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American Journal of Nursing Research, 2019, Vol. 7, No. 2, 116-127
Available online at http://pubs.sciepub.com/ajnr/7/2/3
Published by Science and Education Publishing
DOI:10.12691/ajnr-7-2-3
Safety Training Program for Clinical Laboratory
Workers Regarding Prevention of Occupational Hazards
Amina Abd Elrazek Mahmoud*, Samah Said Sabry
Community Health Nursing, Faculty of Nursing, Benha University, Qalyobyia Governorate, Egypt
*Corresponding author: samahsaid662@yahoo.com
Received November 24, 2018; Revised December 29, 2018; Accepted January 15, 2019
Abstract The practices of safety measures by the clinical laboratory workers in hospitals are necessary for the
prevention of occupational hazards. The aim of this study was to evaluate the effect of safety training program for
laboratory workers' regarding prevention of occupational hazards. Design: A quasi-experimental design was used in
carrying out this study. Setting: The study was conducted at four governmental hospitals in Benha City: - are Benha
University Hospital, Benha Teaching Hospital, Health Insurance Hospital, and Fever Hospital which included
clinical laboratory. The sample of this study included convenient laboratory workers (100) whom are working
at four hospitals were participated in this study. Tools: 1- A structured interviewing questionnaire for the
socio-demographic characteristics of the laboratory workers, and their knowledge regarding occupational hazards,
2- An observational checklist for safe laboratory environment and practices of laboratory workers regarding
prevention of the occupational hazards. Results: Showed a significant positive effect of the program on knowledge
and practices of the laboratory workers (P < 0.001). This study concluded that the program has positive effect to
upgrade the laboratory workers' knowledge and improving their practices regarding prevention of occupational
hazards (P < 0.001). The study recommended that regulatory training program should be strengthened to ensure
basic lab safety practices in hospitals, and providing training courses for large number of hospitals laboratory
workers about prevention of occupational hazards and safety environmental condition.
Keywords: laboratory workers, occupational hazards, and laboratory safety
Cite This Article: Amina Abd Elrazek Mahmoud, and Samah Said Sabry, “Safety Training Program for
Clinical Laboratory Workers Regarding Prevention of Occupational Hazards.” Journal Name, vol. 7, no. 2 (2019):
116-127. doi: 10.12691/ajnr-7-2-3.
1. Introduction
Occupational hazard is a hazard experienced in
the workplace. It can encompass many types including
chemical, biological, psychosocial, and physical hazards
[1]. Many workers are unaware of the potential hazards in
their work environment, which makes them more vulnerable
to Laboratory hazards [2].
Laboratory environment contain hazardous substances.
A hazardous substance is defined as a material/substance
that poses a physical or health hazard. This includes
both chemicals and biological agents. A physical hazard
characteristics: Explosive, flammable, oxidizer, pyrophoric,
organic peroxide, compressed gas, combustible liquid,
unstable (Reactive) and water-reactive. A health hazard
characteristic: carcinogen toxic or highly toxic, reproductive
toxins, irritants, corrosives, sensitizers, hepatotoxins,
nephrotoxins and neurotoxins [3].
Laboratory workers responsible practices and techniques
are required when working with hazardous materials.
So, primary barriers are referring to protective measures
including engineering controls. This includes not only
personal protective equipment but it also includes safety
cabinets, fume hoods, vaccines and autoclaves, while
secondary barriers are the facility design and construction.
These barriers are to provide protection for the individuals
outside the lab, the community, and the environment. In
2008 on of the staff was led to his death by sustained
injuries due to a fire within the laboratory of the
University of California in Los Angeles (UCLA), despite
the strict safety precautions [4,5].
Laboratories mainly have pathological (including some
anatomical), highly infectious waste (small pieces of
tissue, microbiological cultures, stocks of infectious
agents, infected animal carcasses, blood and other body
fluids), sharps, some radioactive and chemical waste.
Special precautions must be taken to reduce the potential
release of these agents. Each laboratory that is using an
infectious agent must perform an additional lab specific
training [6].
Laboratory safety guidelines have been established
to minimize the hazards in a laboratory setting. It is
important for the lab workers to take responsible actions
and keep in mind that irresponsible acts could have lasting
future effects. Training is also important for them to
identify if the hazards increase, the risks increase, and the
responsibility must increase. Personal habits play a large
role in minimizing occupational hazards as not eating,
117 American Journal of Nursing Research
drinking, smoking, chewing gum, applying cosmetics,
removing contact lenses while being in the laboratory, not
storing food or beverages in the lab or in chemical
refrigerator, not mouth pipetting and washing hands
before leaving laboratory or after handling contaminated
material. Also, no open-toed shoes, no shorts unless a lab
coat is used, restrain hair when working with hazardous
materials, remove protective clothing in public and use the
proper personal protective equipment for the job [7].
Hazardous laboratory chemicals include cancer-causing
agents (carcinogens), toxins that may affect the liver, kidney,
or nervous system, irritants, corrosives, and sensitizers, as
well as agents that act on the blood system or damage the
lungs, skin, eyes, or mucous membranes. OSHA rules limit
all industry exposures to approximately 400 substances
[10]. The sharp injuries resulted in 16,000 Hepatitis C
Virus (HCV), 66,000 Hepatitis B Virus (HBV) and
1000 Human Immunodeficiency Virus (HIV) infections in
health-care workers included the laboratory workers
worldwide. Most of the public and several private-sector
healthcare facilities are over-utilized, resulting in an explosive
increase in the number of diagnostic laboratories in the
City [11].
