When it comes to managing a laboratory safety program, it is always favorable to utilize proactive indicators. The best approach is to use indicators and practices that can prevent safety issues in the department before they have a chance to occur. The reality is, however, that no safety program is without weaknesses, and injuries and exposures do happen from time to time. Most of these events are preventable, but occasionally, one occurs that — because of very unusual circumstances — could not be avoided. Whether an event is characterized as unavoidable or preventable, though, lessons can certainly be learned.
A similar logic can be applied to the COVID-19 pandemic. As laboratory leaders watched it spread across the world and make its way to our shores, it became clear that U.S. hospitals and laboratories would be affected in many, perhaps unprecedented ways. This would be an unavoidable event, and it would have far-reaching consequences. Now, more than 18 months later, laboratory leaders can look back at the many lessons learned during the pandemic. As the world moves ahead to contend with virus-variant surges, the need to learn from those past lessons to help laboratories prepare for the future is a top priority.
Lesson 1: Remind lab staff about hazards they handle every day
The initial safety training in school and on the job for laboratorians includes information about the hazards in the workplace. Handling chemical and biological agents is routine in laboratory work creating an unsafe environment for those within. However, regulatory agencies like the Occupational Safety and Health Administration (OSHA) state that employers must provide methods to mitigate those safety hazards, so employees can be safe on the job. Those safety measures can include hazard substitution, the use of engineering controls, safe work practices, and personal protective equipment (PPE). Laboratorians also are trained to use standard precautions, the idea that all specimens should be treated as if they were infectious and potentially harmful.
Over time and without regular safety awareness reminders, lab staff can become complacent about the specimens they work with each day, even if those specimens are known to be hazardous. One of the first lessons the COVID-19 pandemic taught laboratory leaders was that ongoing safety awareness is vital. When new pathogens are introduced, training can prevent unnecessary fear about the work lab employees perform every day
One of the earliest challenges brought about by the pandemic involved managing the anxieties of employees who would need to work with COVID-19 patients and specimens. The news media reported daily death tolls and, incredibly, impossible-to-determine mortality rates. (Remember: there was a lack of testing as well as asymptomatic patients who were never tested.) The specter of the unknown combined with the public and media hype created fear for many laboratorians at work. Lab employees were suddenly afraid of collecting or handling specimens, and healthcare workers began some unnecessary practices like double-bagging swab specimens and wearing gloves when transporting samples through clean spaces. Some laboratory staff even refused to perform COVID-19 tests, and others with direct patient contact would refuse to do their jobs.
Teaching employees to deal with those fears and to continue to do their work swiftly became a priority for lab leaders. Safety leaders were asked to conduct staff huddles and educational sessions. The purpose was to remind staff members that they typically process specimens each day that contain bacteria and other viruses that could be even more hazardous to their health and safety than the coronavirus. Each day, they may face patients who have infectious diseases of many varieties.
In the face of most pathogens, utilizing standard precautions will enable a laboratory employee to remain safe in the workplace. Looking ahead, in future pandemics, it will be helpful to remember that healthcare employees always need regular and consistent information about the proper handling of the hazards they work with and knowledge about how to remain safe on the job, even when the hazards are new.
Lesson 2: PPE should not be taken for granted
Two years ago, no one would have been able to predict a shortage of laboratory PPE. Gloves, lab coats, and even respirators quickly became items that were difficult to purchase, and in-stock supplies were at much lower levels than seen in the past. Some labs purchased whatever supplies they could find, even if they did not meet current safety standards. Other organizations bought large stockpiles of PPE when they could find it, and this created storage issues in some locations. Other problems arose as well. Some hospitals bought reusable lab coats, for example, but they did not have a laundry facility in which to wash them. The initial lesson here is to make sure a laboratory safety representative is involved in these purchasing decisions. The purchasing department may be trying to make fast decisions in these situations in the future, but there are many lab- and safety-specific considerations, and it will be important to have the proper representation on the decision-making team.
As the PPE shortages grew more severe, the Centers for Disease Control and Prevention (CDC) created new guidance for both the extended use and reuse of certain protective equipment. These references offer a lasting resource if labs face future PPE shortages. The CDC provides instructions for handling shortages of lab coats, face protection, and even gloves. The actions to take depend on the situation and the severity of the shortage. For example, N95 respirators can be used multiple times in a single day or for successive days (provided they do not get wet). They can be placed in a clean bag and reused. That was not a usual practice before the pandemic began, but it became difficult to obtain these respirators and many labs did, indeed, use them more than one time before disposal.
Other practices that were seen as the pandemic progressed included PPE reprocessing and disinfection. Many hospitals instituted disinfection protocols using ultraviolet light or hydrogen peroxide vapors to sterilize gowns and respirators for reuse. In some cases, facilities were able to conduct the disinfection on-site, and other organizations hired contractors to perform the work. It was an expensive and sometimes complex undertaking, but it was necessary to provide healthcare staff members with the items needed to continue to safely perform their work.
Finally, some laboratories and hospitals moved from using disposable items (like lab coats) to reusable ones. With costs for disposable lab coats rising and availability dwindling, it made sense for some labs to switch to a coat purchase or rental program. That meant finding a laundry service and changing the way labs handle coats, but in the long run, it would prevent running out of the coats.
As laboratories prepare for the next pandemic wave or the next potential disaster that affects PPE supplies, leaders need to ensure that the lab has a backup plan for these critical safety materials. Consider how PPE reuse or reprocessing could be used and implemented quickly. Review the extended use guidelines to make sure the lab can follow them if necessary. Labs should make the transition today to reusable PPE, so they do not need to make the change in haste when the need suddenly arises.
Lesson 3: The unsafe acts of others can affect the entire team
While the COVID-19 pandemic roared through the country, the public became keenly aware of how the unsafe acts of one person could affect them in a negative way. If a sick individual did not wear a mask, or if they did not keep distant, there was a greater potential of spreading the virus to others. Many were willing to “coach” those who would not conform to the publicly recommended safety practices. The realization that an individual’s safety may be endangered has empowered some to speak up to protect themselves. This is a lesson many laboratory safety leaders would like to see in the workplace.
The unsafe behaviors that often occur in the laboratory — the lack of PPE use, having food in the department, or using cell phones — is certainly unsafe for the perpetrator, but it can also potentially have negative consequences for co-workers. A relaxed approach to safety in one area typically indicates a lack of concern in others. Pathogens can cause infections, accidents can happen, and valuable lab team members can be hindered from working due to those consequences of unsafe practices. Moving forward, it is imperative that ongoing lab safety training includes empowering lab employees to coach team members when they see unsafe acts at work, and it is equally important that leadership supports and models these behaviors.
Moving Forward
These three safety lessons are just some of the lessons learned over the past several months as laboratorians around the world strove to continue to produce quality patient results in the midst of fears of the unknown, product shortages, and ongoing personal and staffing crises. No one can predict what may come next. Coronavirus variants may continue, or the virus may become seasonal like the influenza virus. An entirely different pathogen may be ready to emerge to create the next pandemic. In any case, laboratories need to be ready for the effects of such events. Using the lessons from the recent past can help laboratories be properly prepared, so they can continue to produce quality work safely for the patients they serve around the world.
