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Safety: A to Z (Part I)

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Overview :

Working as a histo-technologist or histology technician has been recognized as potentially damaging to health. The US Department of Labor’s Occupational Information Network identified exposure to hazardous conditions, to contaminants, and to disease and infections as the top 3 health risks for these professions.

Learning Objectives :

  1. Examine the A-Z approach of topics in safety.
  2. Review the day to day dangers that qualifies the Histotechnology career to be one of the most dangerous jobs.
  3. Prepare for the Qualification in Laboratory Safety examination.

Presenter :

Allison Eck is the lead histotechnologist at Doylestown Hospital in Pennsylvania. She has been a histotechnologist for 15 years after graduating with a degree in histotechnology from Harford Community College in Maryland and a bachelor’s degree in biology from Lycoming College in Pennsylvania. She holds her histotechnologist (HTL) and qualification in laboratory safety (QLS) certifications through the ASCP, as well as her Allied Health Instructor (AHI) certification through AMT. Allison has spoken at a variety of professional conferences on respiratory disease as well as lab safety and ergonomics.

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Webinar Transcription

We’re going to be looking at Safety A to Z. This is going to be part one of the presentation so we’re going to cover the first half of the alphabet today and the second half of the alphabet next month.

The objectives for today’s presentation we’re going through an A to Z approach to topics in safety. I’m going to review the day-to-day dangers that qualify the histotechnology career to be one of the most dangerous jobs. The content of this presentation in its entirety can be used to help you prepare for the QLS exam offered by the ASCP.

The idea behind this webinar was decided when a study was published by the U.S. Department of Labor indicating that histology was the most damaging career to your health. We’re all aware that hazards exist in the lab but this webinar is going to take an alphabetical approach to safety, not just in the lab, but organization-wide.

When the U.S. Department of Labor developed their criteria, they looked at three different categories. They wanted to look at the exposure to hazardous conditions, exposure to contaminants, and exposure to disease and infections and they used these to rate an overall unhealthiness score. Histology came in at 63.8 which was the highest of the 15 careers they looked at. This slide is a brief overview of the requirements for the ASCP QLS exam.

A - Active Shooter

ABCs are for safety. We’re going to start with the letter A, Active Shooter. It’s unfortunate we have to start with Active Shooter just because of the gun violence that’s everywhere now. In the laboratory we want to follow the run, hide, and fight acronym. The first thing that should be done in an active shooter situation is to run away. You want to scope out your escape route, only worry about yourself. Don’t worry about your belongings, your purse, your cell phone, any of that. When you are running always keep in mind you want to keep your hands visible while you're running. If you don’t have an option to run, you want to hide. You want to be as quiet as possible so you want to silence your cell phone if you have it one you. Barricade yourself from anybody entering. If you have the ability to lock yourself anywhere, do that, and then only as your last resort should you try to fight the attacker.

Prior to any event occurring, it’s important to be aware of your surroundings. You want to know where your exits are and you want to have a preplanned place to hide in the event of an active shooter incident. Only as a last resort should you try to fight the attacker. It’s much more important that we have you alive rather than the memory of a hero.

There should be a policy in place for an active shooter. A good way to put this in place is to partner with your local police department and run drills. We run drills here quarterly and the police department comes in and pretends to be a shooter, we don’t know where they’re going, so it gives everybody a chance to be surprised. You want to definitely practice these drills; that way, in the event that something does happen, everybody knows how to react.

B - Biological Hazards

Moving onto biological hazards, these are any pathogenic microorganisms that are present in the blood that can cause disease. Most commonly we think of HIV and the hepatitis viruses of our bloodborne pathogens. Looking at microbial sources these are anywhere there’s germs. Germs are everywhere, but you want to think places that a lot of people touch, things get really germy and dirty. Things like doorknobs and handrails and the labs. The lab germs are everywhere. The roots of infection for biological hazards are going to be mucus membrane exposures, exposure to nonintact skin or parenteral contact with blood or infectious materials.

