**INTRODUCTION**

It is a goal of each laboratory to ensure that safe work practices are
established and followed. All laboratory personnel receive formal
training in laboratory safety procedures and are familiar with and
annually review the safety manual, which specifies practices and
techniques designed to minimize hazards. Safety practices and techniques
must be supplemented by appropriate facility design and engineering
features, safety equipment and management policies.

Some general laboratory safety rules are outlined below. Since the risk
of infection from work done in the clinical and diagnostic facilities in
the Laboratory of Pathology is from contact-associated exposures,
Biosafety Level 2 (BL2) practices, equipment and facilities are most
applicable. The essential elements of BL2 practices, some general safety
rules required by the College of American Pathologists (CAP), and
practices related to chemical hygiene are outlined below.

BL2 is suitable for work involving agents of moderate potential hazard
to personnel and environment. In particular, laboratory personnel must
have specific training in handling pathogenic agents, access to the
laboratory should be limited when work is being conducted, appropriate
precautions are taken with contaminated sharp items, and certain
procedures in which infectious aerosols or splashes may be created are
conducted in biological safety cabinets.

Most work, however, is safely performed on the open counter consistent
with BL2 work.

The following policies apply to both agents assigned to BL2 and chemical
hazards. These polices must be practiced by all laboratory sections.
Additional safety policies may be specified within each laboratory
section.

STANDARD PRACTICES

-   Food is stored outside the work area in cabinets or refrigerators
    designated for this purpose only.

-   Access to the laboratory is limited when work with infectious agents
    is in progress.

-   Laboratory personnel receive appropriate immunizations or tests for
    the agents handled (e.g., hepatitis B vaccine or TB skin testing).
    See Section I for more information regarding services provided by
    OMS.

-   BL2 laboratory sections must have a BL2 sign (NIH 645-5) posted on
    the door. This sign designates the type of biohazardous agents used,
    special procedures or precautions for entry, and emergency contact
    information. Sections operating under Biosafety Level 1 designation
    do not require any posting. Refer to Biosafety in Microbiological
    and Biomedical Laboratories (BMBL) published by the Center for
    Disease Control at
    <http://www.cdc.gov/od/ohs/biosfty/bmbl4/bmbl4toc.htm> for specific
    practices, facilities, and equipment for each Biosafety Level
    designation. Contact the NIH Division of Safety (496-5291) to
    determine Biosafety Level designation and to obtain BL2 signs.

-   The Clinical Chiefs have established policies and procedures whereby
    persons are advised of all potential hazards in the laboratory.
    Laboratory personnel are advised of special hazards and required to
    follow any special procedures.

-   Smoking, eating, drinking, and/or chewing gum is not permitted in
    the work area.

-   Application of cosmetics and/or lip balm is not permitted in the
    work area.

-   Handling contact lenses is not permitted in the work area. Persons
    who wear contact lenses in laboratories should also wear goggles or
    a face shield.

-   Handle and store brittle plasticware and glassware with care to
    avoid damage; do not use damaged glassware or plasticware.

-   Recapping, purposeful bending, breaking, removing from syringes, or
    other manual manipulations of needles are strictly prohibited.
    Resheathing instruments or self-sheathing needles may be used to
    prevent recapping of needles by hand.

-   Mouth pipetting is prohibited.

-   Keep work areas clean. Work surfaces are decontaminated daily and
    after any spill of viable or chemical material.

-   Persons wash their hands after handling chemicals, after removing
    gloves, and before leaving the laboratory.

-   Immediately report all splashes, injuries, and spills to the
    Clinical Chief or designate when they occur. Medical evaluation and
    surveillance are provided as appropriate and written records are
    maintained. Employees with occupational injuries or illnesses that
    require medical treatment (more than first aid) must report to OMS.
    All accidents, spills, and injuries are reported to the Chair of the
    Safety Committee for evaluation and presentation to the Quality
    Improvement committee to avoid recurrence.

-   Explicit instructions are posted, and appropriate supplies are
    available, for the emergency treatment of chemical splashes and
    injuries and the control of chemical spills wherever major chemical
    hazards exist in each section.

-   For additional information, see web sites for emergency procedures
    involving:

-   Medical Emergencies:
    <http://www.nih.gov/od/ors/ds/medemergency.html>

-   First aid for Exposure to Blood or Other Potentially Infectious
    Materials [h
    ttp://www.cc.nih.gov/hes/CC/up_book.html#firstaid](http://www.cc.nih.gov/hes/CC/up_book.html#firstaid)

-   Hazardous Materials Incidents and Spills:
    <http://www.nih.gov/od/ors/ds/spills.html>

-   For spills of blood or other potentially infectious materials, see
    <http://www.cc.nih.gov/hes/CC/up_book.html#spills>

-   Emergency procedures (Fire, Chemical, Biological, Radiological, Bomb
    Threats, Odor Management):
    <http://www.nih.gov/od/ors/dps/emb/emrgproc.htm>

-   Telephone Bomb Threats
    <http://www.nih.gov/od/ors/newsltrs/psn/psn34.htm>

-   Bomb Threat Check List
    <http://www.nih.gov/od/ors/newsltrs/psn/bmblist.htm>

-   Handling NIH mail
    <http://www.nih.gov/od/ors/security/mailsecurity.htm>

-   Guidelines for Identifying Suspicious Mail
    <http://www.nih.gov/od/ors/security/idmail.htm>

-   CDC Anthrax Information <http://www.bt.cdc.gov/>

**SAFETY EQUIPMENT AND PERSONAL PROTECTIVE EQUIPMENT**

-   Properly maintained biological safety cabinets are used whenever
    procedures with a potential for creating infectious splashes are
    done. Hazardous chemicals are used under chemical fume hoods. All
    hoods and cabinets are certified by the Division of Safety annually.

-   All emergency eyewash stations must be located within 100 ft. or 10
    seconds travel distance from every area of the laboratory in which
    hazardous chemicals (irritating, corrosive, or toxic by contact or
    absorption) are used. The eyewash is tested regularly and documented
    within each laboratory section.

