to a qualified healthcare professional for evaluation and risk assessment. This is typically an infectious disease specialist or employee health physician
    • Post-Exposure Prophylaxis (PEP): The decision to initiate PEP is based on several factors, including the risk assessment, the source patient’s infection status, and the time elapsed since the exposure. For HIV, PEP typically involves a 28-day course of antiretroviral medications started as soon as possible (ideally within hours) after exposure. For HBV, the employee will receive Hepatitis B Immune Globulin (HBIG) if they have not been vaccinated or have not responded to vaccination. There is currently no post-exposure prophylaxis for HCV, but early treatment is available if infection occurs
    • Follow-up Testing: The employee will undergo follow-up testing for HIV, HBV, and HCV at specific intervals (e.g., 6 weeks, 3 months, 6 months) to monitor for seroconversion (evidence of infection)

Splashes to Mucous Membranes (Eyes, Nose, Mouth)

Splashes of blood or body fluids to the eyes, nose, or mouth can result in infection if the material contains viable pathogens

  • Immediate First Aid
    1. Flush Immediately: Immediately flush the affected area with copious amounts of clean water or sterile saline. Eyewash stations should be readily accessible in the laboratory
    2. Eye Exposure: For eye splashes, use an eyewash station to irrigate the eyes for at least 15-20 minutes, holding the eyelids open to ensure thorough rinsing
    3. Nose/Mouth Exposure: For splashes to the nose or mouth, forcefully expel any liquid and rinse repeatedly with water. Do not swallow the fluid
  • Reporting and Documentation: As with needlesticks, the incident must be reported to the supervisor, and an incident report must be completed with relevant details
  • Source Patient and Employee Evaluation: The same procedures for source patient evaluation, employee evaluation, and post-exposure prophylaxis, as described for needlestick injuries, apply to mucous membrane exposures. The risk of infection is generally lower than with a percutaneous injury, but the potential consequences are the same, necessitating prompt action

Chemical Spills & Exposures

The Hematology laboratory utilizes a variety of chemical reagents, including Wright-Giemsa stain components (methanol), lysing agents, and cleaning solutions. Spills and exposures require specific response protocols based on the chemical involved

  • Spill Control
    1. Alert Others: Immediately alert others in the area about the spill
    2. Consult the SDS: Locate the Safety Data Sheet (SDS) for the chemical to determine the appropriate cleanup and first aid procedures. The SDS provides information on the chemical’s hazards, PPE requirements, and spill containment measures
    3. Don Appropriate PPE: Wear appropriate PPE, as indicated on the SDS, including gloves, eye protection, and a lab coat. If the spill involves a volatile chemical, respiratory protection may be necessary
    4. Contain the Spill: Use absorbent materials (paper towels, spill pillows, or commercial spill kits) to contain the spill and prevent it from spreading. For large spills, use spill control barriers to create a perimeter
    5. Neutralize (If Appropriate): Some chemicals can be neutralized before cleanup. For example, acids can be neutralized with sodium bicarbonate (baking soda). The SDS will provide guidance on neutralization
    6. Clean Up: Carefully clean up the spill, working from the outside towards the center to prevent further contamination. Dispose of the contaminated materials in accordance with laboratory waste disposal procedures
  • Skin and Eye Exposures
    • Skin Contact: Immediately flush the affected area with copious amounts of water for at least 15 minutes. Remove contaminated clothing while rinsing. Seek medical attention if irritation, burns, or other adverse effects occur
    • Eye Contact: Immediately flush the eyes with copious amounts of water using an eyewash station for at least 15-20 minutes, holding the eyelids open. Seek immediate medical attention
  • Inhalation: If a chemical is inhaled, move the exposed individual to fresh air immediately. Seek medical attention if breathing difficulties or other symptoms develop
  • Ingestion: If a chemical is ingested, do not induce vomiting unless directed to do so by a medical professional or the SDS. Seek immediate medical attention. Bring the SDS with you to the medical facility

Fire Emergencies

While the Hematology laboratory typically does not use open flames, flammable chemicals like methanol (Wright’s Stain) are frequently present. Fire prevention and response training are crucial

  • RACE Acronym: Remember the acronym RACE
    • Rescue: Remove anyone in immediate danger, if it is safe to do so
    • Alarm: Activate the fire alarm and notify emergency services (dial 911 or the facility’s emergency number)
    • Contain: Close doors and windows to contain the fire and prevent it from spreading
    • Extinguish/Evacuate: If the fire is small and contained, and you are trained to do so, attempt to extinguish it using a fire extinguisher. If the fire is large or spreading rapidly, evacuate the area immediately
  • PASS Acronym: To operate a fire extinguisher, remember the acronym PASS
    • Pull: Pull the pin on the fire extinguisher
    • Aim: Aim the nozzle at the base of the fire
    • Squeeze: Squeeze the handle to release the extinguishing agent
    • Sweep: Sweep the nozzle from side to side, covering the base of the fire
  • Evacuation Procedures: Know the laboratory’s evacuation routes and assembly points. Follow instructions from emergency personnel
  • Flammable Materials Storage: Store flammable chemicals in approved flammable storage cabinets. Limit the quantities of flammable materials in the laboratory to the minimum necessary for routine operations. Never store flammable materials near sources of ignition

General Considerations

  • Emergency Contact Information: Post emergency contact information (including the phone numbers for emergency services, the poison control center, and key laboratory personnel) in a prominent location
  • Regular Training: Conduct regular fire drills and safety training sessions to ensure that all laboratory staff are familiar with emergency procedures and the location of emergency equipment. Document all training activities
  • Equipment Inspection: Regularly inspect emergency equipment (eyewash stations, fire extinguishers, spill kits) to ensure they are in good working order and readily accessible
  • AED Location: Know the location of the nearest Automated External Defibrillator (AED) in case of cardiac arrest and be trained in its proper use