One thing to note, this is not just going to happen person to person or coming in contact with blood. There are things called fomites which are objects that can carry infection. This can be anything from your lab coat to your pen. They become contaminated and they can cause infection.

One that we tend not to think about but is very prevalent now are cell phones. If we have our cell phones on us in the lab they can be contaminated. There was a study done back in 2009 that demonstrated that phones carry a wide variety of pathogens. They can carry E. coli, pseudomonas, staph aureus and Klebsiella. We want to make sure that we are using universal precautions in the lab, wearing proper PPE and treating all specimens as if they are infectious.

The OSHA bloodborne pathogen standard was enacted and this is one of the most enforced standards when it comes to OSHA standards. Upon your initial training on or around your start date you’re going to want to receive a copy of the lab’s Bloodborne Pathogen Standard, a description of bloodborne diseases, symptoms and their modes of transmission. It’s important to review your employer’s exposure control plan. They will be training you on the proper use of personal protective equipment, information about hepatitis B vaccinations, and also providing an explanation of what to do in case you are exposed to a bloodborne pathogen. This training needs to be done every year and then additional training comes into effect if there’s a change in safety procedures or a change in equipment, or any time that your exposure risk changes. Using universal precautions, we don’t want to be eating or drinking or mouth pipetting in the lab. We shouldn’t be applying cosmetics, long hair needs to be tied back so it’s not getting contaminated, beards and fingernails should be trimmed. Scarves and ties are likely to carry infection and they’re usually not washed on any regular basis and can become contaminated quickly.

C - Carpal Tunnel and Repetitive Motion Disorders

There are ergonomic injuries. Ergonomic injuries are any time there’s pain or dysfunction as a result of static or awkward posture, especially if there’s force repetition or contact stress involved. Some of the more common repetitive motion disorders that we encounter in the lab are carpal tunnel syndrome, a variety of tendonitis, tennis elbow and golfer’s elbow, trigger finger or De Quervain syndrome, low back strain, and thoracic outlet syndrome.

Carpal tunnel is the most common of the repetitive motion disorders we see in the lab. It’s usually the most common due to microtomy and to a lot of typing. It’s also the costliest of the repetitive motion disorders. Carpal tunnel costs employers about $20 billion a year in workman’s comp costs. Carpal tunnel occurs when there’s compression of the median nerve as it travels through the wrist that the carpal tunnel. We’re going to feel some pain, numbness, and tingling in the thumb and first three fingers. The pinky is going to remain uninvolved because there’s a separate set of nerves that go towards the pinky that don’t run through the carpal tunnel. This is caused by repetitive wrist movements and wrist down movements. Prevention of this is to keep your wrists neutral while you’re typing and to avoid repetitive reflection and extension of the wrist. Usually if this starts to become an issue, using wrist splints, getting physical therapy, and using over the counter pain relievers will generally help with the symptoms.

D - Disaster Preparedness

The first question you need to think about is, what is a disaster? A disaster is any event, regardless of the size, that overwhelms available resources. People tend to jump towards natural disasters; tornadoes, hurricanes, earthquakes, fires. When we’re writing up our Emergency Preparedness Policy we want to think of all types of disasters. This could be unexpected system failures like if our HVAC system goes down, if our computer system goes down, if we somehow loose communication throughout the hospital. What happens if there’s a widespread power outage and we no longer have power coming to the hospital? We also want to think about emerging public health threats, cyber-attacks, terrorist events, and also workplace violence or active shooter situations.

It’s imperative that policies and plans are in effect in the event of a disaster. People need to be trained, policies need to be written and there need to be practice drills to ensure effectiveness of all of those policies.

When I put this together, I decided for disaster preparedness to take a mass casualty approach to this. This is a little outside of the lab, but still pertains to the lab itself. First responders, when they are attending to a disaster, they’re going to use this Mass Casualty Incident Triage flowchart. That’s how they’re going to categorize what patients need treatment first. They’re going to be categorized as either red, yellow, or green. The red patients are critical patients, they need immediate medical attention and they need to get to the hospital first. Yellow tagged patients are close to critical but not quite critical. They're going to follow behind the red tagged patients. Green patients are ambulatory, walking, breathing, talking patients who can follow after the critical patients are taken care of.

