GUIDELINES FOR HYGIENIC TESTING
THE PREVENTION OF INFECTIONS DURING PSYCHOPHYSIOLOGICAL RESEARCH
OCTOBER 2004
Contents:
A.Preface
B.Guidelines for the prevention of infections during psychophysiological research
C.Literature
Annex 4A: Working safely with chemical substances
Annex 4B: Working with CidexTM disinfectant
Annex 4C: Washing and caring for your hands
Annex 4D: Overview of relevant telephone numbers and e-mail addresses
A. PREFACE
For a number of years, physiological and non-physiological research in the Faculty of Psychology has been performed in the same building. Not only is this the result of the (former) department of psychophysiology relocating from the Jan Swammerdam Institute to the Psychological Laboratory, other programme groups and ‘sections’ are also using physiological research methods to an increasing degree.
The fact that this form of research is different from other psychological research is often expressed in telling remarks made by subjects who participate in a psychophysiological experiment: ‘Gosh, it looks like a hospital here…’ This kind of conclusion is correct to the extent psychophysiological research quite often features procedures that are medical in character: applying electrodes, taking blood or saliva samples, measuring blood pressure, etc.
Unfortunately the comment is not always correct when it comes to the hygienic aspects of the test room and/or the various procedures. This is probably due to the fact that, on the one hand, physiological and other types of research are performed so close to each other and, on the other hand, the chances of infection are zero because the work is done with ‘healthy’ subjects. Additionally, there may be a lack of knowledge and/or skills in the field of hygienic testing.
Even though it is definitely true that the chances of infection during psychophysiological experiments are smaller than in most medical ‘settings’, a number of arguments can still be made in favour of paying more attention to a hygienic test method:
1) Physiological research usually includes procedures that lead to direct physical contact between the Subject (S) and the Experimenter (E).
2) Instruments are often used that come into direct contact with the S (blunt or sharp needles, electrodes, etc.).
3) The research is generally performed in the same room(s) for all Ss and is done by the same E using the same set of instruments.
From these three points it can basically be concluded that relatively harmless infections such as influenza and the common cold can spread relatively easily from the S to the E and from the E to all Ss. However, this is not essentially different to other psychological research. It only changes when we consider that:
4) For some procedures bodily fluids (blood, saliva, etc.) are deliberately removed from the S, whilst this may occur accidentally during other procedures (e.g. due to skin damage).
This point implies that for physiological research there is a risk that participants (both Ss and E) come into contact with other people’s bodily fluids, either by direct contact or by contact via instruments (in the broadest sense of the word). It should therefore be clear that the transfer of dangerous infections such as Hepatitis B or HIV cannot be deemed impossible in advance. Finally, the following should also be noted:
5) Much physiological research involves the use of chemicals (alcohol, collodion, acetone, CidexR OPA, etc.), almost all of which are volatile, usually stupefying and/or toxic and sometimes corrosive.
6) All aspects of the research (recruitment of subjects, preparation, the research itself, the procedures and discussions after the research) must be planned in such a way that the mental well-being of the subjects is not put at risk. As said before, physiological research evokes associations with hospitals for many people, which can make an S nervous. If the S is ‘treated’ in a clean room and sees that the E is working hygienically this will definitely contribute to his/her confidence in the whole operation. However, there are also situations (e.g. research involving children) in which it is desirable to avoid a ‘hospital atmosphere’ as much as possible for the mental well-being of the S.
In the following a number of recommendations are given with regard to the procedure used for psychophysiological research. The recommendations are based on guidelines for healthcare from the Health Council of the Ministry of Public Health and Environmental Hygiene (1977) and the ‘Centers of Disease Control’ of the ‘U.S. Dept. of Health and Human Services (1987), among others. Furthermore, they almost exactly match the recommendations in the report by the ‘SPR ad-hoc committee on the prevention of disease transmission’ entitled: ‘Guidelines for reducing the risk of disease transmission in the psychophysiology laboratory’ (Putnam, Johnson & Roth, 1992). We have tried to find a compromise between, on the one hand, the strict requirements that apply to healthcare and, on the other hand, the current practice of psychophysiological research. The guidelines for psychophysiological research that arise from this compensate for the lack of knowledge in the field of hygienic testing mentioned above. However, if it is to have any chance of success, a change of attitude among all the people involved will also be required. If one or two people continue working under the assumption ‘that it’s all probably not such a big deal’, the implementation of the guidelines – even when observed by the majority – will be pointless.
