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Laboratory Safety


Title: Laboratory Safety Author: kaz5485 Last modified by: ZOHNER, Kimberly A. Created Date: 4/22/2009 4:43:21 PM Document presentation format: On-screen Show (4:3) – PowerPoint PPT presentation

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Title: Laboratory Safety

Laboratory Safety
  • After finishing this module, employees will be
    able to discuss
  • Standard Precautions
  • Control Methods
  • Personnel Protective Equipment
  • Waste Management
  • How to report a safety concern

Safety, safety, safety.
  • It seems that every time a laboratory employee
    turns around they are required to take another
    safety module. We have Fire Safety, Electrical
    Safety, Hazardous Chemicals, Latex Allergy
    Awareness, Infection Prevention, Tuberculosis
    Control and Blood Borne Pathogens. Safety
    education ensures that the laboratory complies
    with state, local, federal and College of
    American Pathologists mandates. These are all
    good reasons to provide safety education but they
    are not the most important. The most important
    reason to focus on laboratory safety is YOU.
    This module will highlight important safety
    requirements in the laboratory that help keep you

Standard Precautions
  • Standard precautions means that all blood, body
    fluids and tissue specimens will be considered
    potentially infectious for HIV, Hepatitis B,
    Hepatitis C and all other blood borne pathogens.
    Standard precautions include using appropriate
    personnel protective equipment, correct sharps
    handling, good hand washing and good housekeeping

  • Standard precautions are an essential component
    of safe laboratory practices. About 9700 new
    cases of Hepatitis C and Hepatitis B are reported
    in healthcare workers each year. The number of
    infections may actually be much higher since many
    people are unaware that they are infected.
    Hepatitis B vaccine is available free of charge
    for all laboratory staff. Employees are
    encouraged to be vaccinated against Hepatitis B.
    No vaccine is available for HIV or Hepatitis C.

  • All members of the laboratory staff should be
    familiar with the Exposure Control Plan Blood
    Bourne Pathogens. This plan provides policy and
    work practices to prevent the spread of disease
    resulting from exposure to blood or other
    potentially infectious materials. The plan has
    been developed in accordance with the OSHA Blood
    Borne Pathogens Standard, 29 CFR 1910.1030. The
    BJH Lab Exposure Control Plan Blood Bourne
    Pathogens and the OSHA standard can be found on
    the laboratory intranet website as part of the
    Safety Manual. If you do not know how to access
    the Lab Website, contact a manager or supervisor
    for help.

Control Methods
  • Three types of control methods are used to
    provide a safe laboratory environment.
  • Engineering controls
  • Work controls
  • Personnel protective equipment.

Engineering Controls
  • Engineering controls are items that eliminate or
    isolate a hazard. Laboratory management works in
    concert with the Environmental Health and Safety
    department to ensure appropriate engineering
    controls are in place to protect laboratory
    staff. Examples of engineering controls include
  • Sharps containers
  • Safer sharps devices
  • Hand washing facilities
  • Autoclaves
  • Biological safety cabinets
  • Eye wash stations
  • Safety showers
  • Fire extinguishers
  • Fume hoods
  • Spill kits
  • Biohazard waste containers
  • Hazardous waste containers
  • The best engineering controls available are
    useless if staff do not use them.

Emergency Eyewash Stations
  • Eyewashes are located in areas where biological
    or chemical contamination might occur. Eyewashes
    must be kept clean and free of clutter at all
    times. Required weekly maintenance includes
    flushing the lines and cleaning the surface of
    the eyewash. Nothing should be placed in front
    of or around the area that would stop your
    ability to activate the eyewash with one hand in
    a single motion. The faster contaminates are
    removed from the surface of your eye, the better
    the outcome.

