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Phlebotomy Handbook Blood Collection Essentials Seventh Edition Diana Garza Kathleen Becan-McBride Chapter Five Infection Control Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Introduction to Infection Control • Nosocomial infections are acquired by 5-10% of hospitalized patients. • Center for Disease Control (CDC), the Joint Commission, state regulatory agencies, and each health care institution are required to develop and implement infection control policies. • Infection control department of the hospital hire nurses to perform this job and they in turn work very closely with the micro department. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Nosocomial Infections Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Nosocomial Infections Table 5.1 Microorganisms Causing Healthcare Acquired (Nonsocomial) Infections in Patients Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Nosocomial Infections Table 5.2 Microorganisms Causing Health-care Acquired (Nosocomial) Infections in Hospital Areas Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Surveillance • Infection control program closely monitors the following: – Patients at high risk of infection. – Patients with already acquired infections. – Personnel/patients exposed to communicable diseases, contaminated equipment, or hazardous reagents. – Patients in certain areas of the hospital or in certain rooms. – Patients in ambulatory settings: home or long-term care facilities. • Surveillance is also involved in classifying infections according to prevalence rates and monitoring employee health including screening for diseases and offering immunizations. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Surveillance Screening for diseases prior to employment Measles Mumps Tuberculosis Hepatitis Diarrheal disease Syphilis Skin diseases Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Chain of Infection Figure 5.2 The Chain of Nosocomial Infection Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Chain of Infection • Source – In normal environment few things are sterile. – Inanimate objects as well as people are colonized with microorganisms. – Even when an organism is pathogenic some are more pathogenic then others. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Surveillance • Phlebotomists must be aware of these special circumstances: – Take necessary precautions to avoid infecting yourself or the patient. – Mentally prepare yourself to deal in a professional, humane manner with special patients. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Chain of Infection • Nosocomial infections occur when chain of infection occurs and requires the following: source, mode of transmission and susceptible host. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Chain of Infection • Common sources of infection: – – – – – – People Contaminated needles or sharps IV catheters, Foley catheters, cardiac catheters Bronchoscope, respiratory therapy equipment Contaminated clothing Medical instruments used for surgery or diagnostic procedures are reusable but must be thoroughly sterilized. – Some equipment such as tourniquets have low risk of causing infection. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Mode of Transmission • Infections can be transmitted by direct contact, air, medical instruments, other objects or vectors. • Direct contact infections be avoided by hand washing. • Airborne infections may be transmitted by coughing, sneezing, shaking linen, sweeping or inadequate ventilation and can be prevented by using a mask. • Inanimate objects (fomites) such as toys, toilets, sinks, linens and water fountains may provide a means of transmission if contaminated. • Mosquitos, ticks, fleas and mites maytransmit infections. • Stop mode of transmission through appropriate use of infection control procedures. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Chain of Infection Table 5.6 Fomites Found in Health Care Facilities Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Susceptible Host • Factors that affect host susceptibility are: age, drugs, degree and nature of illness, and status of the host’s immune system. • Underlying diseases may change status of host and increase chance of infection. • Treatment of diseases may lower patient’s resistance to infections. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Breaking the Chain • Must break the chain of infection by strict adherence to policies involving : – – – – – – Hand washing Proper waste disposal Appropriate laundry service and housekeeping Control of insects and rodents Use of disposable equipment and supplies Isolation techniques Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Follow Policies • Must break the chain of infection by strict adherence to policies involving : – – – – – – Hand washing Proper waste disposal Appropriate laundry service and housekeeping Control of insects and rodents Use of disposable equipment and supplies Isolation techniques Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Chain of Infection Table 5.5 Considerations for Sources of Health-care Acquired (Nosocomial) Infections Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride OSHA Needlestick Safety and Prevention Act • The Needlestick Safety and Prevention Act mandated that the 1991 Bloodborne Pathogens Standard be revised to strengthen the requirements related to the use of safety-engineered sharp devices. • Requires employers to identify, evaluate and make use of effective safer devices. • For needle use it requires a built-in safety feature or mechanism that allows a single handed method of causing the needle to be permanently covered. • The law mandated that employers allow “front line” employees to evaluate and select the equipment they were most comfortable with. • Employers must maintain an injury log which will include the brand name of the device used which caused the injury. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Legislation • Federal Needlestick Safety and Prevention Act Signed by President Bill Clinton, Nov. 6, 2000. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Isolation Procedures • Isolation procedures vary and range from sterile rooms or wards to isolation procedures for one disease only. • Isolation procedures divide patients into two groups: – Patients with communicable diseases. – Patients who are extremely susceptible to infections Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Isolation Procedures • Isolation techniques formally divided into two types: category-specific precautions and disease-specific precautions. – Category specific provided guidelines for dealing with infectious substances based on route of transmission (wound/drainage, enteric, respiratory, etc). – Disease Specific Isolation Precautions included specific procedures for dealing with more than 150 diseases. