One of the top priorities for every laboratory should be the safety of its employees, facilitated by creating a culture of safety consciousness through education, organization, and accountability. Managing safety is more than having a top-down list of dos and don’ts, a library of educational videos, and a stock of protective gear (though all are important). It is about having strategies in place that anticipate potential problems; having an awareness of the particular laboratory environment and the potential for accidents; and taking responsibility when action is needed. It’s about teamwork; it’s about leadership.

So, while there are universal guidelines for safe laboratory practices, each laboratory’s policies and procedures should reflect particular considerations of hazards that may occur from use of its instrumentation, testing requirements, physical layout, workflow, patient interaction, and traffic patterns.

We are all familiar with the general safety guidelines:

· Always wear appropriate personal protective equipment.

· Wash your hands after working with potentially hazardous materials and before leaving the laboratory.

· Do not eat, drink, smoke, handle contact lenses, apply cosmetics, or store food for human consumption in the laboratory.

· Follow the institutional policies regarding safe handling of sharps.

· Take care to minimize the creation of aerosols and/or splashes.

· Decontaminate all work surfaces before and after work, and immediately after any spill or splash of potentially infectious material with an appropriate disinfectant.

· Decontaminate all potentially infectious materials before disposal.

· Report any incidents that may result in exposure to infectious materials to appropriate personnel (e.g., laboratory supervisor, safety officer).

The COVID19 pandemic has added in a whole separate set of personal safety guidelines for laboratory staff.

In addition, to all of the above an effective safety program must also incorporate the ethos of taking Personal Responsibility:

Safety is a choice. Management can provide all the education and protective equipment in the world – but an employee committed to ignoring safety rules will do so. Every individual makes the decision to follow the guidelines, or not. Ensure anyone seen acting in an unsafe manner is taken aside, coached, and not allowed to continue that way. Anyone repeatedly ignoring safety guidelines and putting fellow staff in jeopardy should be encouraged to choose a different place to work.

Finally, emphasize that safety awareness does not end outside the laboratory; encourage the same safety-consciousness throughout the rest of the medical facility, and certainly when performing Point of Care Testing in other settings.

Building a Culture of Safety

Provide Leadership Support

It cannot be emphasized enough how important support is from the laboratory leaders for building a culture of safety. When this support is communicated effectively throughout the laboratory, it delivers a clear message that safety is a core value and a priority for all. It also conveys a sense of caring for the rest of the laboratory staff, as well as for other facility staff who interact with the laboratory. This inspires the laboratory staff toward greater cooperation, communication and trust and away from fear when errors are uncovered[i].

The following is a list of primary responsibilities of the laboratory leadership, including supervisors, to ensure a safer work environment and promote a culture of safety[ii]:

Conduct Safety Orientation, Training, and Competency Assessment for all Employees

· Institute, train and motivate employees to follow all safety protocols for their work. · Know what personal protective equipment is needed for each task and how this equipment must be properly used, stored and maintained. · Ensure that all employees take mandated safety training courses and document attendance.

Enforce Safe Work Practices:

· Enforce safe laboratory work practices and procedures; failure to do so is an invitation for accidents to occur.

· Encourage staff to identify unsafe or unhealthful working conditions or hazards and not fear being disciplined for doing so.

Correct Unsafe Conditions:

· Take immediate steps to correct unsafe or unhealthful working conditions or hazards. When these cannot be immediately corrected, the supervisor must take temporary precautionary measures. · Follow up to ensure that corrective measures are completed in a timely manner to address the hazard.

Investigate Workplace Accidents:

Incident Management reporting and protocols must be in place, and utilized as required.

Initiatives to Encourage Openness and Transparency[iii]

Creating a culture of safety also means supporting behavior that encourages openness and transparency when errors are made, or accidents happen. This means building a supportive work environment wherein the reporting of safety issues, problems, events, and errors are supported, and handled with the intention of resolution and prevention; not denial or neglect. When honest mistakes are made, and owned up to, these should be viewed as a learning opportunity to improve performance and quality through education, training, and mentoring.

Ensuring Safety Competency

One area of special importance is ensuring the proper training and competency of all non-laboratory staff that are involved in the pre-analytic and post-analytic phases of testing. This is especially true for the pre-analytic phase of patient testing, as office staff are often involved in specimen acquisition and handling, frequently interacting with the testing staff, and close to instrumentation and other equipment.

This group of front office personnel includes receptionists, medical assistants, secretaries, phlebotomists, couriers, and even the office manager; they should be properly safety trained for anything they do that interacts with any aspect of the laboratory operation.

Incident Management

An important part of any laboratory safety program is having an Incident Management Plan, defined as providing a process for the investigation of reported events in order to determine if the occurrences or situations reported have the potential to cause harm or injury to staff and visitors. If this is determined, then appropriate corrective actions can then be taken, and the safety program modified, if necessary, to reduce the risk of re-occurrence.

Creating and sustaining a culture of safety within the laboratory requires a commitment to employees that goes beyond providing top down mandates. It is a commitment that encourages and supports buy-in by the entire staff, and an attitude of “if you see something, say something”, without repercussion; appreciation for open communication and feedback, and, when errors are made, an attitude of learning from these, and not playing the “blame game.” In summary, laboratory safety is enhanced through constant awareness of one’s working environment, having mechanisms in place to investigate incidents, and applying corrective steps, and a constant reinforcement of teamwork and transparency.

[i] Seven Steps to Creating a More Transparent Organization. Reliableplant.

[ii] Safety Responsibilities for Supervisors. NIH Office of Research Services. Division of Occupational Health and Safety.

[iii]Five Ways to Retain Good Staff. Shenkel, R, Gardner,C, Fam. Pract. Manag. 2004 Nov-Dec: 11(10) 57-62.