-   Appropriate personal protective equipment (gloves, gowns, masks and
    eye protectors, etc.) are provided and maintained in a sanitary and
    reliable condition in all technical work areas in which blood and
    body substances are handled and in circumstances during which
    exposure is likely to occur.

-   Personnel must use the proper personal protective devices when
    handling corrosive, flammable, biohazardous, and carcinogenic
    substances.

-   Face protection (goggles, mask, face shield, etc) is used when the
    possibility of splashes to the face exist.

-   Protective lab coats are worn while in the laboratory. The lab coats
    must be removed when leaving the lab and should be laundered
    in-house and never taken home by personnel. All protective wear such
    as disposable gloves, surgical scrubs, aprons, and lab coats must be
    removed before leaving the technical work area.

-   Open-toed shoes, sandals, shorts and other apparel that leave skin
    exposed are not appropriate when working with hazardous chemicals or
    infectious agents.

-   All personnel are instructed in the proper use and care of
    disposable gloves and it is documented on the new employee safety
    orientation checklist.

-   Laboratory personnel must use only non‑latex or powder‑free latex
    gloves when handling specimens.

-   Nitrile gloves are recommended for chemicals.

-   Heavy gloves are recommended for liquid nitrogen.

-   Inspect gloves before use. Use the proper type of gloves (e.g.,
    nitrile for hazardous chemicals).

-   Gloves are worn when hands may contact infectious agents or
    hazardous chemicals.

-   Gloves are disposed of as contaminated waste when work with
    materials is completed, and are not worn outside the laboratory.

-   Wash hands after removing gloves and before leaving the work area.

**LATEX PROGRAM**

Personnel are protected from allergic reaction due to job-related
exposure to natural rubber latex gloves and other products. The Safety
Committee is responsible for selection of products and implementation of
work practices that reduce the risk of allergic reactions. The Safety
Committee is responsible for education of employees regarding latex
allergies. Important information for healthcare professionals regarding
natural rubber latex (NRL) allergy are provided at
<http://www.cc.nih.gov/hes/latex_healthpro.html>. If latex gloves are
used, the supervisor should provide reduced protein, powder-free gloves.
Employees with latex allergies should report to OMS for medical
evaluation. OMS can diagnose an employee with latex allergies and help
with prevention and control strategies.

**LABORATORY FACILITIES AND PHYSICAL SAFETY**

-   E ach lab contains a sink for hand washing.

-   Vacuum breakers (anti‑siphon devices) must be provided on water
    outlets if the spigot or an extension extends below sink level, or
    if the outlet has a suction apparatus attached

-   The laboratory is designed so that it can be easily cleaned. Work
    surfaces should be protected from contamination through the use of
    disposable, absorbent, plastic backed paper. Replace contaminated
    paper as necessary and handle as hazardous waste.

-   There must be unrestricted access to an eyewash station and
    emergency shower. Eyewash stations are tested on a regular basis and
    documented in each laboratory. Emergency showers are tested and
    documented by maintenance on an annual basis.

-   Laboratory airflow (negative pressure relative to corridor) may be
    checked through maintenance if requested.

-   The laboratory is equipped with a zoned automatic fire detection
    system, an overhead sprinkler system and alarm systems. The fire
    alarm is audible in all parts of the laboratory, including storage
    areas, lavatories, and darkrooms. Fire alarm pull stations are
    located throughout the hallway corridors. ABC fire extinguishers are
    in the corridors. Corridors and stairwells have adequate emergency
    lighting for safe evacuation of the laboratory.

-   Rooms larger than 1000 ft 2, or in which major fire hazards exist,
    have at least 2 exit access doors remote from each other, one of
    which opens directly into a means of egress.

ELECTRICAL AND EQUIPMENT SAFETY

Electrical Equipment Safety

-   All instruments and appliances must be grounded, unless they are
    entirely encased in plastic (such as some cover slippers, stainers,
    microtomes).

-   Instruments and appliances must be checked for adequate grounding
    and checked for current leakage by CC Biomedical Engineering
    (496-1311) before initial use, after repair or modification, and
    when a problem is suspected. At the time of the inspection a label
    will be affixed to the item to certify the results of the ground
    check.

-   All shocks must be reported immediately including small tingles.
    Small shocks often precede major shocks and a light tingle may
    indicate potential trouble. Shut off the current and/or unplug the
    instrument if shocks occur. Do not attempt to use an instrument that
    is causing shocks, because it is potentially dangerous and all data
    gathered from the operation of that instrument may be unreliable.

-   Do not work on or attempt to repair any instrument while it is
    plugged in. An exception is the calibration of instruments that
    require adjustments while plugged in. In this case, be sure hands
    are dry, remove all jewelry and proceed with caution. Contact the
    instrument manufacturer or biomedical engineering if repairs are
    needed. All repairs will be documented.

-   Repairs on the electrical system of the building are prohibited. Any
    work to be performed on switches, outlets or circuit boxes (fuses,
    circuit breaker) must be referred to maintenance (ext. 496-1234).

-   Extension cords should be avoided. If used, they must be 3-way type
    and properly grounded. Gauge plugs are prohibited.

-   Employees must call 911 to report any electrical arc (constant
    luminous discharge of electricity) of equipment.

Polarity and Ground Checks

-   Maintenance is responsible for checking each circuit supporting
    fixed electrical receptacles in technical work areas at least
    annually for polarity and ground integrity. Polarity checks on wall
    receptacles are necessary because many laboratory instruments cannot
    be checked for current leakage under conditions of reversed
    polarity.

-   If at any time an outlet becomes faulty or if electric current
    problems are suspected, contact maintenance (ext. 496-1234) to
    resolve the problem.

-   The safety officer of each section maintains the outlet polarity and
    ground check documentation in each laboratory. A copy is sent to the
    Program Assistant for central filing. All documentation must be
    readily available for inspection purposes and tracking of
    compliance.