Once a patient arrives in a hospital, we’re going to set up zones. There are three zones; hot, warm, and cold. The hot zone is where the disaster is occurring so the hot zone is generally outside of the hospital setting. Once the patients get to the hospital they’re going to cross over into the warm zone. This is where decontamination is going to happen. Once decontamination is complete, they can move onto the cold zone. Cold zone is where incident command is going to be stationed. It’s also going to be where they’re receiving medical care. It’s imperative that trained personnel are at the threshold of each zone. We want to keep everybody moving from hot to warm to cold. We don’t want anybody moving backwards from cold into the warm zone.

These are pictures of our decontamination area. We are a CBRN rated disaster area. We can handle the chemical, biologic, radiological, and nuclear disasters here. For a picture, this door goes to the outside of the hospital. Anything outside of that black door is going to be the hot zone. Patients can cross through that door, they’re going to come into the decontamination area. This is going to be the warm zone, and then outside here there is a door and that door is going to lead into the emergency room. That is where our cold zone will take place.

This slide is a reminder to practice, practice, practice. We want to run drills and have trainings on a regular basis so that everybody is always learning from them. We want to make mistakes in the training. We don’t want to make mistakes during the actual disaster.

E - Ergonomics

Ergonomics is defined as the applied science of equipment design intended to maximize productivity by reducing operating fatigue and discomfort. When we take a look at injuries that occur on the job injuries can fall into one of two categories. The first category is going to be negligence, this going to be your spills, slips, and falls. The second category are ergonomic issues. By having an ergonomic assessment and having proper ergonomics in place we can ultimately reduce or eliminate that second category of injuries.

The major risk factors to consider when looking at ergonomic-related injuries are posture, force, repetition, contact stress, and vibration. Force is going to be the amount of muscular effort required to perform the task. When we’re thinking about the pathology lab it can be things like opening specimen containers or doing any kind of pipetting. Repetition is requiring the same muscles, tendons, and joints to perform the same task repeatedly. This is going to be doing anything manually; manually labeling, manually cover slipping, any time you’re doing computer data entry. Awkward postures are going to be any time that your joints are not near their midpoint of their range. This is happening a lot where you’re reaching, bending, grabbing, lifting, or sitting for extended periods of time.

There are a ton of regulatory things that come up with ergonomics and we can probably spend a whole hour talking about that. I want to touch on a couple of important standards. OSHA Standard 5110 outlines a minimum level of safety practices that a company must meet. There’s OSHA General Duty Clause 5(a)1 which state that a workplace must be free of hazards. Then there is a CAP checklist question, GEN.77200 stating that there is a written ergonomics program in place to prevent musculoskeletal disorders in the workplace through prevention and engineering controls. These OSHA standards have to be met and failure to comply with these standards can result in legal action, punitive action, and hefty fines can be levied. It’s important to take note that depending on the severity of the infection, the fines OSHA levies may not just be applicable to your business but also to the associates and the employees of that business.

F - Fire Safety

We’re going to spend a couple of slides looking at prevention and hazards and lab design and fire safety equipment. Fire prevention is understanding what is called the fire tetrahedron. You see a triangle but they’ve added an extra triangle to it so now it’s a tetrahedron. A fire starts when a combustible material and enough oxygen is exposed to a heat source. The rapid oxidation that’s happening is causing the chain reaction and that’s what compiles all four parts of this tetrahedron. When you need to extinguish a fire, you’re going to remove either the oxygen part or you're going to apply a retardant chemical to slow the combustion which makes that chain reaction unsustainable.

In the lab some combustible liquids that we need to be concerned with are alcohols, acetones, and xylenes. These liquids are volatile and vapors will dissipate at ambient temperatures. Combustible liquids can also self-ignite when exposed to their flashpoint heat. We want to ensure that there’s proper flammable signage posted to prevent fires in the lab. Fires in the lab tend to spread very rapidly and cause devastating damage.

