Scalpels and needles are important tools for many forms of lab work, including experiments and production work. Unfortunately, using these devices also carries a relatively high risk of injury. As part of the bloodborne pathogens, or BBP standard, the Occupational Safety and Health Administration, or OSHA, requires many workplaces to have policies and controls in place to protect employees from cuts, needlestick injuries and exposure to bloodborne pathogens. While OSHA regulations do not apply to every lab environment or work position, these guidelines can form the basis for safe work practices that every lab can follow.
Bloodborne Pathogens Occupational Exposure: What Training is Required?
Workers should have bloodborne pathogens training and follow certain safety measures if they have what is called occupational exposure. Occupational exposure means that a worker could reasonably expect to contact blood or “other potentially infectious materials” while performing normal job duties. Under OSHA’s BBP standard, “blood” means human blood, components of human blood, and any medications or other products made from human blood. “Other potentially infectious materials,” or OPIM, includes certain body fluids such as semen, vaginal secretions and amniotic fluid, any unfixed human tissues or organs other than intact skin, and any other body fluid that might be mixed with blood. Working with contaminated sharps, including scalpels and needles, is the most common way that workers are exposed to BBPs or OPIM. Even if lab work doesn’t involve biological materials directly, workers could still be exposed to blood or OPIM if a co-worker is cut by a scalpel or stuck with a needle.
Safe Equipment Means Safe Work
Many work environments prefer using disposable scalpel blades or needles. When possible, workers should use disposable safety scalpels with fixed blades. If reusable scalpels are necessary, blades that can be fully enclosed before removal and replacement should be used. A scalpel blade without a handle should never be used.
OSHA recommends that facilities provide “safer sharps” whenever possible. This can include needleless connectors or injection devices, shielded scalpel blades, self-sheathing needles and retractable syringes.
Working with biological or other hazardous materials requires certain precautions. Access to handwashing facilities and gloves that can protect against work materials are necessary. Washing hands before donning and removing gloves is also necessary. Working with materials that require certain protections under the Centers for Disease Control’s biosafety levels will require procedures such as working in a biosafety cabinet or other physical containment that can protect from splashes.
Glove Selection – Not Just Any Glove Will Work
There are many different types of gloves made from different materials, designed to perform different tasks. Gloves must protect against the materials workers will be exposed to, and should also include safeguards against being cut or punctured.
Indicator gloves – Two sets of different colored gloves designed to be worn together. If the outer layer is cut or punctured, the brightly-colored inner layer is exposed.
Cut/Stab-Resistant Gloves – While using scalpels or other cutting instruments, workers may choose to use cut-resistant glove materials such as Kevlar. Stab-resistant fabric gloves with a thick rubber coating on the palm can sometimes be used when handling needles.
Safe Storage and Use
Scalpels and needles must be stored properly and used safely. A mislaid sharp can cause serious injuries if someone doesn’t know it’s there and discovers it by knocking it over or sitting on it. Sharps must not be left unattended. An approved sharps disposal container should be within reach of workers. Sharps containers should be puncture-resistant and clearly marked. Sharps must never be disposed of in regular trash receptacles. Replacement scalpel blades must be kept in a secure place until use.
Workers should avoid two-handed techniques when handling sharps. Two-handed techniques can include passing a scalpel directly to a coworker, or using one hand to hold a needle while trying to put the cap on with the other.
Only one person should be in control of a sharp at any given time. When a sharp must be handed to another person, the sharp should be placed on a table or counter where it cannot roll away so the second person can pick it up.
Scalpel Blade Replacement and Reusable Needles
While many work areas will use disposable sharps, some work tasks may require scalpel blade replacement or needles designed for reuse. Scalpel blades are extremely sharp, and can be dangerous to change and handle. Tools such as pliers or forceps should be used to hold the blade in place. There are also stainless-steel blade removers available that allow blade removal without the worker touching the blade. If a worker has no other option than handling the blade directly, cut-resistant gloves should be worn.
If reusable needles must be used, cleaning or manipulating them by hand must be avoided if possible. Tools should be used while handling the needle, and needles should be cleaned with a hands-free technique such as an effervescent soak or sonic cleaner.
Recapping needles is one of the most common causes of needle stick injuries. Many facilities simply don’t allow recapping of needles for any reason, and it should always be avoided when possible. Ideally there should be alternatives present such as retractable needles or needleless devices that can remove the chance of an unintended needlestick.
If needles must be recapped, the first choice should be a needle that has a built-in safety device, such as a hinged or sliding safety cap or sheath. These are designed so the cap or sheath can slide over the needle with a one-handed technique that significantly reduces the risk of injury.
If there are no built-in options to recap a needle, needle shields can be used to prop up the cap during insertion.
Sharps Disposal Container Requirements
After use, all disposable sharps should be put into an approved sharps disposal container. These containers are made of a puncture-resistant material, usually a hard plastic, and should be clearly marked. These containers need to be closable for transport, and must be leak-proof on the sides and bottom. Workers must never reach into a sharps disposal container or remove the lid, or try to force materials that won’t fit easily. Some sharps containers are marked with maximum fill lines. If there isn’t a fill line, the lab’s policies for disposal must be followed. This will usually involve emptying or replacing it before it becomes 75% full, but some policies may require them to be emptied earlier. Most facilities will use the same containers for all scalpels and needles, but some may have different containers for contaminated and uncontaminated sharps. Scalpels, needles and other laboratory sharps should never be discarded in the regular trash.
Reusable Sharps Container Requirements
If using reusable sharps, there should be a holding container within reach where they can be placed after use. This not only protects people from being stuck, but also identifies the sharps as dirty or contaminated so people know not to use them until they have been decontaminated. Reusable scalpels and needles that don’t have hazardous contamination will need to be cleaned according to the work area’s procedures. Tools contaminated with biological or other hazardous materials will need to be decontaminated using special processes, or else disposed of as hazardous waste.
What to Do After a Sharps Injury
After a sharps injury, it’s important to make sure that the injured worker receives appropriate medical care to minimize lasting injury. After providing first aid, the worker might need additional medical attention. In many labs, incidents must be entered in a sharps injury log.
If an injury occurs, thoroughly but gently clean the wound with soap and water, then cover it with a bandage. Don’t vigorously scrub, debride, or squeeze the wound. Severe injuries, deep cuts, or sharps injuries that involve blood, OPIM or other infectious or biohazardous agents require immediate treatment and follow-up from a medical provider.
OSHA Requirements for Planning
OSHA-covered employers must have a written exposure control plan designed to protect employees against the hazards in their workplace. They must also make the hepatitis-B vaccine available free of charge to all employees with occupational exposure to BBPs, unless the worker has received it already. Even if a position isn’t subject to OSHA regulations, there should still be similar procedures in place to protect workers from BBP exposure. In case of a potential BBP exposure incident on the job, workers should receive immediate medical care and follow-up care. OSHA-covered employees must receive this free of charge. Post-exposure prophylaxis, or PEP, are drugs that can help prevent workers from becoming infected after a possible BBP exposure. If a doctor recommends PEP, workers will be provided counseling over the benefits and possible risks. If PEP is recommended it should be taken as soon as possible, preferably within 24 hours after exposure.
If an employer provides a worker with medical evaluation or care because of an injury or exposure incident, the employer is required to keep records of the care that was provided, the results of any evaluations or tests, and any diagnoses or medical opinions. Workers have a right to obtain a copy of their records and any analyses based on those records. Employers must keep records confidential and may only release them to the worker or an appointed legal representative.