Evaluating the impact of risk assessment practices on occupational safety in medical laboratories in Kenya

¹Department of Medical Laboratory Sciences, School of Health Sciences, Kenya Methodist University, Nairobi, Kenya

^&Corresponding author
Titus Mutwiri Benjamin, Department of Medical Laboratory Sciences, School of Health Sciences, Kenya Methodist University, Nairobi, Kenya

Introduction    

Occupational safety in medical laboratories is essential for protecting laboratory personnel and supporting the delivery of quality healthcare services. Medical laboratory professionals are routinely exposed to biological, chemical, physical, and radiological hazards while handling infectious specimens, hazardous chemicals, and laboratory equipment [1]. These occupational hazards increase the risk of workplace injuries, infections, and long-term health complications if appropriate risk assessment practices and safety measures are not effectively implemented [2]. Inadequate hazard identification and control may result in chemical burns, injuries associated with laboratory equipment, and occupational exposure to blood-borne pathogens. Medical laboratory environments are characterized by multiple hazards occurring simultaneously, requiring comprehensive risk assessment and effective safety management systems. Accidental needle-stick injuries remain a major occupational hazard because they expose laboratory personnel to blood-borne infections, including Hepatitis B, Hepatitis C, and HIV. Similarly, improper handling of hazardous chemicals, including carcinogenic and toxic substances, may result in chemical burns, respiratory illnesses, and other chronic health conditions [3].

Across Africa, occupational safety in medical laboratories remains a significant public health concern. Many laboratories operate under resource constraints characterized by inadequate infrastructure, limited availability of personal protective equipment (PPE), insufficient safety training, and weak implementation of occupational safety policies. Laboratories in rural and other low-resource settings face additional challenges in managing biological, chemical, and physical hazards effectively, thereby increasing the risk of occupational injuries and exposure to hazardous substances among laboratory personnel [4]. Consequently, inadequate implementation of laboratory safety measures continues to compromise both worker safety and the quality of laboratory services. In Kenya, occupational safety in medical laboratories continues to face considerable challenges despite ongoing efforts to strengthen healthcare systems. Limited funding, inadequate laboratory infrastructure, inconsistent implementation of safety policies, and shortages of essential safety equipment adversely affect the protection of laboratory personnel [5]. Laboratory professionals remain at increased risk of occupational exposure to infectious agents, hazardous chemicals, and other workplace hazards, particularly where access to appropriate personal protective equipment and routine risk assessment practices is inadequate. Although several studies have documented occupational hazards and laboratory safety practices, there is limited empirical evidence on the influence of risk assessment practices on occupational safety in Kenyan medical laboratories. This study therefore sought to evaluate the influence of risk assessment practices on occupational safety in medical laboratories in Kenya, thereby providing evidence to support the development of effective occupational safety policies and interventions.

Methods     

Study design: this study employed an analytical cross-sectional design to examine the association between risk assessment practices and safety culture (SC), which served as the indicator of occupational safety, among medical laboratory professionals in Kenya. An analytical cross-sectional design was considered appropriate because it allows the assessment of associations between risk assessment practices and safety culture at a single point in time.

Study setting and population: the study was conducted among 209 medical laboratory professionals working in medical laboratories across Kenya, including government, private, faith-based organization (FBO), non-governmental organization (NGO), and research laboratories. Of the participating laboratories, 157 (75.1%) were government laboratories, 33 (15.8%) were private laboratories, 12 (5.7%) were faith-based organization laboratories, 4 (1.9%) were non-governmental organization laboratories, and 3 (1.4%) were research laboratories. Based on laboratory level, 71 (34.0%) were sub-county laboratories, 61 (29.2%) were county laboratories, 56 (26.8%) were routine/basic laboratories, and 21 (10.0%) were national referral laboratories. Regarding accreditation status, 125 (59.8%) laboratories were not accredited, 55 (26.3%) were accredited, and 29 (13.9%) were undergoing the accreditation process. A total of 209 laboratory professionals participated in the study, with one eligible respondent recruited from each participating laboratory. Eligible participants included laboratory managers, laboratory technologists, laboratory technicians, laboratory officers, consultants, and other senior laboratory personnel directly involved in laboratory operations and occupational safety activities. Participants had between 1 and 37 years of professional experience (mean = 13.3 years; SD = 7.6). Regarding educational qualifications, 108 (51.7%) held bachelor's degrees, 63 (30.1%) held diplomas, 21 (10.0%) held master's degrees, 13 (6.2%) held higher national diplomas (HND), 3 (1.4%) held PhDs, and 1 (0.5%) held a certificate qualification. A purposive sampling technique was used to recruit participants. Laboratory professionals who had worked in their current laboratory for at least six months and were directly involved in specimen collection, laboratory analysis, biosafety management, or other technical laboratory operations were eligible to participate [6]. Administrative staff, interns, and personnel not directly engaged in laboratory operations were excluded from the study.

