Posted: April 29th, 2018

Occupational Safety Concerns in Medical Laboratories

Occupational Safety Concerns in Medical Laboratories

1. Introduction

By conducting this research study, it is hoped that a comprehensive view of the main occupational safety concerns and the corresponding solutions in medical laboratories can be provided in the near future, through which better protection can be offered to laboratory personnel and the related medical activities can be carried out more effectively and in a safer manner. The results from the study can be used in the planning of laboratory safety measures and the providing of laboratory safety training to laboratory personnel. Last but not least, the information of the main challenges and risk factors can be disseminated to the public through, for example, the laboratory’s website.

There are two specific research questions to be addressed:
1) What are the main occupational safety concerns in medical laboratories?
2) What are the needs for improvement and the main challenges faced by laboratory personnel?

The purpose of this research study is to identify the occupational safety concerns in medical laboratories. By investigating the existing safety measures, the needs for improvement, and the main challenges faced by laboratory personnel, can be identified and better solutions can be provided. Also, this research can be used to raise public awareness of laboratory safety, and this, in turn, can help make sure that when the measures are taken to make laboratories safe places to work, these changes are supported by those who are likely to benefit from them.

Occupational safety is a major concern in medical laboratories. Laboratory personnel are exposed to numerous potential hazards, including chemical, biological, physical, and radioactive hazards, as well as musculoskeletal stresses. Therefore, it is essential to implement and comply with safety precautions and programs to minimize the risk of laboratory accidents and exposures.

1.1 Background

Medical laboratory personnel are exposed to a variety of occupational hazards. Accidents involving slides and cuts while using knives are common. Infection, being transmitted through “sharps” such as needle sticks, is a serious danger. Respiratory problems may be caused by poor ventilation or the inhalation of infectious agents. Electrical safety is also an area of concern. Many laboratories operate complex analyzers and computer systems, some of which incorporate high voltage power supplies. Also, in the case of fire, numerous flammable materials are likely to be present. Devices such as aerosols can make any fires particularly intense and difficult to control. All of these hazards are recognized as potentially harmful and the subject of European directives and UK legislation. Loosely speaking, legislation is concerned with three main areas: the health and safety of staff, the safety of patients and others who may be affected by the work of the laboratory, and the prevention of environmental pollution. Amongst a growing number of legal documents, workplace risk assessments are a fundamental requirement placed upon employers by health and safety law. The need to carry out regular, comprehensive risk assessments is well established, and the Control of Substances Hazardous to Health Regulations and the Management of Health and Safety at Work Regulations explicitly demand it as necessary. So, it is compulsory for all employers to make suitable and sufficient assessments of health and safety risks. In the opinion of the Health and Safety Executive (the organization responsible for Health and Safety regulations in England and Wales), the purpose of risk assessment is not to create excessive amounts of paperwork but to identify sensible measures to control risk.

1.2 Purpose of the Study

The main purpose of the study is to assess occupational safety and health hazards in medical laboratories. The specific objectives are to identify the potential hazards that may lead to work-related injuries and illnesses, to analyze the behavioral and environmental risk factors, to find out the possible solutions and methods of controlling the hazards, and to make conclusions and suggestions for better laboratory safety. With the help of this study, suitable prevention and control measures are going to be established from a scientific prospect. This should include not only the technical precautions and engineering control, but also the formulation of safety policy in both a strategic and practical approach. It is expected that a safe and healthy work environment can be ensured in the medical laboratories by following the proposed safety measures. The findings of the study would also be beneficial to the administrators, laboratory health and safety officers, laboratory professionals and the relevant training organizations. This may act as a reference for establishing the occupational safety and health standard operating guidelines in the medical laboratory work.

