Role of Hazard Analysis in
Academic Research
Anna Sitek
Research Safety Specialist
Goal: Conservation of Life
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Look for similarities
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Do you work with reactive materials?
Do you visit labs where reactive materials are stored?
Relate lessons to your work
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Hazard Analysis process
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CEMS special safety seminar
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Incidents in academia
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UMN Case Study
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Review what happened
Identify how the incident could have been
prevented
Apply Lessons Learned
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Incidents in Academia
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UCLA
Texas Tech
Dartmouth
Yale
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Incidents in Academia
Dartmouth 1997
 Toxic heavy metal
 Inappropriate glove
 Death
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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
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Incidents in Academia
Yale 2011
 Machine
 Work alone, E-stop
not accessible
 Death
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Incidents in Academia
UMN 2014
 Explosive
 Scale, technique
 Injury, damage to lab
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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
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Error
Yale
Hazard
Analysis
Scale
Equipment
Technique
Technique
Technique
Work alone
Result
PPE
PPE
Death
Death
PPE
Death
Injury,
Damage to
lab
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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:
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Scale overwhelmed available controls
Unequal mixing indication of safety issue
Purity and choice of reagents
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used new but not purified
solvent substitution not vetted on large scale
What Happened? – Hazard Analysis
Risk of Hazard = severity x probability
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Severity (scale, inherent properties material)
Probability (experiment conditions)
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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
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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.
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Limits ex. DOW SOC
Hazard Evaluation Resources
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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.
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Controls reflect Hazard Analysis
Hierarchy of Controls
 Elimination: Remove the hazard
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Eliminate the procedure
Change your setup
Substitution: Replace the hazard
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Use a non-hazardous or less hazardous reagent
Use a milder route or process
Controls reflect Hazard Analysis
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Engineering: Change the process or equipment to
reduce the hazard
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Fume hood
Blast shield
Steel vessel
Warning: Post signs warning of the danger
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Sign in your area with details and contact information
External sign (room door, fridge door)
Controls reflect Hazard Analysis
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Administrative: Establish policies to reduce risk or
limit exposure
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Draft Standard Operating Procedures (SOPs) to detail
correct procedures
Personal Protective Equipment: Last line of
defense (“seatbelt”)
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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.
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Communicate Hazards- Safe Operation
Cards
Standardize Process
Review Standard Operating
Procedures
Apply Lessons Learned
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Hazard Analysis
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Hazard Communication
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Limits synthesis
Add physical hazards
Training
Warning relevant journals & organizations
Policy on group meetings
SOPs
SOCs
Safety Culture
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Spread Awareness
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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
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Life-Long Learning
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Always search for new/more resources
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Literature updates
New safety standards, literature and equipment
New materials and techniques
Never assume you know all the answers
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Avoid being “overly comfortable”
“That will never happen to me”
Communicate and Ask Questions
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Good Resources:
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Advisor/PI
Faculty
Postdocs, lab techs, graduate students
Safety professionals
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Research Safety Officer
DEHS
Don’t be satisfied with an unsafe method or
conditions!
Apply Lessons Learned
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What is CEMS doing?
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Safety committee
JST
Share resources?
Seminar
Questions, Suggestions?
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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
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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?
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