I mentioned in an earlier hub that I used to work as a diener in a Laboratory. In response to that hub, a fellow hubber, Mentalist acer, requested that I write a hub about safety precautions in a morgue and clinical lab. This hub is in answer to that. It came at the same time as our Health hubs as a weekly hub topic, so here goes.
Clinical Laboratories where bodily fluids are tested can be hazardous to the technicians who carry out the procedures.
Many people have entered laboratories to give urine, blood, stool or other bodily fluid specimens. Not so many people have actually been in the room where they do autopsies on those who died from many different causes – the morgue.
Most laboratories have a room designated as the morgue. If family members want to know why their loved one died, an autopsy can be person. This is usually done by a Pathologist. If there is a questionable death, or suspicion of foul play, a medical examiner may be called in to do the autopsy.
Morgues can be like a dirty toilet bowel. Filthy conditions can result from the transient traffic of decomposing bodies, together with potentially dangerous chemicals, lack of adequate ventilation and crowded quarters. I imagine in days gone by, morgues lived up to their horror story scenarios. They looked like something between a medieval torture chamber and a meat locker.
Back when I was a diener it was not that bad, but it was quite crowded and only one body could fit in there at a time, except for perhaps a small baby or two kept in the refrigerator (sorry, I do not mean to offend – that is how it was). I think there were not too many safeguards in place in the 70s, but now there are many regulations for those who work in a laboratory or morgue.
You may have watched Dr. G. Medical Examiner on television (one of my favorites), and seen her performing autopsies. I have noticed that she does not wear much protective clothing or cover on her face or hair. Maybe it is all staged, which would explain it. They don’t want to cover her pretty face and hair, but come on – get real.
Morgue Basic Requirements
Hot/cold running water
• 5000-8000 sq ft
In recent years, walk-in refrigerators with double storage space for bodies are being put in the morgues, so twice as many autopsies can be completed at one time. With the potential for disasters, and other situations where increased body storage is needed, morgues will be more able to handle them.
One of the most marked changes lately in some morgues is an observation room, that allows police or students to view an autopsy. Prior to that, the person performing the autopsy was often disrupted by observers asking questions, or by students fainting from the odors.
Improved air systems have been designed to control the spread of infectious diseases and odors in morgues and clinical laboratories.
Most laboratories appoint an employee to be the laboratory safety officer. A safety committee and incident review committee are formed which analyze accidents and maintain procedures. They have mandatory ongoing safety training for laboratory staff. They also post signs in prominent places so all are aware of the potential dangers.
OSHA Occupational Safety and Health Administration of the United States is the governmental body that regulates laboratory safety. Other areas of the government that cooperate with OSHA including EPA, RRCA, NRC, DOT, US Postal Service, CDC, NIOSH, NIH and DHS. Amazing how many are involved, and I am sure there are even more.
A laboratory can at any time be exposed to carcinogens, teratogens, mutagens, sensitizers, irritants, hepatotoxins, nephrotoxins and neurotoxins (lots of poisons).
As an example of what can happen in a laboratory, a 22-year-old science student working in the clinical laboratory acquired Salmonella typhi which caused an intestinal abscess. Not only did he need antibiotic therapy, but he required two surgeries for drainage and the creation of an ileostomy.
At another facility, students were hired to clean out a closed lab. The students were given minimal instructions. They were to move equipment and dispose of chemical and biological wastes. One of the students left chemicals out on the bench top at room temperature (a no no) while they went to lunch. Shortly after, the chemicals exploded and a terrible odor forced the evacuation of the entire building. The students had not been using any protective gear.
Before 1976, sodium azide was used as a preservative in the laboratories. It was disposed of down ordinary plumbing. Lead and copper pipes cause the formation of metal azides which are actually more explosive than nitroglycerin. Serious explosions resulted and injured several people until it was banned from the laboratory.
So, if you are thinking about pursuing a career as a medical technologist, pathologist, hematologist and a host of other jobs, you will be glad to know that laboratories are much safer now that just a few years ago.
One example of the guidelines for autopsy personnel is the PPE (Personal protective equipment).
Those who transfer the remains from a mortuary stretcher to the autopsy table should wear gowns and gloves. Personnel who perform or assist with the autopsy should wear a surgical scrub suit, surgical cap, full sleeve impervious gown, eye and face protection (face shield), shoe covers and surgical gloves (double) with an interposed layer of synthetic mesh cut-proof gloves.
For those who use oscillating saws (to open the skull), it is recommended that they wear an air-purifying respirator.
All protective clothes must be removed when leaving the autopsy area. Hands should be washed well after removing gloves.
All surfaces where an autopsy was performed must be disinfected with high level disinfectant. All equipment should also be cleaned and disinfected.