  • If your eyes are ever splashed with biological or
    chemical material, go immediately to the eyewash
    and activate. Hold the contaminated eye open and
    flush for at least15 minutes. Roll the eye to
    flush as much surface as possible. Try to keep
    the other eye closed to avoid cross-contamination.
    Notify a supervisor or manager after your eye
    has been flushed. If available, a co-worker can
    notify management or Occupational Health for
    further instructions while your eye is being
    flushed. Always complete an Employee Report of a
    Work-Related Injury, Illness or Exposure form.
    If Occupational Health is closed, employees
    should contact the House Nursing Supervisor at
    424-1662 to authorize treatment in the Emergency

Safety Showers
  • Safety showers are located in areas where
    biological or chemical contamination might occur.
    These are tested annually by Facilities
    Maintenance. These are used when spills cover a
    large surface area on a worker. They rapidly
    flush the entire area with large quantities of
    water. Notify a supervisor or manager after the
    area has been flushed. If available, a co-worker
    can notify management or Occupational Health for
    further instructions while the contaminated
    employee is showered. Always complete an Employee
    Report of a Work-Related Injury, Illness or
    Exposure form. If Occupational Health is closed,
    employees should contact the House Nursing
    Supervisor at 424-1662 to authorize treatment in
    the Emergency Department.

Sharps Containers
  • Sharps containers are located in areas where
    needles, scalpel blades or other sharps waste is
    generated. They are bench top boxes with safety
    lids. These containers do not require a liner,
    should be filled to the fill line on the
    container (about ¾ full) and will be locked in
    the closed position and removed by Housekeeping
    for segregated disposal.

Chemical Spill Kits
  • Spill kits are located in areas where there is
    the potential for large quantities of chemicals
    to be spilled. Spill kit sets usually contain a
    kit each for Solvent, Acid Caustic spills.
  • In the event of a large spill contact security at
    362-0911 and clear personnel from the area until
    help arrives. Security will contact EHS. It is
    important to have the SDS sheet for the chemical
    available when Security EHS arrive on the

Exposures Biological Spills
  • If you are exposed to a biological substance
  • Normal business hour pager 490-7358.
  • After- hours hot line for needle stick body
    substance exposures 747-3535
  • Call Housekeeping immediately for biological
    spill clean up.

Work Controls
  • Work Controls are a second type of safety control
    method. Generally, work practices are used to
    eliminate the likelihood of exposure by changing
    the manner in which a task is performed. Most
    work practices apply to all areas of the
    laboratory and are just common sense. The
    practices are
  • NO eating or drinking in the lab
  • NO manipulation of contact lenses
  • NO application of makeup or lip balm
  • NO food or beverages may be kept in refrigerators
    or freezers inside the lab
  • NO mouth pipetting is allowed
  • Always wear a lab coat inside the lab
  • Never wear a lab coat outside the lab
  • Use aseptic techniques for removal of gloves
  • Use proper hand washing techniques

  • Other things to think about
  • Do not touch your face or hair with a gloved
  • Never put a pen or pencil used in the laboratory
    in your mouth.
  • Anything you touch with a gloved hand is
    contaminated. Remember this when using phones or
    touching door knobs.

Proper hand-washing techniques
  • Good hand-washing techniques include washing your
    hands with soap and water or using an
    alcohol-based hand sanitizer.
  • Soap and water must be used when hands are
    visibly soilded.
  • It is important to remember that hand washing is
    the single most important action you can take to
    prevent the transmission of infections.

Proper hand washing with soap and water
  • Follow these instructions for washing with soap
    and water
  • Wet your hands with warm, running water and apply
    liquid soap or use clean bar soap. Lather well.
  • Rub your hands vigorously together for at least
    15 to 20 seconds.
  • Scrub all surfaces, including the backs of your
    hands, wrists, between your fingers and under
    your fingernails.
  • Rinse well.
  • Dry your hands with a clean or disposable towel.
  • Use a towel to turn off the faucet.
  • Use a towel to open door.

  • Alcohol-based hand sanitizers
  • The CDC recommends choosing products that contain
    at least 60 percent alcohol. Only use BJH
    provided sanitizers at work.
  • To use an alcohol-based hand sanitizer
  • Apply about 1/2 teaspoon of the product to the
    palm of your hand.
  • Rub your hands together, covering all surfaces of
    your hands, until they're dry.

If your hands are visibly dirty, wash with soap
and water rather than using a sanitizer.
  • Always wash your hands in the following
  • After removing gloves.
  • Before leaving the lab.
  • Before touching anything in a clean area.
  • Before and after using the restroom.
  • Whenever hands are visibly soiled.
  • Between every patient contact.

