April 5, 2024 • 18 mins
Uncover the hidden complexities of lab safety as we team up with Sean Kaufman and Dan Scungio to dissect the intersections of biosafety, psychological preparedness, and communication within the lab. When a laboratory's casual approach to separation leads to a heated encounter with OSHA, we're forced to question the balance between stringent regulations and practical risk management. Tune in to hear us tackle the debate on absolute physical barriers and the scientific grounds for such measures, especially when lower-risk pathogens enter the equation. It's a conversation that doesn't just skim the surface but probes the depths of what it truly means to maintain a safe laboratory environment.
As we reconstruct the transformation of a standard hospital room into a bulwark of biocontainment during disease outbreaks, the narrative shifts to the human element behind the safety cabinets and floor tape. Dan Scungio illuminates the necessity of clear communication and decontamination processes, aiming to eradicate common misconceptions among lab personnel. Whether it's facing Ebola head-on or establishing steadfast containment strategies, our episode provides essential insights into fostering a culture where safety is second nature. Don't miss these vital discussions that could be the crucial difference in a world where laboratory mishaps are not an option.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Lab Safety Gurus Podcast.
I'm Dan Scungio.
Speaker 2 (00:07):
And I'm Sean Kaufman, and together we're providing
safety insights for thoseworking in laboratory settings,
doing safety together.
Speaker 1 (00:18):
Alright, welcome everybody.
Glad to have you back foranother episode.
I have a question for SeanKaufman.
Speaker 2 (00:26):
That makes me nervous .
It's been a while.
Do you know?
We're on our 11th podcast, Dan11 already.
Yeah, this is 11.
That's my wife's favoritenumber, by the way it is.
Speaker 1 (00:37):
Why is that?
Is there a reason for?
Speaker 2 (00:39):
that she tried to explain it the other day.
She said because one and oneare together.
I thought that's an oddexplanation, but that's what she
said.
It's she.
She said it just seems so equal.
So maybe there's a listener outthere that understands that,
but I I didn't understand theexplanation there may be.
Speaker 1 (00:55):
There may be my wife likes 13, because we got married
on friday the 13th, um.
So containment in thelaboratory.
I'm'm going to ask you aquestion, sean, because I have
worked in a laboratory that wascited by OSHA, and here's why
they got cited.
They built a break room off ofa laboratory, a small.
(01:19):
It was like an emergencydepartment laboratory, an
emergency department laboratory,and there was no space for the
staff to have downtime, breaktime, whatever.
And they built this break roombut they built it in the space
of the laboratory and theseparation between the break
room and the lab was a half wall.
So on the other side of thathalf wall, a refrigerator, a
(01:42):
microwave, a place to eat, atable, a sink, all that good
stuff.
And so when OSHA came in,they're like you can't do that.
Now, that's one OSHAinspector's interpretation of
what can and can't be.
But they made the hospitalbuild like glass from.
(02:02):
But they made the hospitalbuild like glass from the
halfway wall all the way up tothe ceiling and then they had
them put in like a storm door sothat there would be complete
separation.
That was sort of my introductionto containment in my lab safety
career.
So I've always had a mindsetthat containment for a
(02:24):
biological laboratory should becomplete separation from floor
to ceiling, and that's going tobe the way it has to be.
But over time, as I lookedthrough guidelines, regulations,
standards, there was nothing inliterature that states that you
(02:46):
need to have completeseparation from clean spaces and
dirty or contaminated labspaces.
And one of the things I've donein my career is I worked with a
team that was rewriting the ISOstandards for laboratory safety
.
It was the 15190, specific tolab safety, and we talked about
(03:07):
that on the team and we did getthat wording in there that there
should be complete separation.
But, sean, as a biosafetyexpert, is that, am I looking at
it, the right way?
Is that the right thing to betalking about?
Is that the right way to belooking at contamination and
containment?
That's it.
Well, the three things I've gotto say first, I've got
(03:29):
questions for you.
Speaker 2 (03:31):
I don't ever consider myself a biosafety expert, but
I appreciate the compliment I do.
Second, why was OSHA there inthe first place?
Now, typically OSHA is not aproactive organization.