Winni Hofman
Amsterdam, January 2001
Original version: July 1995.
Revised versions:
June 1998, December 1999, Guido Band
October 2004, Martin Elton
B. GUIDELINES FOR THE PREVENTION OF INFECTIONS DURING PSYCHOPHYSIOLOGICAL RESEARCH
1. General information
1.1Within the laboratory[1] the following guidelines apply to:
- all rooms used for psychophysiological research
- all people involved in psychophysiological research
- all people present in rooms intended for psychophysiological research (researchers, students, technical staff, cleaners, etc.)
1.2A number of guidelines serve as recommendations (indicated by R). Other guidelines serve as prescriptions (indicated by P). These must be observed without exception. People should not observe some instructions and ignore others: remember that other people also use the same rooms or equipment!
1.3Work on the basis of the assumption that all subjects and experimenters could be infected.
1.4If the research involves a reasonable chance of blood/blood contact, a hepatitis vaccination is recommended (R).
1.5In supervisor-student situations the supervisor will always have ultimate responsibility for safety and hygiene. He/she should therefore ensure that the student is aware of and familiar with the guidelines described here, and should also ascertain that they are actually observed.
1.6There is a Committee for Research Hygiene with the following duties:
- Keeping these guidelines up to date.
- Providing advice on central laboratory facilities.
- Assessing the practical feasibility of the recommendations made.
- Making students and staff aware of the guidelines.
- Providing additional recommendations/information, also to individual researchers.
- Monitoring compliance with the guidelines.
2. People
2.1 Postpone the research if the Experimenter or Subject has the flu, a severe cold or any other serious infection. (see arguments 1, 2 and 3) (R)
2.2Perhaps superfluously: make sure that your general physical and clothing hygiene is good during the research period. (R)
2.3Always wear (disposable) gloves during the following physiological procedures:
- cleaning/scrubbing of the skin of the Subject (P)
- applying electrodes to cleaned/scrubbed skin (P)
- removing electrodes (P)
- all procedures relating to blood, sperm or vaginal fluid (P)
- working with disinfectants (P)
- if the S or E has clearly visible wounds or skin irritation (P).
- It is recommended to wear gloves for every physiological procedure.
- As stated above (argument 4), there is almost always a chance of (accidental) blood/blood contact.
- Use new gloves for each Subject and dispose of old ones immediately after use.
- Before taking off the glove, take hold of the cuff and ‘peel’ it from your hand in a single movement. The glove will then automatically turn inside out. Never remove a glove by the fingers; this is to prevent touching ‘contaminated’ surfaces.
- Always wash your hands immediately after removing the gloves.
2.4.The easiest procedure for disinfection is washing your hands.[2] You must do this (regardless of whether gloves are used or not!):
- prior to physiological procedures (P)
- after physiological procedures (P)
- after going to the toilet (P)
- after sneezing, coughing or blowing your nose (use paper tissues!) (R)
- after accidental contact with blood or other bodily fluids (P)
Gloves can be damaged. You should therefore always wash your hands, both before putting them on and immediately after taking them off.
2.5.No rings should preferably be worn during research: (R)
- they make it more difficult to wash your hands and
- they increase the risk of the gloves becoming damaged
2.6.Nails should preferably be kept short during the research period: (R)
- in connection with washing your hands and keeping them clean, and
- to prevent the gloves from becoming damaged
3. Instruments
3.1Ready equipment as much as possible in advance, so that the number of cabinets, door-knobs, bottles and jars to be touched during the physiological procedures is kept to a minimum. (R)
3.2 Use disposable materials as much as possible and dispose of them (after single use) in containers intended for this (R):
a.Yellow waste container
location:waste freezer box[3] in general research room.
type of waste:used needles
b.White chemicals drum
location: worktop in general research room
type of waste: used CidexR OPA (general: organic substances with low halogen content)
replacement: full drums can be exchanged for empty ones at the Central Warehouse (building B, B03).
c.Waste-paper baskets
location: in every room
type of waste: other waste (coffee cups, writing paper, etc.)
replacement: by the cleaning staff
•Biomedical waste can be collected first in a cardboard collection tray and later placed in the B1 waste container together with the connection tray.
