Knowledge, Attitude, and Practice of Safety Precautions among Laboratory Tech
Abstract
Background:
The technicians that are working in the medical laboratories are exposed to various health hazards like infectious clinical samples & infectious waste, toxic chemicals, and fire & electrical hazards. It is important for laboratory workers to be aware of the potential hazards and ensure safety in practices. Carelessness, negligence, and unsafe practices may result in serious injuries, not only to the individual but to co-workers and patients as well.
Objectives:
To assess the knowledge, attitude, and practice of laboratory safety precautions among technicians working in the clinical microbiology laboratory.
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Material and Methods:
The study was a cross-sectional study on knowledge, attitude, and practice (KAP) of laboratory safety precautions among technicians. A close-ended structured questionnaire was canvassed to the technicians and responses were analyzed.
Results:
A total of 30 laboratory workers participated in the study. The overall correct responses regarding knowledge of laboratory safety precautions were 74% (673/900) and practices of the same were 79% (427/540). Few (10/30) perceived BMW management as a burden and some (9/30) felt that too much effort is required to follow optimal hand hygiene.
Conclusion:
Training and re-training on Laboratory safety precautions are required along with counseling to induce a positive attitudinal change.
Keywords:
Occupational hazards, Laboratory safety, Laboratory workers, Safety precautions, Laboratory acquired infections
Introduction
The technicians that are working in the medical laboratories are exposed to various health hazards like infectious clinical samples & infectious waste, toxic chemicals, and fire & electrical hazards.
Laboratory acquired infections (LAI) are the infections that are acquired by workers while working in medical or research laboratories. The technologists working in the medical laboratories are exposed to various infectious clinical samples and may acquire an infection while processing these clinical samples. The technologist working in the microbiology laboratory are even more prone to LAI as they are not only exposed to clinical samples but also to cultures of various pathogenic micro-organisms. The most common LAI reported among staff working in medical microbiology laboratories were tuberculosis and enteric infections (1).
The risk factors that are involved in the occupational health hazards in the medical laboratory can be minimized by the use of safety devices, containment facilities, engineering control, and compliance to good clinical laboratory practices while handling infectious materials. All laboratory personnel should be sensitized to laboratory safety practices. The laboratory management should also develop a laboratory safety program and ensure adherence to the safety program to reduce the risk of occupational health hazards. Carelessness, negligence, and unsafe practices may result in serious injuries, not only to the individual but to co-workers and patients as well (1,2).
As it is important for laboratory workers to be aware of these potential hazards and ensure safety in their practices, the present study was conducted to assess the knowledge, attitude, and practice of laboratory safety precautions among technicians working in a medical microbiology laboratory.
Material and Methods
Study Design
The study was a cross-sectional study on knowledge, attitude, and practice (KAP) of laboratory safety precautions among technicians. A close-ended structured questionnaire was canvassed to the technicians. The questionnaire was developed based on standard guidelines and updated literature (2,3,4). The questionnaire included demographic details (age, gender, qualification, experience), KAP about eating, drinking, smoking & applying cosmetics in the laboratory; mouth pipetting, standard precautions, Hand Hygiene (HH), Personal Protective Equipment (PPE), Bio-Medical Waste (BMW) management & disposal of sharp, hazardous material, spill management, immunization, and fire safety plan. In total there were sixty-eight questions.
Site of Study
The study was conducted in the clinical microbiology laboratory of Vardhman Mahavir Medical College & associated Safdarjung Hospital. The Hospital is multispecialty, tertiary care, public hospital situated in Delhi, India. The Hospital has a clinical microbiology laboratory that performs microscopy, serology, culture, identification, and sensitivity of various microorganisms by conventional and/ or molecular techniques as per standard microbiological protocols.
Inclusion Criteria
The technicians working in the clinical microbiology laboratory were included in the study. Participation in the study was on a voluntary basis. The confidentiality of the participants was ensured by avoiding the use of the name or other identifying characters.
Data Collection
The data points were coded and entered into an excel sheet for further analysis.
Ethical Considerations
The study was approved by the Vardhman Mahavir Medical College & Safdarjung Hospital Ethics Committee.
Results
Thirty laboratory technicians participated in the study. There were 13 male and 17 female technicians. Their age ranged from 21 to 57 years and years of experience from one to 25 years. Seventeen technicians had the qualification of BSc MLT or MSc MLT.
