The lab manager reported to me that an employee had a body fluid splash to the mouth, and the manager and the employee both wanted to know if it should be reported. At this point, the story breaks down into two pathways of discussion, one about lab exposures and one about the safety culture. Each of these points will get its due.
1. At the time of this splash incident, the employee was not using eye or face protection. She was handling an open urine specimen; it was in a rack and she was about to place it onto the analyzer when she dropped the rack a short distance and urine splashed up into her face. I always state that face protection must be used in the lab whenever staff handles open specimens or chemicals. In those instances, there is always a risk for splash.
Are goggles sufficient when there is a splash risk? OSHA says we should protect the eyes, nose and mouth whenever a splash to those areas “can be reasonably anticipated.” If a person works with their mouth closed, it could be argued that a splash to the mouth is not likely. Cleary, using full-face protection is the better practice. At a counter where a face shield is mounted, that is helpful. However, once the employee moves away from that shield with any open specimen or chemical, a wearable face shield should be used.
Upon investigation, it was discovered that the urine splashed up onto the employee’s outer bottom lip. By definition, urine is not considered an infectious body fluid unless it is known to be contaminated with blood. This particular specimen was free of blood. Since the urine splashed onto a lip with no open sore, the event was not considered an exposure.
2. From a safety culture standpoint, it was wonderful that the employee felt safe enough to report the incident, even though she wasn’t sure it was an actual exposure. That is the type of open, transparent safety culture that should be desired in all laboratories. Any safety incident (and even near-misses) should be reported. Openly discussing these incidents with staff can help prevent other occurrences. However, the story about the safety culture took an awkward turn.
When discussing the incident with the employee, the lab safety officer asked what could be done to prevent such an incident in the future. It was a standard question on the report that had to be filled out. The employee knew the correct answer- she should utilize face protection when handling open specimens. Specifically, she should wear a face shield when delivering tubes to the urinalysis analyzer. The employee didn’t want her answer documented on the report because it might mean she would be held accountable to wearing the shield from now on.
That means that even after a splash incident, the employee felt she could be careful enough in the future to handle open specimens without face protection. Her desire to not wear face protection overrode her desire to be safe. There’s a problem in there somewhere.
Does the employee not have enough education about the possible consequences of a more serious exposure? Is the safety culture in the lab such that she is not typically held accountable to proper PPE use?
Based on the follow-up conversation with the employee, how would you rate the lab safety culture? Regarding reporting and transparency, it is where it should be. Regarding overall safety culture, PPE use, and peer coaching, there is probably some work still to be done with staff and leadership as well.
No matter how you look at it, the story can be seen to have a happy ending. The actual splash incident was a non-event, no one was exposed or harmed. Good information was gathered about the safety culture as well. Now the safety officer knows what work still needs to be done and can get to it- before the next safety event occurs.