1.3 Research Questions

The research questions are also identified.
This research intends to systematically analyze the occupational safety problems in medical laboratories, and eventually develop a comprehensive framework that can facilitate a culture of safety in these settings.
Explanation: In order to better understand the effects of different occupational hazards and the underlying mechanism, it is essential to comprehensively study the current safety status in medical laboratories and the possible solutions to the identified problems.
To achieve this major goal, the following specific research questions are to be addressed one by one. First, what are the conditions of the existing occupational safety environment in medical laboratories? And what are the key safety concerns and common risk factors that can compromise the safety of laboratory workers? Second, what have been done in the practice of reducing or eliminating the occupational hazards that have been identified in the literature and the current safety status assessment? What are the existing safety guidelines and protocols and how they are implemented in the daily practices? And what are the effectiveness and limitations of these existing safety measures? Third, what is lacking in the current safety protocols and how these limitations might have contributed to the occurrence of different safety incidents reported in the literature? How the barriers in implementing a “safe culture” are being investigated in the literature and in practice? And what needs to be done in order to enhance the safety awareness and eventually build a “culture of safety” in medical laboratory settings? Last but not least, what…

2. Literature Review

2.1 Overview of Occupational Safety in Medical Laboratories

2.2 Common Hazards and Risks

2.3 Existing Safety Measures and Regulations

2.4 Gaps in Current Knowledge

3. Methodology

With many similar studies on research, design and data collection methodologies, but each one has to be specific as per the research topic. The main purpose and importance of this chapter is to provide the reader with detailed methodology which has been used to address the research questions. The research approach that will be used in this study is qualitative approach. This is because qualitative approach is used to analyze social phenomenon. The process of selecting the data and information has to be carefully set because it has to meet specific research requirements. In fact, Saunders et al. (2007) suggested that research methodologies should fit to carry out the research in terms of the research framework and the research type. In addition, the sample selection and data collection methods have to be present prior to the actual research start. Sample selection is the process by which effort is made to select the information from the entire population regarding to the data collection that will be informative to the research. Actually, Berk (2001) states census is an enumeration of the entire population while sample is only a part of the whole group. He further mentioned that the sample is selected to represent the entire population. Therefore, sample selection is subjective given that it is simply a research but the researcher makes effort to make it to be objective. The rationale for selecting different types of respondents and types of data to be collected has to be explained clearly in the sample selection part. On the other hand, data collection refers to gathering of information to be used in the research. It is very important as it can influence the research outcome. Data collection can be done in terms of either quantitative or qualitative. However, there is some researcher like Tuckman (1972) suggests that both types of data should be used in the collection process. This is because both quantitative and qualitative data are commend to provide a fuller and more comprehensive understanding of the research problem.

3.1 Research Design

Quantitative research aims to obtain objective information that can be analyzed and used to draw conclusions and make predictions about a population or phenomena. In this study, a cross-sectional research design will be used. A cross-sectional study involves the collection of data at a single point in time and the analysis of that data at that one time. The other main type of research design that could be used is a longitudinal research design. This involves taking measures of the research subjects over a period of time, often over many years. However, this type of research design would have been less suitable for this study. This is because the numbers of laboratory employees that would have been able to take part in a longitudinal study over the ten or twenty years that would be necessary are small, particularly when the sample is divided into different laboratory staffs of differing occupational groups and roles. In addition, a longitudinal study requires substantial commitment from the researchers to find and retain volunteers to take part in the study. Also, there are substantial costs in terms of time and money associated with a longitudinal study. For example, should participants leave the workplace part way through the study, they would have to be excluded from the study and the process of finding replacement volunteers can be costly and time consuming. There is also the possibility that volunteers who participate may no longer wish to participate part way through the study. This would mean any data collected from those individuals would have to be omitted and replacements would need to be found. On the other hand, a cross-sectional research design is simpler and quicker to carry out such that because the data is being measured at one point in time, the researcher can analyze and draw conclusions from the information relatively quickly at a lesser cost. Cross-sectional surveys are dependable and are often used normally as a social and economic indicator of wellbeing at a given point in time. The major disadvantages are that patterns of change over time cannot be identified. Also, the method cannot find out anything about the history or development of the situation. However, it is a suitable and cost-effective way to collect descriptive data on large numbers of subjects. Cross-sectional studies are simple and are designed to examine data and explanations of diseases at one specific point in time only. Cross-sectional studies are variable, but they could sometimes really change such that a format of a cross-sectional study can be a telephone survey or an online dig. Also, another emerging type of cross-sectional study is trans-sectional studies which consider data collected in many different points in time. For example, trans-sectional research on the issue of unemployment and crime. However, the issue of unemployment and crime cannot be uncovered fully by cross-sectional studies but such kinds of studies have similar properties to both studies.