Personal Protective Equipment (PPE)
  • PPE should be worn when there is a reasonable
    likelihood of exposure to the skin, eyes, mouth
    or other mucous membranes. PPE must not allow
    blood or other potentially infectious material to
    reach clothes, skin or mucous membranes under
    normal conditions.
  • Gloves protect the hands and must fit properly.
  • Lab coats or aprons protect the skin and/or
    clothing, must be knee-length and buttoned or
    snapped at all times in the work area.
  • Masks and respirators protect the mouth and nose.
    The respirator has been designed to also protect
    the respiratory tract from airborne transmission
    of infectious agents.
  • Goggles protect the eyes, and face shields
    protect the entire face.
  • Shoes must adequately cover the foot and have no
    perforations, are not sandals and are not made of

  • PPE must be easily available to all staff and
    come in appropriate sizes. PPE must be removed
    prior to leaving the laboratory.
  • PPE must be removed when visibly soiled. Soiled
    lab coats must be placed in the appropriate
    soiled laundry container.

  • Gloves protect you against contact with
    infectious materials. However, once contaminated,
    gloves can become a means for spreading
    infectious materials to you, other patients or
    environmental surfaces. Therefore, the way YOU
    use gloves can influence the risk of disease
    transmission in your healthcare setting. These
    are the most important dos and don'ts of glove

Work from clean to dirty
  • This is a basic principle of infection control.
    In this instance it refers to touching clean body
    sites or surfaces before you touch dirty or
    heavily contaminated areas.

Limit opportunities for touch contamination -
protect yourself, others and environmental
  • How many times have you seen someone adjust their
    glasses, rub their nose or touch their face with
    gloves that have been in contact with blood or
    other potentially infectious material? This is
    one example of touch contamination that can
    potentially expose you or your coworkers to
    infectious agents. Think about environmental
    surfaces too and avoid unnecessarily touching
    them with contaminated gloves. Surfaces such as
    light switches, door and cabinet knobs can become
    contaminated if touched by soiled gloves. Gloves
    should not be worn outside the laboratory. If
    you must carry specimens to another lab, hold the
    specimens with a gloved hand and open doors or
    touch elevator buttons with an ungloved clean

  • Change gloves as needed. If gloves become torn or
    heavily soiled, change the gloves before starting
    the next task.
  • Always change gloves after use on each patient
    and discard them in the nearest appropriate
  • Gloves can be discarded in regular waste. If
    visibly soiled, they should be discarded in
    bio-hazardous waste containers.

Face Protection
  • Combinations of PPE types are available to
    protect all or part of the face from contact with
    potentially infectious material. The selection of
    facial PPE is determined by the nature of the
    hazard and the likelihood of splashing.

  • Masks should fully cover the nose and mouth and
    prevent fluid penetration. Masks should fit
    snuggly over the nose and mouth. For this reason,
    masks that have a flexible nose piece and can be
    secured to the head with string ties or elastic
    are preferable.
  • Goggles provide barrier protection for the eyes
    personal prescription lenses do not provide
    optimal eye protection and should not be used as
    a substitute for goggles. Goggles should fit
    snuggly over and around the eyes or personal
    prescription lenses. Goggles with anti-fog
    features will help maintain clarity of vision.
  • Face shields are used when skin protection, in
    addition to mouth, nose, and eye protection, is
    needed or desired. The face shield should cover
    the forehead, extend below the chin, and wrap
    around the side of the face.

  • PPE also is used to protect healthcare workers
    from hazardous or infectious aerosols, such as
    Mycobacterium tuberculosis. Respirators that
    filter the air before it is inhaled should be
    used for respiratory protection. The most
    commonly used respirators in the laboratory are
    N95 respirators. The device has a sub-micron
    filter capable of excluding particles that are
    less than 5 microns in diameter. Respirators are
    approved by the CDCs National Institute for
    Occupational Safety and Health. Annual fit
    testing must be performed on staff required to
    wear N95 respirators. More information on the
    BJH respiratory program can be found in the
    Tuberculosis Exposure Control Plan in the
    Laboratory Safety Manual.

