The work of most clinical laboratories involves handling chemical and biological materials, and though large spills of these materials are not common, the risks associated with an accidental release can be substantial. Spills can create slip hazards and dangerous chemical exposure hazards, and even introduce contact with infectious biohazardous organisms. Thus, knowing how to expeditiously and properly manage spills is an important skill set for all laboratory employees.
Proper preparation for spill management and safe remediation requires a multi-faceted approach. Maintaining appropriate spill clean-up supplies and personal protective equipment (PPE) is vital, as is step-by-step training of laboratory staff on the multiple risks posed by spills in various departments and how to handle each type. Running drills on spill management should be integral to a lab’s overall safety and risk management preparedness. Fortunately, there are straightforward, checklist-based methods for achieving continued awareness of a sometimes overlooked, but essential area of safety.
Determine Spill Types and Associated Risk
Along with the accidental release of chemical and biohazardous materials, labs may experience other kinds of spills. Water lines and sewage drains can cause major flooding issues in the department, and depending on the lab’s design and location, these overflows can originate from below the floor or from the ceiling. Likewise, the use of an eye wash station or an emergency shower (with or without an associated floor drain) can create a deluge of water that can quickly spread. Some specialty laboratories may need to be prepared for radioactive materials spills and others might work with cytotoxic materials such as chemotherapeutic agents that can be mishandled or spilled.
As all laboratories are different, a good first step is to perform a spill risk assessment that covers all areas and practices of the lab, including an inventory of PPE and remediation supplies. Work with section managers and team members to evaluate materials used in the lab that could pose a spill risk and the hazards associated with each of those substances. Perform a walk-through of the lab with facility maintenance management to indicate areas that could pose risk to maintenance and/or waste disposal staff and to gain insight into how products used in spill remediation are ultimately disposed. Once these tasks have been completed, create a spill risk assessment chart that can be used to maintain readiness and to document any events (see FIGURE 1).
Some laboratories differentiate between large and small spills, and they may be classified by the type and amount of material spilled. Small spills may occur routinely during the course of a work day, and there may be no need or requirement to report them. A few drops of spilled blood can be quickly cleaned with a wipe and some bleach, for example. These tend to be anticipated spills that can be cleaned quickly with supplies already on hand at the bench. However, larger spills (particularly chemical spills) tend not to be anticipated, and usually require (at minimum) the need for alerting of and assistance from others to the situation. As with any scenario that could arise in the laboratory requiring a multi-person, coordinated response, a team should be designated and trained to handle larger spills and coordinate remediation and documentation.
Spill Response – The S.P.I.L.L.E.D. Method
Laboratory spill response teams should be trained to respond quickly to spills using appropriate cleaners and PPE. Laboratorians are experts in hazardous chemicals by trade and handling of biohazardous specimens is an everyday occurrence. Therefore, laboratory staff should lead the clean-up process and make any necessary procedural decisions, even when non-lab staff are on scene and offer assistance.
Most laboratory spills can be managed by following a standardized process known as the S.P.I.L.L.E.D. method. This acronym can be helpful in generating an orderly, standardized approach to potentially dangerous release events.
S - Secure the Site
Quickly identify and announce the immediate area where a spill has occurred to prevent someone from slipping in the area or tracking the spilled material to another area. If a fume- or gas-producing chemical is spilled, evacuating staff from the immediate area becomes a priority.
P - Protect Yourself
Be sure to don appropriate PPE before making any attempt at spill abatement. In most laboratory spill events, this would mean (at minimum) a lab coat, gloves, and face protection to prevent accidental splashes. More protection may be required when handling particularly hazardous materials such as strong corrosives or rapidly off-gassing chemicals (eg, hydrochloric acid, xylene, formaldehyde). Rubber boots and even respiratory protection should be considered.
I - Inspect the Spill
Identify the spilled material. If it is a hazardous chemical, obtain a Safety Data Sheet (to be kept near any regularly used hazardous chemicals) to see if section 6 provides special information about handling the accidental release or spill of that chemical. Consider other spill concerns, such as broken glass or possible ignition sources if a flammable material is involved.
L - Lay Down a Barrier
If the spill is large and spreading, lay down spill pillows or booms designed specifically to hold back the flow of liquids. Surround the spill area with these materials. The safest and most sensible method for containing the spread of a hazardous liquid is to start on the outside of the spill area and work toward the center.
L - Lay Down Absorbents
No matter the size of the spill, the next step is to place absorbent powders, granules, or clean-up pads to soak up the spilled material. If the absorbent is also a neutralizer (eg, formaldehyde neutralizer, acid/base neutralizer), make sure you allow it to set on the spill for the manufacturer recommended time necessary to enable neutralization.
E - Extract the Materials
Use implements to pick up all of the materials used for stopping and absorbing the spilled substance.
D - Dispose of the Waste
Properly dispose of all materials involved with the spill clean up. If there was glass involved, be sure to use a sharps container. Biohazard material should go into an appropriate regulated medical waste container, and chemical waste materials may need to be disposed of and labeled separately for pick-up by a chemical waste vendor.
A Focus on Hazardous Materials
Incorporating a non-departmental, hazardous materials response (HMR) team can be advantageous, especially if lab response staff is limited. In a hospital, the HMR team could include representatives from security, facilities/maintenance, and environmental services. Security team members can assist with securing the spill area, with facilities/maintenance staff focusing on changes to air exchange rates if harmful vapors are introduced by a chemical spill. Environmental services staff may not have direct responsibility to remove the substance, but the use of absorbent products can create residue on the floor (or the ceiling/walls in some cases), which may need swift attention from environmental services once the spilled material is removed.