3.2 Data Collection Methods

The primary data in this study was collected using two main data collection methods: a structured questionnaire survey and laboratory physical environment and facilities assessment. The questionnaire survey was used to elicit information on employees’ perceived risk factors pertaining to occupational safety and health. This method was chosen primarily because of the need to collect data on people’s views and opinions in a cost-effective and efficient manner, within a limited time, and across many occupations or industry sectors. Also, questionnaires permit the use of more complex, multistage, contingent response formats involving probing questions, skip patterns, and the use of funneling questions. A survey is a means of gathering information about occurrences or conditions that can be observed directly. On the other hand, the physical environment and facilities assessment was used to measure and evaluate employees’ actual working environments in terms of safety and health. This method was chosen because the safety and health of employees, in as far as it is affected by the work environment and processes, is already a subject of legislation. The employer is required to engage a registered safety and health officer to measure and evaluate the working environment and practices specified under the legislation on a regular basis (Risk Management of Hazardous Chemicals, Reg. 46). As such, the data collected through this method can be used to investigate if the management has complied with safety and health regulations when designing and managing various laboratory operations. Also, the data obtained can be used to identify areas and practices that may lead to unsafe working conditions. It is necessary and important to employ this method in laboratories where hazardous substances or dangerous practices are identified during the course of employment. Also, this method would involve close ‘personal’ observation and physical measurements with data collection undertaken in the location and context in which the problems and issues exist. This method is likely to capture rich, quality data and highlight health and safety risks, which might otherwise be overlooked. It can validate employees’ perceptions and improve the focus of health and safety investments. There would be direct relevance and application of the findings in the risk evaluation strategy required by the safety and health legislation for many workplace situations.

3.3 Sample Selection

Previously, the various types of data to be collected were described. In this section, the methodology for selecting samples from laboratory technicians is explained. The laboratory workers’ health data for the years 1995 to 2000 were received from the Medical Board of California, and the data from 2001 to 2006 were received from the Chief of Laboratory Field Services in the California Department of Health Services. These data cover laboratory personnel with various occupational titles such as “Clinical Bioanalyst” and “Clinical Chemist” and so on. For each of these occupational titles, three indices were constructed to represent the degree of automation in their work, that is the optional percentage of time required to monitor the automated analyzers and whether the occupational title involves routine tasks and repetitive work. First, the average patient or specimen processed per day per worker for each laboratory of those data years were annually calculated. Data were collected from the laboratory audited reports and queries to the laboratory workers at the time. For some small size laboratories, there is a possibility that the yearly case number may vary for different years, and so we calculated the average of the years the worker worked. And the number of yearly cases for 365 days were simulated in the data analysis to test whether they have a significant impact on the result or not. Also, the laboratory work’s automation level was estimated by investigating the description of the laboratory practice. The “Clinical and Anatomic Pathology” Public Health licensed list was utilized to obtain the information of the automation level. For those occupational titles which are considered, 3 indices were constructed to represent the degree of automation in their work, that is the optional percentage of time required to monitor the automated analyzers and whether the occupational title involves routine tasks and repetitive work. The inclusion criteria for the sample selection in the data years 1995-2000 shall be explained here. First of all, the researchers will select those samples which are active. And among those active workers, the researchers will select those workers who have the job title “Clinical Bioanalyst”, based on the health and safety standards of the United States. At least there are two types of jobs people usually do. One is labeled as Clinical Bioanalyst and some other is labeled as Clinical Biochemist. But the regulations – distinctly written at the back of the laboratory health and safety protocol manuals – suggested that people who satisfy the listed requirements below belong to Clinical Bioanalyst. This shows that the proposed samples shall give a good simulation of the studied population and at the same time the laboratory shall cover most of the areas including automatic chemistry analysis and even the development of laboratory methodologies. However, if later on someone believes that those samples don’t give a right simulation, more samples are needed and the whole process shall be invoked and documented. Last but not least, the researchers will select for study on those Clinical Bioanalysts whose employment categories are in the CLHF Public Services – codes 13 and 14, that is all of them are doing work in Promotion of Pathology. All the data operation shall operate under the regulation of Health and Safety Ordinance so as to ensure that any proposed projects which provide safeguard on laboratory health and safety shall be honored.