  • QUIZ 1
  • Standard precautions means that only known
    infectious samples will be treated using
    protective measures.
  • True or False
  • Control methods include which of the following.
    Check all that apply.
  • a) Environmental Controls
  • b) Work Controls
  • c) Monitoring Controls
  • d) Personal Protective Equipment
  • Which of the following are not types of personal
    protective equipment. Check all that apply.
  • a) Gloves
  • b) Respirators
  • c) Lab Coats
  • d) Sandals
  • e) Prescription Eye Glasses
  • f) Face Shields

  • While wearing gloves you touch your face or
    adjust your glasses. This is an example of touch
  • True or False
  • What is the number one thing you can do to
    prevent the spread of disease?
  • a) Wear a lab coat
  • b) Wash your hands
  • c) Wear a mask or respirator
  • d) Get the Hepatitis B vaccine
  • e) Follow Standard Precautions
  • When injured at work, who should be notified?
  • a) Manager
  • b) Supervisor
  • c) Occupational Health
  • d) All of the above

Waste Management
The type of waste generated in the laboratory can
be either non-hazardous, hazardous or biological.
Waste management is the responsibility of
Environmental Health Safety and laboratory
personnel. EHS will help the laboratory
determine the type of method to use for safe
disposal of all waste.
Hazardous waste
  • Hazardous waste - any waste or combination of
    wastes which, because of its quantity,
    concentration, physical, or chemical
    characteristics may cause or significantly
    contribute to a potential threat to the health of
    humans or the environment. Hazardous waste is
    regulated under the Resource Conservation and
    Recovery Act (RCRA) Subtitle C. RCRA defines
    hazardous waste as any waste that appears on one
    of the four hazardous waste lists (F-list,
    K-list, P-list U-list) or exhibits at least one
    of four characteristics ignitability,
    corrosivity, reactivity or toxicity.

Satellite Accumulation Area a designated area
for collection of hazardous waste. This area
must comply with the following Missouri
Department of Natural Resources (MDNR) standards
  • Containers must be kept closed between fillings.
  • Containers must be in good condition
  • Waste must be compatible with container.
  • Containers are transported to storage or Final
    Disposal within 3 days of filling.
  • Containers must be marked to identify contents
    and beginning date.
  • Containers must be marked with an end date.
  • Containers must be stored in satellite storage
    for less than one year.
  • The laboratories will conduct a weekly audit of
    satellite accumulation areas that is turned into

  • All reagents, chemicals and gases are evaluated
    for hazardous properties by EHS. This is done
    by reviewing the MSDS sheets provided from the
    manufacturer, RCRA, Missouri Sanitation
    Department and Missouri Department of
    Transportation guidelines. There are three types
    of hazardous waste produced by the laboratories
    gas, liquid and solid.

  • Liquid waste is disposed of via plumbed blue
    waste drains for instrument waste. Waste goes to
    a neutralizing tank in the East Pavilion
    basement. Once neutralized, waste flows from the
    neutralization tank into the sewer system. The
    neutralization tank is shut down once a year for
    cleaning of solid waste. This is the
    responsibility of Facilities Engineering.

  • Reagent waste that is collected by an instrument
    on board and disposed of via the sink drain is
    tested at least twice annually for pH to confirm
    that it falls within acceptable range.
  • The Missouri Sanitation Department (MSD)
    guidelines established for Barnes-Jewish Hospital
    in our NPDES discharge permit are pH 5.5 11.5.
    (Note RCRA guidelines for non-hazardous waste
    disposed of via the sink drain or for plumbed
    instruments is pH 3.0 12.0.)
  • If waste exceeds the allowable range, it is
    treated as hazardous waste. If waste is confirmed
    to be within the allowable range, it is disposed
    of via the sink drain.

Solvent Waste
  • Solvent Waste is collected in 20 gallon drums.
    The drum is labeled with the Flammable Liquids
    sticker and a dated contents sticker. Collection
    duration should not exceed 1 year. Satellite
    waste accumulation containers for solvents that
    are attached to an instrument, should be emptied
    daily into the solvent drum. EHS is notified to
    replace the drum when it is ¾ full. Pick-up must
    occur within 3 days of notification.
    Documentation of all waste disposal is kept in

Biohazardous Waste
  • The laboratory uses three types of containers for
    biohazardous waste collection. Only contaminated
    items should be disposed of in the biohazardous
    was receptacles.
  • Sharps containers
  • Small red containers with flip top lids. These
    containers are emptied by Housekeeping.
  • Large red containers with removable lids. The
    large containers are suitable for discarding
    glass or other breakables.