Usually they show up on scenewhen there's problems.
Why was OSHA there in the firstplace is a good question.
Speaker 1 (03:55):
It is a good question and I don't know the answer.
Speaker 2 (03:57):
Oh, okay.
Speaker 1 (03:58):
I was new to my job as a lab safety officer and I
was not privy to the reason whythe OSHA the state OSHA
representative came in.
Okay, I have dealt with otherissues in my career with OSHA
and I know why they were called,but for that one I didn't know
the actual reason.
They certainly didn't come justto look at the space and I
(04:19):
don't think an employeecomplained about the break room.
Speaker 2 (04:23):
I don't think so, but I don't know that for sure.
Well, usually they'll show uplooking for problems because a
problem has been identified.
That's, again, typically whatI've learned with OSHA.
But here's my third.
This is my third statement here.
Look, all infectious diseasesare not created equal, and
that's one thing that I think weall have to continue to remind.
(04:45):
So, for example, I love usingthis example because when I was
at CDC, I worked in parasiticdiseases and I worked with
cryptosporidium, and Dr MichaelBeach, who is my supervisor
there, used to say do you knowthat one oocyst of
cryptosporidium can live in onepart per million of chlorine for
6.7 days?
(05:05):
He used to say that and I waslike that's amazing when you
compare it to something like HIVor hepatitis B and you're
looking at blood at a swimmingpool and how easily those agents
are inactivated withdisinfectant.
And as I've gotten familiarwith the different containment
levels BSL-1, bsl-2, bsl-3,bsl-4, I've also become more and
(05:31):
more familiar with howinfectious diseases are
transmitted.
And the issue that I have whenwe make statements in safety or
in biosafety or even in bio-riskmanagement, is that we really
have to use science and, ifyou're asking me, does a
complete separation have tooccur.
(05:52):
If we're working with a pathogen, say, for example, a BSL-1
agent that typically will notmake healthy people sick, a
BSL-1 agent that typically willnot make healthy people sick,
what's the science that saysthat you would need a complete
separation?
And if you're working withagents in BSL-2, where it's only
blood-borne, fecal-oral routesof transmission, you're not
(06:12):
having agents that swim in theair and make people sick Again,
if you have good laboratorypractices, science is not
calling for complete separation.
And so again, yes, dan, don'tget me wrong, please hear me,
because I can see you.
I could see you biting at thebit here.
It would be my preference forcomplete separation.
(06:34):
It would certainly be mypreference, absolutely, because
you can carry things in on yourhands, do whatever.
But science does not support acomplete separation, it just
doesn't, unless you seeotherwise.
Speaker 1 (06:49):
No, I don't think I do, but I think in my career
I've been the victim ofoverzealous, non-laboratory
people, maybe.
So here we have the oceaninspector who says this is what
has to happen, which I agreewith him.
I'm with you there should beseparation from your break room
to your lab.
We had another incident where acouple of incidents where
(07:12):
microbiology BSL-2 lab, they'reworking with some blood culture
specimens and they growsomething that's like a
potential bioterrorism organ,like a Francisella.
Speaker 2 (07:23):
Yeah, they're surprised, they have an uh-oh
moment, they have Brucella'sclass.
Speaker 1 (07:27):
We hear that quite a bit.
Yep.
So what happens when thatoccurred is suddenly the
occupational health departmentwants to know I need the name of
everybody who was in thatlaboratory while those plates
were being manipulated, whetheror not an aerosolization
procedure was going on or notwith those plates.
Usually when you're reading,there's not too much that's
(07:49):
happening that could create anaerosol, unless you're doing
some vortexing, and that alldepends on the processes in your
lab.
But they wanted the names ofevery employee who walked in the
department at the time thoseplates were being manipulated
and it was a lot of people, alot of people working in the lab
(08:10):
, couriers coming into thelaboratory to pick up specimens,
people walking through, maybethe safety officer I wasn't on
the list, but they gathered allthose names, did some sort of
monitoring and offeredprophylaxis for all of those
people and then, after thathappened more than once, they
(08:33):
decided to spend the money tobuild a BSL-3 laboratory for
blood cultures, because it'smore likely to happen with blood
cultures than any other kind ofclinical specimen Was that
overkill.