•Never use reusable towels or cloths, etc., use disposables instead; damp locations are very good feeding grounds for bacteria.
3.3 Reusable instruments must be disinfected/sterilised for each S. (R)
•Reusable needles (both blunt and sharp) can be sterilised by means of hot-air sterilisation, not with CidexR OPA 8.
•Instruments intended for invasive procedures must be sterilised; other instruments can be disinfected.
•Collect the material to be disinfected in a cardboard collection tray or a reusable ‘container’ specially intended for the purpose. Throw the collection tray in the B1 waste container after use (see 3.2). A reusable container must be disinfected together with the instruments.
•Thoroughly clean the instruments with warm water and soap before disinfecting. Use (household) gloves for this and a brush, which is to be stored separately or disinfected.
•Where available, follow the disinfection recommendations of the manufacturer. Otherwise:
•Disinfect it by immersing it in activated CidexR OPA solution for 10 minutes (see Annex B).[4]
•It is also possible to disinfect heat-resistant equipment in the hot-air oven (1 hour at 180°C, heat-up time not included).
3.4 When beds are used for the research:
•use cotton blankets, as these can be easily washed (for each Subject) (90°C), just like the other bedlinen.
•Use clean bedlinen for each Subject (blanket as well!).
•Place a washable tick or plastic cover over pillows and mattresses, and clean them for each Subject.
3.5Any towels, face-cloths, etc. intended for use by the Subject must be replaced for each Subject.
4. Research rooms
4.1For the physiological procedures/preparations (applying electrodes, taking blood/saliva samples, centrifuging, disinfecting, pipetting, etc.), use one general research room assigned for this purpose as much as possible[5]. (R)
•In this way any danger of infection will remain limited to a single room, which can be cleaned and disinfected accordingly.
4.2. If certain procedures must be performed in a location different to the room described under point 4.1 (e.g. the test set-up), this must only be done in the subjects section of the research unit. The researcher in question must ensure that the lab coordinator is aware of the types of procedures that are performed in the room and any precautionary measures that should be taken by other users (colleagues, technical staff, etc.). This also applies to research performed outside of the laboratory. (P)
4.3. Rooms in which physiological procedures are performed must not be used for preparing meals or consuming food. (P)
4.4. Rooms in which physiological procedures are performed must be cleaned every day (e.g. with a bleach solution). (R) This includes:
•wiping the floor
•wiping the furniture and other horizontal surfaces with a damp cloth.
4.5. In rooms where physiological procedures are performed the following must be checked every day:
•whether the paper towel roll should be replaced
•whether the soap dispenser should be refilled
•whether the waste-paper basket(s) should be emptied.
4.6. Rooms in which physiological procedures are performed must be wellventilated.
4.7Smoking is prohibited in all the rooms in the basement. (P)
•Volatile and other flammable substances are used.
•These are public areas, which are subject to national regulations.
•Some subjects are non-smokers.
5. Procedures
5.1.Invasive procedures (such as taking blood samples) may only be performed by qualified staff. (P)
5.2.When working with organic substances or chemicals, the work surface must be covered in absorbing paper. (P)
5.3.Prior to using a piece of equipment or substance (centrifuge, hot-air oven, CidexR OPA, etc.) every researcher must familiarise himself/herself with the correct use, safety measures and cleaning instructions for the piece of equipment or substance in question by consulting the user manual. (P)
C. LITERATURE
1.Advies inzake herziene richtlijnen ter preventie en bestrijding van ziekenhuisinfecties (Recommendation regarding renewed guidelines for preventing and combating hospital infections). Ministry of Public Health and Environmental Hygiene, The Hague (1977).
