HIRARC Type of Industry

HIRARC
Type of Industry : Healthcare Service
Department : Haematology Lab
Student’s Name : Sharifah Musaisha Ainna Syed Mustafa
: Nur Atikah Mohamad Danil
Matric Number : A162276
: A161442
Programme : Environmental Health (EVH)
Course Code : NNNE 2483
Course Title : Occupational Safety and Health
Lecturer’s Name : Dr Mazrura Sahani
Year : 2/ Sem 2
Session : 2017/2018
Date : 15 MAY 2018
Introduction
Hazard and risk are everywhere. Every day we are facing variety of hazards and potential risks in most of our daily activities either we realise it or not. Since quarter of our lives spent at work, thus realisation of hazards and risks at workplace is very important in order to ensure the safety, health and welfare of worker at work is guaranteed. Our group has selected to conduct the Hazard Identification, Risk Assessment and Risk Control (HIRARC) in Healthcare services type of industry specifically at Haematology lab.

Haematology is the study about blood, blood-forming tissues and organs as well as blood diseases including the diagnosis, treatment and prevention of diseases of the blood, bone marrow and immunologic, haemostatic, and vascular systems. Thus, haematology lab performed test and assessments related to blood formation and blood disorders. The lab also provides routine and urgent automated blood counting and morphological profiling, coagulation screening, transfusion (blood grouping, antibody screening and blood/blood product provision), specialist haemostasis and haemoglobinopathy investigations. This lab is often found in the hospitals, universities and research and development centre such as Institute of Medical Research (IMR), Malaysia which is categorized as workplaces. Therefore, all the lab workers are protected under the ____ in the Occupational Safety and Health Act 1994.

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The haematology lab under this study was the Haematology lab in the Kuala Lumpur General Hospital or commonly known as HKL. The lab has been separated and solemnly operated as it owns since 1998 and currently holds about 18 lab workers in total. The lab operates 8 hours a day, from 8am to 5pm and 7 days a week except public holidays. It provides tertiary diagnostic and consultative haematology services to all government hospitals and clinics in Malaysia. Besides, it also serves as a training centre for undergraduates from local colleges and universities as well as for doctors majoring in haematology under the Masters in Pathology Program (MPATH) conducted by Universiti Malaya (UM), Universiti Kebangsaan Malaysia (UKM), Universiti Sains Malaysia (USM) and Universiti Putra Malaysia (UPM).

Classify Work Activities
1390650384175Classification of Work Activities
00Classification of Work Activities

2750024296412
1405255114651Defined Task
00Defined Task

1807845313690002566035295275003820795318770004646134319405004707213117850047752029447900275083030442
2000250141605Centrifugation
00Centrifugation
4011134142875Sample Analysis
00Sample Analysis
23976032187580045873882482600048482222971400-61216123825Specimen Handling
00Specimen Handling

1884045102235* Cord Blood sample
00* Cord Blood sample
3917789109220* Haemoglobin Analysis
* G6PD Analysis
00* Haemoglobin Analysis
* G6PD Analysis
-14732080806* Cord Blood sample
00* Cord Blood sample

1966595172085Transferring Sample
00Transferring Sample
4265693187799Waste Handling
00Waste Handling
460375176056Staining
00Staining

1851025136525* Cord Blood sample
00* Cord Blood sample
4225290159224* Chemical waste
* Biological waste
* Physical waste
00* Chemical waste
* Biological waste
* Physical waste
310515152561* Fixing sample
00* Fixing sample

876300374650Cleaning & Sterilization
00Cleaning & Sterilization
3209925370840Record keeping
00Record keeping

774700332105* Lab glassware
00* Lab glassware
3111500332105* File organization
00* File organization

