The Lab Safety Gurus
Discover the secrets to enhancing laboratory safety without the hassle of navigating complex regulations and modifying established practices.
Tune in to the enlightening discussions led by the knowledgeable Dan the Lab Safety Man and infectious disease behaviorist Sean Kaufman. Together, they explore a wide range of lab safety subjects on a weekly basis.
Stay up-to-date with the latest trends and engaging debates surrounding lab safety by tuning in to every episode.
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The Lab Safety Gurus
Strategies for Laboratory Safety in the Face of Emerging Threats
Uncover the hidden complexities of lab safety as we team up with Sean Kaufman and Dan Scungio to dissect the intersections of biosafety, psychological preparedness, and communication within the lab. When a laboratory's casual approach to separation leads to a heated encounter with OSHA, we're forced to question the balance between stringent regulations and practical risk management. Tune in to hear us tackle the debate on absolute physical barriers and the scientific grounds for such measures, especially when lower-risk pathogens enter the equation. It's a conversation that doesn't just skim the surface but probes the depths of what it truly means to maintain a safe laboratory environment.
As we reconstruct the transformation of a standard hospital room into a bulwark of biocontainment during disease outbreaks, the narrative shifts to the human element behind the safety cabinets and floor tape. Dan Scungio illuminates the necessity of clear communication and decontamination processes, aiming to eradicate common misconceptions among lab personnel. Whether it's facing Ebola head-on or establishing steadfast containment strategies, our episode provides essential insights into fostering a culture where safety is second nature. Don't miss these vital discussions that could be the crucial difference in a world where laboratory mishaps are not an option.
Welcome to the Lab Safety Gurus Podcast. I'm Dan Scungio.
Speaker 2:And I'm Sean Kaufman, and together we're providing safety insights for those working in laboratory settings, doing safety together.
Speaker 1:Alright, welcome everybody. Glad to have you back for another episode. I have a question for Sean Kaufman.
Speaker 2:That makes me nervous. It's been a while. Do you know? We're on our 11th podcast, Dan 11 already. Yeah, this is 11. That's my wife's favorite number, by the way it is.
Speaker 1:Why is that? Is there a reason for?
Speaker 2:that she tried to explain it the other day. She said because one and one are together. I thought that's an odd explanation, but that's what she said. It's she. She said it just seems so equal. So maybe there's a listener out there that understands that, but I I didn't understand the explanation there may be.
Speaker 1:There may be my wife likes 13, because we got married on friday the 13th, um. So containment in the laboratory. I'm'm going to ask you a question, sean, because I have worked in a laboratory that was cited by OSHA, and here's why they got cited. They built a break room off of a laboratory, a small. It was like an emergency department laboratory, an emergency department laboratory, and there was no space for the staff to have downtime, break time, whatever. And they built this break room but they built it in the space of the laboratory and the separation between the break room and the lab was a half wall. So on the other side of that half wall, a refrigerator, a microwave, a place to eat, a table, a sink, all that good stuff. And so when OSHA came in, they're like you can't do that. Now, that's one OSHA inspector's interpretation of what can and can't be. But they made the hospital build like glass from. But they made the hospital build like glass from the halfway wall all the way up to the ceiling and then they had them put in like a storm door so that there would be complete separation.
Speaker 1:That was sort of my introduction to containment in my lab safety career. So I've always had a mindset that containment for a biological laboratory should be complete separation from floor to ceiling, and that's going to be the way it has to be. But over time, as I looked through guidelines, regulations, standards, there was nothing in literature that states that you need to have complete separation from clean spaces and dirty or contaminated lab spaces. And one of the things I've done in my career is I worked with a team that was rewriting the ISO standards for laboratory safety. It was the 15190, specific to lab safety, and we talked about that on the team and we did get that wording in there that there should be complete separation. But, sean, as a biosafety expert, is that, am I looking at it, the right way? Is that the right thing to be talking about? Is that the right way to be looking at contamination and containment? That's it. Well, the three things I've got to say first, I've got questions for you.
Speaker 2:I don't ever consider myself a biosafety expert, but I appreciate the compliment I do. Second, why was OSHA there in the first place? Now, typically OSHA is not a proactive organization. Usually they show up on scene when there's problems. Why was OSHA there in the first place is a good question.
Speaker 1:It is a good question and I don't know the answer.
Speaker 2:Oh, okay.
Speaker 1:I was new to my job as a lab safety officer and I was not privy to the reason why the OSHA the state OSHA representative came in. Okay, I have dealt with other issues in my career with OSHA and I know why they were called, but for that one I didn't know the actual reason. They certainly didn't come just to look at the space and I don't think an employee complained about the break room.
Speaker 2:I don't think so, but I don't know that for sure. Well, usually they'll show up looking for problems because a problem has been identified. That's, again, typically what I've learned with OSHA. But here's my third. This is my third statement here.