Centrifuges

-   Do *not* operate centrifuges unless the covers are closed. Keep
    hair, beard, neckties, hair ribbons, hair braids, or other dangling
    items out of the way.

-   Do *not* centrifuge uncovered tubes containing specimens or
    flammable liquids. Use caps or parafilm.

-   Before centrifuging check the integrity of tubes and tube holders.

-   When the centrifuge is in operation, the lid must always be closed.
    If a noise or vibration begins, stop the centrifuge immediately and
    check for improper balancing of loads, caps and rotors.

-   Tubes used in angle head rotors must never be filled in the point
    where the liquid is in contact with the lip of the tube when placed
    in the rotor.

-   Avoid decanting, no matter what type of centrifuge tube is used. IF
    unavoidable, wipe off the outer rim afterwards with a disinfectant;
    otherwise, the fluid on the outer rim will spin off as an aerosol.

-   When centrifuging infectious agents, safety carriers (carriers with
    individual screw caps) or rotors that are sealed shut should be
    used.

-   Centrifuges should be clean and free of spills. The holders (cups)
    and centrifuge should be cleaned as needed. The cups should first be
    disinfected and then washed in warm soapy water and scrubbed with a
    nylon brush.

Other Equipment

Each laboratory section is responsible for training employees in the
proper use of all equipment (e.g., Autoclave, Centrifuge, Cryostat,
Electron Microscope, Lasers, Respirators, Ultraviolet Light Sources,
etc.).

**CHEMICAL HYGIENE PLAN**

The responsibilities of the laboratory director (LP Chief), supervisors,
clinical laboratory manager, and safety committee are outlined in
Section I of this manual. The Environmental Safety Officer of the
Clinical Center serves as the qualified chemical hygiene officer for LP
and is available to work with the LP Safety Committee. Policies for all
operations that involve hazardous chemicals and criteria for the use of
personal protective equipment are found throughout the Safety Manual.
Specific policies regarding hazardous chemicals are in each laboratory
section where appropriate. Exposure monitoring and medical consultation
is outlined in Section I. Each laboratory section has separate Chemical
Inventory and Material Safety Data Sheets (MSDS), which are accessible
to all employees, either in printed or online version. Other references
that list the details of hazards and the precautions for safe handling
and storage are also accessible to employees in each section. The LP
Chemical Hygiene Plan is reviewed annually and updated by the LP Quality
Improvement Committee. The NIH Chemical Hygiene Plan is reviewed
annually and updated as needed by the Division of Safety and the NIH
Occupational Safety and Health Committee. Comments and suggestions on
the improvement of the NIH plan should be directed to the Chief, OSHB at
496-2960.

The following web resources are available:

-   NIH Hazard Communication Program
    <http://www.nih.gov/od/ors/ds/pubs/hcp/contents.htm>

-   NIH Chemical Hygiene Plan
    <http://www.nih.gov/od/ors/ds/pubs/chp/index.htm>

-   OSHA Hazard Communication
    <http://www.osha-slc.gov/SLTC/hazardcommunications/index.html>

-   OSHA Laboratory Standard (Code of Federal Regulations, Title 29,
    Part 1910 and all appendices)
    <http://www.osha-slc.gov/OshStd_toc/OSHA_Std_toc_1910.html>

-   P rocedures for spills and waste disposal are contained at
    <http://www.nih.gov/od/ors/ds/spills.html>

-   Material Safety Data Sheets <http://www.nih.gov/od/ors/ds/msds.html>

**CHEMICAL SAFETY**

-   Do not smell or taste chemicals.

-   Keep chemicals properly labeled. Do not remove manufacturer's label.
    Hazardous caution labels must be placed on all primary and secondary
    containers based on information from manufacturer label, MSDS, or
    chemical inventory evaluation. Always include the name of chemical,
    lot number, date opened (or date prepared or received), and
    expiration date and initials, as specified by CAP requirements for
    each specific area. Each section should follow the labeling
    requirements of the specific CAP checklist designated for their
    area.

**CHEMICAL STORAGE**

-   OSHA requires the establishment of special "designated areas" in
    laboratories for the storage of chemical substances of moderate to
    high chronic toxicity (and including carinogens, teratogens, and
    embryotoxins). A "designated area" may be a cabinet, desiccator,
    fume hood, or refrigerator where toxic substances can be stored or
    used. A sign should be present to alert other laboratory personnel
    that such substances are present. This also serves to alert
    housekeeping and maintenance personnel that they should be
    especially careful when working around these areas.

-   Store chemicals according to the manufacturer's recommendations.

-   Do not store chemicals at high levels above arms reach.

-   Safety cans are used instead of glass bottles for volumes of
    flammable solvents larger than one quart (or larger than one pint
    for solvents that are highly volatile such as ether or pentane) if
    the purity required does not mandate glass storage.

-   S upplies of flammable and combustible liquids should be reasonable
    for the laboratory\'s needs, and must be properly stored. Storage
    areas and/or rooms where volatile solvents are used must be
    adequately ventilated.

-   F lammable or combustible liquids or gas cylinders are positioned
    well away from open flame or other heat sources, not in corridors
    and not within exhaust canopies.

-   Large drum (bulk) containers are not to be used.

-   Bottle carriers are provided for transporting glass containers
    larger than 500 mL that contain hazardous chemicals. Carriers are
    not needed for shatter resistant plastic-coated bottles.

-   Precautionary labels must be present on the containers of all
    hazardous chemicals (flammable liquids Classes I, II, and IIIA;
    corrosives; irritants; asphyxiants; potential carcinogens; etc.),
    indicating type of hazard and what to do if accidental contact
    occurs. If the container is too small for such a label, a sign may
    be posted in the area where the chemical is stored and/or used as
    appropriate.