There are five categories of fires and most people aren’t going to remember what these classifications are, but there’s an easy way to remember; the ABCD and K. A is going to be your ordinary combustibles. This is going to be like your office fires, something with wood or paper. You can remember Category A because this will burn to ash. Category B are your flammable liquids, any of your solvents or alcohols. You can remember B, barrel, because you can store your solvents in a barrel. C is going to be electrical fires, C for current. Combustible metals are going to be Class D for dynamite and Class K fires are going to be your cooking fires, anything that’s happening from your oil or grease in the kitchen and that’s K for kitchen.

This is an image that shows the flashpoints of some of the commonly used reagents in the histology lab.

Lab design, evacuation routes, I want to make sure that an emergency escape plan is posted in the laboratory, in the hallway, somewhere where everybody knows where it is. We want to make sure we have adequate size doors, windows, and hallways. We want to make sure that the exits are always well marked and those exit hallways are unobstructed. We want to make sure that we’re always performing drills, we want to do them quarterly. We want to make sure that there is an 18” ceiling clearance and this is going to help with the sprinkler systems.

When it comes to lab design, evacuation routes and floor plans you want to preplan your escape. This is going to be done through drills and making sure that your evacuation plans are posted. If you can’t escape, RACE, that’s rescue, alarm, contain, and extinguish.

Fire safety equipment, it’s important to know that there are many different types of fire extinguishers out there and you want to make sure the fire extinguisher you have in place is the correct one for the fires that could occur in that room. The ABC fire extinguishers are the red extinguishers that are pretty much everywhere and those are going to put out your basic office fires, any of your flammable liquid fires, and if there is an electrical current fire. If we were working in MRI, we would want to make sure that we have an extinguisher that has a water mist because an ABC extinguisher is not going to contain a fire there. Inspection of equipment has to be done on a regular basis. This varies jurisdiction to jurisdiction. Check with your local authorities to know how often you need to check your fire extinguishers.

To operate a fire extinguisher, we’re going to use the acronym PASS. The first step is we’re going to Pull the pin out of the top of the extinguisher, A is you're going to Aim the nozzle at the base of the fire. The first S is to Squeeze the handle together to discharge the propellant and then we’re going to Sweep the propellant at the bottom of the fire.

G - Green Healthcare

I chose to do Green Healthcare. It doesn’t really fit the safety as we would stereotypically think of safety. We’re looking at it not only is it good for the planet and for the pocketbook but it supports total health and its preventative maintenance on a grand scale.

Starting a green program in a hospital or an organization can be a daunting task, but it’s important to consider at least investigating some options that you have. There are five questions that are a good place to start if you’re trying to promote sustainability and greening in healthcare. The first one is starting a reprocessing program. This is more applicable for operating rooms, cardiac cath labs, electrophysiology labs, places where they use onetime-use instruments. A lot of companies like Stryker or Masimo will put in a reprocessing a program where you’re going to use the onetime-use tool and then you send it back to the company, they reprocess it and then they sell it back to you at a discounted price. You’re not only saving money, but you’re also reducing the waste that you are putting out. It’s been estimated that U.S. healthcare contributes 8% to our total carbon footprint. It doesn’t sound like a lot, but 8% is over 2 million tons of waste every year that healthcare is putting into the environment.

Starting a reprocessing program can save a lot of money and reduce your costs and we have started this program a few years ago and our last fiscal year we saved over a million dollars by putting this into place.

The second statement would be to buy safer cleaning products. There are chemicals in cleaners, sanitizers, and disinfectants that have been warned to pose health risks to fetus and young children and can also create chemical exposure to nurses and janitors and people using those chemicals. The best place to start with this is to choose safer products to help prevent the risks to the vulnerable populations. There is a Green Seal Certified cleaning product list that you could use.

Purchasing meat without antibiotics or serving less meat. No hospital is going to stop serving meat. You’d have a lot of unhappy employees and visitors and patients if we stopped doing that. We can decide to start using antibiotic-free meat. About 80% of the antibiotics used in this country are not used to treat illness but rather to feed livestock and its used in nontherapeutic process purposes. It’s creating antibiotic resistant superbugs. We can make a public health impact by going antibiotic free.