Community health nurse play an important role by
educating and increase awareness among the laboratory
workers about mechanical hazards may result from
improper use, storage, or disposal of glassware as handle
glassware carefully to avoid breakage that could cause
injury or infection. Do not expose hot glassware to cold
water (Allow hot glassware to cool before washing or
placing in a sink.). Dispose of contaminated glass and
sharp objects (microcapillary pipettes, Pasteur pipettes,
and needles) in puncture-resistant containers, store sharp
objects carefully to avoid skin punctures or cuts, wear
safety goggles when using glassware on a burner and
equipment/instruments as cover the back of long hair. And
not operate new or unfamiliar equipment or instruments
without proper training and authorization [12].
Community health nurse plays an important role by
educating and increase awareness among the laboratories
worker to specific precautions about all kinds of sharps
and must be meticulously observed when handling body
fluids of unknown origin because of the possible
transmission of the AIDS and hepatitis Bb viruses in these
specimens. Disposable gloves must be worn during the
manipulation of these test materials. Masks, safety
goggles, and laboratory coats are required; especially if
aerosols and/or splattering of these fluids is likely to occur.
Test specimens and supplies in contact with these fluids
must be placed in a container of disinfectant prior to
autoclaving [8,13].
1.1. Significance of the Study
In Egypt, the calculated weighted mean prevalence for
HBV and HCV among the general populations included
health team was 6.7% and 13.9% respectively. In Egypt,
assessment of lab safety is not a regular activity in most of
the organizations, whereas it could be occurred in limited
levels in the laboratories such as at EL-Mansoura
University. As far as it is known, chemical lab safety is
not assessed in Benha University. Laboratory safety is a
careful process, with the target of preventing injuries and
diseases among laboratory personnel. This includes scientists,
technicians, nurses and cleaning workers. Occupational
Safety Health Administration (OSHA). In recent years,
there have been serious accidents in laboratories, which
included fatalities that could have been prevented by using
safer laboratories procedures. This may be due to ignoring
the use of personal protective equipment, and disregarding
standard operating procedures by the lab workers [14].
Laboratory workers are at risk of infection with blood-borne
pathogens (BBP) through occupational exposure to blood
and infectious body fluids. Percutaneous exposure to
blood, blood products, and infectious body fluids presents
the greatest risk for transmission in the laboratory and
health care setting [15].
1.2. Aim of the Study
The study aimed to evaluate the effect of the safety
training program for clinical laboratory workers regarding
prevention of occupational hazards.
1.3. Research Hypotheses
The safety training program will improve knowledge
and practices of clinical laboratory workers regarding
prevention of occupational hazards
2. Subjects and Methods
2.1. Research Design
A quasi experimental design was utilized to carry out
this study.
2.2. Study Setting
The present study was conducted at four governmental
hospitals which included clinical laboratory, in Benha
City. These four hospitals are Benha University Hospital,
Benha Teaching Hospital, Health Insurance Hospital, and
Fever Hospital.
2.3. Study Subjects
A convenient sample was used in this study, the total
number of studied clinical laboratory workers in the above
mentioned setting were 100, whom divided according the
place of work as: Benha University Hospital (40), Benha
Teaching Hospital (28), Health Insurance Hospital (20),
and Fever Hospital (12).
2.4. Tools of data Collection
Two tools were used for data collection, interviewing
questionnaire and observational checklist.
Tool I: A structured interviewing questionnaire: It consisted
of the following two parts:
Part one: Socio-demographic characteristics of the
laboratory workers. It included 10 items about age, gender,
education, residence, nature of job, years of experience,
income, received training courses about Lab safety,
number and place of training courses.
American Journal of Nursing Research 118
Part two: Designed to assess the laboratory workers'
knowledge which included 16 items divided as: a) knowledge
about occupational health hazards (7 items), and b) knowledge
about laboratory safety (9 items). Scoring system; for each
question was given as follows: 2 if complete answer, 1 if
incomplete answer and 0 if don’t know. The total
knowledge scores were considered good if the score of the
total knowledge ≥ 75%, considered average if it is equals
50- < 75%, and considered poor if it is less than 50%.
Tool II: An observational checklist. It consisted of the
following two parts:
Part one: It was concerned with observation the hospital
safety environmental condition which included 12 items
about cleanliness laboratory area, walls and ground, basin
and its surrounding area, laboratory equipment, tables,
keep equipment in clean and safe place, tab water supply,
ventilation, label code and precaution on chemical
substances, safe personal protective equipment, soft wired
nets on the windows, and lightening in the kitchen. This
part used only before implementing the program. Scoring
system: Each item was assigned a score of: 1 if present,
and Zero if not present.
Part two: It was concerned with the laboratory workers'
practices regarding prevention of the occupational hazards,
which included 5items divided into (53 questions) divided
into: 11 about laboratory dress code, 11 about good personal
hygiene, 5 about good housekeeping practices, 18 about good
laboratory technique, and 8 about decontamination procedure.
Scoring system: Practices score for each answer was given
as follows: 2 if done completely, and 1 if done incompletely.
The total practice were considered satisfactory if the
score of the total practices equals ≥ 75 %, and considered
unsatisfactory if it is less than 75%.
2.6. Content Validity & Reliability
The tools were revised for content validity by 3 juries
who were experts in the Community Health Nursing
Specialties, for clarity, relevance, comprehensiveness,
and applicability. According to their suggestions, the
modifications were applied. Reliability of the tools was
applied by the researcher for testing the internal
consistency of the tool, by administration of the same
tools to the same subjects under similar condition on one
or more occasion. Answers from repeated testing were
compared (test- re –test reliability).
