Module 6

MODULE 6 MODULE IN
PRINCIPLESOF
PRINCIPLES OFMEDICAL
MEDICALLABORATORY
LABORATORY SCIENCE
SCIENCE PRACTICE
PRACTICE11
MLS 112
Bachelor of Science in Medical Laboratory Science
SCHOOL OF NATURAL SCIENCES

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MLS 112
First Sem A.Y. 2020-2021
COURSE LEARNING OUTCOMES

At the end of the term, the would-be Medical
Laboratory Scientists are expected to:
1. Describe the Profession of Medical Laboratory

Science, the Profession’s historical foundation, the
Profession’s code of ethics in the national setting and
the Profession’s impact to the health care industry and
society.
2. Discuss the Medical Laboratory Science curriculum,
the Philippine Medical Technology Board Exam and
relevant international licensure examinations for
Medical Laboratory Scientists
3. Identify the national and international bodies
overseeing the Profession of Medical Laboratory
Science and characterize their functional
responsibilities
4. Describe the clinical laboratory both as a health care
workplace and as a training site of the Medical
Technology Internship program
5. Characterize the Clinical Chemistry section, its
historical development, and the services it offers.
6. Describe the Microbiology section and enumerate the
routine tests carried out inside the Microbiology
section
7. Enumerate the various classes of medically important
parasites and the role of the Parasitology section for
the detection of parasites in stool samples
8. Describe the performance of physical, chemical, and
microscopic examination during routine urinalysis
9. Describe the Hematology section and characterize
the parameters tested in the Complete Blood Count
10. Describe the Immunology-Serology section and
enumerate common tests performed in the Serology
section
11. Characterize the Blood Bank section and the routine
Principles in Medical 12.

service it offers.
Enumerate and define the steps of routine tissue
Laboratory Science
processing in the Histopathology section
13. Discuss biohazard and biosafety principles
14. Enumerate and describe other hazards found inside
Practice 1 15.
the clinical laboratory.
Describe prescribed policies and practices in
healthcare waste management in the Philippines
means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of SLU, is strictly prohibited. 2
COURSE INTRODUCTION
Dear future Registered Medical Technologists,
This course deals with the basic concepts and principles related to the Medical
Technology/ Medical Laboratory Science Profession with emphasis on the practice of

profession, clinical laboratories, curriculum, biosafety principles, and waste management.
This course acquaints the students to the practice of the major disciplines (Clinical
Chemistry, Microbiology, Clinical Microscopy, Hematology, Immunology and Serology,
Blood Banking, Histopathology etc.) in the Medical Technology/ Medical Laboratory
Science profession.
In addition, it provides an avenue for students to be introduced to the clinical and

anatomic laboratories. It also allows students to discuss the historical foundations of the
Profession, the code of ethics which guides the practice of the Profession, the Profession’s
role in the health care industry, and its impact to the society. Furthermore, the course
introduces the hazards that are inherent in the clinical laboratory profession and the safety
principles for management of the said hazards.
By the end of the course, the student should be able to describe the Profession of Medical
Laboratory Science, characterize the clinical laboratory, and practice proper biosafety
and waste management.
MODULE 6 – Hazards In The Clinical Laboratory
This module shall reinforce your knowledge and understanding on biohazards. It will also
introduce you to biosafety and biosecurity principles that are in place to protect the
workplace from biohazards.
This shall also emphasize guidelines from different organizations around the globe
promoting the safety of biomedical healthcare personnel as well as the environment. In
addition, this module shall cover the role of clinical laboratory professionals in dealing with
numerous hazards found in a clinical laboratory.
MODULE SELF MONITORING FORM

To help you keep track of your tasks for this module, you are provided in the below
with a self-monitoring form. Take the time to tick on the “Yes” box for each activity that you
finish and be reminded about pending activities that you are yet to do. Remember that
your success in achieving the module objectives depends entirely on how conscientious
you are of your own progress.
Schedule Activities Completed

Yes No
Week 1 Unit 1: Engage  
Unit 1: Explore  
Unit 1: Explain  
Unit 1: Elaborate  
Unit 1 Quiz:  
Evaluate
Week 2 Unit 2: Engage  
Unit 2: Explain  
Unit 2: Elaborate  
Unit 2 Quiz:  
Evaluate
Do Read Quiz Submit
MODULE CONTENTS
Module Introduction: Hazards In The Clinical Laboratory . . . . . . . . . . . . . . . . . . 04
Module Self-Monitoring Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 04
Module Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05
Module & Unit Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06
Unit 1: Principles of Biohazard and Biosafety . . . . . . . . . . . . . . . . . . . . . . 07
Engage: Laboratory Hazard Signs . . . . . . . . . . . . . . . . . . . . . . . . . . 07
Explore: Hazards in the Workplace . . . . . . . . . . . . . . . . . . . . . . . . . . 08
Explain: Biohazard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 09
Explain: Principles of Biosafety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Elaborate: Crossword Puzzle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Evaluate: Module 6- Unit 1 Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Unit 2: Other Hazards in the Clinical Laboratory . . . . . . . .. . . . . . . . . . . . . . . . 28
Engage: How Will I Protect Myself from Hazards? . . . . . . . . . . . . . . . . . . 28
Explain: Other Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Explain: Waste Management in Clinical Laboratory . . . . . . . . . . . . . . . . 34
Elaborate: Characterize the Chemical . . . . . . . . . . . . . . . . . . . . . . . . 35
Evaluate: Module 6- Unit 2 Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
References . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 36
MODULE OBJECTIVES:
After you are done reading and doing the tasks in this module, you are expected to
be able to:
1. Describe the principles of biohazard and biosecurity;
2. Identify hazards found inside the clinical laboratory;
3. Enumerate and describe the strategies utilized for management of laboratory
hazards; and
4. Enumerate the prescribed strategies, policies, and practices in management of
health care wastes.
This module is divided into two (2) lecture units including:

Lecture Unit 1 – Principles of Biohazard and Biosafety
Unit Objectives:
1. Define the difference between a hazard and a risk.
2. Describe the Occupational Safety Health Administration (OSHA) and other
bodies addressing occupational hazards.
3. Define biohazards and describe the Chain of Infection.
4. Define Biosafety and Biosecurity.
5. Describe the classification of microorganisms according to risk groups.
6. Discuss the Universal Precautions (UP), Body Substance Isolation (BSI), and
Standard Precautions (SP).
7. Discuss the essentials of Standard Precautions.
8. Discuss the Biosafety Levels.
Lecture Unit 2 – Other Hazards in the Clinical Laboratory

Unit Objectives
1. Describe the other hazards found in clinical laboratory.
2. Describe measures that can be used to manage clinical laboratory hazards.
3. Describe general guidelines for management of health care wastes.
UNIT 1: PRINCIPLES OF BIOHAZARD AND BIOSAFETY
ENGAGE LABORATORY HAZARD SIGNS
As prescribed by the DOH Administrative Order No. 2007-0027, also known as the
“Revised Rules and Regulations Governing the Licensure and Regulation of Clinical
Laboratories in the Philippines”, the establishment of biosafety and biosecurity manual in a
clinical laboratory creates a safe work environment.
Provision of hazard signs inside the workplace renders a safety warning to the staff. It
increases the awareness on the risks that are present in the workplace and in doing so,
decreases the likelihood of preventable accidents.
Below are examples of hazards signs you can observe inside a clinical laboratory.
Identify and label each hazard.
EXPLORE HAZARDS IN THE WORKPLACE
Hazards refer to anything in the environment that has the potential to cause harm while
risk is the possibility that something bad or unpleasant (such as an injury or loss) will
happen. For example, a syringe in the workplace is a hazard. However, if the syringe is
stored away in a working cabinet and is not currently being used, then it does not currently
pose any risks.
Unfortunately, workplaces are oftentimes characterized by presence of hazards. After

many devastating incidents that caused injuries and death to workers, the consensus was
that occupational safety was no longer just a moral obligation on the part of the employer
but should already be a matter of law enforcement. This led to the enactment of OSHA.
Occupational Safety and Health Act (OSHA) aims to provide all employees (clinical
laboratory personnel included) a safe work environment. It was enacted by the US
congress in 1970 and has widely been used as a basis by many countries internationally to
come up with their own regulations concerning safety in the workplace.
Occupational Safety and Health Administration (also OSHA) is the governing body
responsible for ensuring and monitoring the implementation of the standards set by the
above-mentioned act. It is authorized to conduct on-site inspections to determine whether
an employer is complying with the mandatory standards.
The clinical laboratory exposes its workers to a variety of hazards, some of which are not
seen in other workplaces. The said hazards that clinical laboratory workers are exposed to
are enumerated below.
LABORATORY HAZARDS
1. Biohazard
2. Chemical Hazard
3. Fire Hazard
4. Electrical Hazard
5. Physical Hazard
6. Sharps Hazard
7. Ergonomic Hazard
Unit 1 focuses on the biohazards while Unit 2 discusses all other hazards that are present in
EXPLAIN BIOHAZARDS
Biohazards include all pathogen or disease-causing microorganisms. These
microorganisms are frequently present in the specimens that are processed in the clinical
laboratory.
The chain of infection illustrates how pathogens are transmitted. Understanding the
chain of infection is essential for one to identify measures that will prevent infection.
A. CHAIN OF INFECTION: 6-PART MODEL
Figure 1. The Chain of Infection: 6-part model

Source: https://rcni.com/hosted-content/rcn/first-steps/chain-of-infection
Components of the 6-part model:
a. INFECTIOUS AGENT / PATHOGEN

o The disease-causing microorganism
b. RESERVOIR
o Animate/ inanimate object where the infectious agent is found normally
living
o Examples include human reservoir (infected patient), animal reservoir, and
inanimate reservoir
c. PORTAL OF EXIT
o Routes and means utilized by the microorganism to escape from the reservoir
d. MODE OF TRANSMISSION
o Method of conduction from the reservoir to the susceptible host
o Types:
1. Contact Transmission
i. Direct contact
 Involves actual contact/ close proximity of the infected
individual and the susceptible host
 Subtypes:
o Vertical Transmission:
 “Mother-to-baby” transmission
 Classification:
 Prenatal/ Transplacental Transmission:
Transfer of infectious agent happens
BEFORE birth usually by crossing the
placenta
 Perinatal Transmission: Transfer happens
during passage through the birth canal
o Horizontal Transmission: Transmission from a person to

another person within a group; No specificity when it
comes to the involved hosts
ii. Indirect contact

 Includes Transmission by Fomites
o Fomites: Non-living object that may transmit an infectious
disease (Examples include tissues, handkerchiefs, towels,
doorknobs, bedding, etc. )
iii. Droplet transmission