If we need to buy new furniture, we can look at purchasing furniture that’s flame retardant-free just due to the chemical exposures that can off-gas from the furniture.

Talking about climate change as a real health issue. Smoke from wildfires, increased ozone, longer pollen seasons, vector-borne illnesses, they all create health problems especially in our most vulnerable populations, the elderly and the young. We can talk about that and see if there are things we can do in the healthcare setting.

H - Hearing Protection

OSHA has a noise standard and then CAP also has piggybacked onto that with their excessive noise checklist questions that requires employees to have a Hearing Conservation Program in place if workers are exposed to a timeweighted average of 85 decibels over an 8-hour work shift. Eight-five decibels is the equivalent to listening to a vacuum cleaner or a blender over eight hours. It’s not painfully loud, but definitely enough that can cause some damage to your hearing. It’s important to note for hearing is that labs generally aren’t very loud but there’s a lot of noise that’s happening. There are the analyzers that are running, fume hoods, biosafety cabinets, cell washers, stirrers, fans and compressors on cryostats and refrigerators, all of that is running in addition to people talking and phones ringing. We want to keep an eye on how loud it actually is. From a safety perspective we want to make sure that we can adequately hear people. We don’t want to misunderstand directions, instructions, or risk not hearing proper lab results.

There is PPE available for hearing protection. Single-use earplugs always work, but you can also get molded earplugs or even use the earmuff style, if need be.

I - IATA/RCRA Regulations

IATA is the International Air Transport Association. This is an association of airlines that work to encourage safety in air transport. Part of their responsibility is the transport of dangerous goods. IATA follows the technical instructions for safe transport of dangerous goods by air and IATA and the DOT require anyone who handles, offers to handle, or transports goods, must be trained and certified to perform those duties.

RCRA stands for the Resource Conservation and Recovery Act. This was enacted in 1976 and is the principle federal law governing disposal of hazardous waste. Those of us that work in pathology are probably familiar with these regulations. This was enacted as a cradle to grave management of waste. Management of the waste is under our jurisdiction from the point of generation to the point of disposal. We, as generators, are ultimately responsible for the disposal of the chemicals. We want to make sure that if a company is coming to take it away, that they are disposing of those chemicals in the proper way. RCRA training has to be done every three years for anybody who generates or disposes hazardous waste. The CAP checklist guideline is GEN.77800 and that’s making sure that we have written policies and procedures in place for hazardous chemical waste disposal. A lot of that can be done taking from those RCRA regulations.

This is why it’s important that we have a cradle to grave method of checking on our waste. We don’t want to end up in a situation like this with hazardous waste lying around in a field somewhere. These are designated superfund sites and a superfund site is any land in the United States that’s been contaminated by hazardous waste and identified by the EPA as a candidate for cleanup because it poses a risk to health or to the environment.

This is a cartoon about increasing our safety trainings. I don’t think that safety trainings tend to happen as often as they should be because it’s not that exciting of a topic. It should happen and people need to be aware of the regulations and safety as it pertains to them.

J - Job Safety Analysis

Job safety analysis is procedures that help integrate accepted safety and health principles to a particular job. When we're performing a job safety analysis, we want to make sure that each basic step of the job is used to identify potential hazards and then we can recommend the safest way to do a job. One of the best ways to do this is to observe somebody doing the job. The advantage to observing somebody is that it doesn’t rely on individual memory and observing the process can prompt recognition of hazards more quickly.

