Role of Hazard Analysis in Academic Research Anna Sitek Research Safety Specialist Goal: Conservation of Life Look for similarities Do you work with reactive materials? Do you visit labs where reactive materials are stored? Relate lessons to your work Hazard Analysis process 2 CEMS special safety seminar Incidents in academia UMN Case Study Review what happened Identify how the incident could have been prevented Apply Lessons Learned 3 Incidents in Academia UCLA Texas Tech Dartmouth Yale 4 Incidents in Academia Dartmouth 1997 Toxic heavy metal Inappropriate glove Death 5 Incidents in Academia UCLA 2009 Pyrophoric, flammable Poor technique, no ppe, improper response Death lawsuit 6 Incidents in Academia Texas Tech 2010 Explosive Scale, technique Injury, damage to lab 7 Incidents in Academia Yale 2011 Machine Work alone, E-stop not accessible Death 8 Incidents in Academia UMN 2014 Explosive Scale, technique Injury, damage to lab 9 Incidents in Academia Dartmouth UCLA Hazard TX Tech UMN High speed parts Explosive Toxic Pyrophoric Explosive Yale 2011 Hazard Analysis Machine Hazard Hazard Hazard Loose hair, E-stop Analysisnot accessible Analysis Analysis death Scale Error Yale Hazard Analysis Scale Equipment Technique Technique Technique Work alone Result PPE PPE Death Death PPE Death Injury, Damage to lab 10 Injury, Damage to lab UMN Case Study UMN Case Study What Happened? – Direct Cause Likely causes (official cause unknown): 1. NaN3 + PEG 300 (moisture?) to yield hydrazoic acid 2. Overheating of NaN3 colorless, volatile, toxic and explosive liquid Explosive decomposition: Contributing factors: Moisture, contaminants in the reagents, stirring, scale What Happened? – Root Cause Flawed Hazard Analysis: Scale overwhelmed available controls Unequal mixing indication of safety issue Purity and choice of reagents used new but not purified solvent substitution not vetted on large scale What Happened? – Hazard Analysis Risk of Hazard = severity x probability Severity (scale, inherent properties material) Probability (experiment conditions) Reaction conditions (T, P, atmosphere, light, solubility, purity of solvents and reagents, mixing, incompatibilities) Operator conditions ( experience, attention, current health etc) Identify how the incident could have been prevented Hazard Analysis Hazard Communication Safety Culture 16 Hazard Analysis- When, How? Scientific Method 1. 2. 3. 4. Theory Prediction Experiment Observation Evaluate Hazards Limits- Can I? Best Practices- How do others? Prepare for problems- What if? 1. 2. 3. Plan Experiment Document Safety Information 2. Propose Conditions Identify Hazards 3. Hazard Analysis 2. 4. Select Controls 3. 1. Communicate Hazards Standardize Process Check plan and implementation 1. 17 Limits ex. DOW SOC Hazard Evaluation Resources 19 Hazard Analysis- When, How? Scientific Method 1. 2. 3. 4. Theory Prediction Experiment Observation Evaluate Hazards Limits- Can I? Best Practices- How do others? Prepare for problems- What if? 1. 2. 3. Plan Experiment 1. 2. 3. 4. Propose Conditions Identify Hazards Hazard Analysis Select Controls Document Safety Information Communicate Hazards Standardize Process Check plan and implementation 1. 2. 3. 20 Controls reflect Hazard Analysis Hierarchy of Controls Elimination: Remove the hazard Eliminate the procedure Change your setup Substitution: Replace the hazard Use a non-hazardous or less hazardous reagent Use a milder route or process Controls reflect Hazard Analysis Engineering: Change the process or equipment to reduce the hazard Fume hood Blast shield Steel vessel Warning: Post signs warning of the danger Sign in your area with details and contact information External sign (room door, fridge door) Controls reflect Hazard Analysis Administrative: Establish policies to reduce risk or limit exposure Draft Standard Operating Procedures (SOPs) to detail correct procedures Personal Protective Equipment: Last line of defense (“seatbelt”) safety goggles/glasses lab coat gloves Hazard Analysis- When, How? Scientific Method 1. 2. 3. 4. Theory Prediction Experiment Observation Evaluate Hazards Limits- Can I? Best Practices- How do others? Prepare for problems- What if? 1. 2. 3. Plan Experiment 1. 2. 3. 4. Propose Conditions Identify Hazards Hazard Analysis Select Controls Document Safety Information Communicate Hazards Standardize Process Check plan and implementation 1. 2. 3. 24 Communicate Hazards- Safe Operation Cards Standardize Process Review Standard Operating Procedures Apply Lessons Learned Hazard Analysis Hazard Communication Limits synthesis Add physical hazards Training Warning relevant journals & organizations Policy on group meetings SOPs SOCs Safety Culture Spread Awareness 27 How can you apply lessons? • PIs, Managers, Committees – set upper limits – Train on factors affecting probability & severity • Experiment Planners – Design around primary reaction vessel – Discuss warning signs with researchers • Experiment Performers – Follow group policies – Communicate with others, signage – Be Mindful 28 Life-Long Learning Always search for new/more resources Literature updates New safety standards, literature and equipment New materials and techniques Never assume you know all the answers Avoid being “overly comfortable” “That will never happen to me” Communicate and Ask Questions Good Resources: Advisor/PI Faculty Postdocs, lab techs, graduate students Safety professionals Research Safety Officer DEHS Don’t be satisfied with an unsafe method or conditions! Apply Lessons Learned What is CEMS doing? Safety committee JST Share resources? Seminar Questions, Suggestions? 31 Thank you! Anna Sitek Research Safety Specialist (612) 625-8925 engl0131@umn.edu Investigation contributors: CHEM Safety Committee: Bill Tolman, Chuck Tomlinson, Ian Tonks, Valerie Pierre DEHS: Jodi Ogilvie, Joe Klancher, Mike Austin Questions How did you hear about the incident? What was your initial reaction? Suggestions for identifying limits? How many people think SOCs are a good idea? Going to review your group policies? 33