2.7. Field Work
• Preparation of data collection tools was carried out
over a period of eight months from the beginning of
March 2018 to end of October 2018, including experts'
opinions, validity, and reliability test were equal 0.81 for
knowledge and 0.76 for practices).
• Official permissions were obtained from the deans
of the Faculty of Nursing- Benha University, also from
administrator of the studied Hospitals.
2.8. Program Construction
The current study was carried out on four phases,
preparatory phase, development phase, implementation
phase and evaluation phase.
1. Preparatory phase: The program was designed after
extensive review of related literature, by the researchers.
Based on results obtained from pre-assessment tools, it
was revised and modified.
2. Program development phase: The program was
developed based on the actual results that were obtained
from pre-program assessment using a structured interviewing
questionnaire sheet, literature review which aimed to
enhance the Laboratory workers knowledge, and practices
toward Laboratory workers.
An objective of the program was to improve laboratory
knowledge and practices toward laboratory safety.
Contents of program: The content of the program
was designed to meet the laboratory workers needs toward
laboratory hazards and laboratory safety measures
and to fit into their interest and level of understanding. Its
contents were:
*Occupational health hazards (chemical, biological,
physical, mechanical, ergonomic, electrical, and
psychological hazards)
*Laboratory safety measures to prevent occupational
hazards (general personal safety, eye safety, safe handling
of biological hazardous material, chemical and gas
safety, radiation safety, fire safety, fire safety, electrical
safety, severe weather safety, and in case of accidents).
Also importance of laboratory dress code, good
personal hygiene, decontamination procedure and good
laboratory technique and good housekeeping practices).
*Safety laboratory (water supply, clean laboratory area,
clean tables, suction fans for ventilation, label code and
precaution on chemical substances, soft wired nets on
the windows, and good lightening in the Lab and keep
clean laboratory equipment in safe place).
3. Program implementation phase: The program was
implemented in a period of eight months, from the
beginning of March 2018 to the end of October 2018.
Implementation of the program was carried out at 4
governmental hospitals. The subject material used has
been sequenced through the 7 sessions (3 session for
theory and 4 sessions for practices). The duration of each
session ranged from 20 to 30 minutes including times for
discussion according to workers’ achievement, progress
and feedback. The sessions contained knowledge about
laboratory hazards and laboratory safety measures.
The workers were divided into small groups; each
group included about 10 workers. The three sessions were
implemented for each group separately for 2 weeks (2
days/week), in addition to one week for pre and posttest.
Sometimes the researcher worked with two groups in the
same day. At the beginning of the first session, an
orientation to the program and its purpose took place.
After each session, a feedback about the previous session
was done as well as the objectives of the new topics
were mentioned. Methods of teaching included lectures,
group discussions, demonstrations, re-demonstration and
role play. An instructional media was used including an
illustrated booklet and purchure.
4. Program evaluation phase: After the implementation
of the program, the post-test was done to workers to assess
knowledge, and practices by the same format of the pre-
test to evaluate the effectiveness of the implemented
program. This was done immediately after the intervention
of program implementation.
119 American Journal of Nursing Research
2.9. Pilot Study
After the development of the tools, a pilot study was
carried out on 10% of the sample (10 workers) to ascertain
the clarity, applicability, feasibility of the tool, to estimate
the exact time needed to fill in the questionnaire, and to
detect any problems that might face the researcher and
interfere with data collection. After conducting the pilot
study, minor necessary changes were done, the tool was
then finalized. The pilot sample was included in the main
study sample.
2.10. Administrative and Ethical
Considerations
Official permission was obtained by submission of
an official letter from the Faculties of Nursing to the
responsible authorities of the study settings to obtain the
permission for data collection.
Personal communication was done with workers to
explain the purpose of the study, assure their best possible
cooperation and ensuring confidentiality of the data. The
researchers emphasized to workers that the study was
voluntary and anonymous. Workers had the full right to
refuse to participate in the study or to withdraw at any
time without giving any reason.
3. Statistical Analysis
The collected data were verified prior to computerized
entry; statistical analysis was done by using the Statistical
Package for Social Science (SPSS) version 20. Data were
presented in tables by using mean, standard deviation,
number, percentage distribution, and Chi- Square and
non-parametric tests (r). Statistical significance was
considered at: P- Value > 0.05 insignificant, P- Value <
0.05 significant, P- Value < 0.001 highly significant.
4. Results
Table 1 shows that; 54% of the studied laboratory
workers aged from 30 to less than 40 years old with
X±SD = 32.70 ± 9.41. 67 % of them were male, and 67 %
of them were living in rural area. As regard experience
years; 67 % of them had less than five years of experience.
Income was enough for 42 % of them while weren't
enough for only38 % of them. This table also shows that;
42 % of the laboratory workers received training courses
about laboratory safety measures. As regards number of
courses 52.38% of them received less than 3 courses while
48 % of them received 3 courses or more. According to
the place of courses; 42.85% of them taken the courses
inside the hospital.
Figure 1 shows that; 43 % of the studied laboratory
workers had secondary education while 27% had basic
education, and 15 % of them had high education and post
graduate.
Figure 2 illustrates that; 49% of the studied laboratory
workers were employee while 32 % of them were
technician workers and 11 % of them were laboratories
doctor, and 8% were cleaning workers.
Table 1. Frequency distribution of the studied laboratory workers
according to their socio-demographic characteristics (n=100)
Socio-demographic characteristics
No.