 Droplets:
o Respiratory particles of moisture containing an infectious
agent
o Typically expelled into the air by coughing, sneezing, and
even by talking
o Usually have a diameter of >5 micrometers and capable
only of traveling short distances (<1 meter)
2. Airborne Transmission
 Pathogen is spread through droplet nuclei (remnants after
evaporation of droplets)
 A droplet nuclei has a diameter less than 5 micrometers and are
typically capable of travelling distances greater than 1 meter
3. Common Vehicle Transmission
 Transfer of infectious agents by an inanimate medium (soil, water,
food)
 Types:
i. Waterborne transmission
 Pathogens are spread by contaminated water, usually with
untreated or poorly treated sewage
 Diseases transmitted via this route include cholera and
leptospirosis
ii. Soil-borne transmission
 The pathogens usually develop in soil and is subsequently
acquired by the susceptible host from the soil
 Diseases transmitted via this route include Hookworm infection
and Ascariasis
iii. Foodborne transmission
 Pathogens are transmitted in foods that are incompletely
cooked, poorly refrigerated, or prepared under unsanitary
conditions
 Diseases transmitted via this route include tapeworm infection
4. Vector-Borne Transmission
 Vector: Invertebrates capable of harbouring infectious agent
 Types:
i. Mechanical transmission
 Utilizes mechanical vectors
 The infectious agent WILL NOT develop while being transported
by the vector
ii. Biological transmission
 Utilizes biological vectors
 The infectious agent WILL develop while being transported by
the vector
e. PORTAL OF ENTRY
o Routes through which the pathogen enter the host
o Preferred portal of entry:
 If not followed, the entry of the infectious agent to the susceptible
human host will result to non-development of a disease or a milder
form of the disease caused by
 Examples of the concept of the preferred portal of entry:
 Development of cholera if an adequate amount of the
causative agent, Vibrio cholerae, enters the host via the
gastrointestinal tract
 Non-development of cholera if Vibrio cholerae enters the host
via the respiratory tract
f. SUSCEPTIBLE HUMAN HOST
B. CHAIN OF INFECTION: 3-PART MODEL
As the name implies, this model only has three components which makes it
significantly different from the 6-part model that was discussed earlier. The three
components that are incorporated in this model are: (a) source, (b) transmission,
and (c) host.
Furthermore, this model also incorporates the biohazard symbol in its
illustration. As presented below, the biohazard symbol has four circles and is
universally adapted to warn about the existence of biological hazards.
Moreover, the 3-part model also presents preventive measures that can be
implemented to break the chain in each of the component.
Figure 1.2. The Chain of Infection: 3-part model

Source: Strasinger, S. & Di Lorenzo, M. (2008). Urinalysis and Body Fluids (5th ed.). Philadelphia,PA: F.A. Davis
Company.
CLASSIFICATION OF BIOLOGICAL HAZARDS
A. Classification from Biosafety in Microbiological and Biomedical Laboratories, 5th Edition
The Biosafety in Microbiological and Biomedical Laboratories is jointly produced by the

Centers for Disease Control and Prevention (CDC) and the National Institutes of Health
(NIH). It is currently on its 5th Edition. The publication classifies the biological agents into 4
groups, based on biosafety levels. (A more detailed discussion on biosafety levels is
presented on “Explain: Principles of Biosafety”)
Classification Description Sample Organism

Biosafety Level 1 Not known to consistently cause Bacillus subtilis,
Agent diseases in healthy adults Mycobacterium gordonae
Biosafety Level 2 Relatively common agents that are Escherichia coli, Hepatitis B
Agent associated with human disease virus, Human
Routes of transmission include Immunodeficiency Virus,
percutaneous injury, ingestion, and Influenza virus
mucous membrane exposure
Biosafety Level 3 Indigenous or exotic agents that may Bacillus anthracis, Francisella,
Agent cause serious or potentially lethal Brucella, Mycobacterium
disease through inhalation route of tuberculosis, Mold stages of
exposure systemic fungi
Biosafety Level 4 Dangerous or exotic agents which post Ebola virus, Lassa virus, Viruses
Agent high individual risk of aerosol- that cause hemorrhagic
transmitted laboratory infections that fevers
are frequently fatal, for which there are
no vaccines or treatments
B. Risk Group Classification

The risk group classification is utilized by both the National Institutes of Health (NIH) and the
World Health Organization (WHO).
Risk Group NIH Guidelines WHO Laboratory Biosafety Manual

Classification
Risk Group 1 Agents not associated with No or low individual and community
disease in healthy adult humans risk
A microorganism unlikely to cause
human or animal disease.
Risk Group 2 Agents associated with human Moderate individual risk; low
disease that is rarely serious and community risk
for which preventive or A pathogen that can cause human
therapeutic interventions are or animal disease but is unlikely to be
often available. a serious hazard to laboratory
workers, the community, livestock or
the environment. Laboratory
exposures may cause serious
infection, but effective treatment
and preventive measures are
available and the risk of spread of
infection is limited.
Risk Group 3 Agents associated with serious or High individual risk; low community
lethal human disease for which risk
preventive or therapeutic A pathogen that usually causes
interventions may be available serious human or animal disease but
(high individual risk but low does not ordinarily spread from one
community risk). infected individual to another.
Effective treatment and preventive
measures are available
Risk Group 4 Agents likely to cause serious or High individual and community risk
lethal human disease for which A pathogen that usually causes
preventive or therapeutic serious human or animal disease and
interventions are not usually can be readily transmitted from one
available (high individual risk and individual to another, directly or
high community risk). indirectly. Effective treatment and
preventive measures are not usually
available
Source: Centers for Disease Control and Prevention. (2009). Biosafety in Microbiological & Biomedical Laboratories 5th Edition
EXPLAIN PRINCIPLES OF BIOSAFETY
Biosafety vs. Biosecurity
“Biosafety protects people from germs while biosecurity protects germs from people.”
Biosafety
o WHO: “Containment principles, technologies, and practices that are
implemented to prevent unintentional exposure to pathogens or toxins, or
their accidental release”
Biosecurity
o WHO: “The protection, control, and accountability for valuable biological
materials within the laboratories, in order to prevent their unauthorized
access, loss, theft , misuse, diversion, or intentional release
Guidelines & regulations set by the Centers for Disease Control and Prevention (CDC) to
prevent exposure to biohazards
A. Universal Precautions (UP)

