This document replaces all preceding documents. It applies to all staff and students undertaking work with human blood products and other human tissues.
The Human Tissue Act and the use of human tissue in the Faculty of Science and Engineering
Before proceeding with studies which involve the removal, storage or use of human tissue for research purposes, compliance with The Human Tissue Act must be ensured. Refer to the reference section of this document for guidance documentation and websites.
Working with Human Tissue
1. This Code of Practice applies to all persons working with human tissue for educational, training and research purposes in the Faculty. Effective implementation of this Code of Practice will ensure safe working with human blood, tissues and other specimens and compliance with the CoSHH Regulations.
2. For work involving human blood, tissues and other specimens where the presence of potentially lethal micro-organisms is unknown:
a. where there is no intention to work with pathogens but they may be present in samples the work must be carried out at Containment Level 2, possibly with additional control measures, unless it is known or suspected that a higher Containment Level is required. In the Faculty of b. Science and Engineering, this level of containment is provided ONLY on the second floor and in the research laboratories of the Rosalind Franklin Building.
b. if it has not been possible to carry out a conclusive risk assessment and the work may involve a serious health risk to employees and students then Containment Level 3 must be used, and this is not available within the Faculty.
3. Where possible, all human tissue must have been either screened or a risk assessment carried out for the presence of HIV and Hepatitis B and C prior to release from the donating hospital, reagent manufacturer/supplier, or prior to blood sampling.
4. Risk Assessments should be carried out prior to commencement of work regarding the handling of blood, tissue or other body fluids. Staff and non-supervised research students handling blood, tissue or other body fluids should obtain appropriate training and immunisations and appropriate records kept. Supervised students should receive an appropriate briefing on working with human blood and the necessary precautions to take prior to starting work with human blood and other tissues.
5. Undergraduate students must closely follow practical protocols written and approved by the academic lead of the session during which the human source material is to be used. These must be consistent with CoSHH regulations. The use of human blood products and human bodily fluids in undergraduate practical sessions must comply with points 2 and 3 of this code.
6. MSc and undergraduate project students must use protocols approved by their supervisors who must ensure the appropriate training is delivered. These protocols must be consistent with CoSHH regulations.
7. Material must normally be transported to the University from the donating hospital in sealed plastic containers packed in ice within a steel impact-resistant flask.
8. Laboratory coats must be worn when working with human tissue. These are to remain in designated areas after use prior to their removal (in sealed bags) for laundering. Lab coats must not leave the laboratory for any other reason. They must not be worn in offices or communal areas.
9. When handling the material, disposable gloves must be worn which are subsequently sent for incineration via clinical waste. Safety glasses must also be worn. During the processes of homogenisation and centrifugation, face masks must also be worn and work carried out in a class 2 safety cabinet.
10. The use of sharps should be avoided but if unavoidable safe sharps practice should be followed. All sharps should be disposed of directly into a purpose-made sharps bin. These should be kept as close to the work area as possible to reduce the distance that sharps are carried before disposal. All sharps should be incinerated. See point 18 for safe sharps practice.
11. Any surface with which tissue comes into contact must be of a non-absorbent nature, usually glass or disposable, single use plastics. The number of vessels used should be kept to a minimum.
12. Tissue must be handled in designated areas only. The movement of material between rooms must occur within closed containers.
13. All low-speed centrifugations must be carried out in capped tubes within a sealed rotor. Subcellular centrifugation is normally conducted in a zonal rotor. Aerosol formation is therefore eliminated during these processes.
14. All fluids known or thought to be contaminated with human material must be mixed with distel (1 in 100 working solution) and left to stand for 20mins prior to disposal.
15. Non-disposable apparatus must be thoroughly cleaned with the proprietary viral disinfectant 'distel' (working dilution 1 in 100) prior to soaking in 100% alcohol. Disposable material must be sealed in suitably marked bags and sent for clinical waste incineration.
16. Human material must be stored in a designated freezer with the containers sealed in plastic bags/boxes bearing BIOHAZARD labels.
17. Other staff and students working in the designated areas must be made aware of the presence of human material, both in its stored form and more importantly, when actually being handled.
18. Access to the Faculty laboratories is strictly limited to 'authorised personnel only. The doors must remain closed at all times - visitors must be prohibited from entering when such tissue is being handled.
19. In the event of an accident involving human tissue where the risk of infection is increased, advice must be sought immediately from the relevant medical authorities. An exposure is significant where
a. Exposure is caused by a puncture wound, cut, scratch or by a splash into the eye, mouth or onto broken skin, or if an aerosol has been accidentally created contamination by inhalation exists
b. The material involved is blood, serum, CSF, genital secretions or other body fluids or unfixed tissue samples
c. The risk of disease transmission is increased if the injury is deep, or caused by a hollow needle especially if just used for venous or arterial puncture, or there is visible blood on the devise
d. A splash of blood etc. onto visibly intact skin is NOT considered a significant risk unless extensive or prolonged
Refer to point 21 for action required following accidental exposure
20. Safe sharps practice:
a. Sharps containers should never be overfilled: discard when ¾ full
b. Any inoculation incident from contaminated equipment should be reported as an accident and advice sought from Occupational Health as soon as possible. Also see the emergency procedures outlined in point 21.
c. Seal the container as described by the instructions on the container and place in the clinical waste holding bins.
21. Action following exposure incident
a. Encourage bleeding, but do not scrub the wound as this may increase tissue damage
b. Wash any wound or contaminated skin with soap and clean water and cover with a sterile dressing
c. If blood is splashed into the eye or mouth, stop and wash out immediately with tap water (use eye wash stations)
d. If first aid treatment is required then call the nearest designated first aider to attend
e. Report to occupational health as a matter of urgency providing Name, Time and Date of injury together with details of the injury
f. Report the accident using the appropriate incident report form.
22. All experiments involving use of human tissue must be fully recorded and these records must be available for inspection at any time (COSHH regulations will also apply, see relevant Code of Practice).
23. This section is concerned with human blood/tissue samples that have been collected elsewhere and are being sent to the University of Wolverhampton for research or educational purposes.
Human Tissue Act : The use of all human tissues and blood samples is regulated by the Human Tissue Act 2004. All work with Human Tissue Samples must comply with the Act. Approval must be sort prior to work.
Risk Assessment : All blood, tissue or other body fluid samples sent to the University for Research Purposes should be handled using standard precautions, treated as a potential risk of blood borne viruses, and be clearly labelled as one of the following:
1. Screened for known pathogens
2. Unscreened but low risk
3. Known to contain pathogens
Sample Receipt : A specific person should be identified to receive the sample(s) and ensure the sample is properly receipted, unpacked and stored. All work with samples labelled 1. or 2. should be carried out in at Containment Level 2. The University does not have the facilities to receive or carry out work with samples labelled 3.
Code of Practice: Registration and Storage of Human Tissue for the Purpose of Research in the Faculty of Science and Engineering – Compliance with the Human Tissue Act (2004)
University of Wolverhampton Policy for Use of Human Tissue for Research: http://www.wlv.ac.uk/research/about-our-research/policies-and-ethics/ethics-guidance/use-of-human-tissue-for-research/uow-policy-for-use-of-human-tissue-for-research/
Code of Practice : Human Blood Sample Collection in the Faculty of Science and Engineering
Human Tissue Authority Website : https://www.hta.gov.uk