  • Segregation of infectious waste is both a cost
    issue and a compliance issue to the hospital.
    However, we will not compromise the safety of
    employees or the community.
  • Staff is encouraged to err on the conservative
  • In other words, if there is any question about
    waste being contaminated, treat it as
    contaminated and dispose of it as infectious

  • The formal interpretation from OSHA, using the
    CDC guidelines, indicates that infectious waste
    is liquid or semi-liquid blood or other
    potentially infectious materials contaminated
    items that would release blood or other
    potentially infectious materials in a liquid or
    semi-liquid state if compressed items that are
    caked with dried blood or other potentially
    infectious materials and are capable of releasing
    these materials during handling. The key words
    that dictate disposal methods are "compressed"
    and "caked" and "are capable of releasing these
    materials during handling".

Biohazard containers should contain only
contaminated items.
  • Diluted or undiluted body fluid or other
    infectious substance
  • Items moderately (moist) to heavily (saturated)
    contaminated with diluted or undiluted body fluid
    or other infectious substance
  • Items caked with dried body fluid or other
    infectious substance
  • Items which contain or did contain any quantity
    of infectious material

  • For example Vacutainer tubes and stoppers,
    pour-off tubes, blood gas syringes (without
    needles), sample cups, heavily soiled gloves,
    tissues from pipet tip wiping, paper towels from
    minor clean-up of biohazards. If gloves or other
    products are deemed non-infectious they can be
    disposed of in the bulk trash.

  • SDS sheets are provided by manufacturers to list
    all potentially hazardous components that are
    contained in reagents, chemicals or other
    products. The listed components can either be
    hazardous to humans or the environment. There
    are a large number of hazardous chemicals that
    laboratory personnel work with on a daily basis.
    We sometimes forget that even something as simple
    as a toner cartridge contains hazardous

  • SDS sheets contain the following information
  • Chemical Product and Company Identification
  • Composition and Information on Ingredients
  • Hazards Identification
  • First Aid Measures
  • Fire and Explosion Data
  • Accidental Release Measures
  • Handling and Storage
  • Exposure Controls/Personal Protection
  • Physical and Chemical Properties
  • Stability and Reactivity Data
  • Toxicological Information
  • Ecological Information
  • Disposal Considerations
  • Transport Information
  • Other Regulatory Information

SDS sheets should be located in a prominent and
easily accessible location in each laboratory.
There should be a sign posted for employees to
easily find their location. SDS sheets can also
be found on the laboratory website by using the
MSDS online link.
Other Safety Concerns
Laboratory safety is the responsibility of all
laboratory personnel. It is up to us to bring
unsafe practices to the attention of Supervisors,
Managers and the Laboratory Safety Officers.
There are also other governing agencies that you
can notify of unsafe practices. This is how the
laboratory can provide a Culture for Patient
Reporting adverse events related to failed
medical devices
  • When information reasonably suggests that a
    laboratory product has or may have caused or
    contributed to a patient death or serious patient
    injury, the FDA requires health care
    professionals in hospitals to report the event.
    If the event is death, the report must be made
    both to FDA and the device manufacturer. If the
    event is serious patient injury, the report may
    be made to the manufacturer only, unless the
    manufacturer is unknown, in which case the report
    must be submitted to FDA. Reports must be
    submitted on FDA Form 3500A (http//
    acom/morechoices/fdaforms/cdrh.html) or an
    electronic equivalent as soon as practicable,
    but, no later than 10 working days from the time
    personnel become aware of the event.

  • FDA defines "serious patient injury" as one that
    is life threatening or results in permanent
    impairment of a body function or permanent damage
    to a body structure or necessitates medical or
    surgical intervention to preclude permanent
    impairment of a body function or permanent damage
    to a body structure. Inaccurate test results
    produced by an IVD and reported to the health
    care professional may lead to medical situations
    that fall under the definition of serious injury
    as described above, and therefore are reportable

  • BJH Policy Medical Device Reporting of Failed
    Medical Device contains detailed information on
    reporting. A preliminary report should be
    completed and forwarded to BJH Risk Management.
    An employee may voluntarily report serious
    adverse patient events related to a medical
    device. Information on how to submit a voluntary
    report is provided at http//
    report/hcp.htm, or by calling 1-800-FDA-1088.