%
Age / years
≤20
19
19.00
30-
54
54.00
40+
27
27.00
X±SD= 32.70 ± 9.41
Range = 30.00
Gender
Male
67
67.00
Female
33
33.00
Residence
Rural
67
67.00
Urban
33
33.00
Experience years
˂ 5
67
67.00
5+
33
33.00
Monthly Income
Enough and saving
10
10.00
Enough only
42
42.00
Not enough
38
38.00
Received training courses
42
42.00
No. of courses (n= 42)
˂3
22
52.38
≥3
20
47.62
The place of courses (n= 42)
Inside the hospital
18
42.85
Outside the hospital
24
57.15
Figure 1. Percentage distribution of the studied laboratory workers according to their educational levels (n=100)
15%
15%
43%
27%
0%
10%
20%
30%
40%
50%
Postgraduate
High education
Secondary education
Basic education
Educational …
American Journal of Nursing Research 120
Figure 2. Percentage distribution of the laboratory workers categories according to their nature of job (n=100)
Table 2 describes that, all 100 % of the studied
hospitals laboratory had tap water supply, while 75 % of
them had clean laboratory area, clean tables, suction fans
for ventilation, label code and precaution on chemical
substances, soft wired nets on the windows, and good
lightening in the Lab and 25 % of them had clean laboratory
equipment, and keep equipment in clean and safe place.
Table 3 explains that; the studied laboratory workers'
knowledge regarding to laboratory health hazards (chemical,
biological, physical, mechanical, ergonomic, electrical,
and psychological hazards) improved significantly after
the program implementation (P < 0.001).
Table 4 explains that; the studied laboratory workers'
knowledge about laboratory safety (general personal
safety, eye safety, safe handling of biological hazardous
material, chemical and gas safety, radiation safety, fire
safety, fire safety, electrical safety, severe weather safety,
and in case of accidents) improved significantly after the
program implementation (P < 0.001).
Figure 3 illustrates that, before the program implementation;
23 % of the of the laboratory workers had good total
knowledge scores regarding laboratory safety, while after
the program implementation total knowledge scores
increased to 62 %.
Table 5 shows that; the variable "laboratory dress code
"were done completely for 38 % of the studied laboratory
workers before the program implementation and increased
to 90 % after the program. While the variable"
good personal habits "was 45 % before the program
implementation and increased to 81 % after the program
implementation, the variable" decontamination procedure"
was 43 % before the program implementation and increased
to 76% after the program implementation, and the variables
"good laboratory technique and good housekeeping
practices" were 41%, 33.33% respectively before
the program implementation and increased to 70%,
71% respectively after the program There were high
statistically significant differences (P <0.001).
Figure 4 illustrates that; before the program
implementation; only 44% of the laboratory workers
had satisfactory practices regarding laboratory safety
measures, while after the program implementation
increased tendency to 72%.
Table 6 reveals that; there were high statistically
significant differences between the studied laboratory
workers' total knowledge scores and their age, gender,
educational levels, nature of job, experience years, and
their received training courses (P < 0.001).
Table 7 reveals that; there were highly statistically
significant differences between total practices scores of
the studied laboratory workers regarding prevention of
laboratory hazards and their educational levels, nature of
job, experience years, and their received training courses
(P < 0.001).
Table 8 shows that, highly statistically significant
positive correlation coefficient between total knowledge
and practices scores of the studied laboratory workers
(P < 0.001).
- According to the research hypothesis
The safety program will improve the laboratory
workers knowledge and practices to prevent occupational
hazards (Table 2, Table 3, Table 4, Table 5 & Figure 3).
Table 2. Frequency distribution of laboratory safety environment of
the studied laboratory' hospital (n= 4 hospitals)
Laboratory Safety Environment Yes No
No. % No. %
Clean laboratory area. 3 75.0 1 25.0
Clean laboratory walls and ground. 2 50.0 2 50.0
Clean basin and its surrounding area. 2 50.0 2 50.0
Clean laboratory equipment. 1 25.0 3 75.0
Clean tables. 3 75.0 1 25.0
Keep equipment in clean and safe place. 1 25.0 3 75.0
Present tap water supply. 4 100.0 0 0.0
Present of suction fans for ventilation. 3 75.0 1 25.0
Present label code and precaution on
chemical substances. 3 75.0 1 25.0
Present safe personal protective
equipment. 2 50.0 2 50.0
Present of soft wired nets on the windows. 3 75.0 1 25.0
Present good lightening in the Lab. 3 75.0 1 25.0
0
5
10
15
20
25
30
35
40
45
50
Laboratories
Doctor
Technician Nurse
Clearer
Cleaning worker
11.0
32.0
49.0
8.0
121 American Journal of Nursing Research
Table 3. Statistically differences of laboratory workers' knowledge about occupational health hazards pre and post intervention program
(n= 100)