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Center for Disease Control new Isolation Guidelines • Standard Precautions which combines Universal Precautions and isolation practices for moist, potentially infectious body substances (BSI) into a single set of safeguards to be used on all patients. – BSI Practices based on the assumption that all body substances may carry infectious agents. – Focuses on isolation of potentially infectious moist body substances: blood, urine, saliva, feces, sputum, wound drainage, all other body fluids, nonintact skin and mucous membranes. – Designed to reduce risk of transmission of microorganisms. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions • Changes necessary to avoid inconsistent use of Universal Precautions and Body Substance Isolation (BSI). • The old categories of disease-specific precautions will be collapsed into three categories: airborne, droplet and contact. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Health Care Providers’ Health • Warning labels may be posted on or next to the patients’ hospital room door or other areas of the health care institution to warn of possible hazards. • • • Isolation signs Radiation hazard signs Biohazard signs Figure 5.1 Biohazard Sign Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions Review • Synthesize the major features of Universal Precautions and BSI and applies them to all patients receiving care in hospitals. • The focus is on applying a single set of precautions to be utilized for all non-intact skin, mucous membranes and potentially infectious moist body substances regardless of whether or not they contain visible blood Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions Review • Designed to reduce the risk of transmission of blood borne pathogens • Standard Precautions apply to: – blood – all body fluids, secretions (saliva, sputum), excretions (urine, feces) except sweat regardless of whether or not they contain visible blood – non-intact skin (wound drainage) – mucous membranes Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions • Use appropriate barrier protection to prevent skin and mucous membrane exposure when contact with blood or body fluids is anticipated. • Wash hands and contaminated surfaces/equipment immediately if contaminated with blood or body fluids and after removing gloves. • Take the necessary precautions to prevent injuries caused by handling/disposing of needles, scalpels and other sharp instruments. • Use of special equipment to protect from saliva exposure during resuscitation. • Appropriate protection when exudative lesions or dermatitis is present. • Pregnant health care workers must strictly adhere to infection control policies. • Immunization of employees is required for infectious agents (measles, mumps, rubella) transmitted by air. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Transmission Based Precautions • Airborne Precautions for diseases transmitted by small droplets, • Droplet precautions for diseases transmitted by large droplets. • Contact precautions for disease transmitted by direct contact with the patient, ie, wounds, skin infections, enteric infections, etc. • There may be times when a patient requires more than 1 type of Transmission Based Precaution category. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions Figure 5.3 Isolation Signs Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions Figure 5.4 Droplet Precautions Pearson Education Copyright 2005 Aiborne Precatuions Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions Figure 5.5 Contact Precautions Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Tuberculosis Isolation • Indicated for patient with infectious tuberculosis and is sometimes called AFB (acid fast bacilli) isolation. • Drug resistant TB is becoming more prevalent and the new guidelines emphasize the importance of wearing an appropriate mask that is fitted to the individual employee. • OSHA requires the use of a National Institute for Occupational Safety and Health (NIOSH) approved high efficiency particulate air (HEPA) respirator as a minimum level for HCWs entering AFB isolation rooms. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride TB Transmission Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Protective or Reverse Isolation • Protect patient who is highly susceptible to infection. • All articles entering room must be sterile. • Gown, glove, mask • Used supplies can be removed from room. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride OSHA Standards Health Care Employers • Employers must provide measures that will protect workers exposed to biological hazards. • Mandatory training and compliance in the use of Standard/Universal Precautions. • Employers must provide appropriate PPE. • Engineering practice controls that isolate or remove blood-borne pathogen hazards, ie, sharps containers. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride OSHA Standards Health Care Employers • • • • Work practice controls to reduce likelihood of exposure. Appropriate cleaning methods of contaminated surfaces. Provide free Hepatitis B (HBV) vaccine. Post-exposure follow up for employees exposed to HBV and HIV. • Training and education information on blood borne pathogens available for employees at no cost and accessible during working hours. • Labels and signs that warn of biological hazards and contaminated waste. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Blood Borne Exposure Procedures • Health care facilities must provide a confidential medical evaluation, treatment and follow up for any employee with a blood borne exposure incident. • Immediately after an exposure incident the employee must: – Apply appropriate first aid – Report the incident – Be given appropriate medical evaluation, treatment and counseling. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Blood Borne Exposure Procedures • Medical evaluation involves the following five steps and is kept confidential: – HCWs blood is tested for HBV, HCV and HIV. – Source individual tested for HBV, HCV and HIV, if permission is given. – If source individual is HIV positive, or exposure is to an unknown specimen the HCW is counseled and evaluated for HIV infection immediately, 6 weeks, 12 weeks and 6 months. – AZT therapy is provided to the exposed employee as soon as possible, preferably within 1-2 hours of exposure. – If source individual refuses to consent to testing and is in a high-risk category, the exposed HCW is given immune globulin and HBV vaccination. – The HCW is counseled to be alert for acute viral symptoms within 12 weeks of exposure. