Home > Business Journals > Medical Laboratory Observer

Addressing management issues.(Management Q & A)(Interview)

By Anne Pontius | Medical Laboratory Observer - July, 2009

Get the Mag

Weekly Updates

[-] Text Size [+]

Plan, prepare for disasters

Q I recently moved to Florida, an area that has had a few close calls (and direct hits) with some scary storms. What do you suggest I do to make sure the lab is prepared for a disaster?

A Working in Florida affords you the opportunity to plan ahead and prepare for hurricanes, and, in the process, be prepared for other disasters as well. Hurricane preparedness should be addressed under a disaster plan. Some facilities have a specific hurricane plan that is updated yearly. Hospital plans should include laboratory services, and lab staff should be aware of the overall plan. Check with a supervisor if you are not aware of the current plan or if you have suggestions to improve your facility's emergency preparedness.

Staffing is always a critical component. Be sure to have updated list of cell phone numbers and home phone numbers of all staff. Disaster preparedness includes updating the call list (staff roster) at least once each year (prior to June 1 in the case of hurricanes) with staff assignments--for before, during, and after the disaster. Do not rely on information stored electronically, as power outages are expected during severe storms; keep hard-copy lists of staff, administrators, and emergency contacts. Make sure all staff members know where to find emergency supplies. Every hurricane survival kit should include flashlights, batteries, bleach, cleaning supplies, food, distilled water, drinking water, battery-operated radio, blankets, gloves, first-aid kit, and hand sanitizers.

Phones often do not work during or after a disaster, so make staffing plans in advance. Be flexible, because staff members may be on vacation, will evacuate ahead of the storm, or could be directly affected by the hurricane. Transportation will also be affected, as roads are often closed and fuel supplies may be scarce, which can impact staff members' access to transportation. Many hospitals set up a transport service to get staff to and from work, so have addresses and directions readily available.

Other things to consider include operations issues. During hurricane season, maintain a surplus supply of routine inventory from outside vendors, because transportation in and out of the area may be impossible. Know in advance which vendors have local deliveries. Ensure you have an adequate blood supply inventory, and know how to contact the supplier in the event of an urgent need. Do you have validated coolers and ice for blood inventory and other supplies, if needed? How will results, supplies, blood, and other medical supplies be delivered? If instruments use water, what would happen if there is a problem with the water source? Calculate how much water will be needed to maintain essential operation and keep an adequate supply available.

What is your backup laboratory if you have to send tests outs? Do you have agreements with other hospitals/labs to do work in times of disaster? Establish a list of hospitals/labs that might be able to provide supplies and staff if needed.

Remember, the best plan is to plan ahead, but disaster preparedness should be designed to be flexible in order to accommodate unplanned circumstances. Hold a debriefing after any disaster to look at what worked and what improvements are needed to help refine future preparations.

Helpful emergency preparedness resources are available online at www.nhc.noaa.gov, www.FEMA.gov, www.cdc.gov, and www.redcross.org.

--Marian J. Cavagnaro, MS, MT(ASCP) DLM

Director, Laboratory Services

Memorial Hospital West

Pembroke Pines, FL

Bottom line: Ms. Cavagnaro has done an excellent job of laying out how you develop a disaster plan; there is no way to summarize it--you need it all. Keep in mind that if a disaster does strike your facility, even the best-laid plans may not cover every detail. Make sure everyone in the laboratory is well trained on disaster preparedness and how to implement it, which includes understanding that flexibility and variations may be necessary to accommodate the circumstances of the particular disaster.

Are workers' clothes carrying germs?

Q People who work in labs typically get dressed at home before going to work, but before they get to work they walk their dogs, hug their spouses, take their children to school, and put gas in their cars. Are their clothes and shoes contaminated by the time they get to the lab? Could any of the bacteria they have encountered on the way to work contaminate the lab environment? Would it make more sense for lab personnel and other healthcare workers to change into clean clothes after they arrive to work?

A You are correct. Most laboratorians do get dressed for work at home and men may perform chores or make stops before entering the laboratory. For routine lab testing, such as hematology and chemistry, this should not present a problem. Many food service employees do the same thing.

Donning a clean lab coat after entering the laboratory should protect the environment from any contamination acquired along the way. The human body naturally hosts more microorganisms than clean clothes would pick up between home and the laboratory. Also, clothing generally should not come into contact with specimens or reagents and probably does not shed microorganisms.

Microbiology, especially if cell cultures are involved, may present a different dilemma. More care must be exercised to prevent contamination. Again, a clean lab coat should suffice unless one is entering a sterile environment. In this case, a complete change of clothing, possibly even a shower, and adding hair and shoe coverings might be necessary.

Laboratory personnel should also consider the reverse. They should never wear or take any contaminated items home, If contamination of street clothing is expected, scrubs or a lab coat is mandatory. The scrubs or lab coat must then be left at the laboratory for cleaning.

--Madonna Ann Bachman. BS MT(ASCP), CLC(AMT)

Regulatory Compliance Department Director

DoctorsManagement

Knoxville, TN

A There are few studies that look at the contamination of uniforms of healthcare workers worn from home as they are beginning their work day, but according to the Association for Professionals in Infection Control, or APIC, in its report on the use of scrubs and related apparel in healthcare facilities: "To date, there have been no indications in the literature that scrub apparel worn home has been responsible for the transmission of infections of any kind." According to the Centers for Disease Control and Prevention and the World Health Organization, their guidelines regarding uniforms and the microbiology laboratory are as follows:

"Protective coats, gowns, smocks, or uniforms designated for laboratory use must be worn while working in the laboratory. This protective clothing should be removed and left in the laboratory before leaving for non-laboratory areas. All protective clothing is either disposed of in the laboratory or laundered by the institution; it should never be taken home by personnel/'

In a recent study examining the microbial contamination of medical students' white coats, the students perceived the coats as "clean" as long as the garments were not visibly contaminated with bodily substances, even after wearing the coats for several weeks. The heaviest bacterial load was found on the sleeves and the pockets of these garments; the organisms most frequently isolated were Staphylococcus aureus, diphtheroids, and Acine-tobacter spp. The sleeves of the coat may make contact with patients and, potentially, serve to transfer environmentally stable microorganisms.

Therefore, one may draw the conclusion that laboratory staff should not wear scrubs out in the community. An example of great infection prevention and control activities occurred in hospitals in Scotland; they simply do not wear their scrubs in public places. To prevent cross-contamination and cut down on hospital acquired infections, their dress code prohibits medical staff from wearing their uniforms outside of work, except where it is part of the workers' duties to work in the community or in emergencies. The dress code applies to all staff, regardless of whether or not they are required to wear uniforms.

--Irena L Kenneley, PhD, APRN-BC, CIC

Assistant Professor

Case Western Reserve University

Frances Payne Bolton School of Nursing and APIC National Scientific Research Council member

Madison, OH