Occupational Health Hazards Before- program (%) After- program (%) X2 P-value
Complete Incomplete Don’t know Complete Incomplete Don’t Know
Chemical Hazards 0.00 36.00 64.00 16.00 45.00 39.00 173.407 <0.000**
Biolaogical hazards 11.00 37.00 52.00 33.00 47.00 20.00 168.485 <0.000**
Physical hazards 37.00 10.00 53.00 58.00 19.00 23.00 117.426 <0.000**
Mechanical hazards 2.00 52.00 46.00 25.00 55.00 20.00 161.636 <0.000**
Ergonomic hazards 7.00 40.00 53.00 18.00 42.00 40.00 164.135 <0.000**
Electrical hazards 11.00 29.00 60.00 13.00 49.00 38.00 173.927 <0.000**
Psychological hazards 13.00 70.00 17.00 28.00 63.00 9.00 223.423 <0.000**
** Highly statistically significant difference (P ≤ 0.001).
Table 4. Percentage distribution of statistical differences between before & after the laboratory workers knowledge regarding laboratory
safety (n=100)
Laboratory Safety Knowledge Before- program (%) After- program (%) X2 P-value
Complete Incomplete Don’t know Complete Incomplete Don’t Know
General Personal Safety 4.00 19.00 77.00 16.00 5300 31.00 196.040 <0.000**
Eye Safety 13.00 20.00 67.00 15.00 35.00 50.00 195.667 <0.000**
Safe Handling of Biologically
Hazardous Material 12.00 22.00 66.00 26.00 53.00 21.00 196.040 <0.000**
Chemical and Gas Safety 16.00 32.00 52.00 28.00 40.00 32.00 200.000 <0.000**
Radiation Safety 14.00 19.00 67.00 37.00 30.00 33.00 188.350 <0.000**
Fire Safety 14.00 40.00 16.00 78.00 12.00 10.00 126.01 <0.000**
Electrical Safety 12.00 68.00 20.00 31.00 58.00 11.00 33.85 <0.000**
Severe Weather Safety 37.00 43.00 20.00 90.00 20.00 18.00 62.67 <0.000**
In Case of Accidents 15.00 25.00 60.00 80.00 30.00 17.00 105.03 <0.000**
** Highly statistically significant difference (P < 0.001).
Figure 3. Percentage distribution of the laboratory workers' total knowledge score regarding laboratory safety before & after the program
implementation (n=100)
0%
10%
20%
30%
40%
50%
60%
70%
Before-Program
After-Program
23%
62%
29%
21%
48%
17%
Good
Average
Poor
American Journal of Nursing Research 122
Table 5. Percentage distribution of statistical differences between before & after the program implementation regarding laboratory safety
practices of the studied laboratory workers (n= 100)
Practices
Before- program (%)
After- program (%)
X2 P-value
Done Completely
Done Incompletely
Done Completely
Done Incompletely
Laboratory Dress Code
38.00
62.00
90.00
10.00
6.94
< 0.001**
Good Personal Habits 45.00 55.00 81.00 19.00 5.91 < 0.001**
Good Housekeeping Practices
33.00
67.00
72.66
28.00
6.54
< 0.001**
Good Laboratory Techniques
41.00
59.00
70.00
30.00
4.23
< 0.001**
Decontamination Procedure
43.00
57.00
76.00
24.00
5.33
< 0.001**
** Highly statistically significant difference (P < 0.001).
Figure 4. Percentage distribution of laboratory workers' total practices scores regarding laboratory safety measures before & after the program
implementation (n= 100)
Table 6. Statistically relation the laboratory workers' total knowledge scores & their socio-demographic characteristics training courses about
laboratory safety (n=100)
Socio-demographic Characteristics
Total knowledge
Chi –Square
Before- program (%)
After- program (%)
X2 P-value
Good
Average
Poor
Good
Average
Poor
Age / years
12.76 < 0.001**
≤20
2.00
8.00
9.00
10.00
5.00
4.00
30-
9.00
17.00
28.00
27.00
10.00
17.00
40+
7.00
12.00
8.00
16.00
6.00
5.00
Gender
11.02 < 0.001**
Male
13.00
24.00
30.00
38.00
10.00
19.00
Female
9.00
4.00
20.00
18.00
11.00
3.00
Educational level
63.57 < 0.001**
Basic education
7.00
7.00
13.00
15.00
5.00
7.00
Secondary education
20.00
16.00
7.00
32.00
9.00
3.00
University education
8.0
5.00
3.00
10.00
5.00
0.00
Postgraduate
10.00
4.00
1.00
12.00
3.00
0.00
Nature of work
36.64
< 0.001**
Laboratories Doctor
8.00
3.00
0.00
11.00
0.00
0.00
Technician Nurse
16.00
9.00
7.00
23.00
6.00
3.00
Clearer
12.00
20.00
17.00
33.00
10.00
6.00
Cleaning worker
2.00
2.00
4.00
5.00
2.00
1.00
Experience years
16.88 < 0.001**
˂ 5
27.00
20.00
20.00
47.00
11.00
9.00
5+
12.00
10.00
11.00
26.00
5.00
2.00
Received training courses (n= 42)
12.86 < 0.001**
Yes
20.00
12.00
10.00
33.00
6.00
3.00
No
10.00
8.00
40.00
23.00
5.00
28.00
No of courses (n= 42)
18.52 < 0.001**
˂3
11.00
9.00
2.00
19.00
3.00
0.00
≥3
10.00
10.00
0.00
17.00
3.00
0.00
** Highly statistically significant difference (P < 0.001).
0%
10%
20%
30%
40%
50%
60%
70%
80%
Before-Program
After-Program
44%
72%
56%
28%
Satisfactory
Unsatisfactry
123 American Journal of Nursing Research
Table 7. Relations between the laboratory workers total practices scores & their socio-demographic characteristics and training courses about
laboratory safety (n=100)
Socio-demographic Characteristics
Total practices scores
Before- program (%) After- program (%) Chi –Square
Satisfactory
Unsatisfactory
Satisfactory
Unsatisfactory
X2
P-value
Educational level
95.25 < 0.001**
Basic education 9.00 17.00 19.00 8.00
Secondary education
20.00
23.00
36.00
8.00
University education 8.00 7.00 12.00 3.00
Postgraduate
9.00
6.00
13.00
2.00
Nature of work
58.54 < 0.001**
Laboratories Doctor 7.00 4.00 10.00 1.00
Technician Nurse
22.00
11.00
30.00
3.00
Clearer 20.00 29.00 39.00 10.00
Cleaning worker
3.00
5.00
6.00
2.00
Experience years
11.00 < 0.001**
˂
5 29.00 38.00 50.00 17.00
5+
19.00
14.00
26.00
7.00
Received training courses (n= 42)
18.56 < 0.001**
Yes
22.00
20.00
36.00
8.00
No
26.00
32.00
34.00
24.00
No. of received courses (n= 42)
