1. Handwashing is one of the most important safety practices. Hands must be washed with soap and water. If water is not readily available, alcohol hand gels (minimum 62% alcohol) may be used. Hands must be thoroughly dried. The proper technique for handwashing is as follows:

a. Wet hands and wrists thoroughly under running water.

b. Apply germicidal soap and rub hands vigorously for at least 15 seconds, including between the fingers and around and over the fingernails (Figure 2-1, A).

c. Rinse hands thoroughly under running water in a downward flow from wrist to fingertips (see Figure 2-1, B).

d. Dry hands with a paper towel (see Figure 2-1, C). Use the paper towel to turn off the faucet handles (see Figure 2-1, D).

Hands must be washed:

2. Eating, drinking, smoking, and applying cosmetics or lip balm must be prohibited in the laboratory work area.

3. Hands, pens, and other fomites must be kept away from the worker’s mouth and all mucous membranes.

4. Food and drink, including oral medications and tolerance-testing beverages, must not be kept in the same refrigerator as laboratory specimens or reagents or where potentially infectious materials are stored or tested.

5. Mouth pipetting must be prohibited.

6. Needles and other sharp objects contaminated with blood and other potentially infectious materials should not be manipulated in any way. Such manipulation includes resheathing, bending, clipping, or removing the sharp object. Resheathing or recapping is permitted only when there are no other alternatives or when the recapping is required by specific medical procedures. Recapping is permitted by use of a method other than the traditional two-handed procedure. The one-handed method or a resheathing device is often used (see Chapter 3). Documentation in the exposure control plan should identify the specific procedure by which resheathing is permitted.

7. Contaminated sharps (including, but not limited to, needles, blades, pipettes, syringes with needles, and glass slides) must be placed in a puncture-resistant container that is appropriately labeled with the universal biohazard symbol (Figure 2-2) or a red container that adheres to the standard. The container must be leak-proof (Figure 2-3).

8. Procedures such as removing caps when checking for clots, filling hemacytometer chambers, making slides, discarding specimens, making dilutions, and pouring specimens or fluids must be performed so that splashing, spraying, or production of droplets of the specimen being manipulated is prevented. These procedures may be performed behind a barrier, such as a plastic shield, or protective eyewear should be worn (Figure 2-4).

9. Personal protective clothing and equipment must be provided to the worker. The most common forms of personal protective equipment are described in the following:

a. Outer coverings, including gowns, laboratory coats, and sleeve protectors, should be worn when there is a chance of splashing or spilling on work clothing. The outer covering must be made of fluid-resistant material, must be long-sleeved, and must remain buttoned at all times. If contamination occurs, the personal protective equipment should be removed immediately and treated as infectious material.

    Cloth laboratory coats may be worn if they are fluid resistant. If cloth coats are worn, the coats must be laundered inside the laboratory or hospital or by a contracted laundry service. Laboratory coats used in the laboratory while performing laboratory analysis are considered personal protective equipment and are not to be taken home.

    All protective clothing should be removed before the worker leaves the laboratory; it should not be worn into public areas. Public areas include, but are not limited to, break rooms, storage areas, bathrooms, cafeterias, offices, and meeting places outside the laboratory.

    A second laboratory coat can be made available for use in public areas. A common practice is to have a different-colored laboratory coat that can be worn in public areas. This second laboratory coat would be laundered by the employee.

b. Gloves must be worn when the potential for contact with blood or body fluids exists (including when removing and handling bagged biohazardous material and when decontaminating bench tops) and when venipuncture or finger sticks are performed. One of the limitations of gloves is that they do not prevent needle sticks or other puncture wounds. Provision of gloves to laboratory workers must accommodate latex allergies. Alternative gloves must be readily accessible to any laboratory worker with a latex allergy. Gloves must be changed after each contact with a patient, when there is visible contamination, and when physical damage occurs. Gloves should not be worn when “clean” devices, such as a copy machine or a “clean” telephone, are used. Gloves must not be worn again or washed. After one glove is removed, the second glove can be removed by sliding the index finger of the ungloved hand between the glove and the hand and slipping the second glove off. This technique prevents contamination of the “clean” hand by the “dirty” second glove (Figure 2-5).¹ Contaminated gloves should be disposed of according to applicable federal or state regulations.

c. Eyewear, including face shields, goggles, and masks, should be used when there is potential for aerosol mists, splashes, or sprays to mucous membranes (mouth, eyes, or nose). Removing caps from specimen tubes, working at the cell counter, and centrifuging specimens are examples of tasks that could result in creation of aerosol mist.

10. Phlebotomy trays should be appropriately labeled to indicate potentially infectious materials. Specimens should be placed into a secondary container, such as a resealable biohazard-labeled bag.

11. If a pneumatic tube system is used to transport specimens, the specimens should be transported in the appropriate tube (primary containment), placed into a special self-sealing leak-proof bag, appropriately labeled with the biohazard symbol (secondary containment). Requisition forms should be placed outside of the secondary container to prevent contamination if the specimen leaks. Foam inserts for the pneumatic tube system carrier prevent shifting of the sample during transport and also act as a shock absorber, thus decreasing the risk of breakage.

    When specimens are received in the laboratory, they should be handled by someone wearing gloves, a laboratory coat, and other protective clothing, in accordance with the type and condition of specimen. Contaminated containers or requisitions must be decontaminated or replaced before being sent to the work area.

12. When equipment

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