o Mandates that personnel should treat all blood and blood-contaminated
samples as potentially infectious
o Universal Precautions did not treat other bodily fluids that are not visibly
contaminated with blood as potentially infectious
B. Body Substance Isolation (BSI)

o Considers all body fluids and moist body substances to be potentially
infectious
o Main flaw: Did not recommend hand washing following removal of gloves
unless visual contamination is present
C. Standard Precautions (SP)

o Combined major features of universal precautions and body substance
isolation
o Most commonly implemented by clinical laboratories
o Essentials include proper hand washing, utilization of personal protective
equipment (PPE), and preventing exposure to potentially infectious aerosols/
droplets
ESSENTIALS OF STANDARD PRECAUTIONS
1. PROPER HAND WASHING

o Single most effective way of controlling the spread of infectious diseases
Steps in Proper Hand Hygiene in Health Care Setting (based on WHO guidelines)
a. Wet hands with clean, running water and apply soap.
b. Rub hands together to make a lather
 According to WHO guidelines, rubbing of hands should last for AT
LEAST 20 SECONDS
 Proper duration of hand-rubbing is approximately equal to the
duration of singing 2 HAPPY BIRTHDAY SONGS
A. Rub hands palm to palm B. Right palm over left dorsum with C. Palm to palm with fingers
interlaced fingers and vice versa interlaced
D. Backs of fingers to opposing E. Rotational rubbing of left thumb F. Rotational rubbing,

palms with fingers interlaced clasped in right palm and vice versa backwards and forward with
clasped fingers of right
hand in left palm and vice
versa
Figure 1.3. Rubbing Steps in Proper Hand Washing Technique
c. Rinse hand with clean water

d. Dry hands with single-use towel and use towel to turn off the faucet
2. UTILIZATION OF PERSONAL PROTECTIVE EQUIPMENT (PPE)

o Protective clothing, helmets and other garments designed to protect the
wearer’s body from injury or infection
o Common PPE worn by laboratory personnel:
Laboratory gown Scrub suits Head cover
Goggles Respirators Rubber boots and overshoes
Medical Mask Face Shield
Figure 1.4. WHO GUIDELINES IN DONNING PERSONAL PROTECTIVE EQUIPMENT
Figure 1.5. WHO GUIDELINES IN DOFFING PERSONAL PROTECTIVE EQUIPMENT
Figure 1.6. WHO GUIDELINES IN DONNING PERSONAL PROTECTIVE EQUIPMENT
Figure 1.7. WHO GUIDELINES IN DOFFING PERSONAL PROTECTIVE EQUIPMENT
3. BIOSAFETY CABINETS (BSC)
- Device that encloses a workplace in such a way that protects the workers from
exposure to aerosols that may potentially contain infectious disease agents
- Air that may contain infectious agent is sterilized by passing through the HEPA filter
*HEPA filter
o High Efficiency Particulate Air Filter
o Characterized by pores having a diameter of 0.3 um
o Removes air-suspended materials having diameter greater than 0.3 um
o Capable of removing up to 99.97% of air-suspended materials
A. Biosafety Cabinet Class I

o Aka Open Front BSC
o Working mechanism:
 Allow room (unsterilized) air to pass into the cabinet and around the
working area and the materials within
 Does not protect the sample/ product from possible
contamination
 Before being exhausted from the cabinet: Air passes through HEPA
filter, sterilizing the air to be exhausted
 Protects the worker and the environment from potentially
infectious aerosols
BIOSAFETY CABINET CLASS I
Figure 1.8. Biosafety Cabinet Class I

Source: Public Health Agency of Canada (2004). Laboratory Biosafety Guidelines, 3 rd Edition
Mechanism of Biosafety Cabinet Class I (Further Explanation):
Negative atmospheric pressure causes unfiltered room to be drawn in through the
work opening and across the work surface. The inward flow protects the personnel from
potentially infectious aerosols.
However, since unfiltered air was allowed to circulate across the work surface where
the sample is processed. Therefore, the sample is NOT protected from possible
contamination.
From the work/ processing area, air is further drawn towards the common plenum of
the biosafety cabinet. The air then passes through an HEPA filter as it passes through the
exhaust plenum. Hence, the air that leaves the cabinet is sterilized. Therefore, it protects
the environment from potentially infectious aerosols.
BSC I provides worker and environment protection BUT DOES NOT provide product/
sample protection.
B. Biosafety Cabinet Class II

o Protects the worker from potentially infectious aerosols; Also capable of
protecting the sample from possible contamination
o Principle:
 Air passes through HEPA filter BEFORE flowing over the materials within
 Air that reaches the materials within the working area is already
sterile, Protects the specimen from contamination
 Air to be exhausted first passes through HEPA filter
 Protects the worker and the environment from potentially
infectious aerosols
BIOSAFETY CABINET CLASS II
Figure 1.9. Biosafety Cabinet Class IIA