-   Additional information on general storage compatibility of chemicals
    and segregation information may be found at
    <http://www.nih.gov/od/ors/ds/pubs/chp/compat.htm>

**GAS CYLINDERS**

-   No more than one extra cylinder of compressed, flammable gas (other
    than those actually connected for use) should be stored at any one
    workstation.

-   All compressed gas cylinders must be secured to prevent accidental
    falling and damage to the valve or regulator.

-   Use proper regulators for each type of gas tank as recommended by
    the instrument manufacturer.

-   Only non-flammable gas cylinders are currently used in LP; if
    flammable gas cylinders are used in the future, the following
    polices will apply:

-   Flammable gas cylinders must be stored in a separate, ventilated
    room or enclosure, reserved exclusively for that purpose, and which
    has a fire‑resistance classification of at least two hours.

-   If acetylene or other flammable gas is piped in a manifold
    compressed gas system, the cylinders must be stored in a separate
    room and piping system must be properly installed and approved by
    the Division of Safety.

**WASTE DISPOSAL**

The NIH has five categories of waste and specific procedures for
segregation, labeling & collection. See the NIH guide to waste disposal
(waste calendar) at <http://www.nih.gov/od/ors/ds/wastecal/guide.htm>.
The law requires proper disposal of waste. The generator is responsible
for ensuring waste is properly segregated and labeled from the point of
generation to collection by the contractor.

Additional information regarding waste disposal may be found at
<http://www1.od.nih.gov/oma/manualchapters/intramural/3032/>

Additional information regarding proper management of chemical waste in
laboratories is found in the Appendix in a memo format.

**ERGONOMICS**

Ergonomics is an applied science concerned with designing and arranging
objects (e.g., equipment, computers, pipettes, etc) in the workplace to
maximize a safe and efficient interaction with them. Ergonomics may
reduce the number of injuries in the workplace particularly by reducing
the number of repetitive motions. Guidelines on ergonomics are available
at:

-   <http://www.nih.gov/od/ors/ds/ergonomics/index.html>

-   <http://www.niehs.nih.gov/odhsb/ergoguid/home.htm>

-   <http://odp.od.nih.gov/whpp/ergonomics/ergonomics.html>

-   <http://www.cdc.gov/niosh/ephome2.html#second>

-   <http://www.cdc.gov/niosh/ergoweb.html>

REFERENCES

-   Center for Disease Control: Office of Health and Safety.
    Microbiological and Biomedical Laboratories (BMBL).
    <http://www.cdc.gov/od/ohs/biosfty/bmbl4/bmbl4toc.htm>

-   Chief, Waste Management Section, EPB, DS, ORS and Chief, Safety
    Operations Section, OSHB, DS, ORS. Memo: Proper Management of
    Chemical Waste in Laboratories. July 23, 2001.

-   College of American Pathologists. Laboratory General Checklist. June
    21, 2001.

NIH Clinical Center. Annual Review of the Environment of Care Program:
Medical Equipment Management Plan
<http://www.cc.nih.gov/ccc/safety/ec2000/equip2000.html>

-   NIEHS Health and Safety Manual. Chapter 4 - General Safety and
    Laboratory Policies/ Centrifuge Safety.
    <http://www.niehs.nih.gov/odhsb/manual/man4a.htm>

-   OSHA National News Release USDL: 01-170. June 7, 2001. Labor
    Secretary Announces Deadline on Ergonomics Plans Forums with Guiding
    Principles. Available:
    [http://www.osha.gov/media/oshnews/june01/national-20010607.htm](http://www.osha.gov/media/oshnews/june01/national-20010607.html)

**STANDARD PRACTICES**

1.  Food is stored outside the work area in cabinets or refrigerators
    designated for this purpose only.

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1.  Access to the laboratory is limited when work with infectious agents
    is in progress.

2.  Laboratory personnel receive appropriate immunizations or tests for
    the agents handled (e.g., hepatitis B vaccine or TB skin testing).
    See Section I for more information regarding services provided by
    OMS.

3.  BL2 laboratory sections must have a BL2 sign (NIH 645-5) posted on
    the door. This sign designates the type of biohazardous agents used,
    special procedures or precautions for entry, and emergency contact
    information. Sections operating under Biosafety Level 1 designation
    do not require any posting. Refer to Biosafety in Microbiological
    and Biomedical Laboratories (BMBL) published by the Center for
    Disease Control at
    <http://www.cdc.gov/od/ohs/biosfty/bmbl4/bmbl4toc.htm> for specific
    practices, facilities, and equipment for each Biosafety Level
    designation. Contact the NIH Division of Safety (496-5291) to
    determine Biosafety Level designation and to obtain BL2 signs.

4.  The Clinical Chiefs have established policies and procedures whereby
    persons are advised of all potential hazards in the laboratory.
    Laboratory personnel are advised of special hazards and required to
    follow any special procedures.

5.  Smoking, eating, drinking, and/or chewing gum is not permitted in
    the work area.

6.  Application of cosmetics and/or lip balm is not permitted in the
    work area.

7.  Handling contact lenses is not permitted in the work area. Persons
    who wear contact lenses in laboratories should also wear goggles or
    a face shield.

8.  Handle and store brittle plasticware and glassware with care to
    avoid damage; do not use damaged glassware or plasticware.

9.  Recapping, purposeful bending, breaking, removing from syringes, or
    other manual manipulations of needles are strictly prohibited.
    Resheathing instruments or self-sheathing needles may be used to
    prevent recapping of needles by hand.

10. Mouth pipetting is prohibited.

11. Keep work areas clean. Work surfaces are decontaminated daily and
    after any spill of viable or chemical material.

12. Persons wash their hands after handling chemicals, after removing
    gloves, and before leaving the laboratory.

13. Immediately report all splashes, injuries, and spills to the
    Clinical Chief or designate when they occur. Medical evaluation and
    surveillance are provided as appropriate and written records are
    maintained. Employees with occupational injuries or illnesses that
    require medical treatment (more than first aid) must report to OMS.
    All accidents, spills, and injuries are reported to the Chair of the
    Safety Committee for evaluation and presentation to the Quality
    Improvement committee to avoid recurrence.