16.43 < 0.001**
˂3
10.00
12.00
19.00
3.00
≥3 11.00
9.00 17.00 30.00
** Highly statistically significant difference (P < 0.001).
Table 8. Correlation coefficient between total knowledge scores of the studied laboratory workers and their total practices scores regarding
prevention of laboratory hazards pre and post program (n=100).
Variables
r / P-value
Total Knowledge Scores/ Pre Total Knowledge Scores/ Post
r P-value r P-value
Total Practices Scores/ Pre 0.867 0.001** ----------
Total Practices Scores/ Post ---------- 0.973 0.001**
**Highly statistically significant difference (P < 0.001).
5. Discussion
The clinical laboratory is a workplace where many
occupational hazardous such as chemicals, complex
instrumentation, and potential pathogens are encountered
on a daily basis. However: the laboratory can be a safe
place to work and learn if possible hazards are identified;
safety and infection control protocols are followed.
Education of health care professionals about the general
prevalence, risk of transmission, and availability of
prophylaxis and treatment is imperative. Knowledge
related to the importance of taking basic precautions
through the use of gloves, gowns, and masks has been
proven to decrease exposure incidents elsewhere, and
should also prove to be effective in Egypt [16].
Regarding to demographic characteristics of the studied
laboratory workers, more than of half of them aged from
30 to less than 40 years old, more than two thirds of them
were male. As regard experience years; more than two
thirds of them had less than five years of experience.
Income was enough for more than two fifth, while weren't
enough for only more than one third of them. These
findings were not in accordance with [17], who studied"
Assessment of profession hazards regarding medical
laboratory in Taraboloss city in Libya" and pointed out
that, most of the studied laboratory workers aged 20-30
years, about two thirds of them were female, and most of
them had less than ten years of experience years.
The result revealed that, more than one third of the
studied laboratory workers received training courses about
laboratory safety measures. This finding in line with [18]
who studied" Knowledge, attitudes and practices of health
care personnel towards waste disposal management at Ain
Shams University Hospitals, in Egypt and reported that,
nearly two thirds of the nurses had received training
regarding laboratory safety measures. While less than one
fifth of the doctors and only one tenth of the lab
technicians had received this training. None of the sanitary
staff had reported about any training in relation to
laboratory safety measures. This might be laboratory
safety measures training of both the technical staff and the
nontechnical staff is critical for the proper and appropriate
management of laboratory safety measures.
As regards number of courses: more than half of the
studied laboratory workers received less than 3 courses
while less than of them received 3 courses or more. These
results in the line with study conducted by [19] who
studied "Quality of laboratory was conducted in clinical
microbiological laboratories of four MOH (Ministry of
Health) hospitals in Alexandria "and founded that, slightly
less than one-third of the studied sample received one
or more training courses on Universal Precautions (UP)
American Journal of Nursing Research 124
included lab safety measures while none of cleaning
workers received any type of previous training. This
could be laboratory safety measures training and close
monitoring are not the only solution; increasing the social
expectation for mass education, increased motivation, and
a firmer sense of ethics among laboratory workers will
reduce or prevent laboratory hazards.
According to the place of courses more than two fifth of
the studied laboratory workers taken the courses inside the
hospital. This result was supported by [20] who studied
"knowledge and awareness of routine biosafety measures
and proper waste disposal Practices among healthcare
workers in Karachi, Pakistan" and they found that, all the
studied laboratory workers taken the courses inside the
hospital. This might be the studied laboratory workers
who were completely unaware of lab safety knowledge
and biosecurity practices and needed education about
personal safety, appropriate handling and lab safety
measures to prevent lab hazards inside the hospital.
The present study revealed that; the studied laboratory
workers according to their educational levels, more than
two fifth of them had secondary education while about
one quarter of them had basic education, and more than
tenth of them had high education and post graduate. These
results disagree with study conducted by [4] who studied"
Safety measures at post gradates in institutes of
Alexandria University and found that, less than half of the
studied sample had high education; post graduate; more
than half of them had secondary education.
Regarding the laboratory workers categories according
to their nature of job, the present study revealed that;
less than half of them were employee while one third
of them were technician workers and tenth of them
were laboratories doctor, and only 8% were cleaning
workers. These results disagree with study conducted by
[19] who studied safety measures Bacteriological
Laboratories/-Quality at Alexandria University and found
that, Among 37 laboratory staff, less than half of the
studied sample were physicians, more than half of them
had were technicians, with different scientific degree.
Regarding studied hospitals laboratory condition, all of
the studied hospitals laboratory had tap water supply,
while three quarters of them had clean laboratory area,
clean tables, suction fans for ventilation, label code and
precaution on chemical substances, soft wired nets on the
windows, and good lightening in the Lab and more than
one fifth of them had clean laboratory equipment, and
keep equipment in clean and safe place. These finding
disagreed with [21] who studied evaluating effectiveness
of occupational safety and health measures in the
scientific laboratories in the Palestinian Universities in
Gaza strip: a filed study and they founded that, more
than two thirds of the studied hospitals laboratory had
tap water supply, while less than two thirds of them had
clean laboratory area, clean tables, suction fans for
ventilation, label code and precaution on chemical
substances, soft wired nets on the windows, and poor
lightening in the lab and less than half of them had clean
laboratory equipment.