3.4 Data Analysis

To identify the key risk factors and major occupational safety concerns in medical laboratories, the frequencies for the “worst case scenario” of each biomaterial encountered were calculated. The survey results depicted in Figs. 3.1(a) and (b) showed that an overwhelming proportion of the participants might be exposed to the blood samples, which contain pathogen agents. This was then followed by exposure to the formalin-fixed, paraffin-embedded (FFPE) tissues. As other biohazards may present in these tissues, such as the human papillomaviruses (HPV), it is crucial to ensure safety against any potential infections by the aerosols from the cut surfaces during the preparation process. For instance, a Standard Operating Procedure (SOP) should be established to require the tissues to be fixed in a closed container before being trimmed, in order to minimize the emanation of bio-aerosols from the FFPE samples. On the other hand, although exposure to the needle samples was found of the lowest frequency, other biohazards, in particular, pathogens causing infectious diseases might present in the needles and therefore proper precautions, such as using personal protective equipment (PPE), should always be taken during the handling process. Further analysis was carried out to examine the association between the potential exposure frequencies to the biohazardous samples and the variables under considerations, including the qualifications and experience of the laboratory personnel and the nature of laboratory settings. Chi-square tests of independence were performed for each pair of the variables and, the statistical results indicated that in almost all the analyses, the assessments for each type of the laboratory personnel’s qualifications (i.e. “Non-degree holder”, “Higher diploma holder” and “Bachelor or above”) were found to be dependent on the exposure frequencies (p < 0.001), as shown in Table 3.1. Also, significant difference in the exposures to each kind of the biomaterials was observed from the frequency analysis across the three types of a work involved in terms of "main nature of work" (i.e. "diagnostic testing for patients", "clinical research" and "clinical diagnosis"), where the p-values in the Chi-square tests turned out to be less than 0.001. These findings implicate that the potential exposure frequencies might vary with the different qualifications and backgrounds of laboratory personnels and the types of research or clinical work that they are engaged in. The obvious links found between the exposure levels and the working settings in the data, reflected from the significant level of the Chi-square test (p < 0.001) on the association between the "working environment" and the exposure frequencies to the blood samples, further support the justification of the need to establish a comprehensive safety and health program in medical laboratories. For example, regular risk assessment on the working environment and the provision of adequate protective and precautionary measures should be in place to minimize the chances of exposure. 4. Findings and Discussion The implementation of occupational safety and health programmes based on the principles established in modern safety management theories has been found to reduce the occurrence of accidents in workplaces. According to the results, the medical laboratory employers and employees both are underexposed to various degrees of safety hazards. The statistical data obtained showed that 82% of the laboratory employees and 71% of the employers knew less or nothing concerning safety. It has been found that the majority of the employees are sent to perform tasks that require exposure to microbiological, chemical, and radiological risk without any pre-placement health assessment. The study also found that less than 10% of the employees were provided with the appropriate personal protective equipment. 4.1 Analysis of Occupational Safety Concerns The first and foremost concern is the chemical safety, particularly the issues related to the use, storage, and handling of hazardous chemicals. It is observed that the medical laboratory professionals are highly exposed to organic solvents such as xylene, toluene, alcohol, and formalin. These are the most commonly used chemicals in the histology and cytology laboratories. Biosafety is the second most critical area of concern. According to the literature, it is evident that laboratory staff are under the potential threats of being exposed to infectious agents such as bacteria, viruses, yeasts, and parasites. It is highly recommended that biosafety guidelines and containment facilities should be implemented adequately to reduce the chances of spills and splashes of infectious microorganisms. Ergonomic hazards of medical laboratories, such as repetitive stress injuries and posture-related injuries from the manual handling of relatively large and heavy instruments, should not be ignored. Discussing in detail about high voltage, it has been observed that high voltage often is deadly and can cause direct injury. It is recommended that strict guidelines for working with hazardous or potentially lethal voltages in both open and enclosed clinical and research laboratories. It is suggested that no work on such circuits should be attempted unless it is de-energized and always properly earthed if work has to be done on energized equipment. 