In this guest blog, Linda Gylland, MLS (ASCP) QLS, a lab safety officer for Sanford Health in Fargo, North Dakota, discusses the dangers and policies she faces daily working with chemicals in the laboratory, and offers some suggestions for dealing with spills.
Some of our local medical news headlines have recently focused on the “Multistate Outbreak of Listeriosis Linked to Commercially Produced, Prepackaged Caramel Apples.” As of 12/22/14 the case count was 29, involving 10 states, 5 deaths and 29 hospitalizations. Another headline read “Outbreak of Cryptosporidiosis among Responders to a Rollover of a Truck Carrying Calves.” The laboratory identifies both organisms in these outbreaks.
Other types of “breaks,” specifically thermometers and spills also occur in laboratory and other medical settings. If a chemical spills in the lab, we clean it up following procedure in our Spills policy if it is a “minor spill” (less than 300 mL). We have spill kits and PPE with instructions for each type of spill (acids, bases, and organics). Depending on the nature of the spill, if it is small and can be maintained by lab staff, they would refer to the SDS for instructions on spill cleanup and emergency procedures. Baking Soda, sand, absorptive pillows are some of the items in our spill station. The most common scenario is to absorb the spill with paper towel, cover with 10% bleach, absorb for 10 minutes, and dispose into biohazard bag or appropriate container. If it is a larger spill (greater than 300 mL) and exceeds the limits of the personal protection available and for which staff is trained, we would contact:
- The local fire department hazmat team to verify measures to be taken
- Our hospital safety department
- Emergency preparedness department
- The poison control center
Depending on the chemical, (a hazardous chemical with toxic vapors), we would immediately evacuate staff to a place of safety and then contact outside help. The majority of lab tests now come in kits with small amounts of reagents and foil packs that are placed in analyzers, so large amounts of chemicals are not used like in the olden days! Histology and Cytology labs use large amounts of xylene, alcohols and formalin. They are all prepared with spill kits (including formalin solidifier) and also have extra PPE including face shields.
If a chemical spills in someone’s eyes, they would immediately go to the eye wash station, flush their eyes for 15 minutes and seek medical attention.
We had a mercury thermometer break inside a reagent refrigerator a few years ago and had to evacuate our department, including leaving our shoes in the lab (to be checked with a mercury scanning device later) and going home wearing disposable “surgical booties.” Luckily this happened in the fall before any snow was on the ground! The PM shift could not enter that department until the hazmat team finished their work about 4 hours later! All was well; the mercury was contained in the Ziploc bag with the broken thermometer. It was later decided that these extra steps of caution may not have been necessary, but it was better to be safe than sorry. Policies were re-written to include banning of all mercury thermometers. Most labs use thermometers with mercury substitutes now.
Our ER department also experienced a similar problem when a mercury thermometer broke. The area was closed off, an outside company came in to check for mercury in the room, the carpeting and furniture was replaced, and everything (including the walls) was cleaned. They got an acceptable “reading” from the company and were then able to resume normal activity.
Mercury thermometers are seldom used anymore, and this problem should not be occurring. In the past we heard about events such as:
- Dec 2006 – a mercury spill in a Minnesota secondary school (a student dropped a barometer). The school was closed for 3 days with $150,000 cleanup costs.
- Dec 2006 – a mercury spill in LA subway stop. It was closed 1 day: A questionable terrorist activity or just another accident.
- Jan 2008 – Michigan prohibited the sale of mercury containing GI devices and blood pressure devices
- Aug 23, 2011 – Houston area family medical practice had a blood pressure device fall- one ounce of mercury was on the floor, staff evacuated, called hazmat and cleaned up within one hour.
- Nov 17, 2011 – Morganton, N.C. Developmental Center storage room had a blood pressure device fall from a cart. A few drops of mercury fell on the floor. The room was sealed off; the facility was closed for 2 days.
- Dec 14, 2011 – Oregon, OH Medical Clinic had the same situation with a blood pressure cuff falling from a cart, mercury leaked onto the carpet. The clinic was evacuated, closed for the remainder of the day and a private company called in to clean.
So why the worry about mercury when we used to clean nickels with it in our childhood? It is now known to be an unwanted hazard in the workplace and one bead exposed to air will vaporize immediately. It may reach harmful levels; the greatest risk is with accidental spills which can result in mercury poisoning from inhalation, ingestion, injection and absorption. The vapors can penetrate the Central Nervous System and cause hand tremors, shyness, insomnia and emotional instability.
It is important to always remember “safety first” in all aspects of life. It might be safer to make your own caramel apples, take extra precautions when handling calves and think twice about the types of thermometers you are using.