Was that overdoing it?
We have fewer exposureincidents because there's fewer
people working in the blood room, as we now call it.
(08:55):
Was that?
Speaker 2 (08:58):
overdoing.
Listen, I am a big believer inaggressively dealing
prophylactically with potentialexposures.
I am an absolute.
I'm very happy to hear what yousaid, because in cases where we
know that potential exposureshave occurred and we don't
(09:19):
prophylactically offer counteryou know we don't we don't offer
countermeasures to potentialexposures of dangerous pathogens
then we haven't done our job.
Now look, one of the thingsthat is very it's unrealistic.
See, most of my experience, dan,as you know, is dealing in
research labs, laboratorieswhere we know very well what
(09:43):
we're working with and thereforewe're always adequately
prepared.
But I think many listeners donot understand that there are
labs out there that are tryingto determine what people are
sick with and in those momentsthose labs are working outside
of a biosafety cabinet, sothey're not expecting to trip up
on an agent that has spreadthrough routes of aerosol.
(10:06):
Trip up on an agent that hasspread through routes of aerosol
and all of a sudden they findthemselves having an agent like
Brucella that is exposed andrequires a higher level of
containment and there could havebeen a potential exposure in
the environment.
And here's the challenge, dan,and correct me if I'm wrong the
amount of samples that somebodyis doing from a diagnostic
(10:28):
aspect, whether it be in aclinical or public health
setting, may be so numerous andso vast that actually doing them
in higher levels of containmentis it can be quite difficult if
you don't have the resources,like you had mentioned, a BSL-3
lab or even just a hugebiosafety cabinet.
Speaker 1 (10:47):
So you have?
Yeah, so you have challengesthere.
Yeah, and it's not common tocreate a special room for blood
cultures in a clinicallaboratory.
Speaker 2 (10:56):
Most labs don't have the ability to do that, and the
reason why, just again for thelisteners, is I mean, dan,
seriously, think about it.
I say it, you know, once everyI mean a lot of people.
We almost average once everyfive or six years is when I'm
seeing, when I go to diagnosticlabs.
But how often do you get asurprise like a brucello?
How often does that occur?
Speaker 1 (11:18):
uh, probably in.
So so this is for a reference,microbiology laboratory.
Uh, it can be between two andthree times a year.
Speaker 2 (11:28):
Okay, okay, and is that that's more clinical, like
hospital labs?
Speaker 1 (11:32):
Yes, okay, good yeah.
Speaker 2 (11:33):
I'm talking, I was referring to public health.
But if that, but in that, inthat time year wise Dan, on
average, how many samples dothose clinical labs process?
Speaker 1 (11:45):
Oh my gosh.
Speaker 2 (11:45):
Yeah, give me, give me a rough idea those clinical
labs process, oh my gosh.
Speaker 1 (11:50):
Yeah, give me a rough idea.
Speaker 2 (11:55):
The number blood culture bottles in that
reference lab were in thethousands.
Yeah, so what I want listenersto understand is, for the one
lightning strike there arethousands of samples that are
processed, and so to change thewhole protocol for that one
potential lightning strike, thatcan not only slow your
diagnostic procedures down,which in the end would hurt your
(12:16):
patients, but it could alsoincrease costs substantially.
So it's a true conundrum, so tospeak.
Speaker 1 (12:24):
Yeah.
So let me touch on something,sean, then, that I know that
you're also an expert in, andthat's something like Ebola.
So in certain hospitals thatare not treatment hospitals but
maybe assessment hospitals,they're set up with different
levels of different types ofunits highly infectious disease
(12:47):
units, which include alaboratory, and in certain
situations the laboratory is nota permanent location.
So I know of a hospital, forinstance, where their highly
infectious disease lab is apatient room, normally by day,
in the emergency room, and thenwhen they open up the highly
infectious disease unit, thelaboratory gets to use this room
(13:08):
and then, when they open up thehighly infectious disease unit,
the laboratory gets to use thisroom and there is a biological
safety cabinet in the room.
It's behind, like a garage door,for example.
It's always kept there.