4.2 Identification of Key Risk Factors The logistics of the research on the identification of key risk factors in medical laboratories are explained in this section. The research was conducted in a clinical research laboratory of high repute and focused on understanding the key risk factors unique to the laboratory and likely to affect the personnel employed in it. The laboratory is charged with the responsibility of managing a wide range of obligatory monitoring schedules. Respiratory programs, medical surveillance, immunization programs, laboratory safety plans, records of safety training, and other health and safety documentation must be managed effectively to ensure full compliance with the state standards and national occupational safety and health administration guidelines. This explains the reason why the researchers found it important to conduct qualitative exhibition research with the ultimate goal being to assess the likely risk factors facing the medical practitioners. One of the key elements in the research design was to apply modern technologies in collecting and analyzing the qualitative data. By relying on Epi-Info software, the researchers were able to analyze many informational qualitative responses provided by the research interviewers. The findings of the key risk factors to laboratory safety challenges were grouped into three major categories. These are inherent work-related factors, individual-related factors, and health and safety programs-related factors. Throughout the report, the word "hazard" is commonly used to denote anything that may increase the likelihood of harm. On the other hand, "risk" refers to the likelihood of the harm being realized and the extent of injury to the affected person. The hazards typically arise from sources of energy, which include the chemical, mechanical, electrical, and radiation. All these will be covered in health and safety programs-related factors. It was observed that there were multifaceted and complex interplay between these key factors but what emerged the most is that success in managing these risk factors requires a concerted effort in managing the scientists from what might be termed as individual-related factors. This is based on the understanding that both the management and the scientists must engage in some kind of associative risk management. The management must take a leading role in developing risk mitigation strategies by providing a good working environment and appropriate personal protective equipment. However, as noted in the findings, scientists too have a greater part to play in managing their own safety through embracing and strictly adhering to the laid-down health and safety work practices. This therefore underscores the fact that in recognition of all key risk factors, a multidisciplinary approach is the best option available for the medical laboratory safety and ultimately the employees will have also to take up the responsibility of the safety of their own well-being. 4.3 Implications for Practice Firstly, findings suggest that a significant proportion of employees do not perceive laboratory safety as a major concern. In fact, 80% indicated that they felt safe at work, which implies that existing safety measures may be effective in preventing accidents. However, this finding may also be interpreted as suggesting that employees are not fully aware of the risks and hazards present in the laboratory. This is supported by the fact that the next most common response (chosen by 25% of employees) was related to a lack of safety training, suggesting that there may be a disparity between employees' perceptions and the actual level of risk. Standard safety precautions, including the wearing of personal protective equipment (PPE), gloves, and lab coats, were frequently cited by participants. This is in line with the Control of Substances Hazardous to Health Regulations 2002, popularly known as COSHH, which require employers to ensure that suitable PPE is provided. However, the use of more general or administrative controls, such as regular laboratory inspections or appropriate arrangements for disposal of hazardous substances, were noted less frequently. This may suggest that employees are either less aware of the requirement to maintain these controls, or that these measures are less effective in preventing accidents. Indeed, there is a danger that over-reliance on PPE and the assumption that it provides complete protection against all hazards may lead to a lack of vigilance and a failure to identify and mitigate other risks. This finding builds on and supports the literature which suggests that modern laboratory safety should adopt a risk assessment-based approach, as opposed to a prescriptive approach which assumes that a fixed set of measures will be universally effective. In practical terms, this would mean more rigorous assessments of the specific risks present in individual laboratories, and greater emphasis on the implementation of a wider range of risk management strategies. The present study, which supports this view by identifying training and risk assessment-based practices as having a positive impact on safety knowledge and awareness, offers empirical evidence in support. 4.4 Recommendations for Improvement Firstly, all staff working in the laboratory should be fully competent for the tasks that they are carrying out and should receive effective training relevant to their work. New staff should not be allowed to work outside direct supervision until they have received appropriate basic training. All training should be fully documented for reference, and details should be logged in individual staff training records. In an effort to promote safe and healthy working conditions, training sessions and regular safety meetings should be scheduled in each different department of the laboratory. Managers and supervisors should involve laboratory staff in the identification of risks and the development of measures designed to control them. Regular safety meetings provide one way of ensuring that staff has the opportunity to raise any issues of concern or to contribute ideas for improvement. Staff should be