key: cord-0049203-7u0fkf3o
authors: nan
title: Safety Precautions
date: 2020-08-28
journal: Diagnostic Pathology: Intraoperative Consultation
DOI: 10.1016/b978-0-323-57019-0.50011-x
sha: 6c164f5df712687cf10f342ac4316b8a6f71d38c
doc_id: 49203
cord_uid: 7u0fkf3o

nan

• Risk to personnel in intraoperative consultation (IOC) room is greater than risk to pathology personnel in general due to multiple factors ○ Time constraints -Activities (e.g., examining specimens, cutting sections) need to be performed quickly ○ Multiple people from different departments use IOC room -Pathology personnel, surgeons, operating room nurses, and researchers may be present -Not all people may be familiar with best practices for room and specimens ○ Multiple people may be involved in examining single specimen -Each person must be responsible for appropriate and careful handling and disposal of sharps ○ Unfamiliarity with room &/or equipment -Some personnel may only use room intermittently □ Safety equipment may not always be used appropriately □ Materials may not be replaced or replenished appropriately -Room may be used at night and on weekends when personnel familiar with room are not present ○ Less experienced personnel may perform tasks at irregular intervals -May only use cryostat during IOCs ○ Patients undergoing surgery may have undiagnosed infectious disease -Pathology personnel who are immunocompromised or with compromised skin (dermatitis, weeping skin lesions, or wounds) may have increased vulnerability • It is important to have protocols and personnel in place to ensure safety ○ One person should be designated as being in charge of IOC room -Ensures room is properly equipped and maintained 

• Splash injury into eyes or mouth • Cutaneous exposure into breaks in skin

• Personal protective equipment must always be worn ○ Protective goggles or face masks must be worn when handling specimens that are likely to pose risk of splashing ○ Double gloves should be worn when handling particularly bloody specimens or specimens of known or suspected infectious risk • Extreme care should be exercised when cutting into hard, intact mass that could be cystic ○ Piercing cyst can result in forceful ejection of fluid several feet ○ Waterproof barrier may be kept over site of incision until it is determined if fluid is present or not ○ Cysts should be opened near sink to aid in disposal of fluid cyst contents • Eating, drinking, smoking, and application of cosmetics or lip balm are not allowed in IOC room ○ Food cannot be stored in room or refrigerators and must not be discarded in waste containers • Material that will leave IOC room must be clean to protect personnel outside room from exposures ○ Outer specimen container is kept clean ○ All paperwork is kept clean -If contamination occurs, paperwork can be placed inside protective plastic sleeve or information copied onto clean form 

• Radioactive agents are sometimes used intraoperatively ○ Sentinel lymph node identification ○ Radioactive seeds for localization of breast lesions ○ Octreotide to localize neuroendocrine lesions • Dose used is generally too low to result in significant exposure to pathology personnel ○ Special procedures are generally not required to limit exposure -Standard gloves are adequate for protection ○ Radioactive seeds contain iodine-125 that emits low energy gamma rays of 20-30 keV -Titanium capsule surrounds internal core filament containing iodine-125 -If internal core filament is damaged, area must be treated as radioactive spill □ Damaging seed should be avoided by not using scissors and very carefully sectioning specimen with scalpel under guidance with gamma probe • Adequate storage area required for retrieved radioactive material ○ Radioactive seeds can be safely stored in metal container -Seed must be stored in closed container listing corresponding surgical pathology number -Log book is required to document specific seed, when retrieved from specimen and when released to Radiation Safety Department

• If radioactive agents used during surgery, risk to pathology personnel should be considered • If radioactive materials need to be retrieved (e.g., radioactive seeds), procedures for doing so must be instituted • Pathologists must have necessary equipment (e.g., Geiger counter, gamma probe) to monitor radioactive material and to detect radioactive medical devices

• Personal protective equipment (PPE) is defined as equipment designed to prevent exposure of skin or clothing to blood or other infectious materials ○ Worn to minimize exposure to hazards that cause serious workplace injuries and illnesses ○ Includes chemical, radiological, physical, electrical, mechanical, or other workplace hazards • Must be provided by institution to employees • Must be discarded appropriately when contaminated and when leaving IOC room

• Gloves must always be worn when handling tissues ○ Rings with sharp surfaces should be removed as they can increase likelihood of puncture • 2 pairs of gloves are recommended if infectious agent suspected • Latex gloves protect against biohazards but not chemicals ○ Latex is permeable to chemicals and can rapidly degrade when exposed to some types • Nitrile and neoprene gloves protect against biohazards and exposure to fixatives ○ Personnel with latex allergy may use nitrile gloves • Metal mesh and Kevlar cloth gloves are available if puncture injuries are possible ○ Latex or nitrile gloves are worn beneath and over gloves • Soiled gloves should be discarded and replaced when touching other objects in room ○ Gloves should also be changed between specimens to avoid any chance of contamination • Hands must always be washed after handling specimens and when leaving IOC room ○ Small, inapparent breaks in gloves are common ○ If 2 gloves are worn and blood is present between gloves, gloves should immediately be removed to determine source of blood -If hand injury is identified, first aid and evaluation of infection exposure is required

• Eye protection should be worn if splash injuries are possible ○ Safety glasses or goggles ○ Full face mask ○ Face protection should include side shields • Special respiratory masks protect against aerosolized TB ○ N-95 masks filter at least 95% of particulates that are 3 μm or larger ○ Requires each person to be individually fitted for mask ○ In practice, these masks are uncomfortable and not often used • Surgical masks ○ Designed to protect patients from exhalations of person wearing mask ○ Inadequate to protect pathology personnel from aerosolized infectious agents -Can provide protection of mouth and lower face from splashes

• Scrub suits may be worn when exposure is probable ○ These clothes can be easily exchanged for clean replacements if exposure occurs • Aprons are used over clothes or scrub suits to protect torso ○ Sleeve protectors or aprons with sleeves are preferable when numerous specimens are handled • Disposable jumpsuits offer complete coverage of body • Lab coats should not be used for protection if also worn outside of IOC room

• Ideally, 1 cryostat should be designated for known or possible infectious cases ○ Cases requiring decontamination include known or suspected HIV, HBV, HCV, SARS-related coronavirus, prion disease, myobacterial disease, or systemic fungal disease ○ After cryostat is used for such cases, it must be marked and not used again until after decontamination • All cryostats must be decontaminated at defined intervals ○ Cryostat is defrosted ○ Tuberculocidal disinfectant is used to clean interior ○ Trimmings and sections of tissues must be removed • More frequent decontamination is necessary if known infectious cases have been processed

• "Clean" areas should be designated where gloves must not be worn ○ Typically microscopes, telephones, door knobs -Most common items used by personnel not directly involved in processing specimens ○ Only clean hands without gloves are allowed to handle material in these areas ○ Avoids possible contamination with biohazardous material that has touched gloves • All soiled disposable material should be immediately placed in appropriate biohazard containers • Exposed surfaces are cleaned and disinfected with diluted bleach or other appropriate sterilants

• Fix in adequate amount of formalin as soon as possible • Container must be leakproof and securely sealed • Specimens that may be infected with CJD must be specifically labeled as biohazard and stored separately ○ These specimens require additional handling to inactivate prions 

Cut-resistant protective gloves in pathology--effective and cost-effective

Decontamination and CJD: the latest guidance

Occupational injuries in a pathology residency program

OSHA. Bloodborne pathogens, standard 1910.1030

Respiratory protection, standard 1910

Personal protective equipment