They have to bring all theequipment in there, don that
specialized PPE and work in thatpatient room.
That patient room is in ahallway.
There's no ante room and sowhen people bring specimens from
(13:33):
down the hall from the Ebolapatient, potentially they're
carrying that specimen inside ofa special carrying container.
They're handing it into thedoorway of the Ebola lab we'll
say HIDU laboratory and thentaking care of things.
But trash has to come out ofthat room when the trash is full
(13:57):
and has to go down the hallwayto the outside door, category A
trash we're talking about.
When people doff, they'redoffing inside that room where
they've done the work.
So I know some laboratorianswho work in these situations.
We haven't had to, you know,bring up the HIDU lab officially
but during training and drillsthere are people who are nervous
(14:20):
about that.
How nervous do they need to beabout doffing in the same room
where they perform testing?
And there's like a line of tapeon the floor.
This is your red zone and thisis your green zone, and they
know that viruses don't knowcolors.
Speaker 2 (14:35):
Well, everything you're saying today, Dan, is
making me happy, and I mean thatEverything you've just said
makes me happy, because one ofthe worst things that a hospital
can do is bring in a verydangerous infectious disease
into its lab, contaminate thelab environment and shut down
diagnostics for the wholehospital.
We have to remember thatpatients are going to need the
(14:56):
lab tremendously, and what Imean by that is, again,
laboratory scientists are theheroes.
The doctors ask for labs to bedone and the labs give the
answers to the doctors and theyallow the doctors and nurses to
treat the patients.
So when you have something likeEbola come in, you don't want
it going to your main centrallab, you want to set up a
special space, and so I thinkthat makes me very, very happy.
(15:18):
The second thing I think that'simportant to bring out is that
when we're doing diagnostics,we're not working with large
quantities of cultured samples,is that when we're doing
diagnostics, we're not workingwith large quantities of
cultured samples, meaning thatwe really don't need a fully
designed, engineered BSL-4laboratory to run diagnostics or
basic blood tests for somebodywho may be infected with a
(15:40):
bloodborne infection.
The fact that you're gonna doyour work in a biosafety cabinet
, the fact that you're gonna bemaking sure that in a biosafety
cabinet, the fact that you'regoing to be making sure that the
people doing that work are welltrained, the fact that you're
going to have great PPE andyou'll know the difference
between contaminated PPE and notcontaminated PPE, and the fact
that you have tape and I want tobring this reference up.
(16:01):
The tape on the ground is notsignifying a clean and dirty
environment in the lab.
The tape on the ground is abehavioral cue.
It is telling staff to docertain behaviors at different
points in time so that when wedo practice containment
strategies, we're doing it in away that phases out and ensures
the highest level of containment.
(16:22):
So you know again, dan,everything that you've said to
me is is an outstanding strategy.
Obviously the staff, becauseit's new and because it will be
dealing with a very highpathogenic.
You know this could be realtime.
We had two nurses in Texas getEbola.
I want people to be to becautiously respectful of what
(16:44):
they're working with.
I want people to be cautiouslyrespectful of what they're
working with.
I want them to be a littlenervous, but I also want them to
feel confident that they aredoing what they need to do to
protect themselves.
So, based on what I'm hearingyou say, that's an exceptional
strategy and again, I would justmake sure people are trained to
the point where they feelextremely comfortable, because
you also want them to be trainedon a gross contamination what
(17:05):
happens if they do drop a bloodvial and it splatters outside of
the cabinet and onto them.
I want them prepared for thatand the minute we start
preparing for those types ofsituations, we build their
self-efficacy or theirconfidence that they can do this
safely with a highly dangerouspathogen.
Speaker 1 (17:23):
Yeah, absolutely, thank you.
I feel better about our setup,certainly in my organization,
but many others that I've heardof as well.
What you say, like with thetape being a behavioral cue, I
don't think people realize that.
I think they're thinking of itas how is this any cleaner an
(17:44):
area than this?
Because when we doff out ofthat, the PPE, you take your
foot out of the bodysuit and youmove it over.
You know you're sitting in thesame chair that straddles the
tape and then you're moving yourfoot over into the clean area.
I'm using air quotes with cleanarea.