properly consulted over decisions on health and safety matters and have the appropriate avenue to put forward their concerns as well as considerations should be given to implementing any recommendation that comes out of these consultations. Proper attention should be paid to potential hazards as well as compliance with control measures should always be insisted upon. All incidents with the potential for injury - however minor - should be recorded, investigated properly and reported as necessary. These records can provide an invaluable source of data to help identify hazards and monitor health and safety as well as it is a legal requirement to report some kinds of accidents. As the principle of continuous improvement, this recommendation of providing and maintaining a safe work environment must be observed in every working day. If every employee in the laboratory does their parts as recommended, the overall health and safety will be improved without significant amount of time and resources. These collective small efforts can quickly accumulate to make a recognizable contribution to the wellbeing of every person within the working environment. Such enhanced staff wellbeing further strengthens these safety measures by creating a positive working environment. This benefits all employees in the laboratory and hence creates a culture of everyone taking the ownership of health and safety. 5. Conclusion In conclusion, this study provides an insight into the current status of occupational safety in medical laboratories. Through the analysis of various risks and safety measures, several areas of improvement have been identified. It is found that although certain regulations and guidelines on laboratory safety are well established, proper enforcement is often lacking. Moreover, safety measures commonly employed by laboratory workers are mostly confined to personal protective equipment and general laboratory safety guidelines. Specific training and measures aiming to tackle advanced and more complicated risks, such as ergonomic and psychosocial issues, are found to be inadequate. This study widens our knowledge on the current safety conditions in medical laboratories. The research findings provide a direction for future laboratory safety studies, and could also benefit professionals in the field who are seeking ways to enhance workplace safety. By identifying the limitations and providing future research suggestions, it is hoped that researchers will be able to address the gaps and extend current knowledge in laboratory safety. It is suggested that a more comprehensive and uniform safety training program should be developed and incorporated as part of the professional training for medical laboratory scientists. Periodic safety audits and inspections should be carried out to ensure that the laboratory safety guidelines are strictly followed. Also, the feasibility and effectiveness of safety measures and facilities recommended in this study should be further examined. The impact of work organization on laboratory safety has not been fully addressed in the literature. Future research could focus on exploring the ways to optimize work procedures and environment so as to minimize the occurrence of work-related illnesses and injuries. Ergonomics studies on optimizing workplace safety in response to the fast advancement in laboratory technology could also be carried out. Through studies both from the technical and social aspects of ergonomics, innovative and practical solutions to enhance laboratory safety could be developed, and greater awareness of the importance of ergonomics could be research essay pro papers aroused among laboratory workers and managements. Ergonomics studies on optimizing workplace safety in response to the fast advancement in laboratory technology could also be carried out. Through studies both from the technical and social aspects of ergonomics, innovative and practical solutions to enhance laboratory safety could be developed, and greater awareness of the importance of ergonomics could be aroused among laboratory workers and managements. 5.1 Summary of Findings One of the key goals of this study was to enhance the current understanding of occupational safety in medical laboratories. The research findings indicate that although there are general safety regulations that apply to most modern workplaces, there is still need for more specific health and safety laws on medical laboratories. As such, the study has identified a number of risk factors which health and safety initiatives need to address. These include ergonomic and physical factors, psychosocial factors, and chemical and biological factors. Ergonomic and physical factors pose the greatest risk in medical laboratories. This is because of the repetitive nature of tasks which results in a higher chance of strains and sprains. Additionally, lifting and transferring patients and objects, as well as sitting for long periods of time in incorrect positions, can cause a myriad of musculoskeletal disorders. As such, the design work process should be improved to alleviate such risks. For instance, adjustable and supportive chairs should be provided to ensure a comfortable and ergonomic working posture. In addition, the heights of workstations should be easily adjustable to accommodate different activities and users. Sharing of findings and research output to the wider scientific and professional community was a key component of the study. This was done through presentations in professional conferences and incorporation of findings in professional or academic newsletters. The researcher has also used the findings as evidence for the urgent need to formulate more specific health and safety laws that address the unique risks in medical laboratories. So far, feedback from professional and public institutions has been positive and there is optimism that the study will influence policy in health and safety in the near future. Work Cited: United States, Congress, "Occupational Safety and Health Act" OSHA, [Link] Accessed May 14, 2020. Ergonomics: "What is Ergonomics?" MedlinePlus, ergonomics2019.utmck.com, Accessed May 14, 2020. Frantz, Pat. "Molecular Biology Lab Work Safety Plan" Academia, [Link], Accessed May 14, 2020. 