Hazard Identification
No. Types of Hazard Examples Legislation
1. Biological Hazard Blood-borne pathogens
eg: – HIV virus
Dengue virus
Hepatitis B (HBV), C (HCV)
Malaria Occupational Safety Health Act, OSHA 1994
Biological Toxins
eg: – Botulinum toxin
Anthrax Biological Waste
eg: – Contaminated agar plates
Unused blood sample
Tested blood sample 2. Physical Hazard Sharp objects
eg: – Vacutainer needle
Scissor Occupational Safety Health Act, OSHA 1994
Uneven surface
eg: – Uneven floor surface Hot surface/objects
eg: – Laboratory ovens
Water bath Radiation
eg: – Ultraviolet ray, UV 3. Chemical Hazard Solvents
eg: – Acetonitrile
Methanol Classification, Labelling & Safety Data Sheet of Hazardous Chemicals Regulations, CLASS 2013
Staining
eg: – May-Grünwald Giemsa,MGG
Perls’ Prussian blue
PAS diastase stain (PAS-D)
Peroxidase
Dual esterase
Acid Phosphate Chemical Waste
eg: – Tested sample 4. Ergonomic Hazard Sitting Posture
eg: – Improper sitting posture Occupational Safety Health Act, OSHA 1994
Volumetric Handling
eg: – Pipetting
Transferring of blood sample Lifting heavy objects Risk Assessment
No. Types of Hazard Type of Activities Prospective Risks Risk Assessment
(L) (S) (R)
285750220980
00
1. Biological Hazard Specimen Handling
eg: – Blood
Cord Blood
Bone marrow
Leakage of sample during the sample transport The sample is not clearly labelled or not labelled Splashing of sample to the eyes during specimen handling Biological Waste Handling Leakage of biological waste 285750276860

00

2. Physical Hazard Specimen Handling
eg: – Blood
Cord Blood
Bone marrow Needle puncture injuries Cuts from sharp objects (eg: scissor) Injuries due to breaking of lab glassware Centrifugation Centrifuge tube breaks due to imbalance of the rotor vibration Microbial aerosols generation due to leakage of centrifuge rotor Sample Analysis Usage of UV ray in G6PD Analysis Uneven surface Trip and fall Cleaning and sterilization of lab glassware Injuries due to breaking of lab glassware Thermal burns due to touching hot surfaces/objects
Transferring Sample
eg: – Blood
Cord Blood
Bone marrow Spills Physical Waste Handling Injuries due to leakage of physical waste bins/bags
196850330200
00
3. Chemical Hazard Sample Preparation
eg: – Staining
Smearing
Chemical spills Splashing of chemicals to the eyes while handling specimen Chemical Waste Handling The chemical waste is not clearly labelled or not labelled Skin irritation due to leakage of chemical waste 4. 793751122680
00
-48895537845
020000
Ergonomic Hazard In appropriate posture:-
Sitting Posture
eg: – Improper
sitting posture
in sample
analysis
(microscopic task)
Lifting heavy objects
Record / Data keeping
eg: – Key-in data for
online database
system Work-related musculoskeletal disorders (WMSDs) / Back pain
Cumulative trauma disorders (CTDs)
Repetitive strain injuries (RSIs) Volumetric Handling
eg: – Pipetting
Transferring of blood sample DeQuervain’s Tendinitis Trigger Finger
*Kindly refer appendix 1 for guideline of risk assessment values for (L)= likelihood,
(S)= severity and (R)= risk.

Refrences
Online Article
Bennett A1, Parks S. (2006). Microbial aerosol generation during laboratory accidents and subsequent risk assessment. Journal of Applied Microbiology, 100(4), 638-658. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16553720.

Governmental Publications
Department of Occupational Safety, Ministry of Human Resources, Malaysia (DOSH). (2008). Guidelines for Hazard Identification, Risk Assessment and Risk Control (HIRARC). Malaysia. Retrieved from http://www.dosh.gov.my/index.php/ms/list-of-documents/guidelines/hirarc-2/1846-01-guidelines-for-hazard-identification-risk-assessment-and-risk-control-hirarc-2008/file.