This might be when the laboratory’s safe environment
under suitable conditions, such as suitable area, availability
of facilities, and good degree of cleanliness, sufficient
lighting and ventilation, and the staff performance in these
suitable safety environments would significantly be better
and correct.
The result of the present study revealed that; the studied
laboratory workers' knowledge regarding to laboratory
health hazards chemical, biological, physical, mechanical,
ergonomic, electrical, and psychological hazards improved
significantly after the program implementation (P < 0.001).
These results agree with study conducted by [22] who
studied the "Awareness and practices regarding biomedical
waste management among health care workers in tertiary
care hospital of Haldwani, Nainital" and found that, the
studied laboratory workers' knowledge regarding to
biological laboratory hazards improved significantly after
the program implementation (P < 0.001). This might be
due to the success of lab safety measures programme
depends on the both knowledge and practice of the studied
laboratory workers.
The present study revealed that, the studied laboratory
workers' knowledge regarding to laboratory chemical
hazards, The results of the study disagree with study
conducted by [4] who studied " Laboratory chemical
safety measures at postgraduates" in Institutes of
Alexandria University and found that, the studied
laboratory workers' knowledge regarding to chemical
laboratory hazards improved but not significantly after the
program implementation (P < 0.001).
According to [23] who mention that; lab environment
contain hazardous include fire, breakage of glassware,
sharps, spillages, Pressure equipment & gas cylinders,
extremes of heat & cold, chemical hazards, biological
hazards and radiation. So, the nurse must be educate the
lab worker's to important follow the control measures in
order of preference as use a less risky substance, use a
safer form of that substance (e.g solution instead of
powder, Totally enclose the process (eg a glove-box),
partially enclose the process (eg with a fume cupboard),
ensure good general ventilation, safe systems of work,
reduce exposure times, increase distance, reduce volumes
and personal protective equipment (as a last resort for
primary protection.
Regarding to the studied laboratory workers' knowledge
about laboratory safety (general personal safety, eye safety,
safe handling of biological hazardous material, chemical
and gas safety, radiation safety, fire safety, electrical
safety, severe weather safety, and in case of accidents
improved significantly after the program implementation
(P < 0.001). These findings was agreement with (5] who
studied "Quality management in medical laboratory in the
Arabic World and reported that studied laboratory
workers' knowledge about laboratory safety (general
personal safety, eye safety, safe handling of biological
hazardous material, chemical and gas safety, radiation
safety, fire safety, electrical safety, severe weather safety,
in case of accidents and improved significantly after the
program implementation (P < 0.001).
Furthermore, the present study revealed that; laboratory
studied workers' total knowledge score regarding laboratory
safety, before the program implementation; more than one
fifth of the studied laboratory workers had good total
knowledge scores regarding laboratory safety, while after
the program implementation total knowledge scores
increased to about two third of the studied laboratory
workers. This result agree with the study conducted by [25]
125 American Journal of Nursing Research
who studied "Improvement of knowledge, attitudes and
practices of health care workers towards the transmission
of blood-borne pathogens" and found that, studied
laboratory workers as lab technicians had the best level of
knowledge in the pre-intervention phase followed by the
nurses, while after the program implementation had good
total knowledge scores regarding laboratory safety,
increased to three quarters. This finding agreement
with [25] who studied" Knowledge, attitude and practices
of bio-medical waste management amongst staff of
institutional trauma center level II in C. S. M. Medical
University, Lucknow", and found that less than one fifth
of the laboratory workers had good total knowledge scores
regarding laboratory safety, while after the program
implementation total knowledge scores increased to less
than two thirds.
The present study revealed that; laboratory safety practices
as reported by the studied laboratory workers, the variable
"laboratory dress code policy "were done completely for
more than one third of the studied laboratory workers
before the program while improved in most of them after
the program implementation. While eating, drinking, and
applying cosmetics (personal habits) in the laboratory are
very common in more than half of studied lab worker
before program implementation, to increase the variable
"good personal habits" after the program implementation
in most of the studied laboratory workers. But these
practices were prohibited in only 25 (10%) of the labs.
These results supported by [27] who studied " The impact
of applying ISO.15189 standard of quality and competence
of medical laboratories on patients satisfaction in the
Jordanian private medical laboratories" and found that;
variable "good personal habits" and "laboratory dress code
policy "were done completely for more than one third of
the studied laboratory workers before the program
implementation while improved in most of them after the
program implementation.
According [29] who mentioned that; gowns made of
impervious material are worn to protect the wearer’s
clothing/uniform from possible contamination with
micro-organisms and exposure to blood, body fluids
secretions and excretions, and an apron protects the
wearer and the uniform from contact with the
contaminated body fluids. Plastic aprons are used over the
gown when taken lab sample where possible splashes with
blood and body substances may occur in the lab.
Although the Lab Director establishes policies
and procedures for potential biohazards and biosafety
measures. This might be studied laboratory workers that
those policies were not comprehensive or implemented
consistently in this study.
