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Blood Bank

Emergency Procedures

In the high-throughput environment of a Clinical Blood Bank, the potential for accidents involving biological hazards, chemical agents, and physical dangers is significant. Emergency procedures are codified protocols designed to mitigate harm immediately following an accident. The difference between a minor incident and a permanent injury often depends on the laboratory scientist’s ability to recall and execute these steps without hesitation. All personnel must be familiar with the location and operation of emergency equipment, including eyewash stations, safety showers, fire extinguishers, and spill kits

Biological Exposure Emergencies

Exposure to bloodborne pathogens (HIV, Hepatitis B, Hepatitis C) is the most significant occupational risk in Blood Bank. Exposures generally fall into two categories: percutaneous (needlesticks or cuts from contaminated sharps) and mucocutaneous (splashes to the eyes, nose, or mouth). The immediate response is critical to reducing viral load transmission

Percutaneous Injury (Needlesticks/Cuts)

If a laboratory scientist is stuck by a needle, cut by a broken tube, or pierced by a capillary tube/lancet:

  • Immediate Action
    • Wash the site immediately: Use soap and water. Do not use caustic agents like bleach, which can damage the skin and potentially increase viral uptake
    • Do Not Squeeze: Avoid “milking” or squeezing the wound, as this may damage the tissue and increase local blood flow, potentially aiding the dissemination of the pathogen
    • Bandage: Cover the wound with a sterile bandage
  • Reporting: Notify the immediate supervisor right away. An incident report must be filed to document the time, date, nature of the accident, and the source patient (if known)
  • Medical Evaluation (Post-Exposure Prophylaxis - PEP)
    • Source Testing: If the source patient is known, they should be tested for HBsAg, HCV, and HIV (subject to consent laws)
    • Employee Testing: The employee is tested to establish a baseline serological status
    • Treatment: Depending on the risk assessment, the employee may receive Hepatitis B Immune Globulin (HBIG), a Hepatitis B booster, or antiretroviral therapy (ART) for HIV. ART is most effective when started within hours of exposure

Mucous Membrane Exposure (Splashes)

Splashes often occur during the opening of specimen tubes (“popping the cap”) or the cutting of donor segments

  • Ocular Exposure (Splash to the Eyes)
    • Eyewash Station: Proceed immediately to the nearest eyewash station. Use the “push” handle to activate the flow
    • Technique: Hold the eyelids open with thumb and forefinger to ensure irrigation reaches behind the lid. Roll the eyeballs to ensure full coverage
    • Duration: Flush continuously for a minimum of 15 minutes
    • Contact Lenses: If wearing contact lenses, they should be removed as soon as possible during the flushing process, as they can trap contaminants against the cornea
  • Oral/Nasal Exposure
    • Flush the mouth or nose with copious amounts of tap water. Do not swallow the water used for rinsing

Fire Safety

Laboratories are vulnerable to fire due to the combination of electrical equipment (centrifuges, refrigerators), chemical fuels (alcohol, solvents), and oxygen sources. Fire safety training centers on two primary acronyms: RACE (what to do) and PASS (how to use an extinguisher)

The RACE Protocol

Upon discovering a fire or smelling smoke, the laboratory scientist must follow this sequence:

  • R - Rescue: Immediately remove any persons in immediate danger to a safe area. This takes precedence over saving equipment or blood products
  • A - Alarm: Activate the nearest fire alarm pull station and call the facility’s emergency number (e.g., Code Red) to alert the fire department and response teams
  • C - Contain: Close all doors and windows to the affected area. This limits the oxygen supply to the fire and prevents the spread of toxic smoke and heat. In a laboratory, this also includes closing fume hood sashes
  • E - Extinguish/Evacuate: If the fire is small and contained (e.g., in a trash can), use a fire extinguisher to put it out. If the fire is large or spreading, evacuate the area immediately via the designated exit route. Do not use elevators

The PASS Protocol

When using a portable fire extinguisher, the operator must ensure they are using the correct class (usually an ABC Multipurpose Dry Chemical extinguisher in labs) and follow these steps:

  • P - Pull: Pull the pin at the top of the extinguisher that keeps the handle from being accidentally pressed
  • A - Aim: Aim the nozzle or hose low, pointing at the base of the fire, not the flames
  • S - Squeeze: Squeeze the handle to release the extinguishing agent
  • S - Sweep: Sweep the nozzle from side to side at the base of the fire until it appears to be out. Watch for reignition

Classes of Fire in the Lab

  • Class A: Ordinary combustibles (paper, wood, plastic)
  • Class B: Flammable liquids (alcohol, xylene, grease). Note: Never use water on a Class B fire as it will spread the liquid.
  • Class C: Electrical equipment (centrifuges, analyzers). Note: Never use water on a Class C fire due to electrocution risk.
  • Class K: Kitchen fires (oils/fats) - rarely seen in the lab proper but possible in break rooms

Chemical Exposure Emergencies

While biological hazards are the primary focus in Blood Bank, chemicals like strong acids, bases, or liquid nitrogen pose significant risks

Skin Contact with Corrosives

  • Immediate Action: Proceed to the safety shower
  • Remove Clothing: While under the shower, remove all contaminated clothing, shoes, and jewelry. Clothing can hold the chemical against the skin, exacerbating the burn
  • Duration: Flush the body for at least 15 minutes
  • No Neutralization: Do not attempt to neutralize an acid burn with a base (or vice versa) on the skin. The neutralization reaction is exothermic (releases heat), which causes thermal burns on top of the chemical burns. Use only water

Liquid Nitrogen Accidents

Used for frozen blood storage, liquid nitrogen presents hazards of asphyxiation and cryogenic burns

  • Skin Contact: If liquid nitrogen contacts skin, it causes immediate frostbite. Rinse the area with lukewarm (not hot) water. Do not rub the area, as frozen tissue is brittle and can be damaged
  • Major Spill/Leak: If a large volume of liquid nitrogen spills, it rapidly expands and displaces oxygen
    • Evacuate: Leave the area immediately to prevent asphyxiation
    • Ventilate: Do not re-enter until the oxygen levels have returned to normal (verified by oxygen sensors)

Documentation & Reporting

After the immediate medical needs are met, the administrative side of the emergency procedure begins. This is required for regulatory compliance (OSHA) and workers’ compensation

  • Incident Report: A formal document detailing the “Who, What, Where, When, and How” of the event. It should be factual and non-accusatory
  • OSHA 300 Log: Recordable injuries (those requiring medical treatment beyond first aid, days away from work, or loss of consciousness) must be logged by the employer
  • Root Cause Analysis: The safety officer or supervisor investigates why the emergency occurred (e.g., faulty equipment, lack of training, failure to follow SOP) to implement preventative measures