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Blood Bank

Safe Work Practices

Safe work practices are the behavioral modifications and standardized procedures established by the laboratory to reduce the likelihood of exposure to hazards. While engineering controls (physical devices) and PPE (protective gear) provide barriers, safe work practices rely on the discipline and technique of the laboratory scientist. In Blood Bank, where the volume of open specimens and the frequency of sharps usage (segment cutting) are high, strict adherence to these practices is the primary method of preventing occupational transmission of bloodborne pathogens (HIV, HBV, HCV)

Personal Conduct & Hygiene

The most fundamental safe work practices involve prohibiting activities that increase the risk of ingestion, inhalation, or direct mucosal absorption of pathogens. These rules apply strictly to “clean” and “dirty” area designations within the laboratory

  • Prohibited Activities: Eating, drinking, smoking, applying cosmetics (including lip balm), and handling contact lenses are strictly forbidden in technical work areas. These actions bring hands - which may be microscopically contaminated - to the face, mouth, and eyes
  • Food Storage: Food and drink must never be stored in refrigerators, freezers, shelves, cabinets, or on countertops where blood or other potentially infectious materials are stored. Separate, dedicated break room refrigerators are required
  • Hair and Jewelry: Long hair must be tied back to prevent it from contacting specimens or moving equipment (e.g., centrifuges). Dangling jewelry should be avoided as it can harbor pathogens or catch on equipment
  • Hand Washing: This is the single most effective work practice for infection control. Hands must be washed with soap and water:
    • Immediately after removing gloves (gloves are not a substitute for washing)
    • Whenever hands are visibly contaminated
    • Before leaving the laboratory
    • Before and after patient contact (phlebotomy)

Sharps Management & Segment Safety

Blood Bank operations involve unique sharps hazards, particularly the processing of donor unit segments. Segments are sealed tubing containing blood that is often under pressure. Improper handling is a leading cause of mucocutaneous exposure

  • Segment Opening Technique: When opening segments for crossmatching without an automated piercing device, the laboratory scientist must:
    • Wrap the segment in gauze or a protective pad before cutting
    • Use scissors to cut the segment away from the face and body
    • Wear a face shield or work behind an acrylic splash shield to prevent pressurized spray from reaching the eyes or mouth
  • Needle Safety
    • No Recapping: Needles must never be recapped using a two-handed technique. If recapping is absolutely necessary (rare in Blood Bank), a mechanical device or a one-handed “scoop” technique must be used
    • No Manipulation: Needles must not be bent, sheared, or broken by hand
  • Disposal: Sharps must be placed immediately into a puncture-resistant, leak-proof, labeled container. The container must be replaced when it is 3/4 full; laboratory scientists must never reach into a container or force an item into an overfilled box

Minimizing Aerosols & Splashes

Aerosols are microscopic droplets that can remain suspended in the air and be inhaled. Splashes are larger droplets that impact surfaces or skin. Work practices must be designed to minimize the generation of both

  • Centrifugation
    • Tubes must be capped or sealed during centrifugation
    • If a tube breaks, the centrifuge must be turned off and allowed to stand for at least 30 minutes to allow aerosols to settle before opening
    • Sealed centrifuge buckets or rotors should be loaded and unloaded inside a biological safety cabinet if possible (though less common in routine Blood Bank, this is standard for high-risk fluids)
  • Tube Opening
    • Rubber stoppers (e.g., on patient samples) should be removed by twisting and pulling gently while covering the top with gauze to catch any spray
    • Avoid “popping” the caps off, which releases a fine mist of the specimen
  • Pipetting
    • Mouth pipetting is strictly prohibited. Mechanical pipetting devices must always be used
    • Biohazardous materials should be dispensed gently down the side of the tube or container to avoid splashing, rather than dropped from a height

Chemical & Thermal Safety Practices

Blood Banks utilize specific chemicals and extreme temperatures that require distinct safety behaviors

  • Liquid Nitrogen: Used for the long-term storage of rare red blood cells
    • Asphyxiation Hazard: Liquid nitrogen expands 695 times in volume when it vaporizes. Work practices dictate that dispensing must occur in well-ventilated areas to prevent oxygen displacement
    • Thermal Burns: Cryogenic gloves and face shields must be worn. The practice of “pouring” liquid nitrogen requires slow, controlled movements to prevent splash-back
  • Irradiators: Used to prevent TA-GVHD (Transfusion-Associated Graft-Versus-Host Disease)
    • If the irradiator uses a radioactive source (e.g., Cesium-137), employees must be trained in security protocols (prevention of theft/terrorism) and radiation safety (minimizing time, maximizing distance, and using shielding)
  • Chemical Storage: Flammable chemicals (like alcohol for phlebotomy prep) must be stored in flame-proof cabinets. Incompatible chemicals (acids and bases) must be stored separately to prevent reaction

Housekeeping & Spill Response

Maintaining a clean work environment significantly reduces the risk of accidental contact with pathogens

  • Routine Decontamination: Work surfaces must be cleaned with an appropriate disinfectant (e.g., 1:10 sodium hypochlorite/bleach or an EPA-registered tuberculocidal agent):
    • At the beginning and end of every shift
    • Immediately upon visible contamination
    • After completion of any procedure
  • Spill Response: In the event of a spill (e.g., dropping a unit of blood or a rack of tubes):
    • Alert: Notify coworkers immediately to prevent them from walking through the hazard
    • Protect: Don appropriate PPE (gloves, gown, face protection) before starting cleanup
    • Absorb: Cover the spill with absorbent material (paper towels) to contain it
    • Disinfect: Pour disinfectant over the absorbent material and allow it to sit for the recommended contact time (usually 10–20 minutes)
    • Glass Removal: Broken glass must never be picked up with hands, even if gloved. Mechanical means such as a brush and dustpan, tongs, or forceps must be used