2.Recommendations for the prevention of HIV transmission in health-care settings. Centers for Disease Control (1987). Morbidity and Mortality Weekly Report, 36, (suppl 2S), 1s–18s.
3.Update: Universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health-care settings. Centers for Disease Control (1988). Morbidity and Mortality Weekly Report, 37, 377–388.
4.Extracts from ‘Electrode maintenance and infection control in the EEG laboratory’ [A.M.Grass & E.R.Grass]. In: Regan, D. Human brain electrophysiology. New York: Elsevier (1989).
5.CidexR OPA information brochure. Johnson & Johnson Medical BV
6.CIDEX™ approval certificate, Ministry of Welfare, Health and Culture (1991).
7.Putnam, L.E., Johnson, R.Jr. & Roth, W.T. (1992) Guidelines for reducing the risk of disease transmission in the psychophysiology laboratory. (SPR ad hoc committee report). Psychophysiology, 29 (2), 127-141.
ANNEX 4A: WORKING SAFELY WITH CHEMICAL SUBSTANCES
Chemical substances are considered to be all substances that are used during physiological research: alcohol, acetone, electrode paste, CidexR OPA, collodion, etc.
1Make sure that all bottles, jars, dishes, etc. are clearly and accurately labelled.
2Always check the label before using a substance,
•especially to make sure that the correct substance is being used, but also
•to establish whether certain precautionary measures have to be taken (read the user instructions or information leaflet where necessary[6]).
3Bottles, jars, dishes and Cidex containers must be kept closed as much as possible to prevent drying-out, evaporation.
•this is because of economic and health aspects,
•furthermore, many fumes directly affect the eyes, which is naturally highly undesirable in connection with visual tasks, etc.
4Never smell bottles, etc. directly; always wave some of the fumes towards your nose when smelling is necessary.
5Always make sure that the room is wellventilated.
6 Never use a bottle or jar for substances other than those stated on the label.
7 When substances come into contact with the skin, immediately rinse with lots of water for safety reasons.
8 When substances accidentally come into contact with the eyes, immediately rinse thoroughly with water. Never rub your eyes! Bend the plastic hose on the tap upwards and use it as an ‘eye shower’. Where required, an eye rinsing bottle is present in the storage cabinet in K16. Always use the cold tap and control the water supply with your free hand. Rinse both eyes one after the other and pause after a while to protect the eyes from hypothermia.Notify a doctor where required (first-aid hotline: 6228, psychology reception).
9For cases of poisoning, please contact:
•OLVG: 020 - 5999111 (ask for the hospital pharmacy)
•National Poisoning Centre: 030 - 2748888
10Never smoke in rooms where work is performed with chemical substances and be careful with open fire.
•Most substances that are used for psychophysiological research are (highly) flammable.
11Never flush chemicals down the sink, but collect them in a chemicals drum intended for the substance type in question (see 3.2). The colour of the drum indicates which class of chemicals may be poured into the drum. Information about the colour coding of chemicals drums can be requested from the H&S and Environmental Service of UvA (extension 6201). The drums themselves can be obtained from the Central Warehouse (building B, B03), which also takes care of replacing full drums.
12Always transport chemicals in a well-sealed container that has a clear label.
ANNEX 4B. WORKING WITH CIDEXR OPA DISINFECTANTS
The following is a summary of an information brochure published by Johnson & Johnson Medical BV and is in accordance with Annex I to the approval certificate of the substance Cidex by the Ministry of Welfare, Health and Culture dated 04-02-1991. For specific questions, please contact:
Johnson & Johnson Medical BV
Hospital Products Division
Postbus 188
3800 AD Amersfoort
Tel: 0800-0225566 (free)
Tel: 033-4500500
For CidexR OPA instructions for use, please consult the wall chart in the labelling room or read the instructions for use on any bottle. For more information, please contact psychology technical support or visit The description of CidexR OPA (as of 18-10-2004) is stated below.