Source: Public Health Agency of Canada (2004). Laboratory Biosafety Guidelines, 3 rd Edition
o Types of BSC II
 BSC Class IIA: 70% of air is recirculated to the working area; 30% of air is
exhausted
 BSC Class IIB1: 30% of air is recirculated to the working area; 70% of air
is exhausted
 BSC Cass IIB2: No recirculation of air; Total exhaust of air through an
exhaust HEPA filter
Mechanism of Biosafety Cabinet Class II (Further Explanation):
Negative pressure makes the room air to be drawn into the FRONT GRILLE of the
cabinet (NOTICE THE BLUE ARRROW IN THE ILLUSTRATION on page 21). This protects the
worker from potentially infectious aerosols.
After being drawn in the front grille of the biosafety cabinet, air is further drawn into
the common plenum of the cabinet. Air passes through the supply HEPA filter before it is
allowed to circulate through the working/ processing area. Hence, the air is sterilized
before entering the surface area, therefore, the product/ sample is protected from
possible contamination.
Air is then drawn back to the common plenum of the cabinet and the air EITHER
PASSES THROUGH THE SUPPLY FILTER TO BE RECIRCULATED TO THE WORKING AREA OR IT WILL
PASS THROUGH THE EXHAUST HEPA FILTER TO BE EXHAUSTED OUT OF THE CABINET. If the air
passed through the exhaust HEPA filter, it is therefore sterilized before being released to the
environment. This provides environmental protection.
BSC class II provides worker protection, product/ sample protection, and

environmental protection.
The different types of BSC class II varies in terms of the amount of air that is allowed
to be recirculated in the working area/ surface. BSC class IIA recirculates 70% of air to the
working area while exhausting 30% of air. BSC class IIB1 recirculates 30% of air to the
working area while exhausting 70% of air. BSC Class IIB2 does NOT recirculate air to the
working area. This means that for BSC Class IIB2, all air are exhausted through the exhaust
HEPA filter
C. Biosafety Cabinet Class III
o Completely enclosed and are equipped with glove ports; Infectious material
within is handled with rubber gloves that are attached and sealed
BIOSAFETY CABINET CLASS III
Figure 1.10. Biosafety Cabinet Class III

Source: Public Health Agency of Canada (2004). Laboratory Biosafety Guidelines, 3rd Edition
BIOSAFETY LEVELS (Based on CDC/NIH Biosafety in Microbiological and Biomedical

Laboratories, 5th Edition)
1. Biosafety Level I (BSL-1)

o Minimal Risk; Only Biosafety Level 1 agents are encountered
o Practices include the essentials of Standard Precautions
o Does not utilize Biological Safety Cabinets, only needs hand washing facilities
2. Biosafety Level II (BSL-2)

o Moderate Risk; Biosafety Level 2 agents are likely to be encountered by the
workers
o In addition to BSL 1 practices, BSL-2 also includes the following practices
 Vaccination against common infectious agents such as Hepatitis B
 Limiting access to the laboratory during working procedures
 Training laboratory personnel in handling pathogenic agents
 Direction by competent supervisors
 Performing aerosol-generating procedures in BSC Class I or BSC Class II
3. Biosafety Level III (BSL-3)
o High risk; Biosafety Level 3 agents are encountered by the workers
o In addition to BSL 2 practices, BSL-3 also includes the following practices:
 Controlled access
 Decontamination of all wastes
 Decontamination of laboratory clothing before laundering
 Performing aerosol-generating procedures in BSC Class I, Class II, or
Class III
4. Biosafety Level IV (BSL-4)

o Extreme risk; Biosafety Level 4 agents are encountered in the workplace
o In addition to BSL 3 practices, also includes:
 Clothing change before entering
 Shower on exit
 Special protective clothing
 Requiring performance of procedures inside BSC Class III
BSL Agents Practices Primary Barriers and Facilities
Safety Equipment
1 Not known to consistently Standard microbiological practices  No primary barriers required Laboratory bench and sink
cause diseases in healthy  PPE: Laboratory coats and gloves; required
adults eye, face protection, as needed
2  Agents associated with BSL-1 practices plus: Primary barriers: BSL-1 plus:
human disease  Limited access  BSCs or other physical  Autoclave
 Routes of transmission  Biohazard warning signs containment devices used for all
include percutaneous  “Sharps” precautions manipulations of agents that
injury, ingestion, mucous  Biosafety manual defining cause splashes or aerosols of
membrane exposure any needed waste infectious materials
decontamination or medical  PPE: Laboratory coats, gloves,
surveillance policies face and eye protection, as
needed
3 Indigenous or exotic agents that BSL-2 practice plus: Primary barriers: BSL-2 plus:
may cause serious or  Controlled access  BSCs or other physical  Physical separation from
potentially lethal disease  Decontamination of all waste containment devices used for all access corridors
through the inhalation route of  Decontamination of open manipulations of agents  Self-closing, double-door
exposure laboratory clothing before  PPE: Protective laboratory access
laundering clothing, gloves, face, eye and  Exhausted air not
respiratory protection, as needed recirculated
 Negative airflow into the
laboratory
 Entry through airlock or
anteroom
 Hand washing sink near
laboratory exit
4  Dangerous/ exotic agents BSL-3 practices plus: Primary barriers: BSL-3 plus:
which post high individual  Clothing change before  All procedure conducted in Class  Separate building or
risk of aerosol-transmitted entering III BSC isolated zone
laboratory infections that  Shower on exit  If Class III BSC is not available:  Dedicated supply and
are frequently fatal, for  All material decontaminated Class I or II BSCs in combination exhaust, vacuum, and
which there are no on exit from facility with full-body, air-supplied decontamination systems
vaccines or treatments positive pressure suit
 Agents with a close or
identical antigenic
relationship to an agent
requiring BSL-4 until data
are available to redesignate
the level
 Related agents with
unknown risk of
transmission
perty of and for the exclusive use of SLU. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting in any form or by any
ans, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of SLU, is strictly prohibited. 25
ELABORATE CROSSWORD PUZZLE
Class Code: ________ Class No: _______ Name (FN, GN): _________________
Instructions: The Crossword Puzzle below will test your understanding of concepts and
terms based on what you've studied in this module unit. Complete the crossword by filling
in a word that fits each clue
Across
3. Object where the infectious agent is normally found living