Figure 1 depicts the knowledge of laboratory technicians regarding laboratory safety precautions. In total there were 30 questions to assess the knowledge and overall correct responses were 74% (673/900). The majority of the technicians had knowledge that standard precautions should be taken while handling clinical samples 90% (27/30). There were more than 90% correct responses regarding knowledge about the prohibition of eating/ drinking/ smoking/ mouth pipetting/ applying cosmetics in the laboratory 92% (110/120), the requirement of wearing gloves while doing venepuncture or handling clinical samples 100% (60/60) and indications of using bio-hazard symbol 100% (60/60). Only 17% (5/30) of the technicians reported knowing about personal protective equipment and 13% (4/30) about the right duration of hand hygiene by alcohol hand rub. (Figure 1)
Figure 2 represents the practice of safety precautions as reported by the laboratory technicians while working in the clinical microbiology laboratory. In total there were 18 questions to assess the practice and overall correct responses were 79% (427/540). The majority of the technicians reported not eating/ drinking/ smoking/ applying cosmetics/ mouth pipetting in the laboratory 98% (118/120). They also reported wearing gloves during venepuncture or when handling clinical samples 98% (59/60). 63% (19/30) of the technicians were immunized against Hepatitis B (Hep B). On further questioning, it was found that these technicians indeed received the Hep B vaccine in the past but some of them were unable to recall whether they had received all three doses of the vaccine. Only 23% (7/30) reported being tested for a protective Hep B antibody titer. (Figure 2)
Figure 3 shows the attitude of the staff towards laboratory safety precautions. Overall there were 20 questions on attitude (15 on safety precautions and 5 on measures to improve HH). All technicians agreed that Hep B immunization and wearing gloves at the time of phlebotomy are essential for their safety (30/30). However, 10/30 of technicians perceived BMW management as a burden, and 9/30 perceived performing hand hygiene as too much effort to comply. (Figure 3)
Figure 4 shows the attitude towards the effectiveness of actions to improve HH in the laboratory. The majority of the technicians felt that the suggested measures will improve HH compliance in the laboratory. (Figure 4)
Discussion
Laboratory technicians are exposed to a variety of potential occupational health hazards. Although all occupational hazards are important, Laboratory acquired infections have gained much attention and undermined the other hazards that are inherent in laboratory activities. The laboratory practices also include the use of chemical reagents, gases, and solvents that may constitute a non-microbiological hazard. These agents may be explosive, flammable, or toxic, and fires, gassings & explosions may occur in laboratories. To these immediate hazards, the long-term risk involved in handling carcinogenic chemical reagents must also be added (5).
It is difficult to measure the actual risk of LAI in India. It is not mandatory to monitor or report the LAI to any professional body. Although an accredited laboratory is bound to do surveillance of LAI and take corrective and preventive action. However, it is difficult to collect surveillance data on LAI as the infections are either subclinical or have an atypical clinical presentation (6).
“International Organization for Standardization (ISO) has developed a standard that will help organizations to improve employee safety, reduce workplace risks and create better, safer working conditions in the medical laboratory” (7). It is important for every laboratory worker to be aware of potential hazards and safety practices. Hence the present study was conducted to assess the knowledge, attitude, and practice of laboratory safety measures among technicians working in a clinical microbiological laboratory.
Standard precautions are developed to minimize the risk of transmission of micro-organisms from both known and unknown sources of infection like clinical samples. Hand hygiene, PPE, and proper handling of needles and sharps are components of standard precautions (8). In the present study, it was observed that the majority of the technicians had reported having good knowledge about standard precautions (90%) in contrast to the study conducted by Shekhar et al (9). However, only 17% of the technicians reported knowing about PPE and 13% about the right duration of HH by alcohol hand rub. There were only 58% correct responses regarding the right method of disposing of needles (Figure 1). This suggests that further training is required regarding the various components of standard precautions. Also, not even half of the technicians were aware of the hazardous material in their laboratory or eyewash facility.
The majority of the technicians reported practicing safety precautions while working in the laboratory. As the correct responses about the knowledge of the right way of disposing of needles were 58%, the same was reflected in the practices also (57% correct responses). The status of a protective Hep B antibody titer was known only to 23% of the technicians; hence active measures are required regarding immunization against Hep B infection.
Few studies have been done to study the behavioral pattern of laboratory workers who are more involved in laboratory accidents (10, 11). It was observed that “persons involved in the laboratory accidents tend to have low opinions of safety programs, to take excessive risks, to work too fast, and to be less aware of the infectious risks of the agents they were handling” (6). In the present study, the technicians perceived various components of laboratory safety precautions as an important measure for their own safety (Figure 3). However, few perceived BMW management as a burden, and some felt that too much effort is required to follow optimal hand hygiene. Behavioral change regarding these aspects may be incorporated into the training program of the technicians. Also, training and re-training on Laboratory safety precautions are required along with counseling to induce a positive attitudinal change, especially on BMW management and hand hygiene.
There are some limitations of the study. Firstly, the findings are based on a self-reported questionnaire and not on observations hence some bias in the results cannot be ruled out. Secondly, the study is a single department study with a small sample size. This limits the generalizability of the results.
Conclusions
The laboratory technologists had poor knowledge about personal protective equipment, alcohol-based hand rub, eyewash facility, and hazardous material. Overall staff is following good laboratory safety precautions. However behavioral change in the management of bio-medical waste and hand hygiene is required.
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