Speaker 2 (18:03):
Yeah, yeah, I mean yeah, yeah.
Speaker 1 (18:05):
Well, I think a big part of this is having that
conversation with staff to makesure that they are as
comfortable with their safetythat you know, and all the
precautions that we're taking.
That's really key.
Speaker 2 (18:19):
Very good.
Yeah, I think it sounds to melike you're well prepared.
We are the lab Safety Gurus,Dan Scungio and Sean Kaufman.
Speaker 1 (18:31):
Thank you for letting us do lab safety together.
Welcome to the Lab Safety Gurus Podcast.
I'm Dan Scungio.
Speaker 2 (00:07):
And I'm Sean Kaufman, and together we're providing
safety insights for thoseworking in laboratory settings,
doing safety together.
Speaker 1 (00:18):
Alright, welcome everybody.
Glad to have you back foranother episode.
I have a question for SeanKaufman.
Speaker 2 (00:26):
That makes me nervous .
It's been a while.
Do you know?
We're on our 11th podcast, Dan11 already.
Yeah, this is 11.
That's my wife's favoritenumber, by the way it is.
Speaker 1 (00:37):
Why is that?
Is there a reason for?
Speaker 2 (00:39):
that she tried to explain it the other day.
She said because one and oneare together.
I thought that's an oddexplanation, but that's what she
said.
It's she.
She said it just seems so equal.
So maybe there's a listener outthere that understands that,
but I I didn't understand theexplanation there may be.
Speaker 1 (00:55):
There may be my wife likes 13, because we got married
on friday the 13th, um.
So containment in thelaboratory.
I'm'm going to ask you aquestion, sean, because I have
worked in a laboratory that wascited by OSHA, and here's why
they got cited.
They built a break room off ofa laboratory, a small.
(01:19):
It was like an emergencydepartment laboratory, an
emergency department laboratory,and there was no space for the
staff to have downtime, breaktime, whatever.
And they built this break roombut they built it in the space
of the laboratory and theseparation between the break
room and the lab was a half wall.
So on the other side of thathalf wall, a refrigerator, a
(01:42):
microwave, a place to eat, atable, a sink, all that good
stuff.
And so when OSHA came in,they're like you can't do that.
Now, that's one OSHAinspector's interpretation of
what can and can't be.
But they made the hospitalbuild like glass from.
(02:02):
But they made the hospitalbuild like glass from the
halfway wall all the way up tothe ceiling and then they had
them put in like a storm door sothat there would be complete
separation.
That was sort of my introductionto containment in my lab safety
career.
So I've always had a mindsetthat containment for a
(02:24):
biological laboratory should becomplete separation from floor
to ceiling, and that's going tobe the way it has to be.
But over time, as I lookedthrough guidelines, regulations,
standards, there was nothing inliterature that states that you
(02:46):
need to have completeseparation from clean spaces and
dirty or contaminated labspaces.
And one of the things I've donein my career is I worked with a
team that was rewriting the ISOstandards for laboratory safety
.
It was the 15190, specific tolab safety, and we talked about
(03:07):
that on the team and we did getthat wording in there that there
should be complete separation.
But, sean, as a biosafetyexpert, is that, am I looking at
it, the right way?
Is that the right thing to betalking about?
Is that the right way to belooking at contamination and
containment?
That's it.
Well, the three things I've gotto say first, I've got
(03:29):
questions for you.
Speaker 2 (03:31):
I don't ever consider myself a biosafety expert, but
I appreciate the compliment I do.
Second, why was OSHA there inthe first place?
Now, typically OSHA is not aproactive organization.
Usually they show up on scenewhen there's problems.
Why was OSHA there in the firstplace is a good question.
Speaker 1 (03:55):
It is a good question and I don't know the answer.
Speaker 2 (03:57):
Oh, okay.
Speaker 1 (03:58):
I was new to my job as a lab safety officer and I
was not privy to the reason whythe OSHA the state OSHA
representative came in.
Okay, I have dealt with otherissues in my career with OSHA
and I know why they were called,but for that one I didn't know
the actual reason.
They certainly didn't come justto look at the space and I
(04:19):
don't think an employeecomplained about the break room.