14. Explicit instructions are posted, and appropriate supplies are
    available, for the emergency treatment of chemical splashes and
    injuries and the control of chemical spills wherever major chemical
    hazards exist in each section.

15. For additional information, see web sites for emergency procedures
    involving:

-   Medical Emergencies:
    <http://www.nih.gov/od/ors/ds/medemergency.html>

-   First aid for Exposure to Blood or Other Potentially Infectious
    Materials [h
    ttp://www.cc.nih.gov/hes/CC/up_book.html#firstaid](http://www.cc.nih.gov/hes/CC/up_book.html#firstaid)

-   Hazardous Materials Incidents and Spills:
    <http://www.nih.gov/od/ors/ds/spills.html>

-   For spills of blood or other potentially infectious materials, see
    <http://www.cc.nih.gov/hes/CC/up_book.html#spills>

-   Emergency procedures (Fire, Chemical, Biological, Radiological, Bomb
    Threats, Odor Management):
    <http://www.nih.gov/od/ors/dps/emb/emrgproc.htm>

-   Telephone Bomb Threats
    <http://www.nih.gov/od/ors/newsltrs/psn/psn34.htm>

-   Bomb Threat Check List
    <http://www.nih.gov/od/ors/newsltrs/psn/bmblist.htm>

-   Handling NIH mail
    <http://www.nih.gov/od/ors/security/mailsecurity.htm>

-   Guidelines for Identifying Suspicious Mail
    <http://www.nih.gov/od/ors/security/idmail.htm>

-   Public Health Emergency Preparedness and Response information
    <http://www.bt.cdc.gov/>

**SAFETY EQUIPMENT AND PERSONAL PROTECTIVE EQUIPMENT**

-   Properly maintained biological safety cabinets are used whenever
    procedures with a potential for creating infectious splashes are
    done. Hazardous chemicals are used under chemical fume hoods. All
    hoods and cabinets are certified by the Division of Safety annually.

-   All emergency eyewash stations must be located within 100 ft. or 10
    seconds travel distance from every area of the laboratory in which
    hazardous chemicals (irritating, corrosive, or toxic by contact or
    absorption) are used. The eyewash is tested regularly and documented
    within each laboratory section.

-   Appropriate personal protective equipment (gloves, gowns, masks and
    eye protectors, etc.) are provided and maintained in a sanitary and
    reliable condition in all technical work areas in which blood and
    body substances are handled and in circumstances during which
    exposure is likely to occur.

-   Personnel must use the proper personal protective devices when
    handling corrosive, flammable, biohazardous, and carcinogenic
    substances.

-   Face protection (goggles, mask, face shield, etc) is used when the
    possibility of splashes to the face exist.

-   Protective lab coats are worn while in the laboratory. The lab coats
    must be removed when leaving the lab and should be laundered
    in-house and never taken home by personnel. All protective wear such
    as disposable gloves, surgical scrubs, aprons, and lab coats must be
    removed before leaving the technical work area.

-   Open-toed shoes, sandals, shorts and other apparel that leave skin
    exposed are not appropriate when working with hazardous chemicals or
    infectious agents.

-   All personnel are instructed in the proper use and care of
    disposable gloves and it is documented on the new employee safety
    orientation checklist.

-   Laboratory personnel must use only non‑latex or powder‑free latex
    gloves when handling specimens.

-   Nitrile gloves are recommended for chemicals.

-   Heavy gloves are recommended for liquid nitrogen.

-   Inspect gloves before use. Use the proper type of gloves (e.g.,
    nitrile for hazardous chemicals).

-   Gloves are worn when hands may contact infectious agents or
    hazardous chemicals.

-   Gloves are disposed of as contaminated waste when work with
    materials is completed, and are not worn outside the laboratory.

-   Wash hands after removing gloves and before leaving the work area.

**LATEX PROGRAM**

Personnel are protected from allergic reaction due to job-related
exposure to natural rubber latex gloves and other products. The Safety
Committee may assist with selection of products and implementation of
work practices that reduce the risk of allergic reactions and help
educate employees regarding latex allergies. Important information for
healthcare professionals regarding natural rubber latex (NRL) allergy
are provided at <http://www.cc.nih.gov/hes/latex_healthpro.html>. If
latex gloves are used, the supervisor should provide reduced protein,
powder-free gloves. Employees with latex allergies should report to OMS
for medical evaluation. OMS can diagnose an employee with latex
allergies and help with prevention and control strategies.

**LABORATORY FACILITIES AND PHYSICAL SAFETY**

1.  Each lab contains a sink for hand washing.

2.  Vacuum breakers (anti-siphon devices) must be provided on water
    outlets if the spigot or an extension extends below sink level, or
    if the outlet has a suction apparatus attached

3.  The laboratory is designed so that it can be easily cleaned. Work
    surfaces should be protected from contamination through the use of
    disposable, absorbent, plastic backed paper. Replace contaminated
    paper as necessary and handle as hazardous waste.

4.  There must be unrestricted access to an eyewash station and
    emergency shower. Eyewash stations are tested on a regular basis and
    documented in each laboratory. Emergency showers are tested and
    documented by maintenance on an annual basis. A list of emergency
    showers is located in Appendix H.

5.  Laboratory airflow (negative pressure relative to corridor) may be
    checked through maintenance if requested.

6.  The laboratory is equipped with a zoned automatic fire detection
    system, an overhead sprinkler system and alarm systems. The fire
    alarm is audible in all parts of the laboratory, including storage
    areas, lavatories, and darkrooms. Fire alarm pull stations are
    located throughout the hallway corridors. ABC fire extinguishers are
    in the corridors. Corridors and stairwells have adequate emergency
    lighting for safe evacuation of the laboratory.

7.  Rooms larger than 1000 ft 2, or in which major fire hazards exist,
    have at least 2 exit access doors remote from each other, one of
    which opens directly into a means of egress.