Variables: the study examined the relationship between ten dimensions of risk assessment practices (independent variables) and safety culture (SC), which served as the indicator of occupational safety (dependent variable). The independent variables comprised risk assessment (RA), hazardous substances (HZ), personal protective equipment (PPE), emergency preparedness (EP), training and education (TE), health surveillance (HS), risk communication (RC), infection prevention and control (IPC), fire safety (FS), and radiation safety (RS). Each construct was measured using multiple questionnaire items rated on a five-point Likert scale ranging from 1 ("strongly disagree") to 5 ("strongly agree"). The questionnaire demonstrated acceptable internal consistency, with an overall Cronbach's alpha coefficient of 0.780 based on responses from 209 participants. Pearson correlation analysis was performed to examine the relationships between the study variables. Multiple linear regression analysis was subsequently conducted to examine the association between the ten dimensions of risk assessment practices and safety culture (Figure 1). All predictor variables were entered simultaneously into the regression model using the Enter method.

Data resource and measurement

Data collection tool: a structured self-administered questionnaire was used as the primary data collection instrument. The questionnaire comprised sections covering socio-demographic characteristics and the ten constructs used in the study, with safety culture serving as the outcome construct: risk assessment (RA), hazardous substances (HZ), personal protective equipment (PPE), emergency preparedness (EP), training and education (TE), health surveillance (HS), safety culture (SC), risk communication (RC), infection prevention and control (IPC), fire safety (FS), and radiation safety (RS). The instrument was adapted from validated occupational safety questionnaires and modified to suit the Kenyan medical laboratory context. Content validity was established through expert review by specialists in occupational health and medical laboratory practice. The internal consistency of the instrument was assessed using Cronbach's alpha, which yielded an overall reliability coefficient of 0.780, indicating acceptable reliability (Table 1).

Data collection: data were collected between May and July 2025 using both online and paper-based self-administered questionnaires distributed to laboratory professionals working in participating medical laboratories across Kenya. Participants were recruited through laboratory management, institutional contacts, and professional networks. Before completing the questionnaire, all participants were informed about the purpose of the study and provided written informed consent. Completed questionnaires were checked for completeness and consistency before coding and entry into the study database to ensure data quality.

Sample size: a total of 209 laboratory professionals participated in the study, representing a broad spectrum of healthcare facility types and laboratory levels across Kenya. Participants were drawn from government (157; 75.1%), private (33; 15.8%), faith-based organization (12; 5.7%), non-governmental organization (4; 1.9%), and research laboratories (3; 1.4%). The participating laboratories included sub-county (71; 34.0%), county (61; 29.2%), routine/basic (56; 26.8%), and national referral laboratories (21; 10.0%). Participants had between 1 and 37 years of professional experience (mean = 13.3 years; SD = 7.61). Their highest educational qualifications included certificate (1; 0.5%), diploma (63; 30.1%), higher national diploma (13; 6.2%), bachelor's degree (108; 51.7%), master's degree (21; 10.0%), and PhD (3; 1.4%). The sample size was considered adequate to provide sufficient statistical power for both descriptive and inferential analyses.

Data analysis: data were coded and analyzed using IBM SPSS Statistics version 27. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize participants' socio-demographic characteristics and responses to the study variables. Pearson's correlation analysis was performed to determine the strength and direction of the relationships between the study variables. Multiple linear regression analysis was conducted to examine the association between risk assessment (RA), hazardous substances (HZ), personal protective equipment (PPE), emergency preparedness (EP), training and education (TE), health surveillance (HS), risk communication (RC), Infection prevention and control (IPC), fire safety (FS), and radiation safety (RS), and safety culture (SC), which served as the indicator of occupational safety. All predictor variables were entered simultaneously into the regression model using the Enter method. Statistical significance was set at p < 0.05, and 95% confidence intervals were reported where appropriate. The reliability of the questionnaire was assessed using Cronbach's Alpha (α= 0.780), indicating acceptable internal consistency. Study findings were presented using tables and figures.

Ethical considerations: ethical approval for the study was obtained from the Kenya Methodist University Institutional Ethics Review Committee (REF No. KEMU/ISERC/INT/02/2025). The research approval license was given by the National Commission for Science, Technology and Innovation REF No. NACOSTI/P/25/417488. Permission to conduct the study was obtained from the participating institutions before data collection commenced. All participants provided informed consent before participating in the study. Confidentiality and anonymity were maintained throughout the study by excluding personal identifiers from the questionnaires. Participation was voluntary, and respondents were free to withdraw from the study at any stage without any consequences. All study procedures were conducted in accordance with the ethical principles of the Declaration of Helsinki.