Speaker 2 (04:23):
I don't think so, but I don't know that for sure.
Well, usually they'll show uplooking for problems because a
problem has been identified.
That's, again, typically whatI've learned with OSHA.
But here's my third.
This is my third statement here.
Look, all infectious diseasesare not created equal, and
that's one thing that I think weall have to continue to remind.
(04:45):
So, for example, I love usingthis example because when I was
at CDC, I worked in parasiticdiseases and I worked with
cryptosporidium, and Dr MichaelBeach, who is my supervisor
there, used to say do you knowthat one oocyst of
cryptosporidium can live in onepart per million of chlorine for
6.7 days?
(05:05):
He used to say that and I waslike that's amazing when you
compare it to something like HIVor hepatitis B and you're
looking at blood at a swimmingpool and how easily those agents
are inactivated withdisinfectant.
And as I've gotten familiarwith the different containment
levels BSL-1, bsl-2, bsl-3,bsl-4, I've also become more and
(05:31):
more familiar with howinfectious diseases are
transmitted.
And the issue that I have whenwe make statements in safety or
in biosafety or even in bio-riskmanagement, is that we really
have to use science and, ifyou're asking me, does a
complete separation have tooccur.
(05:52):
If we're working with a pathogen, say, for example, a BSL-1
agent that typically will notmake healthy people sick, a
BSL-1 agent that typically willnot make healthy people sick,
what's the science that saysthat you would need a complete
separation?
And if you're working withagents in BSL-2, where it's only
blood-borne, fecal-oral routesof transmission, you're not
(06:12):
having agents that swim in theair and make people sick Again,
if you have good laboratorypractices, science is not
calling for complete separation.
And so again, yes, dan, don'tget me wrong, please hear me,
because I can see you.
I could see you biting at thebit here.
It would be my preference forcomplete separation.
(06:34):
It would certainly be mypreference, absolutely, because
you can carry things in on yourhands, do whatever.
But science does not support acomplete separation, it just
doesn't, unless you seeotherwise.
Speaker 1 (06:49):
No, I don't think I do, but I think in my career
I've been the victim ofoverzealous, non-laboratory
people, maybe.
So here we have the oceaninspector who says this is what
has to happen, which I agreewith him.
I'm with you there should beseparation from your break room
to your lab.
We had another incident where acouple of incidents where
(07:12):
microbiology BSL-2 lab, they'reworking with some blood culture
specimens and they growsomething that's like a
potential bioterrorism organ,like a Francisella.
Speaker 2 (07:23):
Yeah, they're surprised, they have an uh-oh
moment, they have Brucella'sclass.
Speaker 1 (07:27):
We hear that quite a bit.
Yep.
So what happens when thatoccurred is suddenly the
occupational health departmentwants to know I need the name of
everybody who was in thatlaboratory while those plates
were being manipulated, whetheror not an aerosolization
procedure was going on or notwith those plates.
Usually when you're reading,there's not too much that's
(07:49):
happening that could create anaerosol, unless you're doing
some vortexing, and that alldepends on the processes in your
lab.
But they wanted the names ofevery employee who walked in the
department at the time thoseplates were being manipulated
and it was a lot of people, alot of people working in the lab
(08:10):
, couriers coming into thelaboratory to pick up specimens,
people walking through, maybethe safety officer I wasn't on
the list, but they gathered allthose names, did some sort of
monitoring and offeredprophylaxis for all of those
people and then, after thathappened more than once, they
(08:33):
decided to spend the money tobuild a BSL-3 laboratory for
blood cultures, because it'smore likely to happen with blood
cultures than any other kind ofclinical specimen Was that
overkill.
Was that overdoing it?
We have fewer exposureincidents because there's fewer
people working in the blood room, as we now call it.
(08:55):
Was that?
Speaker 2 (08:58):
overdoing.
Listen, I am a big believer inaggressively dealing
prophylactically with potentialexposures.
I am an absolute.
I'm very happy to hear what yousaid, because in cases where we
know that potential exposureshave occurred and we don't
(09:19):
prophylactically offer counteryou know we don't we don't offer
countermeasures to potentialexposures of dangerous pathogens
then we haven't done our job.
