Encouraging Prompt Injury and Illness Reporting in a Biomedical Laboratory

by Elizabeth Gilman Duane, MS, RBP, CBSP

bfoster_e_a002832723Environmental Health & Safety (EHS) and Occupational Health (OH) professionals strive to educate laboratory workers on the importance of prompt injury and illness reporting in a biomedical laboratory setting. When a laboratory worker sustains an injury such as a needlestick or has an exposure to a chemical or biohazardous material, it’s crucial that the worker immediately report the incident to the institution’s OH and EHS staff.

Prompt assessment, treatment and follow-up are of the utmost importance for worker health and are necessary for compliance with regulatory requirements. Additionally it allows EHS and OH staff to immediately begin follow-up activities in response to the injury or illness and conduct the incident investigation to determine the root cause.

At the June 2012 Occupational Health Colloquium presented by the Eagleson Institute and the Elizabeth R. Griffin Research Foundation titled “Preventing and Treating Biological Exposures”, there was consensus among OH and EHS professionals that upwards of 70% of the injuries and illnesses in academic laboratories are not reported.  There was agreement that in order to reduce this percentage, OH and EHS professionals must increase efforts to reinforce with laboratory workers the requirement for prompt reporting.

To be effective, an injury and illness reporting program must have a variety of elements that are clearly communicated to workers and reinforced through regular retraining efforts.  As part of a continuous improvement program, the injury and illness reporting program must be periodically reviewed and updated as necessary.  Take time to review your injury and illness reporting procedures and past workplace injuries and illnesses in order to continually improve your institution’s program.

Regulatory Review

The Occupational Safety and Health Administration (OSHA) requires that employers record workplace injuries and illnesses for employees including establishing a method for employees to report work-related injuries and illnesses promptly; and informing each employee how to report work-related injuries and illnesses.  In addition, OSHA Standards such as the Bloodborne Pathogen Standard (29 CFR 1910.1030) requires post-exposure evaluation and follow-up to be provided to workers that sustain an exposure to a bloodborne pathogen. For laboratories working with recombinant DNA, the National Institutes of Health (NIH) Guidelines for Research Involving Recombinant or Synthetic Nucleic Acid Molecules require that any significant research-related accidents and illnesses be reported to the NIH Office of Biotechnology Activities.  Certain cities may also have specific injury and illness reporting requirements.  For example, the Cities of Boston and Cambridge have public health and biosafety regulations that require prompt reporting of exposures to infectious agents in the workplace.  Finally, workers’ compensation requirements vary from state to state, but all have requirements for prompt reporting should an employee become injured or ill due to a workplace accident or exposure.

Prompt reporting also allows the OH program staff along with the institution’s EHS department to review the case, determine if other laboratory workers have potentially been exposed, and report the information to the appropriate public health officials.

In addition, it is important to realize that exposures to pathogens may not necessarily originate from an overt accident such as an animal bite or a needlestick that result in prompt reporting.  Even “near-misses” should be reported so that they may be reviewed proactively to prevent a future injury or illness from occurring.

Key Program Elements to Promote Prompt Reporting

One reason for not reporting, or delaying the reporting of an injury or illness, is fear of negative consequences. Injury and illness reporting programs must be non-punitive.  Workers must not deem that reporting a workplace injury or illness will result in embarrassment, retaliation, negative impact on their performance review or lead to loss of employment. Leadership must demonstrate their commitment to a non-punitive system.  Another common reason for delayed reporting is the mindset that it will distract from valuable time spent on research. The institution must place high importance on prompt reporting. Senior leadership along with the EHS department and the OH program staff, must work cooperatively together to communicate this message to workers.

Biosafety training programs must address the signs and symptoms associated with illnesses typically caused by the agents handled in the workplace.  Workers must be instructed to monitor their own health and report illnesses that require absences immediately to their supervisor.  It is important to stress that in some cases the initial signs and symptoms of a laboratory-acquired infection may be similar to those of illnesses such as colds, influenza, or gastroenteritis.  Procedures must also be in place for supervisors to report worker absences to OH program staff.  Employees must understand that this is not “overreacting” and will not be perceived that way by management. It is far better to rule out a laboratory-acquired infection than to find out after a period of time has elapsed that an exposure occurred that led to infection.

Emergency contact numbers for OH program staff and procedures should be readily displayed in the workplace and a mechanism for 24/7 reporting is essential.  The availability of online reporting mechanisms often facilitates the prompt reporting of injuries and illnesses.  In some workplace settings, job aids such as wallet cards are appropriate.  For example, for workers who have job tasks that involve handling Non-Human Primates or their tissues, a wallet card is a good way to facilitate prompt recognition of symptoms that may be a result of a workplace exposure to Herpes B virus should an infected worker present to a medical facility not associated with the worker’s place of employment.

In some cases, special situations require additional coordination on the part of EHS and OH program staff.  For example, at an academic institution with non-employees such as students as well as employees working in laboratories, it is essential to put in place and communicate procedures for each category of worker. Students often are required to report to their academic health center, while employees may have requirements to report to a local hospital or to an onsite OH clinic. These processes should be established and clearly communicated.

EHS and OH professionals need to continuously promote injury and illness reporting procedures with laboratory workers in order to drive down the number of unreported cases.  In order to do so, program elements must be reviewed to ensure that there are no barriers to reporting and that procedures facilitate prompt reporting to EHS and OH professionals.  Take the time to review your program and determine what works well and what can be improved.

Betsy is Biosafety / Laboratory Safety Service Leader at EH&E.  She has over 25 years experience in the laboratory safety and biosafety fields. For more information, contact Betsy at bgduane@eheinc.com.