Results     

Socio-demographic characteristics: a total of 209 laboratory professionals participated in the study, representing medical laboratories across Kenya. Most respondents were employed in government laboratories (157, 75.1%), followed by private laboratories (33, 15.8%), faith-based organization (FBO) laboratories (12, 5.7%), non-governmental organization (NGO) laboratories (4, 1.9%), and research laboratories (3, 1.4%). More than half of the respondents held Bachelor's degrees (108, 51.7%), while 63 (30.1%) held Diplomas, 21 (10.0%) Master's degrees, 13 (6.2%) Higher national diplomas (HND), 3 (1.4%) PhDs, and one respondent (0.5%) held a certificate qualification. Participants had between 1 and 37 years of professional experience, with a mean of 13.32 years (SD = 7.61). The participating laboratories comprised sub-county laboratories (34.0%), county laboratories (29.2%), routine/basic laboratories (26.8%), and national referral laboratories (10.0%). Regarding accreditation status, 125 (59.8%) of laboratories were not accredited, 55 (26.3%) were accredited, and 29 (13.9%) were undergoing accreditation (Table 2).

Descriptive analysis: overall, respondents reported moderate to high implementation of risk assessment practices across the participating laboratories (Table 3). Infection prevention and control recorded the highest mean score (M = 3.70, SD = 1.03), followed by personal protective equipment (M = 3.76, SD = 1.00), hazardous substances (M = 3.70, SD = 0.97), and safety culture (M = 3.63, SD = 1.00). Risk assessment recorded a mean score of 3.34 (SD = 0.98), while emergency preparedness (M = 3.20, SD = 1.05), training and education (M = 3.04, SD = 1.11), and fire safety (M = 2.94, SD = 1.23) demonstrated moderate implementation. The lowest mean scores were observed for health surveillance (M = 2.53, SD = 1.15) and radiation safety (M = 2.43, SD = 1.20), indicating that these areas require greater attention.

Correlation analysis: Pearson correlation analysis demonstrated positive and statistically significant associations between all dimensions of risk assessment practices and safety culture, which served as the indicator of occupational safety (p < 0.001 for all comparisons). The strongest positive correlation with safety culture was observed for infection prevention and control (r = 0.783), followed by emergency preparedness (r = 0.743), risk communication (r = 0.729), personal protective equipment (r = 0.708), hazardous substances (r = 0.665), health surveillance (r = 0.618), fire safety (r = 0.586), risk assessment (r = 0.558), and radiation safety (r = 0.426) (Table 4). These findings indicate that stronger implementation of risk assessment practices was associated with a stronger safety culture in medical laboratories.

Multiple regression analysis: multiple linear regression analysis was performed to examine the influence of risk assessment practices on safety culture, which served as the indicator of occupational safety (Table 5). The overall regression model was statistically significant (F(10,194) = 54.065, p < 0.001) and explained 73.6% of the variation in safety culture (R²= 0.736; adjusted R²= 0.722). Infection prevention and control (β= 0.344, p < 0.001), personal protective equipment (β= 0.237, p < 0.001), emergency preparedness (β= 0.189, p = 0.013), risk communication (β= 0.162, p = 0.029), and risk assessment (β = -0.135, p = 0.023) were statistically significant predictors of safety culture. Hazardous substances (p = 0.542), training and education (p = 0.052), health surveillance (p = 0.288), fire safety (p = 0.322), and radiation safety (p = 0.379) were not statistically significant predictors. Overall, the findings indicate that infection prevention and control, personal protective equipment, emergency preparedness, risk communication, and risk assessment were independently associated with safety culture in Kenyan medical laboratories.

Discussion     

This study evaluated the influence of risk assessment practices on occupational safety in medical laboratories in Kenya. Overall, the findings indicate that participating laboratories demonstrated moderate to high implementation of risk assessment practices and occupational safety measures. Respondents reported positive perceptions of key safety domains, including personal protective equipment (PPE), hazardous substance management, health surveillance, infection prevention and control, and safety culture. These findings suggest that many medical laboratories have established safety management systems that help protect laboratory personnel from occupational hazards. Similar findings have been reported in previous studies, which indicate that effective risk assessment and adherence to occupational safety practices reduce workplace exposures and improve laboratory safety performance [7]. Although the overall implementation of risk assessment practices was encouraging, important gaps remain. Respondents rated the use of risk assessment findings to prioritize workplace hazards highly, indicating that laboratories recognize the importance of systematic hazard identification and risk management. However, regular review and updating of risk assessments received comparatively lower ratings, suggesting that some laboratories may not consistently revise their risk assessments to reflect changes in laboratory processes, emerging hazards, or technological advancements.