**ELECTRICAL AND EQUIPMENT SAFETY**

-   All instruments and appliances must be grounded, unless they are
    entirely encased in plastic (such as some cover slippers, stainers,
    microtomes).

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-   Instruments and appliances must be checked for adequate grounding
    and checked for current leakage by CC Biomedical Engineering
    (496-1311) before initial use, after repair or modification, and
    when a problem is suspected. At the time of the inspection a label
    will be affixed to the item to certify the results of the ground
    check.

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-   All shocks must be reported immediately including small tingles.
    Small shocks often precede major shocks and a light tingle may
    indicate potential trouble. Shut off the current and/or unplug the
    instrument if shocks occur. Do not attempt to use an instrument that
    is causing shocks, because it is potentially dangerous and all data
    gathered from the operation of that instrument may be unreliable.

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-   Do not work on or attempt to repair any instrument while it is
    plugged in. An exception is the calibration of instruments that
    require adjustments while plugged in. In this case, be sure hands
    are dry, remove all jewelry and proceed with caution. Contact the
    instrument manufacturer or biomedical engineering if repairs are
    needed. All repairs will be documented.

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-   Repairs on the electrical system of the building are prohibited. Any
    work to be performed on switches, outlets or circuit boxes (fuses,
    circuit breaker) must be referred to maintenance (ext. 496-1234).

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-   Extension cords should be avoided. If used, they must be 3-way type
    and properly grounded. Gauge plugs are prohibited.

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-   Employees must call 911 to report any electrical arc (constant
    luminous discharge of electricity) of equipment.

Polarity and Ground Checks

-   Maintenance is responsible for checking each circuit supporting
    fixed electrical receptacles in technical work areas at least
    annually for polarity and ground integrity. Polarity checks on wall
    receptacles are necessary because many laboratory instruments cannot
    be checked for current leakage under conditions of reversed
    polarity.

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-   If at any time an outlet becomes faulty or if electric current
    problems are suspected, contact maintenance (ext. 496-1234) to
    resolve the problem.

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-   The safety officer of each section maintains the outlet polarity and
    ground check documentation in each laboratory. A copy is sent to the
    Program Assistant for central filing. All documentation must be
    readily available for inspection purposes and tracking of
    compliance.

CENTRIFUGES

-   Do *not* operate centrifuges unless the covers are closed. Keep
    hair, beard, neckties, hair ribbons, hair braids, or other dangling
    items out of the way.

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-   Do *not* centrifuge uncovered tubes containing specimens or
    flammable liquids. Use caps or parafilm.

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-   Before centrifuging check the integrity of tubes and tube holders.

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-   When the centrifuge is in operation, the lid must always be closed.
    If a noise or vibration begins, stop the centrifuge immediately and
    check for improper balancing of loads, caps and rotors.

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-   Tubes used in angle head rotors must never be filled in the point
    where the liquid is in contact with the lip of the tube when placed
    in the rotor.

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-   Avoid decanting, no matter what type of centrifuge tube is used. IF
    unavoidable, wipe off the outer rim afterwards with a disinfectant;
    otherwise, the fluid on the outer rim will spin off as an aerosol.

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-   When centrifuging infectious agents, safety carriers (carriers with
    individual screw caps) or rotors that are sealed shut should be
    used.

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-   Centrifuges should be clean and free of spills. The holders (cups)
    and centrifuge should be cleaned as needed. The cups should first be
    disinfected and then washed in warm soapy water and scrubbed with a
    nylon brush.

**OTHER EQUIPMENT**

Each laboratory section is responsible for training employees in the
proper use of all equipment (e.g., Autoclave, Centrifuge, Cryostat,
Electron Microscope, Lasers, Respirators, Ultraviolet Light Sources,
etc.).

**CHEMICAL HYGIENE PLAN**

The responsibilities of the laboratory director (LP Chief), supervisors,
clinical laboratory manager, and safety committee are outlined in
Section I of this manual. The Environmental Safety Officer of the
Clinical Center serves as the qualified chemical hygiene officer for LP
and is available to work with the LP Safety Committee. Policies for all
operations that involve hazardous chemicals and criteria for the use of
personal protective equipment are found throughout the Safety Manual.
Specific policies regarding hazardous chemicals are in each laboratory
section where appropriate. Exposure monitoring and medical consultation
is outlined in the Section titled \"Roles, Responsibilities, and
Requirements,\" located
[here](http://home.ccr.cancer.gov/lop/intranet/PolicyManual/SafetyOverview/roles.asp).
Each laboratory section has separate Chemical Inventory and Material
Safety Data Sheets (MSDS), which are accessible to all employees, either
in printed or online version. Other references that list the details of
hazards and the precautions for safe handling and storage are also
accessible to employees in each section. The LP Chemical Hygiene Plan is
reviewed annually and updated by the LP Quality Improvement Committee.
The NIH Chemical Hygiene Plan is reviewed annually and updated as needed
by the Division of Safety and the NIH Occupational Safety and Health
Committee. Comments and suggestions on the improvement of the NIH plan
should be directed to the Chief, OSHB at 496-2960.

The following web resources are available:

-   NIH Hazard Communication Program
    <http://www.nih.gov/od/ors/ds/pubs/hcp/contents.htm>

-   NIH Chemical Hygiene Plan
    <http://www.nih.gov/od/ors/ds/pubs/chp/index.htm>

-   OSHA Hazard Communication
    <http://www.osha-slc.gov/SLTC/hazardcommunications/index.html>

-   OSHA Laboratory Standard (Code of Federal Regulations, Title 29,
    Part 1910 and all appendices)
    <http://www.osha-slc.gov/OshStd_toc/OSHA_Std_toc_1910.html>

-   P rocedures for spills and waste disposal are contained at
    <http://www.nih.gov/od/ors/ds/spills.html>

-   Material Safety Data Sheets <http://www.nih.gov/od/ors/ds/msds.html>

**CHEMICAL SAFETY**

-   Do not smell or taste chemicals.