4. Mode of transmission where the infectious agent is passed from the mother to the
developing fetus or newborn
7. Biological substance that poses a threat to the health of living organisms
9. Aims to eliminate hazards in the workplace and provide a safe work environment
Down
1. Type of sieve used by biological safety cabinets

2. Mode of transmission where the infectious agent does not develop while being
transported by the vector
4. Invertebrates capable of harbouring infectious agent
5. Containment principles, technologies, and practices that are implemented to prevent
unintentional exposure to pathogens or toxins, or their accidental release
6. Disease-causing microorganism
8. Possibility that something bad or unpleasant will happen
EVALUATE MODULE 6- UNIT 1 QUIZ

For CBL students: Refer to the Final Term Summative Assessment Module and answer
Module 6- Unit 1 Quiz.
For OBL students: Wait for the instructions of the class instructor.
UNIT 2: OTHER HAZARDS IN THE CLINICAL LABORATORY
ENGAGE HOW WILL I PROTECT MYSELF FROM HAZARDS?
As a BSMLS student in Saint Louis University, you are required to complete a one-year
internship training program in a clinical laboratory. List five statements that describe how
you plan to conduct yourself so as to protect yourself from hazards that are present in a
clinical laboratory set-up.
Class Code: ________ Class No: _______ Name (FN, GN): ___________________
EXPLAIN OTHER HAZARDS
1. CHEMICAL HAZARDS
Basic Principles in Management of Chemical Hazards
A. Chemical Spills
- In cases of chemical contact with skin and eyes, flush with large amounts of water
for AT LEAST 15 MINUTES.
- Emergency showers and eye wash stations should be present.
- Safety showers: Should be able to dispense 30 to 50 gallons of water per minute at
a pressure of 20 to 50 psi
B. Chemical Handling
- Chemicals should be mixed following established instructions
- Add ACID TO WATER, not the other way around.
- Mixing chemicals should be done under the fume hood.
o Fume Hoods:
 Expel noxious and hazardous fumes from chemicals
 Face velocity should be 100 to 120 feet/ minute
- Mouth pipetting is never accepted in the laboratory
C. Chemical Storage
- Chemicals should be placed in easily manageable sizes
- General guidelines for chemicals that should be stored separately:
Substance Stored Separately
Flammable liquids Flammable solids
Mineral acids Organic acids
Caustics Oxidizers
Perchloric acid Water-reactive substances
Air-reactive substances Others
Heat-reactive substances requiring Others
refrigeration
Unstable substances (shock-sensitive Others
explosives)
D. Chemical Hygiene Plan

- Required by OSHA to be present at workplaces that handles hazardous chemicals
- A document that presents the following information:
 Appropriate work practices and standard operating procedures
 Utilization of PPE
 Engineering controls, such as fume hoods and flammables safety cabinets
 Employee training requirements
 Medical consultation guidelines
- Chemical Hygiene Officer: Responsible for documenting and implementing the
chemical hygiene plan
E. Material Safety Data Sheet

- Lists all of the hazardous chemical present in a workplace
- Includes the following:
 Physical and chemical characteristics
 Fire and explosion potential
 Reactivity potential
 Health hazards and emergency first aid procedures
 Methods for safe handling and disposal
F. Chemical Labelling
- Chemicals should be labelled with the description of their specific hazard:
 Poisonous
 Corrosive: Injurious to the skin or eyes by direct contact or to the tissue of the
respiratory and GIT if inhaled or ingested
 Carcinogenic: Cancer-causing chemicals
 Teratogenic: Substances that can cause functional and physical defects in the
human embryo or fetus after the pregnant mother is exposed to the substance
 Reactive : Substances that, under certain conditions, can spontaneously explode
or ignite
 Flammable
 Combustible
To differentiate flammable from combustible chemicals, one should be familiar with
the concept of flash point. Flash point is the temperature at which sufficient vapour is given
off from the chemical to form an ignitable mixture with air. Flammable chemicals have a
flash point below 37.80C (1000F). Combustible chemicals have a flash point equal to or
above 37.80C (1000F)
It is very important that the workplace has appropriate chemical labels that will alert
the laboratory personnel to specific hazards of a chemical. Hence, many clinical
laboratories have adopted the National Fire Protection Association (NFPA) Symbol. The
NFPA symbol is a diamond-shaped, color-coded symbol with four quadrants.
Each quadrant represents a hazard that the chemical exposes the workers to. At a
glance, emergency personnel can assess health hazards (blue quadrant), flammable
hazards (red quadrant), reactivity/stability hazards (yellow quadrant), and other special
information (white quadrant) of the chemical. In addition, each quadrant shows the
magnitude of severity, graded from a low of 0 to a high of 4, of the hazards within the
posted area.
Figure 2.1. THE NFPA SYMBOL