Speaker 2:Look, all infectious diseases are not created equal, and that's one thing that I think we all have to continue to remind. So, for example, I love using this example because when I was at CDC, I worked in parasitic diseases and I worked with cryptosporidium, and Dr Michael Beach, who is my supervisor there, used to say do you know that one oocyst of cryptosporidium can live in one part per million of chlorine for 6.7 days? He used to say that and I was like that's amazing when you compare it to something like HIV or hepatitis B and you're looking at blood at a swimming pool and how easily those agents are inactivated with disinfectant. And as I've gotten familiar with the different containment levels BSL-1, bsl-2, bsl-3, bsl-4, I've also become more and more familiar with how infectious diseases are transmitted. And the issue that I have when we make statements in safety or in biosafety or even in bio-risk management, is that we really have to use science and, if you're asking me, does a complete separation have to occur.
Speaker 2:If we're working with a pathogen, say, for example, a BSL-1 agent that typically will not make healthy people sick, a BSL-1 agent that typically will not make healthy people sick, what's the science that says that you would need a complete separation? And if you're working with agents in BSL-2, where it's only blood-borne, fecal-oral routes of transmission, you're not having agents that swim in the air and make people sick Again, if you have good laboratory practices, science is not calling for complete separation. And so again, yes, dan, don't get me wrong, please hear me, because I can see you. I could see you biting at the bit here. It would be my preference for complete separation. It would certainly be my preference, absolutely, because you can carry things in on your hands, do whatever. But science does not support a complete separation, it just doesn't, unless you see otherwise.
Speaker 1:No, I don't think I do, but I think in my career I've been the victim of overzealous, non-laboratory people, maybe. So here we have the ocean inspector who says this is what has to happen, which I agree with him. I'm with you there should be separation from your break room to your lab. We had another incident where a couple of incidents where microbiology BSL-2 lab, they're working with some blood culture specimens and they grow something that's like a potential bioterrorism organ, like a Francisella.
Speaker 2:Yeah, they're surprised, they have an uh-oh moment, they have Brucella's class.
Speaker 1:We hear that quite a bit.
Speaker 1:Yep. So what happens when that occurred is suddenly the occupational health department wants to know I need the name of everybody who was in that laboratory while those plates were being manipulated, whether or not an aerosolization procedure was going on or not with those plates. Usually when you're reading, there's not too much that's happening that could create an aerosol, unless you're doing some vortexing, and that all depends on the processes in your lab. But they wanted the names of every employee who walked in the department at the time those plates were being manipulated and it was a lot of people, a lot of people working in the lab, couriers coming into the laboratory to pick up specimens, people walking through, maybe the safety officer I wasn't on the list, but they gathered all those names, did some sort of monitoring and offered prophylaxis for all of those people and then, after that happened more than once, they decided to spend the money to build a BSL-3 laboratory for blood cultures, because it's more likely to happen with blood cultures than any other kind of clinical specimen Was that overkill.
Speaker 1:Was that overdoing it? We have fewer exposure incidents because there's fewer people working in the blood room, as we now call it. Was that?
Speaker 2:overdoing. Listen, I am a big believer in aggressively dealing prophylactically with potential exposures. I am an absolute. I'm very happy to hear what you said, because in cases where we know that potential exposures have occurred and we don't prophylactically offer counter you know we don't we don't offer countermeasures to potential exposures of dangerous pathogens then we haven't done our job. Now look, one of the things that is very it's unrealistic.
Speaker 2:See, most of my experience, dan, as you know, is dealing in research labs, laboratories where we know very well what we're working with and therefore we're always adequately prepared.
Speaker 2:But I think many listeners do not understand that there are labs out there that are trying to determine what people are sick with and in those moments those labs are working outside of a biosafety cabinet, so they're not expecting to trip up on an agent that has spread through routes of aerosol. Trip up on an agent that has spread through routes of aerosol and all of a sudden they find themselves having an agent like Brucella that is exposed and requires a higher level of containment and there could have been a potential exposure in the environment. And here's the challenge, dan, and correct me if I'm wrong the amount of samples that somebody is doing from a diagnostic aspect, whether it be in a clinical or public health setting, may be so numerous and so vast that actually doing them in higher levels of containment is it can be quite difficult if you don't have the resources, like you had mentioned, a BSL-3 lab or even just a huge biosafety cabinet.
Speaker 1:So you have? Yeah, so you have challenges there. Yeah, and it's not common to create a special room for blood cultures in a clinical laboratory.
Speaker 2:Most labs don't have the ability to do that, and the reason why, just again for the listeners, is I mean, dan, seriously, think about it. I say it, you know, once every I mean a lot of people. We almost average once every five or six years is when I'm seeing, when I go to diagnostic labs. But how often do you get a surprise like a brucello? How often does that occur?
Speaker 1:uh, probably in. So so this is for a reference, microbiology laboratory. Uh, it can be between two and three times a year.
Speaker 2:Okay, okay, and is that that's more clinical, like hospital labs?
Speaker 1:Yes, okay, good yeah.
Speaker 2:I'm talking, I was referring to public health. But if that, but in that, in that time year wise Dan, on average, how many samples do those clinical labs process?
Speaker 1:Oh my gosh.
Speaker 2:Yeah, give me, give me a rough idea those clinical labs process, oh my gosh.
Speaker 1:Yeah, give me a rough idea.