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-   Keep chemicals properly labeled. Do not remove manufacturer's label.
    Hazardous caution labels must be placed on all primary and secondary
    containers based on information from manufacturer label, MSDS, or
    chemical inventory evaluation. Always include the name of chemical,
    lot number, date opened (or date prepared or received), and
    expiration date and initials, as specified by CAP requirements for
    each specific area. Each section should follow the labeling
    requirements of the specific CAP checklist designated for their
    area.

-   The LP has an overall goal of eliminating mercury and using
    non-mercury substitute when possible.  More information about the
    NIH has a mercury abatement program may be reviewed at
    <http://orf.od.nih.gov/nomercuryhome.htm>

-   Each lab should post the Chemical Inventory and Accidental Notice
    contained in [Appendix
    J](http://home.ccr.cancer.gov/lop/intranet/PolicyManual/SafetyAppendices/NOTICE.doc)

**LIQUID NITROGEN SAFETY**

**Purpose**

The purpose of this procedure is to insure that adequate policies,
procedures, and practices in place for the safe handling of liquid
nitrogen in Hematopathology, Ultrastructural Pathology, and Flow
Cytometry.

**Policy & Personal Protective Equipment**

-   Use of the following personal protective equipment is mandatory when
    decanting or entering an open container of liquid nitrogen:

    -   Loose fitting, insulated gloves made to withstand cryogenic
        liquids. The gloves should be loose enough so they can be thrown
        off easily and rapidly.

    -   Shield all or your skin with long sleeve shirts and trousers.
        Pant legs should go over the top of footwear so spills cannot
        get into footwear and cause extreme tissue damage before
        removal. Rubber aprons, overalls without pockets or cuffs, and
        hightop shoes are preferred.

    -   Always wear chemical splash goggles AND face shield to guard
        against splashes and possible vessel rupture causing flying
        debris.

-   The storage and use of all containers of liquid nitrogen must be
    only in well-ventilated areas. If working in an oxygen-deficient
    atmosphere, wear an oxygen-supplying respirator. When working in
    closed area, use an oxygen alarm to alert anyone in the room of
    oxygen-deficient atmosphere before dangerous levels are reached.

-   Store liquid nitrogen tanks in upright position in cool, dry,
    well-ventilated area away from emergency exits or heavy traffic
    areas. Do not store liquid nitrogen tanks in areas of refuge. If
    cylinders are involved in a fire, safely relocate or keep cool with
    water spray. Do not store in areas greater than 125°F (51°C).

-   Do not drag, slide or roll storage cylinders. Use suitable hand
    truck to move vessels and always secure in upright position during
    movement and transport.

-   The Material Safety Data Sheet for liquid nitrogen is available in
    each lab using the material.

**Special Safety Precautions**

-   Extreme temperatures of liquid nitrogen cause most solids to become
    brittle.

-   Contact to eyes or skin can cause serious frostbite injuries or
    tissue damage resembling burns.

-   Contact with a cryogenically cooled material is dangerous; do not
    touch cryogenically cooled material with bare flesh.

-   To minimize chances of freezing material to skin, remove watches and
    jewelry from the hands and wrists before using liquid nitrogen.

-   When liquid nitrogen warms to a gaseous state it displaces oxygen.
    Oxygen-deficient atmospheres can cause dizziness, nausea, vomiting,
    unconsciousness, confusion, and death. Unconsciousness could occur
    without any preceding signs of danger.

-   Never plug or cover a cryogenic container, otherwise explosions or
    ruptures may occur.

-   Use only containers designed specifically for cryogenic liquids such
    as Dewar flasks and cryogenic storage tanks. Fill slowly to protect
    from excessive stress that can damage the container. Do not fill
    containers past 80% capacity.

-   Nitrogen is an asphyxiant. Rapid expansion of liquid nitrogen to gas
    is colorless, odorless, and tasteless and can lead to asphyxiation.
    Always work in well ventilated areas. Just one liter of gas can
    expand to 24.6 cubic feet, which is an expansion ratio of 1:696.
    Liquid nitrogen can rapidly fill small spaces causing very dangerous
    situations.

-   The Division of Fire Safety and Prevention may be contacted at (301)
    496-0487 to evaluate work space requirements for ventilation of
    oxygen alarms.

**First Aid**

Signs and symptoms of exposure:

-   Nausea

-   Drowsiness

-   Blue coloration of skin and lips

-   Unconsciousness

-   Death

Remove an incapacitated worker from further exposure and implement
appropriate emergency procedures and/or first aid. Immediately contact
OMS (301-496-4411) for medical assistance or call code blue (111) if
overcome by loss of oxygen.

The following procedures are recommended:

-   EYE CONTACT: Remove victim from source of contamination. Open
    eyelids, allowing liquid to evaporate. See medical attention.

-   SKIN CONTACT: Exposed tissues should be restored to normal body
    temperature by running warm water (100-108°F or 37-42°C) over the
    affected part. DO NOT USE AN OPEN FLAME FOR THIS PURPOSE. Water
    should never be more than 112°F (44°C) and the affected part should
    not be rubbed at any time -this can cause further damage to the
    area. The victim should get emergency care as quickly as possible to
    minimize further damage and for damage assessment.

-   INHALATION: If a person is overcome by loss of oxygen while working
    with cryogenic liquids, that person should be moved to a
    well-ventilated area immediately. A self contained breathing
    apparatus (SCBA) may be required for rescue so the rescuer does not
    also fall victim. Artificial respiration should be applied if
    breathing has stopped. If the person is having difficulty breathing,
    oxygen should be supplied. Emergency medical help should be
    summoned.

**References**

-   College of American Pathologists. General Checklist and Commentary.
    July 2003.