Source: Strasinger, S. & Di Lorenzo, M. (2008). Urinalysis and Body Fluids (5th ed.). Philadelphia,PA: F.A..
Davis Company.
A sample case for the interpretation of an NFPA label is presented in the “Elaborate”
section.
2. FIRE HAZARD
The chemistry of fire is presented by the Fire Tetrahedron.
The Fire Tetrahedron presents the four components that should be present for fire to exist.
 Oxygen
 Fuel
 Heat
 Uninhibited Reaction
An uninhibited reaction is a chain reaction where burning continues & accelerates.
Figure 2.2. Fire Tetrahedron

Source: Bishop, M., Fody, P., & Schoeff, L. (2010). Clinical Chemistry Techniques, Principles,
Correlations (6th ed.). Philadelphia, PA: Lippincott Williams & Wilkins, Wolters Kluwer Co.
- Classes of Fire:
Class Involved Combustible Material Type of Fire Extinguisher
of Fire
A Ordinary combustible, paper, wood Pressurized water (A)
plastic, fabric Dry Chemical (A,B,C)
B Flammable liquids/ gases, and Carbon Dioxide (B,C)

combustible petroleum products Dry Chemical (A,B,C)
C Energized electrical equipment Carbon Dioxide (B,C)

Dry Chemical (A,B,C)
Halon (Halogenated Extinguishers)
Halon is considered as the best
extinguisher for Class C fires
D Combustible/ reactive metals (Mg, Metal X

Na, K)
K Liquids used in food preparation such Wet Chemical

as grease, animal & vegetable oil
Upon discovery of fire, R.A.C.E should be applied.
Rescue- Rescue anyone in immediate danger
Alarm- Activate the institutional fire alarm system
Contain- Close all doors to potentially affected areas
Extinguish- Attempt to extinguish the fire, if possible. Exit the area.
For proper utilization of fire extinguishers, remember the P.A.S.S.

Pull pin
Aim at the BASE of the fire
Squeeze handles
Sweep nozzle side to side
3. ELECTRICAL HAZARD
The clinical laboratory has many electrical equipment. If handled improperly, these
equipment can cause accidental shocks.
Below are the general rules that should be observed to prevent electrical accidents in
 Report frayed cords and overloaded circuits.
 Designated personnel should monitor equipment closely.
 Wet equipment should be allowed to dry before reusing.
 Equipment should be unplugged before cleaning.
 Never operate electrical equipment with wet hands.
 Know the exact location of the electrical control panel for the electricity to your
work area.
 All electrical equipment should be grounded with a three-pronged plug.
 In cases of accidents involving electrical shock:
- Electrical source must be removed immediately.
- Do not touch the individual or the equipment involved.
4. PHYSICAL HAZARD
Laboratory personnel should be aware of the physical hazards that are present in the
laboratory. The presence of heavy electrical equipment, the utilization of compressed
gases, and improperly placed machines are all possible causes of physical injuries.
Below are general precautions that should be observed to prevent physical injuries in
 Avoid running in rooms and hallways
 Bend the knees when lifting heavy objects
 Keep long hair pulled back; Use close-toed shoes
 Avoid dangling jewelry
 Maintain a clean, orderly work area
5. RADIOACTIVE HAZARD
Nonionizing radiation are emitted by many equipment in the laboratory.
Source: Bishop, M., Fody, P., & Schoeff, L. (2010). Clinical Chemistry Techniques, Principles, Correlations (6th ed.). Philadelphia,
PA: Lippincott Williams & Wilkins, Wolters Kluwer Co.
6. SHARPS HAZARD
- Examples include needles, lancets, broken glass wares
- Present a biological hazard, transmission of blood-borne pathogens
- Should be disposed in a puncture-proof container
7. ERGONOMIC HAZARDS
- Strain disorders caused by repetitive and tedious manual tasks
 Example: If a microscope is positioned too low for the microscopist, the user will
need to hunch, placing a lot of stress and strain on his/ her upper back and neck
every time he/she uses the said microscope. Because of the repetitive nature of
the task ( a medical technologist in the microbiology section will need to use the
said equipment multiple times in a day), he/she will eventually develop strain
disorders of the upper back if the practice is not corrected.
- Primary contributing factors:
 Position/ Posture
 Applied force
 Frequency of repetition
 Positioning of equipment
EXPLAIN WASTE MANAGEMENT IN CLINICAL LABORATORY
A. Color-coded Garbage Bags

There are many types of wastes that are generated by the clinical laboratory. For proper
segregation of wastes, the clinical laboratory utilizes color-coded garbage bags.
a. Black: General wastes; Dry, non-infectious
b. Green: Wet, non-infectious wastes
c. Yellow: Wet, infectious wastes
d. Puncture-proof containers (usually red): Sharps
e. Orange: Radioactive wastes
f. Yellow with black band: Chemical wastes
B. Biological Waste Disposal

