Safety in the Surgical Pathology Laboratory
The key to safety in the surgical pathology labora-tory is to recognize that this area is a dangerous place. A variety of noxious chemicals are rou-tinely used in the surgical pathology laboratory, and tissues infected with the human immunode-ficiency virus (HIV), hepatitis viruses, mycobac-teria, and other agents enter through its doors on a daily basis. Not only are these infectious agents present in the laboratory, but their transmission is also facilitated by the frequent handling of bloody tissues and the routine use of surgical blades, knives, saws, and other sharp instru-ments. Clearly, the surgical pathology laboratory is no place to ‘‘let down one’s guard’’ by becom-ing careless or distracted. Rather, safety in the work area should become an ingrained habit, and universal precautions should be exercised with all specimens.
The prosector should regard all tissues as poten-tially infectious, not just those tissues removed from patients known to have an infectious dis-ease. For the protection of oneself and for the safety of others, the prosector should wear pro-tective gear in the cutting area at all times. Protective gear prevents contact of potentially infectious materials with the skin and mucous membranes, and it diminishes the transfer of infectious material outside of the surgical pa-thology laboratory. At the very least, protective gear should include surgical scrubs, waterproof shoe coverings, a surgical gown and/or water-proof forearm wraps, gloves, a cap, a mask, and eye protection. A waterproof apron should also be worn to prevent the absorption of fluids onto the clothing and skin. Hands should be protected by well-fitting surgical gloves. To prevent seepage of fluids, two pairs of gloves are preferred to one pair, and these gloves should be changed frequently. Keep in mind that even two pairs of gloves will not protect against punc-tures and cuts. Fine mesh metallic or synthetic gloves that are cut-resistant are recommended in those instances where one is unfamiliar with the use of a sharp instrument or when one is dissecting a specimen with sharp edges (e.g., a bone resection). Soiled or bloody garments and coverings should not be worn outside of the cutting area.
In order to avoid inadvertent wounds, there should be no more than one blade in the dissec-tion field at any one time. Needles, razor blades, scalpel blades, and other sharp disposable ob-jects should be promptly discarded into appro-priate containers following their use. Trash items soiled with blood or other potentially infectious materials should be discarded into designated biohazard containers located in the cutting area. Upon completion of the dissection, the specimen should be stored in a container with adequate formalin. Specimen containers should be wiped clean of any potentially infectious materials, securely closed to prevent leakage, accurately labeled, and stored in a designated storage area.In cases of known viral hepatitis, HIV infection, or tuberculosis, the cutting area should be washed clean and wiped with a disinfectant such as dilute bleach, and a biohazard label should be affixed to the specimen container.