The present study revealed that, the variable
"decontamination procedure" was less than half of studied
laboratory workers before the program implementation
and increased to more than three quarters of them after the
program. This result in the line with [20] who studied
"Knowledge and awareness of routine biosafety measures
and proper waste disposal Practices among healthcare
workers in Karachi, Pakistan" and who found that, studied
laboratory workers practices improved after the program
in labs decontaminate as seventy percent (70%) (n=175)
of the labs decontaminate work surfaces daily, while
22% (n=55) decontaminate cultures. Approximately, 67.2%
(n=168) of the labs decontaminate lab equipment using an
effective disinfectant; 2% (n=18) properly decontaminate
spills involving infectious materials; and 10% (n=25)
decontaminate equipment and materials before removal
from the lab. Cultures, specimens, and body fluids are
placed in proper leak-proof containers during work and
transportation in 90% (n=225) of labs.
Additionally, the present study result disagree with [19]
who studied "Quality of laboratory was conducted in
clinical microbiological laboratories of four MOH (Ministry
of Health) hospitals in Alexandria "and founded that, absence
of formal documented training program for orientation of
new employees and continuous education and training
programs. So; low level of the staff knowledge. This
might be documentation is deficient in all laboratory areas
including policies and procedure for specimen management,
test process, quality control, equipment management,
reagent management, verbal/telephone orders or reporting
system, laboratory safety program, hazardous material and
waste management.
Regarding to laboratory safety practices by the studied
laboratory workers, the "good laboratory technique and
good housekeeping practices" were two fifth of them
before the program implementation and increased to three
quarters after the program. There were high statistically
significant differences (P<0.001). These findings agreement
with [22] they mention that, as regards good laboratory
technique and good housekeeping practices" were more
than one third of sample before the program implementation
and increased to three quarters after the program. There
were high statistically significant differences (P <0.001)
The result of the present study revealed that; studied
laboratory workers' total practices scores before the
program implementation; only less than half of them had
satisfactory practices regarding laboratory safety measures,
while after the program implementation increased
tendency to three quarters. This result supported by [28] in
Egypt and who found that, laboratory workers' total
practices scores before the program implementation; only
less than one third of them had satisfactory practices
regarding laboratory safety measures, while after the
program implementation increased tendency to half of
them. Also, this result agree with the study conducted by
[25] who studied "Improvement of knowledge, attitudes
and practices of health care workers towards the
transmission of blood-borne pathogens" in Egypt
and found that, the practice score of the nurses and
lab technicians significantly increased following the
intervention. The marked improvement of the practice
score by nearly one third (from two third to most of them)
and nearly one fifth (from two third to most of them)
among the lab technicians and nurses respectively.
According to [23] who mentioned that, standard
precautions consider every person (patient/clients or staff)
as potentially infectious and susceptible to infection, use
appropriate hand hygiene techniques including; routine
hand washing, wear personal protective equipment which
include: boots, aprons, gowns, gloves, masks, protective
eyewear and caps, appropriately handle sharps, patient
care and resuscitation equipment, and appropriately
manage patient placement and environmental cleaning,
safely dispose of infectious waste materials to protect
those who handle them and prevent injury or spread to the
American Journal of Nursing Research 126
community and process instruments by decontamination,
cleaning, and either sterilization or high-level disinfection
following recommended procedures.
Relations between the laboratory workers' total
knowledge scores, their demographic characteristics and
training courses about laboratory safety. There were high
statistically significant differences between the studied
laboratory workers' total knowledge scores and their age,
gender, educational levels, nature of job, experience years,
and their received training courses (P < 0.001). These
results in the line with study conducted by [19] who
studied quality of laboratory was conducted in clinical
microbiological laboratories of four MOH (Ministry of
Health) hospitals in Alexandria and founded that, the
years of experience and training program are significantly
affecting the level of studied laboratory workers, where
the lab staff who has < 10 years of experience and with
training program showed best test results and performance
level.
Relations between the studied laboratory workers total
practices scores their demographic characteristics and
training courses about laboratory safety, the result of the
present study revealed that; there were highly statistically
significant differences between total practices scores of
the studied laboratory workers regarding prevention of
occupational hazards and their educational levels, nature
of job, experience years, and their received training courses
(P < 0.001). This might be because the laboratories
as any workplaces contain numerous hazards as well as
ergonomic disease. These hazards have to overcome to
make safer laboratories requires mandatory rules, training
programs and laboratory workers with experience.
According to [16] promulgated the OSHA laboratory
safety standards Worldwide. Laboratory safety requires
mandatory rules, training programs a commitment to them
and expectation of the consequences when those rules are
not met. Institutions need well developed structures and
supports that extend beyond the laboratory well to the
institution it-self. The responsibility safety rests ultimately
with head of the institution and its operating units,
chemical safety officer, laboratory managers, supervisors,
technicians and all lab workers.
Finally, the current study revealed a highly significant
statistical difference between total knowledge scores of
the studied laboratory workers and their total practices
scores regarding prevention of laboratory hazards
(P < 0.001). This result was supported by [20] who
studied "Knowledge and awareness of routine biosafety
measures and proper waste disposal practices among
healthcare workers in Karachi, Pakistan" and they found
that, a highly significant statistical difference between
total knowledge scores of the studied laboratory workers
and their total practices scores regarding prevention of
occupational hazards (P < 0.001). This might be overall
satisfaction with the training program and the competence
of the coordination team were rated very well by a
majority of the studied laboratory workers.
6. Conclusion & Recommendation
This study and research hypotheses concluded that the
training safety program has positive effect to upgrade
the laboratory workers' knowledge and improving their
practices regarding prevention of laboratory hazards and
safety environmental condition hazards (P < 0.001). The
study recommended that regulatory training program
should be strengthened to ensure basic lab safety practices
in hospitals, and make training courses for large number
of hospitals laboratory workers about prevention of
laboratory hazards safety environmental condition.
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