Appendices

00

Safety issues in the industry
Safety issues in the hematology laboratory can be discussed in four types of hazard which are fire hazards, chemical hazards, electrical hazards and needle puncture. There are numerous flammable and combustible chemicals used in the laboratory such as alcohol and benzene. Laboratory workers are exposed to this flammable chemicals in laboratory almost every day and risk of fire occurrence are high. Unplanned and ‘accidental fire’ could happen when the workers lost control of the chemicals and equipment used in the laboratory. Fires due to poorly installed or maintained systems and fires due to sparks serving as an ignition source for flammable or combustible materials
Next, chemicals used in the hematology laboratory are considered hazardous and are governed by the Occupational Exposure to Hazardous Chemicals in Laboratories Standard. Those chemicals can cause adverse health effect to all the workers if not handling properly. Adverse effect are dependent on the factors of the exposure. It depends on the type of chemical, the amount or dose of chemical exposed, the duration, routes of exposure and frequency. Even though the body naturally attempts to eliminate substances out of the body, the body might not be able to remove all the chemicals. The laboratory workers have higher risk of getting adverse health effect as they are exposing to all toxic chemicals almost every day.
Other safety issues in laboratory is electrical hazard. Laboratory workers may be exposed to electrical hazards including electric shock, arc blasts, electrocutions and explosions. The typical laboratory contains a wide variety of electrically-powered equipment including stirrers, shakers, pumps, hot plates, heaters, power supplies, ovens, and electrophoresis equipment. Potential exposures to electrical hazards can result from faulty electrical equipment or instrumentation or wiring, damaged receptacles and connectors, or unsafe work practices. These and all electrical devices used in the lab setting present a potential danger of injury due to electric shock.

Needle puncture is a serious safety issues for laboratory personnel. Other items that can cause a puncture similar to a needle puncture include sedimentation rate tubes, applicator sticks, capillary tubes, glass slides, and transfer pipettes. Bloodborne pathogen can be spread through needle puncture. Bloodborne pathogens are pathogenic microorganisms that, when present in human blood, can cause disease. They include, but are not limited to, hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Laboratory workers have higher risk of getting these disease as it can be transmitted through needle puncture.

Occupational health issues in laboratory
Occupational health issues can be associated with ergonomic. Ergonomics is the science devoted to optimizing human performance by matching the machine to the man. The goal is to maximize work output and product quality while minimizing the health hazards to the worker. An ergonomic hazard is a physical factor within the environment that harms the musculoskeletal system. Musculoskeletal disorders such as carpal tunnel syndrome and lower back pain constitute the most important cause of work-related absence due to illness and occupational disability.
These conditions can be attributed to poor design of equipment and body posture. The reporting of musculoskeletal disorders and other work-related disorders attributable to ergonomic hazards has increased significantly in the laboratory. Transcriptionists, phlebotomists, and histotechnologists are most prone to musculoskeletal disorders due to the repetitive nature of their work.
The most common injuries associated with ergonomics is lower back pain. The most common cause of lower back pain is postural stress. For this reason, lower back pain is frequently brought on by sitting too long and prolonged bending. Back injuries are categorized as ergonomic disorders when they result from chronic, or long term injury to the back rather than from one specific incident. Lower back pains are preventable. Laboratory workers are often experiencing lower back pain as there are no back rest at all their working chairs. This kind of chairs do not provide good back support. They need to bend their body a bit while doing laboratory work, this condition will lead to lower back pain in prolonged time. Once back muscles or ligaments are injured from laboratory activities, additional injuries are more likely to occur because the back muscles, discs and ligaments may be weakened and can lose their ability to support the back. Other main causes of low back injuries in the laboratory is the overhead lifting of materials off of shelves and frequent rearrangement of laboratory equipment due to lack of space also lead to a significant amount of back injuries. According to the National Safety Council, back disorders account for 31% of all musculoskeletal disorders.

Carpal tunnel syndrome is the most common nerve entrapment disorder. Symptoms result from compression of the median nerve as it passes through the wrist within the carpal tunnel. Within this limited space, swelling of any of the components can increase pressure in the tunnel because the median nerve provides both sensory (feeling) and motor (muscular movement) innervation to both the thumb and middle three fingers, damage can result in pain and disability. Carpal tunnel syndrome can result from any process that leads to increased pressure on the contents of the tunnel. The nerve is the most vulnerable component. Nonspecific tenosynovitis (swelling of the tendon sheaths) of the flexor tendons within the tunnel may be the most common cause of increased pressure. Decreased capacity of the tunnel may result from prior fracture or discoloration of the hand or forearm, rheumatoid arthritis or congenital anomalies.