This observation is consistent with previous studies emphasizing that risk assessment should be a continuous process rather than a one-time activity to ensure effective hazard control and continuous quality improvement [8]. Pearson correlation analysis demonstrated significant positive relationships between all dimensions of risk assessment practices and safety culture, which was used as the indicator of occupational safety. These findings indicate that laboratories with stronger implementation of risk assessment practices tended to report better safety culture. Multiple linear regression analysis further demonstrated that infection prevention and control, personal protective equipment, emergency preparedness, risk communication, and risk assessment were significant predictors of safety culture, whereas hazardous substances, training and education, health surveillance, fire safety, and radiation safety were not statistically significant predictors. These findings indicate that infection prevention and control, personal protective equipment, emergency preparedness, risk communication, and risk assessment were significantly associated with safety culture, which served as the indicator of occupational safety. Emergency preparedness emerged as one of the comparatively weaker aspects of laboratory safety despite generally favorable implementation of occupational safety practices. Lower ratings for regular emergency drills suggest that many laboratories may not routinely evaluate their emergency response procedures. Similar findings have been reported in resource-constrained settings where inadequate infrastructure, limited financial resources, and competing operational priorities reduce the frequency of emergency preparedness activities [9]. Strengthening emergency preparedness through regular simulation exercises, periodic review of emergency response plans, and continuous staff training would improve laboratory readiness to respond effectively to accidents, hazardous spills, and other workplace emergencies.

The regression findings demonstrate that risk assessment practices collectively explained a substantial proportion of the variation in safety culture, accounting for 73.6% of the observed variation. Infection Prevention and Control emerged as the strongest predictor, followed by personal protective equipment, emergency preparedness, risk communication, and risk assessment. These findings emphasize that strengthening infection prevention measures, ensuring consistent use of appropriate personal protective equipment, promoting effective communication of workplace risks, conducting routine risk assessments, and maintaining emergency preparedness are critical components of an effective occupational safety programme in medical laboratories. The findings have important implications for laboratory management and occupational safety policy. Laboratory managers should institutionalize routine risk assessment reviews, strengthen infection prevention programmes, improve emergency preparedness, promote effective communication of workplace hazards, and reinforce the consistent use of personal protective equipment. Continuous staff training and regular monitoring of compliance with occupational safety procedures should also be prioritized. At the national level, regulatory agencies and professional bodies should strengthen oversight of laboratory safety programmes and encourage wider implementation of internationally recognized occupational safety frameworks, including the World Health Organization (WHO) Laboratory Biosafety Manual and ISO 15189 quality management standards.

These measures would contribute to strengthening occupational safety systems and improving the quality of laboratory services in Kenya. This study has several limitations. First, the analytical cross-sectional design assessed exposure and outcome variables at a single point in time and therefore cannot establish causal relationships. Second, the use of self-reported questionnaire data may have introduced reporting and social desirability bias, with respondents potentially overestimating compliance with recommended occupational safety practices. Third, although the study included medical laboratories from different sectors across Kenya, relatively few participants were recruited from research laboratories and non-governmental organizations, which may limit the generalizability of the findings to these settings [10]. Finally, the study relied on self-reported information rather than direct observation of laboratory practices. Despite these limitations, the study provides valuable evidence on the influence of risk assessment practices on occupational safety in Kenyan medical laboratories and offers practical recommendations for strengthening laboratory safety management.

Conclusion     

This study evaluated the influence of risk assessment practices on occupational safety in medical laboratories in Kenya. The findings demonstrate that stronger implementation of risk assessment practices is associated with a stronger safety culture, which was used as an indicator of occupational safety. Multiple linear regression analysis identified infection prevention and control, personal protective equipment, emergency preparedness, risk communication, and risk assessment as significant predictors of safety culture. Although participating laboratories demonstrated moderate to high implementation of occupational safety practices, important gaps remain in the routine review of risk assessments, emergency preparedness, and continuous safety training. These findings highlight the importance of reviewing and strengthening laboratory safety management systems, including infection prevention and control, personal protective equipment, emergency preparedness, risk communication, and routine risk assessment processes, to enhance safety culture in medical laboratories. Future research should employ longitudinal or interventional study designs to evaluate the long-term influence of risk assessment practices on occupational safety and explore additional organizational and contextual factors that contribute to safer laboratory working environments.

Competing interests     

The author declares no competing interests.

Authors' contributions     

The authors have read and approved the final version of this manuscript.

Tables and figure     

Table 1: reliability analysis of the study instrument (N = 209)

Table 2: socio-demographic characteristics of study participants (N = 209)

Table 3: descriptive statistics of the study constructs (N = 209)

Table 4: Pearson correlation between risk assessment practice dimensions and safety culture (SC) (N = 209)

Table 5: multiple linear regression analysis predicting safety culture (SC) (N = 209)

Figure 1: normal P-P plot of regression standardized residual; observed cum prob: observed cumulative probability; expected cum prob: expected cumulative probability

References