When we are going to conduct an assessment, the first thing we have to do is select the job to be analyzed. Then we’re going to break down the job into a sequence of steps. From there we can identify potential hazards and then determine preventative measures to overcome these hazards. This is a very basic breakdown of what a job safety analysis should look like. We chose something, this is changing a flat tire. The first thing you’re going to do is you’re going to put the vehicle in park. What are some potential hazards? The vehicle could be too close to passing traffic, it could be parked on uneven or soft group, or the vehicle could roll. Going from the potential hazards we can put in preventative measures. We can drive to an area that’s clear of traffic, we can make sure that we choose a level parking area. We can make sure we apply the parking break. Make sure that the car is in park or place blocks behind the wheels to prevent it from rolling back. Then after we’ve got the car parked, we need to remove the spare and the toolkit. Potential hazards, strain from lifting the spare. Preventative measure is turning the spare to the upright position using your legs and standing as close as possible, living the spare out of the truck and rolling it and so on.

That is where we're going to end for today and we’ll pick up with K next month. I want to acknowledge Donna Chuddley at St. Luke’s Hospital in Bethlehem who helped put this together. She’s responsible for half of the content in here. Some references. Thank you everybody and have a safe journey.

Questions and Answers

Q: When we are working in a laboratory, especially histopathology laboratories, is there a risk that germs from tissues may be present in the environment or air, and what is the surety that these germs don’t stick to our clothes or hands or shoes?
A: Germs are present in the tissue, especially their fresh state. You want to make sure you are wearing a lab coat that’s going to keep them off of your clothes. Shoes, unfortunately are dirty. I don’t know that there’s a guarantee to keep them clean. The biggest risk for transmitting those germs is during frozen sectioning because we’re sectioning fresh tissue. The biggest rule that I have, this isn't everywhere, I’m sure a lot of people will disagree with me, but using the cryospray is completely banned in my laboratory. That cryospray aerosolizes all over the germs and since the lid to the cryostat needs to be open to do that your aerosolizing everything into the air and putting yourself and your coworkers at risk for any pathogens.

Q:After tissue processing are these microorganisms gone or not?
A: They are gone. Tissue processing will kill all pathogens, with the exception of prions so after it is gone through the tissue processor its essentially not considered hazardous any more.

Q: Is it necessary to have a separate lab disaster policy or can you incorporate the lab portion into a hospital policy?
A: Having a hospital policy is fine as long as the hospital policy designates the role of the laboratory in any disaster.

Q: Is there any long-term harm from constant exposure to chemicals such as formalin in a histopathology lab?
A: There are. You definitely want to refer to your Safety Data Sheets for each specific one you’re concerned about. We know formaldehyde is a carcinogen. We know that xylene can cause reproductive effects. Making sure that you’re wearing your proper PPE and monitoring your exposures you should be fine.

Q: What is the best way to begin an ergonomic plan?
A: If you’re in a hospital setting you can reach out either to your Occupational Health Department or to Human Resources and see if there’s a certified ergonomic assessment specialist in your organization. They generally will work in physical therapy or occupational therapy and they can come and do an assessment for you. It’s pretty quick. It’s them seeing what you’re doing, watching how you work, and just looking at the environment. They can make suggestion about any changes that need to be made. As far as if you’re going to write the policy, if you go on the NIOSH website, they have six steps to how to write a plan. It’s basically looking at your indicators, reviewing any past medical history, what you’ve done, what kind of engineering controls you’ve put in place, and then how you’ve changed around some plans.

Q: A lab technician working in histopathology lab developed cancer. What could be the possible reason even after applying personal protection procedures? What could the cause be outside of the lab?
A: There's really no way to know for sure that it was due to working in the lab. It’s a good question, but I think that’s a big gray area that I don’t know that I could answer.

Q: Can you talk more about other hand injuries, such as injuries to the thumb joint over time, not carpal tunnel. Are you thinking about trigger thumb perhaps?
A: I’m thinking they’re talking about trigger finger or De Quervain’s syndrome which De Quervain’s is essentially trigger finger, but in the thumb. What’s happening in those situations is your fingers move on a pulley system, if that makes sense. As your tendons pull that’s what brings your fingers in toward the palm of your hand. When that pulley can’t move because of swelling, that’s what causes that sticking motion, that’s where you get that trigger finger name from. That’s usually caused by excessive gripping or twisting, a lot of fist movements. I’m not sure what exactly they're looking for because there’s a ton of information. I talk about it extensively in another talk that I do.