- All, EXCEPT URINE, must be placed in appropriate containers with the biohazard
symbol
- The waste is then decontaminated following institutional policy
 Soaking the sample in 5% Lysol or 10% sodium hypochlorite solution for at least
15 minutes
 Autoclaving
 Pickup by a certified hazardous waste company
- Urine may be discarded by pouring it in a laboratory sink
 Disinfection of the sink using a 1:5 or 1:10 DILUTION OF SODIUM HYPOCHLORITE
should be PERFORMED DAILY
 Sodium hypochlorite dilutions stored in plastic bottles are effective for one month
if protected from light after preparation
- Empty urine containers can be discarded as non-biologically hazardous materials
ELABORATE CHARACTERIZE THE CHEMICAL
A chemical has the NFPA label presented below.
Based on what was discussed regarding the NFPA symbol, characterize the said chemical.
Correct answer:
Based on the NFPA label of the chemical, this means that the chemical:
 has a flash point below 730F.
 produces violent chemical changes.
 poses extreme danger to health.
 cannot be handled with water.
EVALUATE MODULE 6- UNIT 2 QUIZ

For CBL students: Refer to the Final Term Summative Assessment Module and answer
Module 6- Unit 2 Quiz.
For OBL students: Wait for the instructions of the class instructor.
REFERENCES
Centers for Disease Control and Prevention. (2009). Biosafety in Microbiological and
Biomedical Laboratories 5th Edition
Public Health Agency of Canada (2004). Laboratory Biosafety Guidelines, 3rd Edition
Bishop, M., Fody, P., & Schoeff, L. (2010). Clinical Chemistry Techniques, Principles,
Correlations (6th ed.). Philadelphia, PA: Lippincott Williams & Wilkins, Wolters Kluwer
Co.
Strasinger, S. & Di Lorenzo, M. (2008). Urinalysis and Body Fluids (5th ed.). Philadelphia,PA:
F.A. Davis Company.
Pommerville, J. (2011). Alcamo’s Fundamentals of Microbiology (9th ed.). London: Jones &
Bartlett Publishers.
Tortora, G. Funke, B. & Case, C. (2010). Microbiology: An Introduction (10th ed.).St Louis:
Mosby, Inc.
World Health Organization. (2004). Laboratory Biosafety Manual (3rd ed.). Geneva,
Switzerland, WHO.

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MODULE 6 MODULE IN

Bachelor of Science in Medical Laboratory Science

SCHOOL OF NATURAL SCIENCES

COURSE LEARNING OUTCOMES

1. Describe the Profession of Medical Laboratory

Principles in Medical 12.

Technology/ Medical Laboratory Science Profession with emphasis on the practice of

In addition, it provides an avenue for students to be introduced to the clinical and

MODULE SELF MONITORING FORM

Schedule Activities Completed

Do Read Quiz Submit

Module Introduction: Hazards In The Clinical Laboratory . . . . . . . . . . . . . . . . . . 04

Module Self-Monitoring Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 04

Module & Unit Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06

Unit 1: Principles of Biohazard and Biosafety . . . . . . . . . . . . . . . . . . . . . . 07

Engage: Laboratory Hazard Signs . . . . . . . . . . . . . . . . . . . . . . . . . . 07

Explore: Hazards in the Workplace . . . . . . . . . . . . . . . . . . . . . . . . . . 08

Explain: Principles of Biosafety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Elaborate: Crossword Puzzle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Evaluate: Module 6- Unit 1 Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Unit 2: Other Hazards in the Clinical Laboratory . . . . . . . .. . . . . . . . . . . . . . . . 28

Engage: How Will I Protect Myself from Hazards? . . . . . . . . . . . . . . . . . . 28

Explain: Other Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Explain: Waste Management in Clinical Laboratory . . . . . . . . . . . . . . . . 34

Elaborate: Characterize the Chemical . . . . . . . . . . . . . . . . . . . . . . . . 35

Evaluate: Module 6- Unit 2 Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

This module is divided into two (2) lecture units including:

Lecture Unit 2 – Other Hazards in the Clinical Laboratory

ENGAGE LABORATORY HAZARD SIGNS

Unfortunately, workplaces are oftentimes characterized by presence of hazards. After

A. CHAIN OF INFECTION: 6-PART MODEL

Figure 1. The Chain of Infection: 6-part model

Components of the 6-part model:

a. INFECTIOUS AGENT / PATHOGEN

o Horizontal Transmission: Transmission from a person to

ii. Indirect contact

iii. Droplet transmission

f. SUSCEPTIBLE HUMAN HOST

Figure 1.2. The Chain of Infection: 3-part model

CLASSIFICATION OF BIOLOGICAL HAZARDS

A. Classification from Biosafety in Microbiological and Biomedical Laboratories, 5th Edition

The Biosafety in Microbiological and Biomedical Laboratories is jointly produced by the

Classification Description Sample Organism

B. Risk Group Classification

Risk Group NIH Guidelines WHO Laboratory Biosafety Manual

Biosafety vs. Biosecurity

A. Universal Precautions (UP)

B. Body Substance Isolation (BSI)

C. Standard Precautions (SP)

1. PROPER HAND WASHING

D. Backs of fingers to opposing E. Rotational rubbing of left thumb F. Rotational rubbing,

c. Rinse hand with clean water

2. UTILIZATION OF PERSONAL PROTECTIVE EQUIPMENT (PPE)

A. Biosafety Cabinet Class I

BIOSAFETY CABINET CLASS I

Figure 1.8. Biosafety Cabinet Class I

B. Biosafety Cabinet Class II

BIOSAFETY CABINET CLASS II

Figure 1.9. Biosafety Cabinet Class IIA