Early symptoms include numbness, painful tingling, burning pain and weakness in the thumb and first three fingers. These symptoms are often precipitated by repetitive hand or finger actions. Shaking the hand may bring relief. Numbness rarely radiates proximal to the wrist, but sometimes the forearm and shoulder aches. Typically the dominant hand is most affected. Weakness eventually develops in the muscles that abduct and oppose the thumb. In advanced cases, the thumb cannot move properly in opposition to the other fingers, and the worker may drop objects.

Next, rotator cuff tendonitis is a shoulder disorder characterized by inflammation of the muscle to the humerus (upper arm bone). Rotator cuff tendonitis has several causes, which may be classified as extrinsic or intrinsic. Elevation of the arm leads to pressing of the supraspinatus tendon against the acromion. When it is repetitive or excessive, the resulting irritation and ischemia (reduction in blood supply) lead to rotator cuff tendonitis. The primary symptoms of rotator cuff tendonitis are shoulder pain, sometimes radiating down the arm. Generally tendonitis pain gets worse by movement and relieved by rest, but it may occur at night also, especially if the cause is impingement. Movement may be limited by pain, stiffness or weakness. Rotator cuff injuries are common among workers who perform repetitive tasks with their elbows above mid-torso height, particularly if their arms are raised overhead.

Thoracic outlet syndrome consists of upper symptoms resulting from pressure on nerves of blood vessels between the base of the neck and the axilla (armpit). The syndrome may involve any of the several structures in the thoracic region, and symptoms make it difficult to distinguish the specific area. Structures that are subject to compression are usually the nerves of the brachial plexus. Symptoms include neck pain, arm weakness and numbness extending along the inner forearm into the medial two fingers. Symptoms may be precipitated or aggravated by postural changes, especially arm elevation. Vascular symptoms are aching or throbbing in the arms, coldness and periodic blanching of the fingers. Diagnosis is difficult because many physical signs are nonspecific.

Occupational Safety and Health Management
Control measures to reduce workplace exposure
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 has several effective steps. Regular handwashing particularly before and after certain activities is one of the best ways to remove germs, avoid getting sick, and prevent the spread of germs to others. Hands must be washed whenever there is a visible contamination with blood or body fluids, after completion of work, after gloves are removed and between glove changes, before leaving the laboratory, before and after eating and drinking, applying cosmetics or lip balm, changing contact lens, before and after all other activities that entail hand contact with mucous membranes, eyes, or breaks in skin. It is quick, simple, and can keep everyone from getting sick. Handwashing is a win for everyone, except the germs.
Next, 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.

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. 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 or a red container that adheres to the standard. The container must be leak-proof.

Personal protective equipment (PPE) must be provided to the workers. 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 (PPE) 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. Never wear sandals or open-toed shoes in the laboratory. This is a requirement. Feet are especially vulnerable to anything that falls
Gloves must be worn when the potential of in 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 there is visible contamination. 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 inserting your fingers (ungloved hand) inside the glove at the top of your wrist and turn the second glove inside out while tilting it away. This technique prevents contamination of the “clean” hand by the “dirty” second glove. Contaminated gloves should be disposed of according to applicable federal or state regulations.

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.

If a liquid, powder or aerosol chemical splashes into eyes, flush your eye with water. Flush them out immediately with large quantities of water from the eye wash fountain or saline solution from an eye wash bottle. Flushing should be continued for fifteen minutes and then prompt medical attention should be obtained.
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. Those PPE should fit the workers perfectly to reduce and eliminate contaminants from entering the body. Contaminated containers or requisitions must be decontaminated or replaced before being sent to the work area.