Another benefit of a designated HMR team is the establishment of standardized procedures and decision making. Many factors affect an accidental release event approach, such as the size of the spill, the material spilled, the size of the room, the room ventilation, the number of staff in the immediate area, etc. Coordinating a prescribed response from multiple, trained staff members will serve to mitigate the impact of hazardous materials on personnel, hardware, and the laboratory environment.
Spill Supplies and Maintenance
There are a variety of commercially available supplies that can be used for cleaning laboratory spills. Small biological spills can usually be handled with a disinfectant spray and wipes. If broken glass is involved, then a small broom and dustpan should be used. The use of absorbent pads or powders are more useful for larger biological spills.
Remain prepared for a possible large water leak or spill in the laboratory by storing absorbent boom socks in the department. These flexible, foam-filled booms can absorb and contain considerable volumes of fluid and can help stop the flow of a deluge of fluid, such as would occur with the use of a safety shower.
Many varieties of chemical spill kits also are available, and multiple kit types may be required in the lab depending on the chemical inventory. Universal absorbent powders and pads can be used for many chemical spills if the released chemical is inert or has a neutral pH. If formaldehyde is used in the department, be sure to maintain a store of neutralizing powders or pads for those fluids. Formaldehyde produces a harmful vapor, and spills should not be cleaned up quickly; rather, a neutralizer should be used that halts the off-gassing process. Once the chemical is neutralized, it can be handled per the S.P.I.L.L.E.D. procedure outlined above. Spilled acidic and basic solutions also should be treated using a commercially available neutralizer.
Manufacturers offer special chemotherapy kits (for use with acutely hazardous medication spills) that require special training, but laboratory staff are rarely involved in the response to this type of spill. Typically, pharmacy personnel or employees in the oncology unit comprise the spill response team for chemotherapy-related incidents.
The College of American Pathologists (CAP) has specific requirements regarding the use of chemical spill kits in laboratories. Chemical absorbents, granules, or powders often do not have expiration dates assigned by the manufacturer. In these cases, CAP requires that labs label the absorbent container with the date the product was put into service, even if the container has not been opened (Laboratory General Checklist; Chemical Safety, GEN.88000). The CAP also states that kits with no expiration dates must be regularly assessed for usability. This required assessment simply includes a visual inspection of the product (at least annually) to make sure the container is not cracked or broken, to ensure the material inside has not been affected by moisture, and that the product appears to be ready for use. This annual inspection of the spill kit should be documented.
Spill remediation supplies should be located wherever a spill is likely to occur (eg, near eye wash or emergency shower stations). It is rarely a good idea to maintain one central spill kit, especially if the laboratory is large and the types of potential spills vary in different locations. Be sure to have enough of each type of spill clean-up material on hand based on the amount of material that could be accidentally released at one time. All spill kits should be identified by clear signage for easy location when needed.
Training and Drills
Being prepared for a spill event in the laboratory requires more than simply placing the correct supplies and appointing members of a response team. Likely, the most important actions of a successful lab spill response will depend on having run through multiple drill scenarios.
Given the wide assortment of cleaning products that can be purchased, attention needs to be given to developing specific or individual procedures that outline the proper use of each. Standardization of products within the lab and across system laboratories can simplify the development of such procedures. As part of new employee onboarding, be sure to inform on the location and proper use of each type of remediation product appropriate to the department. Be sure to include information such as required contact times for disinfection or neutralization, special PPE that may be required to use the product, and even when it may be unsafe to use the product (for example, bleach should not be used to clean a formaldehyde spill as the chemical combination can create chlorine gas).
Performing regular spill drills is effective in determining whether lab staff is truly prepared to handle the release of a hazardous material in the laboratory. Drills can be performed in a variety of ways, and they should involve all departmental staff, including evening and night shift staff, and staff not included in the response team. Perform drills at least quarterly in order to maintain staff readiness.
One example of a spill drill is to appoint a staff member to portray a spill-related victim. Have the employee walk into the area with a container of water (labeled with the identity of a commonly-used chemical). The container is dropped on the floor, and the victim pretends to have been splashed in the eyes with the substance. Observe how staff members respond. The response should include administering first aid to the victim, the identification of the spilled material, and the orderly and safe clean-up of the water using actual spill supplies.
Other drill methods can be employed that do not involve the actual use of supplies, but these may not be as effective. Shredded paper in a container representing a chemical can be spilled and staff can be instructed to pretend to use the real spill supplies. A “desk top” drill also can be used in which the response team leader describes a spill scenario and staff verbally walk through the response process. Unfortunately, the staff response to these less intense drills is typically less urgent, and they tend to learn and retain less about spill response actions.
The first time a spill drill is conducted, you may be surprised at how badly the response goes, even if training has occurred recently. As with other less common emergency response events (eg, fire, natural disaster, etc), the necessary behaviors do not become natural without hands-on practice. That is why a regular schedule of drills for all staff members is important.
One way to measure the effectiveness of the spill training and supplies is to document the drills each time they occur. Use a spill drill evaluation form (see FIGURE 2) to produce evidence that staff response is improving or that more training may be necessary. Drilling staff to handle an accidental release in the lab does not take very much time, but it is critical to the safety of lab staff and the safety of lab operations.
Daniel J. Scungio, MT(ASCP)SLS, CQA(ASQ), has over 30 years’ experience as a certified medical technologist and worked as a laboratory generalist in hospitals ranging from 75 to 800 beds before becoming a laboratory manager, a position in which he served for over 10 years. Dan is now the laboratory safety officer for Sentara Healthcare, a system of more than seven hospitals and over 20 laboratories and draw sites in the Tidewater area of Virginia. As “Dan the Lab Safety Man,” he also serves as a professional speaker, trainer, and lab safety consultant.
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