Speaker 2:The number blood culture bottles in that reference lab were in the thousands. Yeah, so what I want listeners to understand is, for the one lightning strike there are thousands of samples that are processed, and so to change the whole protocol for that one potential lightning strike, that can not only slow your diagnostic procedures down, which in the end would hurt your patients, but it could also increase costs substantially. So it's a true conundrum, so to speak.
Speaker 1:Yeah. So let me touch on something, sean, then, that I know that you're also an expert in, and that's something like Ebola. So in certain hospitals that are not treatment hospitals but maybe assessment hospitals, they're set up with different levels of different types of units highly infectious disease units, which include a laboratory, and in certain situations the laboratory is not a permanent location. So I know of a hospital, for instance, where their highly infectious disease lab is a patient room, normally by day, in the emergency room, and then when they open up the highly infectious disease unit, the laboratory gets to use this room and then, when they open up the highly infectious disease unit, the laboratory gets to use this room and there is a biological safety cabinet in the room.
Speaker 1:It's behind, like a garage door, for example. It's always kept there. They have to bring all the equipment in there, don that specialized PPE and work in that patient room. That patient room is in a hallway. There's no ante room and so when people bring specimens from down the hall from the Ebola patient, potentially they're carrying that specimen inside of a special carrying container. They're handing it into the doorway of the Ebola lab we'll say HIDU laboratory and then taking care of things. But trash has to come out of that room when the trash is full and has to go down the hallway to the outside door, category A trash we're talking about. When people doff, they're doffing inside that room where they've done the work. So I know some laboratorians who work in these situations. We haven't had to, you know, bring up the HIDU lab officially but during training and drills there are people who are nervous about that. How nervous do they need to be about doffing in the same room where they perform testing?
Speaker 1:And there's like a line of tape on the floor. This is your red zone and this is your green zone, and they know that viruses don't know colors.
Speaker 2:Well, everything you're saying today, Dan, is making me happy, and I mean that Everything you've just said makes me happy, because one of the worst things that a hospital can do is bring in a very dangerous infectious disease into its lab, contaminate the lab environment and shut down diagnostics for the whole hospital. We have to remember that patients are going to need the lab tremendously, and what I mean by that is, again, laboratory scientists are the heroes. The doctors ask for labs to be done and the labs give the answers to the doctors and they allow the doctors and nurses to treat the patients. So when you have something like Ebola come in, you don't want it going to your main central lab, you want to set up a special space, and so I think that makes me very, very happy. The second thing I think that's important to bring out is that when we're doing diagnostics, we're not working with large quantities of cultured samples, is that when we're doing diagnostics, we're not working with large quantities of cultured samples, meaning that we really don't need a fully designed, engineered BSL-4 laboratory to run diagnostics or basic blood tests for somebody who may be infected with a bloodborne infection. The fact that you're gonna do your work in a biosafety cabinet, the fact that you're gonna be making sure that in a biosafety cabinet, the fact that you're going to be making sure that the people doing that work are well trained, the fact that you're going to have great PPE and you'll know the difference between contaminated PPE and not contaminated PPE, and the fact that you have tape and I want to bring this reference up. The tape on the ground is not signifying a clean and dirty environment in the lab. The tape on the ground is a behavioral cue. It is telling staff to do certain behaviors at different points in time so that when we do practice containment strategies, we're doing it in a way that phases out and ensures the highest level of containment. So you know again, dan, everything that you've said to me is is an outstanding strategy. Obviously the staff, because it's new and because it will be dealing with a very high pathogenic. You know this could be real time.
Speaker 2:We had two nurses in Texas get Ebola. I want people to be to be cautiously respectful of what they're working with. I want people to be cautiously respectful of what they're working with. I want them to be a little nervous, but I also want them to feel confident that they are doing what they need to do to protect themselves. So, based on what I'm hearing you say, that's an exceptional strategy and again, I would just make sure people are trained to the point where they feel extremely comfortable, because you also want them to be trained on a gross contamination what happens if they do drop a blood vial and it splatters outside of the cabinet and onto them. I want them prepared for that and the minute we start preparing for those types of situations, we build their self-efficacy or their confidence that they can do this safely with a highly dangerous pathogen.
Speaker 1:Yeah, absolutely, thank you. I feel better about our setup, certainly in my organization, but many others that I've heard of as well. What you say, like with the tape being a behavioral cue, I don't think people realize that. I think they're thinking of it as how is this any cleaner an area than this? Because when we doff out of that, the PPE, you take your foot out of the bodysuit and you move it over. You know you're sitting in the same chair that straddles the tape and then you're moving your foot over into the clean area. I'm using air quotes with clean area.
Speaker 2:Yeah, yeah, I mean yeah, yeah.
Speaker 1:Well, I think a big part of this is having that conversation with staff to make sure that they are as comfortable with their safety that you know, and all the precautions that we're taking. That's really key.
Speaker 2:Very good. Yeah, I think it sounds to me like you're well prepared. We are the lab Safety Gurus, Dan Scungio and Sean Kaufman.
Speaker 1:Thank you for letting us do lab safety together.