Reporting other safety concerns
  • Employees should immediately report any concerns
    regarding the quality of laboratory testing or
    safety related issues to laboratory management
    If an employee does not feel that a concern has
    been adequately addressed they should contact
    Laboratory Administration or submit an employee
    feedback form available on the Department of
    Laboratories website. Employees may communicate
    with any regulatory agency if they feel that an
    issue involving quality of patient testing or
    safety has not been adequately addressed. All
    communications will be held in strict confidence.
    The Department of Laboratories will not harass
    or take punitive action against any employee who
    has reported a concern to a regulatory agency.

Reporting a concern
  • Employees may communicate a concern directly to
    regulatory agencies and/or laboratory and
    hospital administration.

For Quality of Patient Testing Issues
  • BJH Safety Event Management System (SEMS)
  • Problem documentation form
  • College of American Pathologists, 1-866-236-7212.
  • Joint Commission on Accreditation of Healthcare
    Organizations, 1-800-994-6610 or

For Compliance Related Issues
  • Laboratory Action Line, 1-800-525-2521
  • BJH HIPAA Website http//bjcnet/bjh/hipaa

College of American Pathologists Patient Safety
  • The College of American Pathologists had
    developed as set of Laboratory Patient Safety
    Goals for laboratories to use in their efforts to
    improve patient safety and reduce laboratory
    medical errors. The goals focus on the pre- and
    post analytic phases of laboratory testing with
    the objective of improving patient test
    management processes, including patient
    identification, test ordering, and critical
    results reporting and interpretation. The goals
    also reinforce the laboratorys role in patient
    safety with the objective of improving
    identification, communication and correction of
    medical errors and integrate the laboratorys
    patient safety role within health care

Goal 1 Improve Patient and Sample Identification
  • At the time of specimen collection
  • At the time of analysis
  • At the time of result delivery

Goal 2 Improve the Verification and
Communication of Life Threatening or Life
Altering Information Regarding
  • Malignancies
  • HIV and infectious disease
  • Cytogenetic abnormalities
  • Critical values

Goal 3 Improve the Identification,
Communication and Correction of Errors
  • Timeliness of identification of errors
  • Revised reports
  • All inaccuracies in the medical record should be
    documented and communicated at the time the
    inaccuracy becomes known. The correct test result
    or diagnosis should be made clear in an amended
    or corrected report as soon as possible. The
    reason that the original result was reported
    incorrectly (i.e., due to error or other reason)
    may not be known and need not be reported in the
    medical record.

  • When an incorrect result or diagnosis causes
    material injury to a patient, the correct
    result/diagnosis and the fact that the result has
    been changed must also be reported to the
    patient. For an inaccuracy caused by or directly
    involving a pathologist, the pathologist involved
    in the case should discuss the matter with the
    physician who ordered the pathology consultation.
    The two physicians should jointly determine how
    best to communicate the result to the patient.

Goal 4 Improve Integration and Coordination of
Laboratory Patient Safety Role within Healthcare
Organizations and Operations
  • Nursing
  • Administration
  • Point of care testing personnel
  • Providers
  • Exchange of information and review by relevant

  • SDS sheets contain all of the following except.
  • a) First Aid Measures
  • b) Toxicological Information
  • c) List of Hazardous Ingredients
  • d) How to use the reagent
  • e) Handling and Storage
  • Hazardous waste can be collected in a satellite
    container until the container is full.
  • True or False
  • Which of the following are considered
    Biohazardous waste. Check all that apply.
  • a) Vacutainer tube of blood
  • b) Urine specimen
  • c) Nasal swab
  • d) Gloves, not visibly soiled
  • e) Paper towels used to clean workbench with

  • Hazardous waste is any waste that is considered
    hazardous to
  • a) Humans
  • b) Environment
  • c) All of the above
  • EHS is notified of a full solvent drum. It is
    picked up 1 year later. This complies with our
    hazardous waste disposal guidelines.
  • True or False
  • Any employee can report unsafe practices to OSHA,
    CDC, CAP or the Laboratory Action Hotline.
  • True or False
  • All of the following are CAP Patient Safety Goals
  • a) Improve Patient and Sample Identification
  • b) Improve the Communication of Life
    Threatening Information
  • c) Improve the Verification of Results
  • d) Improve the Identification, Communication
    Correction of Errors