Q: I can tell you from personal experience because I’m looking at a trigger thumb right now which happens to be attached to my right hand that there are several ways to treat it. One is through injection and the other is by snipping the band that holds the tendon in place to free the inflamed portion to travel freely. You can only get injections so many times before there's too much risk.
What are some other ergonomic measures that one could take to avoid hand injuries in general?

A: In histology we’re working with a lot of small things; you’re working with forceps, you’re working with small tissue so there’s a lot of that pinching and grasping movement especially when it comes to embedding. Then you’re doing a lot of hand work when you’re working with microtomy and making slides. The biggest ergonomic fix is to eliminate that job. Obviously, we can’t. That’s our job. To not do it constantly, if there's a rotation of jobs it frees you up from that repetition. That’s what we’ve put in place so not one person is doing the same job all day, every day, and that’s the fix we’ve put in place to help reduce those types of injuries.

Q: Working on different equipment in laboratories sometimes there are parts in machines for service which we need to work on without gloves. Is it okay just washing the hands properly after working? I’m a service engineer with a local distributor. Would hand sanitation be enough or is some other method required to ensure that the germs don’t remain?
A: Proper handwashing is key to preventing any transmission of any sort of pathogens. Making sure you’re washing your hands with warm water and soap. Washing with the soap for, I think it’s 15 seconds or how long it takes you to recite the alphabet is what they teach my son in kindergarten. That should be enough.

Q: What are some ways of improving posture when completing labs that may cause you to be slouched over for long periods of time, such as embedding and microtomy?
A: The first big thing is making sure that workstation is set up properly. If you are sitting to perform those tasks you want to make sure that your chair is at the right height for the counter. When you’re sitting you want to make sure that the backs of your thighs are along the seat of the chair, that you're sitting upright and that your elbows are bent at a 90-degree angle. That’s the first thing is making sure you’re using proper ergonomics in your workstation setup.

The second thing you can do is workplace exercises that are available that you can do in your chair or standing that can reverse. If you’re slouching, they’re going to be upper back bends and things to combat that awkward posture.

Q: Are there any replacements for formalin?
A: There are, but I can’t say how good they are. I’ve never used them. I’ve only used formalin. I think that’s the gold standard when it comes to routine pathology. I think there are other solutions out there but I am not aware of the quality of them.

Q: If there is concern over the volume in a lab what type of ear protection is sufficient?
A: It depends on how loud the volume is and you can use a standard decibel counter to find out your reading. If it’s pretty close to the 85 decibels, just using the single-use foam ones you can buy at the drug store are fine. If you’re in a situation where something is really loud and you’re in the hundreds you’re going to want to use the earmuff type headphones.

Q: How about xylene substitutes?
A: There are a lot of substitutes for xylene out there not without their own risks. There are limonene-based ones that are citrus-based and they can cause reactions in people. I personally think the smell is disgusting and I know it causes headaches in some of my techs. There are alternatives out there but none of them are risk-free.

Q: Are you familiar with the best posture for working so that the neck is not stretched too much when working for longer periods of time?
A: I think it depends on what you’re doing. If you’re working at a computer there are certain workstation setups for what are called visual display terminals that actually tell you where you should place your monitor so that your neck remains neutral. I think there’s not one generic answer for that. I think it depends on what task you’re doing.

Q: What is the best way to deal with a fresh infectious sample to avoid contracting infections?
A: There are so many gray areas. Get it into fixatives as quickly as possible. If it’s something that has to be worked on fresh, if we know, we can wear masks or respirators to prevent any inhalation. Wearing an N95 mask will help prevent those droplets from getting into your respiratory system, not using the cryospray in the cryostats. Getting it into the fixative as quickly as possible is going to be your best and safest bet.

Q: Does xylene-free tissue processing have any influence on IHC?
A: I do not know the answer to that question. But I would think that if you did xylene-free as with xylene, I would imagine you would just have to validate your procedures.

Q: How important is wearing hairnets when working in a pathology lab?
A: I don’t know that it’s important. I would just think as long as your hair is pulled back that should be sufficient enough.

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