Now look, one of the thingsthat is very it's unrealistic.
See, most of my experience, dan,as you know, is dealing in
research labs, laboratorieswhere we know very well what
(09:43):
we're working with and thereforewe're always adequately
prepared.
But I think many listeners donot understand that there are
labs out there that are tryingto determine what people are
sick with and in those momentsthose labs are working outside
of a biosafety cabinet, sothey're not expecting to trip up
on an agent that has spreadthrough routes of aerosol.
(10:06):
Trip up on an agent that hasspread through routes of aerosol
and all of a sudden they findthemselves having an agent like
Brucella that is exposed andrequires a higher level of
containment and there could havebeen a potential exposure in
the environment.
And here's the challenge, dan,and correct me if I'm wrong the
amount of samples that somebodyis doing from a diagnostic
(10:28):
aspect, whether it be in aclinical or public health
setting, may be so numerous andso vast that actually doing them
in higher levels of containmentis it can be quite difficult if
you don't have the resources,like you had mentioned, a BSL-3
lab or even just a hugebiosafety cabinet.
Speaker 1 (10:47):
So you have?
Yeah, so you have challengesthere.
Yeah, and it's not common tocreate a special room for blood
cultures in a clinicallaboratory.
Speaker 2 (10:56):
Most labs don't have the ability to do that, and the
reason why, just again for thelisteners, is I mean, dan,
seriously, think about it.
I say it, you know, once everyI mean a lot of people.
We almost average once everyfive or six years is when I'm
seeing, when I go to diagnosticlabs.
But how often do you get asurprise like a brucello?
How often does that occur?
Speaker 1 (11:18):
uh, probably in.
So so this is for a reference,microbiology laboratory.
Uh, it can be between two andthree times a year.
Speaker 2 (11:28):
Okay, okay, and is that that's more clinical, like
hospital labs?
Speaker 1 (11:32):
Yes, okay, good yeah.
Speaker 2 (11:33):
I'm talking, I was referring to public health.
But if that, but in that, inthat time year wise Dan, on
average, how many samples dothose clinical labs process?
Speaker 1 (11:45):
Oh my gosh.
Speaker 2 (11:45):
Yeah, give me, give me a rough idea those clinical
labs process, oh my gosh.
Speaker 1 (11:50):
Yeah, give me a rough idea.
Speaker 2 (11:55):
The number blood culture bottles in that
reference lab were in thethousands.
Yeah, so what I want listenersto understand is, for the one
lightning strike there arethousands of samples that are
processed, and so to change thewhole protocol for that one
potential lightning strike, thatcan not only slow your
diagnostic procedures down,which in the end would hurt your
(12:16):
patients, but it could alsoincrease costs substantially.
So it's a true conundrum, so tospeak.
Speaker 1 (12:24):
Yeah.
So let me touch on something,sean, then, that I know that
you're also an expert in, andthat's something like Ebola.
So in certain hospitals thatare not treatment hospitals but
maybe assessment hospitals,they're set up with different
levels of different types ofunits highly infectious disease
(12:47):
units, which include alaboratory, and in certain
situations the laboratory is nota permanent location.
So I know of a hospital, forinstance, where their highly
infectious disease lab is apatient room, normally by day,
in the emergency room, and thenwhen they open up the highly
infectious disease unit, thelaboratory gets to use this room
(13:08):
and then, when they open up thehighly infectious disease unit,
the laboratory gets to use thisroom and there is a biological
safety cabinet in the room.
It's behind, like a garage door,for example.
It's always kept there.
They have to bring all theequipment in there, don that
specialized PPE and work in thatpatient room.
That patient room is in ahallway.
There's no ante room and sowhen people bring specimens from
(13:33):
down the hall from the Ebolapatient, potentially they're
carrying that specimen inside ofa special carrying container.
They're handing it into thedoorway of the Ebola lab we'll
say HIDU laboratory and thentaking care of things.
But trash has to come out ofthat room when the trash is full
(13:57):
and has to go down the hallwayto the outside door, category A
trash we're talking about.
When people doff, they'redoffing inside that room where
they've done the work.
