As part of our effort to provide information of interest to histologists, we recently had the pleasure of interviewing Dr. Tami Maier, a biosafety professional from the Medical College of Wisconsin. After working in a research laboratory setting for more than 12 years, Tami transitioned into a role in lab safety. Based on job hazard analysis and injury statistics, Tami has been involved in promoting sharps safety, with a particular interest on the use of sharps in the histology laboratory. With a goal to reduce injury, she has been actively consulting with histologists regarding laboratory workflow, discussing the proper use of equipment and proper work practice controls.

Thought Leader Interviews

Sharps Safety in the Histology Laboratory: An Interview with Biosafety Professional Dr. Tami Maier

Sharps Safety in the Histology Laboratory: An Interview with Biosafety Professional Dr. Tami Maier

As part of our effort to provide information of interest to histologists, we recently had the pleasure of interviewing Dr. Tami Maier, a biosafety professional from the Medical College of Wisconsin. After working in a research laboratory setting for more than 12 years, Tami transitioned into a role in lab safety. Based on job hazard analysis and injury statistics, Tami has been involved in promoting sharps safety, with a particular interest on the use of sharps in the histology laboratory. With a goal to reduce injury, she has been actively consulting with histologists regarding laboratory workflow, discussing the proper use of equipment and proper work practice controls.

What assistance do you wish people would ask you for routinely, instead of waiting until an incident occurs?
When possible, I like to involve users in the exploration of alternative solutions, as the possible options might affect their workflow. This partnership shows respect for their expertise, promotes dialog about safer alternatives and shows empathy that may help overcome the resistance to change. This also provides an opportunity to interact with and influence inexperienced staff, where advice on standard operating procedure development can prevent bad habits from forming. As there are a variety of labs on campus, including basic research, clinical or specialized core facility labs, I alter my communication approach depending on which type of lab staff I am interacting with.

Clinical pathology labs and histology core facilities have staff routinely follow SOPs when handling specimens on instruments with sharp blades, where experience leads to mastery of the tasks. However, even the best trained histologists can be injured due to a failure in equipment or work practices. When an injury occurs, it is a reminder of the inherent risks associated with the use of sharp blades and the need to prevent complacency.

In basic research labs, there are often less-experienced staff that perform histology tasks with sharp blades less frequently. They might not be familiar with all the safety features of the equipment or the proper work practices that should be implemented. As I interact with these staff on campus, I am able to provide guidance on equipment controls and work practices or connect these staff with more experienced histologists as warranted.

What are your guiding principles to general lab safety?
It is critical to identify, understand, and communicate the risks inherent in a task or workflow. A risk assessment for each step needs to be performed: Why does this need to be done? How should this be done? Can changes be made that would enhance safety while allowing the job to be completed effectively? I like to focus on the underlying principles illustrated in the Hierarchy of Controls when assessing risk mitigation. The best strategy for protecting workers from a hazard is to eliminate a hazard or actively isolate staff from exposure to hazards using engineering controls or defined standard operating procedures. Although most people are familiar with using personal protective equipment (PPE) for protection during exposure to a known hazard, in the hierarchy this is the least effective way to protect workers and should be implemented only when there is no other way to prevent exposure to the hazard.

When you work with people, is there push back about implementing safety recommendations regarding sharps?
There is. Comments such as “We’ve always done it this way and no injuries have ever occurred” or “Your suggestions don’t fit my workflow” are relatively common. My response is to compare the safety-associated changes with sharps handling to other tasks such as mouth pipetting. Although convenient and easy, people have been exposed to infectious biologicals and harmful chemicals when mouth pipetting. The use of pipette aids is now universal when historically mouth pipetting was a common practice. Similarly, there are now a variety of tools available for handling sharps that reduce the need to directly handle sharps with the hand. Scalpel blades can be removed using hands-off scalpel blade removal systems or there are safety-engineered blades that can be retracted or shielded after use. For the handling of sharp blades associated with microtomes or cryostats, a combination of using the blade guard engineering control and hand tools, such as brushes, forceps, hemostats or magnetic tools, can help reduce the chance for injury by keeping fingers away from the blades.

The overall goal is to work with staff as they develop their procedures to help them integrate safety devices and practices into their workflow with minimal inconvenience. When interacting with lab staff, we remind them why a task requires specific work practices to prevent injury. We then move to how it can be done safely by looking at possible options and solutions. We want to partner with staff on safety, as this promotes a positive safety culture as well as accountability. Importantly, an essential component involved in the success of initiatives is behavioral-based safety.

Behavioral Safety. You mentioned that when we met this past summer at the Tri-State NSH meeting in Madison, Wisconsin. Could you elaborate?
Histologists routinely rely on equipment safety controls and effective standard operating procedures. When injuries occur, the most common root cause is associated with unsafe behavior. Injury reporting is encouraged, using it as a growth opportunity without fear of repercussions. When adjustments to a procedure need to be made, they are more willing to ask for assistance with this type of safety culture.

One of the most effective ways to promote safe behavior is by having a strong growth mindset. As a safety officer, I strive to find alternative solutions to problems, providing recommendations to staff and leadership as warranted. Staff need to be patient when learning how to use a new instrument or tool. The “best” way can change over time, as advances in technology or the development of new tools occurs.

So, you’ve gained a lab’s trust and you have a great give-and-take as you assess their practices. How do you work with a lab on those inherently dangerous steps like handling sharps that just can’t be eliminated?
From a behavioral standpoint, it is interesting that sharp injuries often happen just before use or just after use but before disposal. The user is very focused on a task during use, but they start to shift focus onto something else before disposal is complete. An effective way to reduce injury is to reduce the amount of time the sharp is exposed prior to disposal. Simply having a sharps container near the workspace allows for prompt disposal.

As we discussed earlier, there are hands-off scalpel blade removal systems and safety-engineered blades that can be retracted or shielded after use. The same retraction and shielding mechanisms have been used to develop safety-engineered needles. In histology labs, many injuries occur when taking the section blade on or off the equipment or when performing tasks near the blade. The use of tools that keep fingers away from the blade whenever possible has been shown to reduce staff injury.

With the substitutions available, like the scalpel guards, why aren’t they implemented more universally?
The resistance to change can be hard to overcome, particularly if the reason why a change is needed is not understood or appreciated. There can be a lack of patience when learning a new method that might take longer at first, which would slow down their workflow. Also, some of the substitutions come with a cost, which often is a real or perceived barrier to implementation. When given an opportunity to discuss options with staff, I talk about the pros and cons of the different choices. I encourage staff to have a variety of options available to choose from, as some might apply to specific applications or users might develop a preference when given a variety of options. To facilitate exploration, I share information on available products that might be of interest.

What would you say to histologists that handle microtome blades with their fingers? Are there substitutions, PPE, etc. for them?
All discussions about blade safety focus on the desire to avoid directly handling the blade with the fingers. I remind staff of the engineering controls such as the blade guard that shields the blade when it is not in active use. There are hand-held devices that allow alignment, removal, and disposal of the blade without touching the blade. When following up after an injury, the focus is on engineering control use and work practices. Personal protective equipment (PPE), such as cut resistant gloves, is not encouraged, as keeping the fingers away from the blade is a priority.

Thank you so much for your time, Tami. We appreciate you sharing your experience and expertise with the histology community. Any thought you would like to leave us with?
Involve your safety officer early in planning for new procedures, when purchasing equipment, or when hiring new personnel. We can share ideas, assess product options, and provide training support if needed. We have a mutual interest in advancing research while preventing staff injury.