-   [Lab Safety Supply. How to Work Safely with Cryogenics. EZ Facts
    Safety Info-Document #290, What is
    Cryogenics?](http://www.labsafety.com/refinfo/ezfacts/ezf290.htm)

-   [National Institute of Environmental Health Sciences. Health and
    Safety Manual, Chapter 4, General Safety and Laboratory Policies,
    Section C: Cryogenic
    Liquids](http://www.niehs.nih.gov/odhsb/manual/man4c.htm)

-   [OSHA Technical Links,
    Nitrogen](http://www.osha.gov/SLTC/healthguidelines/nitrogen/recognition.html)

-   Written communications regarding first aid and OMS procedures. James
    Schmitt, M.D., M.S., Medical Director, Occupational Medical Service.
    February 2004.

**CHEMICAL STORAGE**

-   OSHA requires the establishment of special "designated areas" in
    laboratories for the storage of chemical substances of moderate to
    high chronic toxicity (and including carinogens, teratogens, and
    embryotoxins). A "designated area" may be a cabinet, desiccator,
    fume hood, or refrigerator where toxic substances can be stored or
    used. A sign should be present to alert other laboratory personnel
    that such substances are present. This also serves to alert
    housekeeping and maintenance personnel that they should be
    especially careful when working around these areas.

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-   Store chemicals according to the manufacturer's recommendations.

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-   Do not store chemicals at high levels above arms reach.

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-   Safety cans are used instead of glass bottles for volumes of
    flammable solvents larger than one quart (or larger than one pint
    for solvents that are highly volatile such as ether or pentane) if
    the purity required does not mandate glass storage.

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-   S upplies of flammable and combustible liquids should be reasonable
    for the laboratory\'s needs, and must be properly stored. Storage
    areas and/or rooms where volatile solvents are used must be
    adequately ventilated.

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-   F lammable or combustible liquids or gas cylinders are positioned
    well away from open flame or other heat sources, not in corridors
    and not within exhaust canopies.

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-   Large drum (bulk) containers are not to be used.

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-   Bottle carriers are provided for transporting glass containers
    larger than 500 mL that contain hazardous chemicals. Carriers are
    not needed for shatter resistant plastic-coated bottles.

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-   Precautionary labels must be present on the containers of all
    hazardous chemicals (flammable liquids Classes I, II, and IIIA;
    corrosives; irritants; asphyxiants; potential carcinogens; etc.),
    indicating type of hazard and what to do if accidental contact
    occurs. If the container is too small for such a label, a sign may
    be posted in the area where the chemical is stored and/or used as
    appropriate.

-   Additional information on general storage compatibility of chemicals
    and segregation information may be found at
    <http://www.nih.gov/od/ors/ds/pubs/chp/compat.htm>

**GAS CYLINDERS**

1.  No more than one extra cylinder of compressed, flammable gas (other
    than those actually connected for use) should be stored at any one
    workstation.

2.  All compressed gas cylinders must be secured to prevent accidental
    falling and damage to the valve or regulator.

3.  Only non-flammable gas cylinders are currently used in LP; if
    flammable gas cylinders are used in the future, the flammable gas
    cylinders must be stored in a separate, ventilated room or
    enclosure, reserved exclusively for that purpose, and which has a
    fire‑resistance classification of at least two hours.

**WASTE DISPOSAL**

The NIH has five categories of waste and specific procedures for
segregation, labeling & collection. See the NIH guide to waste disposal
(waste calendar) at <http://www.nih.gov/od/ors/ds/wastecal/guide.htm>.
The law requires proper disposal of waste. The generator is responsible
for ensuring waste is properly segregated and labeled from the point of
generation to collection by the contractor.

Additional information regarding waste disposal may be found at
<http://www1.od.nih.gov/oma/manualchapters/intramural/3032/>

Additional information regarding proper management of chemical waste in
laboratories is found in the Appendix in a memo format.

**ERGONOMICS**

Ergonomics is an applied science concerned with designing and arranging
objects (e.g., equipment, computers, pipettes, etc) in the workplace to
fully accommodate the worker and maximize a safe and efficient
interaction with them. Ergonomics may reduce the number of injuries in
the workplace particularly by promoting proper posture, reducing
excessive reaching, force, and the number of repetitive motions
promoting education of body mechanics. Guidelines on ergonomics are
available at::

-   <http://www.nih.gov/od/ors/ds/ergonomics/index.html>

-   <http://www.niehs.nih.gov/odhsb/ergoguid/home.htm>

-   <http://odp.od.nih.gov/whpp/ergonomics/ergonomics.html>

-   <http://www.cdc.gov/niosh/ephome2.html#second>

-   <http://www.cdc.gov/niosh/ergopage.html>

To prevent musculoskeletal disorders (MSDs) in the workplace, NIH has a
program to evaluate your work area and suggest improvements for
prevention and work control. To receive an ergonomic work assessment,
please contact the **Occupational Safety and Health Branch** at
496-3457.

**REFERENCES**

-   Center for Disease Control: Office of Health and Safety.
    Microbiological and Biomedical Laboratories (BMBL).
    <http://www.cdc.gov/od/ohs/biosfty/bmbl4/bmbl4toc.htm>

-   Chief, Waste Management Section, EPB, DS, ORS and Chief, Safety
    Operations Section, OSHB, DS, ORS. Memo: Proper Management of
    Chemical Waste in Laboratories. July 23, 2001.

-   College of American Pathologists. Laboratory General Checklist. June
    21, 2001.

-   NIH Clinical Center. Annual Review of the Environment of Care
    Program: Medical Equipment Management Plan
    <http://www.cc.nih.gov/ccc/safety/ec2000/equip2000.html>

-   NIEHS Health and Safety Manual. Chapter 4 - General Safety and
    Laboratory Policies/ Centrifuge Safety.
    <http://www.niehs.nih.gov/odhsb/manual/man4a.htm>

-   OSHA National News Release USDL: 01-170. June 7, 2001. Labor
    Secretary Announces Deadline on Ergonomics Plans Forums with Guiding
    Principles. Available:
    <http://www.osha.gov/media/oshnews/june01/national-20010607.html>