The most effective way to control ergonomic hazards is to eliminate the risk factors altogether. It can be done by changing the tools, equipment, job design, or work area to remove the hazard completely. This is called ‘engineering controls’. Example of engineering controls that can be done is redesign workstations and work areas to eliminate reaching, bending, or other awkward postures. Other examples are providing adjustable tables and chairs that can be used by workers with a range of sizes and shapes and that allow neutral postures, provide carts for transporting material and mechanical hoists to eliminate lifting. Next, use tools that fit the hand, have no sharp edges, and eliminate awkward hand and wrist positions. Change where materials are stored to minimize reaching, design containers with handles or cutouts for easy gripping. Improving the workplace is the heart of ergonomics by changing the work to fit the workers. The design should accommodate the wide range of people assigned to the task. While working with computer to key in data or any work-related, take a break for every hour such as up and walk around, get a drink of water, stretch whatever muscles are tight.
Workers Protection and Preventive Program and Training
The Small Group Activity Method (SGAM) is based on the idea that every training is a place where learning is shared. With SGAM, learning is not a one-way street that runs from trainer to worker. Rather SGAM is a structured procedure that allows us to share information. It is based on three learning exchanges which are (i) Worker-to-Worker (ii) Trainer-to-Worker (iii) Worker-to-Trainer.

The SGAM Description
Worker-to-Worker Most of us learn best from each other. SGAM is set up in such a way as to make the worker-to-worker exchange a key element of the training. The worker-to-worker exchange allows participants to learn from each other by solving problems in their small groups
Trainer-to-Worker Lecture-style training assumes that the trainer knows all the answers. With SGAM it is understood that the trainers also have a lot to learn and this is the purpose of the worker-to-trainer exchange. It occurs during the report-back and it is designed to give the trainer an opportunity to learn from the participants.

Worker-to-Trainer This is the trainer’s opportunity to clear up any confusion and make points they think are key. By waiting until the summary section, trainers know better what people need to know
Hazard Prevention and Control
To prevent and control hazards effectively, one must look at eliminating hazards, making fixes and bringing about real change by using OSHA’s Hierarchy of Controls/Systems of Safety approach. Look first to eliminating hazards by making fixes and changes that address hazards at their source. If hazards cannot be completely eliminated, hazard control methods involving Engineering Controls are the next best way to address hazards. For training purposes, the pyramid concept has been slightly changed to a chart with examples of how the employer should start at the top of the chart with what is most effective – elimination (top of the pyramid), not start at the bottom with what is least effective

819150-5778500
Control Example Example
Elimination/Substitution Substitute less hazardous material
Reduce pressure, temperature
Engineering Controls Ventilation systems
Circuit breakers
Warning Systems
Signs, backup alarms, labels
Administrative Controls Procedures
Safe job procedures
Rotation of workers
Safety equipment inspections
Training
Hazard Communication Training
Personal Protective Equipment Safety glasses & face shields
Hearing protection
Gloves
Housekeeping
Blood and other potentially infectious materials can contaminate work surfaces easily. Contamination can be caused by splashes, poor work practices, and droplets of blood on the work surface. To prevent contamination, all work surfaces should be cleaned when procedures are completed and whenever the bench area or floor becomes visibly contaminated.

Hepatitis B virus vaccination
Laboratory employees should receive the Hepatitis B Virus (HBV) vaccination series at no cost before or within 10 days after beginning work in the laboratory. An employee must sign a release form if he or she refuses the series. The employee can request and receive the hepatitis vaccination series at any time, however. If an exposure incident (needle puncture or exposure to skin, eye, face, or mucous membrane) occurs, post-exposure evaluation and follow-up, including prophylaxis and medical consultation, should be made available at no cost to the employee. Employees should be encouraged to report all exposure incidents, and such reporting should be enforced as standard policy.

Training and documentation
Hematology staffs should be properly educated in epidemiology and symptoms of bloodborne diseases, modes of transmission of bloodborne diseases, use of protective equipment, work practices, ways to recognize tasks and other activities that may result in an exposure, and the location of the written exposure plan for the laboratory. Education should be documented and should occur when new methods, equipment, or procedures are introduced.
Regulated medical waste management
Specimens from the hematology laboratory are identified as regulated waste. There are different categories of regulated medical waste. State and local regulations for disposal of medical waste must be followed. OSHA regulates some aspects of regulated medical waste such as needle handling, occupational exposure, labeling of containers, employee training, and storing of the waste. The Occupational Exposure to Bloodborne Pathogens Standard provides information on the handling of regulated medical waste. Detailed disposal guidelines are specific to the state disposal standards. When two regulations conflict, the more stringent standard is followed.

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