So I know some laboratorianswho work in these situations.
We haven't had to, you know,bring up the HIDU lab officially
but during training and drillsthere are people who are nervous
(14:20):
about that.
How nervous do they need to beabout doffing in the same room
where they perform testing?
And there's like a line of tapeon the floor.
This is your red zone and thisis your green zone, and they
know that viruses don't knowcolors.
Speaker 2 (14:35):
Well, everything you're saying today, Dan, is
making me happy, and I mean thatEverything you've just said
makes me happy, because one ofthe worst things that a hospital
can do is bring in a verydangerous infectious disease
into its lab, contaminate thelab environment and shut down
diagnostics for the wholehospital.
We have to remember thatpatients are going to need the
(14:56):
lab tremendously, and what Imean by that is, again,
laboratory scientists are theheroes.
The doctors ask for labs to bedone and the labs give the
answers to the doctors and theyallow the doctors and nurses to
treat the patients.
So when you have something likeEbola come in, you don't want
it going to your main centrallab, you want to set up a
special space, and so I thinkthat makes me very, very happy.
(15:18):
The second thing I think that'simportant to bring out is that
when we're doing diagnostics,we're not working with large
quantities of cultured samples,is that when we're doing
diagnostics, we're not workingwith large quantities of
cultured samples, meaning thatwe really don't need a fully
designed, engineered BSL-4laboratory to run diagnostics or
basic blood tests for somebodywho may be infected with a
(15:40):
bloodborne infection.
The fact that you're gonna doyour work in a biosafety cabinet
, the fact that you're gonna bemaking sure that in a biosafety
cabinet, the fact that you'regoing to be making sure that the
people doing that work are welltrained, the fact that you're
going to have great PPE andyou'll know the difference
between contaminated PPE and notcontaminated PPE, and the fact
that you have tape and I want tobring this reference up.
(16:01):
The tape on the ground is notsignifying a clean and dirty
environment in the lab.
The tape on the ground is abehavioral cue.
It is telling staff to docertain behaviors at different
points in time so that when wedo practice containment
strategies, we're doing it in away that phases out and ensures
the highest level of containment.
(16:22):
So you know again, dan,everything that you've said to
me is is an outstanding strategy.
Obviously the staff, becauseit's new and because it will be
dealing with a very highpathogenic.
You know this could be realtime.
We had two nurses in Texas getEbola.
I want people to be to becautiously respectful of what
(16:44):
they're working with.
I want people to be cautiouslyrespectful of what they're
working with.
I want them to be a littlenervous, but I also want them to
feel confident that they aredoing what they need to do to
protect themselves.
So, based on what I'm hearingyou say, that's an exceptional
strategy and again, I would justmake sure people are trained to
the point where they feelextremely comfortable, because
you also want them to be trainedon a gross contamination what
(17:05):
happens if they do drop a bloodvial and it splatters outside of
the cabinet and onto them.
I want them prepared for thatand the minute we start
preparing for those types ofsituations, we build their
self-efficacy or theirconfidence that they can do this
safely with a highly dangerouspathogen.
Speaker 1 (17:23):
Yeah, absolutely, thank you.
I feel better about our setup,certainly in my organization,
but many others that I've heardof as well.
What you say, like with thetape being a behavioral cue, I
don't think people realize that.
I think they're thinking of itas how is this any cleaner an
(17:44):
area than this?
Because when we doff out ofthat, the PPE, you take your
foot out of the bodysuit and youmove it over.
You know you're sitting in thesame chair that straddles the
tape and then you're moving yourfoot over into the clean area.
I'm using air quotes with cleanarea.
Speaker 2 (18:03):
Yeah, yeah, I mean yeah, yeah.
Speaker 1 (18:05):
Well, I think a big part of this is having that
conversation with staff to makesure that they are as
comfortable with their safetythat you know, and all the
precautions that we're taking.
That's really key.
Speaker 2 (18:19):
Very good.
Yeah, I think it sounds to melike you're well prepared.
We are the lab Safety Gurus,Dan Scungio and Sean Kaufman.
Speaker 1 (18:31):
Thank you for letting us do lab safety together.
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