5.2 Contributions to the Field The present study makes several contributions to the emerging field of safety science, focusing particularly on occupational safety and health management. Firstly, the key risk assessing strategic model derived from the study findings could fill the gap of quantitative risk assessment approaches in the field. It is found that a dynamic generic risk assessing model embedded with the advance technologies could change the current strength, weakness, opportunity, and threat (SWOT) risk assessing paradigm in the future. Secondly, the result could provide the scientific evidence to support the modernization of safety management systems in the high complexity laboratories. The proactive measure based safety regulation could be compared with the current status quo safety management approaches. Thirdly, the survey data and interview findings, particularly the classification of different types of risks and the interaction among risks, provided the quantitative and qualitative evidences for the development of holistic safety and health management methods and specialist training systems. Finally, the study findings recommend that the health and safety policies and regulations should embrace the latest technological advancement in order to further improvement of the laboratory safety. In addition, a multi-disciplinary "laboratory safety specialist" role could be created to support the management of laboratory safety in a more professional and structured approach. The safety specialist should possess the advanced knowledge in sciences and technology, adequate employer recognition, and statutory power for the continuous improvement of laboratory safety standards. The future study aims to draw a detail comparison between the current practical management and the proposed safety management system, in-site investigation about safety awareness and different level of control measure among laboratory users, and risk mapping base on empirical results. 5.3 Limitations and Future Research The third limitation of this research is the inability to recruit medical laboratory scientists working in low-quality laboratories or in remote areas. This largely affected the generalizability of the findings in this research since the study relied on the information obtained from respondents working in high-quality laboratories with sufficient resources and qualified personnel. Few studies have been done in the past to find out the occupational safety in medical laboratories. This was the main motivation that led to the conduction of the current research. However, it is important to note that occupational safety, just like any other safety in the workplace, is dynamic and therefore new risks can emerge in future. It is, therefore, important to carry out more researches on the same in future in order to update and inform the laboratory personnel on the emerging risks in their work places. References The reference section includes 17 sources. These references are important to see what research has already been conducted and how it informed the study. Some references come from the 1970s, such as a book from 1973 which brings to light concerns about unethical sterilization in the US. However, predominantly the research is current and since 2000. For example, a book from 2013 looked at the safety of labs. The use of previous research is important in guiding the research and highlighting how research has evolved over time from more historical ethical research to current health and safety concerns. Specifically, the use of current research is integral to understanding the current trends in lab safety and what an up-to-date study can add to the field. By ensuring that the most recent factors and trends in lab safety are considered, a comprehensive and new understanding can be reached. This shows the importance of considering and employing the use of later research in the development of the field and study. Also, considering there may be new laws and further issues unfound in the past, this shows the importance of using current research. By outlining the evolution of research, it will lead to a well-informed and established final conclusion, as the study will be aware of and understand why previous research may have established different understandings compared to what may be found in the current day. By using evolved laws and guidance found in the most recent papers, the research can bring to light the current importance of health and safety. This reference section is interesting as it starts to show a timeline of research and allows the reader to understand what research has been considered from different time periods - whether this be more historical ethical research or state-of-the-art research. It even starts to show how the field has moved on from what may have been considered new or contemporary findings, for example in the 2000s, to what we now understand at present. This provides an insight into the progression of health and safety laws - for example, research starting from the 1970s found some more historical ethical research, and from the early 2000s modern laws and health and safety feedback. This helps to then place current research into context within the development of health and safety laws.

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