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Infection Control in Hospital Units • Isolation for hospital outbreaks – May dictate need for special precautions, isolation procedures or screening of employees. – Examples: Staph outbreak in nursery, undiagnosed chicken pox, positive TB test on employee or inpatient. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Infection Control in Hospital Units • Infection control procedures in a nursery unit – Infants immune system not developed and they have increased susceptibility to infection. – May pick up pathogens from mom, other babies or hospital personnel. – Hand washing procedure much stricter and must be adhered to. – Gloves must be worn. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Infection Control in Hospital Units • Infection control procedures in a nursery unit. – Nursery usually provides gowns to be worn while in the nursery. – To decrease exposure each baby is assigned to one nurse. – Special case is infant whose mom has genital herpes. • Baby and mother are isolated. • Must use gown and gloves. • Remove contaminated articles by double bagging. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Herpes • Neonatal infection with herpes simplex virus type 1, showing ulcerating and vesicular skin lesions. • Lesions may be present in small numbers. • The virus was transmitted during birth. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Infection Control in a Burn Unit • Patient is highly susceptible to infection. • Infection rate dramatically decreases if patient is in a completely closed environment. – Bed surrounded by plastic curtain with sleeves, use sleeves to care for patient. – Everything kept outside of curtain. • If facility lacks the curtain, house patient in special room. • Must use gown, gloves, double bagging of soiled articles and strict adherence to hand washing technique. • Sterilize/disinfect room frequently. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Infection Control in an Intensive Care or Postoperative Unit • Patients who are critically ill or have had surgery are more susceptible to infections. • Most hospital ICUs are big open rooms with numerous patients for easy monitoring. • Patients with known infections are isolated according to infection. • Strict hand washing, gowning and gloving policies are necessary. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride ICU Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Infection Control in a Dialysis Unit • Patients often immunosuppressed, increasing the risk of acquiring an infection, especially hepatitis. • Gown and gloves worn on unit. • Strict adherence to hand washing technique and glove use. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Dialysis Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Infection Control in the Clinical Laboratory • Performed primarily by microbiology personnel. – Maintains lab records for surveillance purposes. – Reports infectious agents, drug resistant microorganisms and outbreaks. – Evaluates effectiveness of sterilization or decontamination procedures. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Infection Control in the Clinical Laboratory • Acquisition of infections is prevented by: – Prohibiting eating, drinking, mouth pipetting or smoking in the lab. – Proper hand washing at the appropriate times. – Use of appropriate barrier protection such as gloves, protective clothing, and eye protection. – Decontamination of work surfaces periodically during the day and prior to leaving. – Proper disposal of sharps, including broken glass. – Proper handling of equipment. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions Specific Isolation Techniques and Procedural Steps 1. Handwashing Figure 5.12 Decontaminate Hands Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions Figure 5.6 Wet Hands with Water Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions Figure 5.7 Dispense a Small Amount of Soap to the Hands Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions Figure 5.8 Rub Hands Together Vigorously for at Least 15 Seconds Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions Figure 5.9 Rinse Hands in a Downward Motion with Water Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions Figure 5.10 Turn Off the Water with a Dry Disposable Towel Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Infection Control in the Clinical Laboratory • Phlebotomists play an important role in preventing the spread of infection during the blood collection process: • Must use proper technique during blood collection. • Must strictly adhere to infection control policies and procedures specifically appropriate use of gowns, gloves and masks. – Pay close attention to posted signs which illustrate special PPE. – Know how to put on and remove gown, gloves, and mask. – Know where to dispose of the materials used in the patient room. • One phlebotomist may collect specimens from 50 patients, the potential is there to spread infections all over the hospital. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Entering and Exiting Patient’s Rooms • Take only supplies needed into the room. – Use tourniquet in the room or leave yours – Label specimen in room and leave the pen. – Place specimens in isolation bag • Dispose of PPE (mask, gloves and /or gown) and used supplies in the room. • After washing hands use a clean, dry paper towel to open door, use foot to hold open as you exit Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions Figure 5.11 Supplies for Isolation Procedures Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions Specific Isolation Techniques and Procedural Steps 2. Gowning Figure 5.13 Gowns should be large enough to cover all clothing Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions Figure 5.14 Place on arm at a time through the gown’s sleeves Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions Figure 5.15 Tie in back Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions Figure 5.16 Tie or use Velcro to close gown Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions 3. Masking Figure 5.17 Don Mask Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions 4. Face shields Figure 5.18 Face shields or goggles may be worn Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions 5. Completing the protection Figure 5.19 Gloves should be pulled over the ends of gown sleeves Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions 6. Isolation Item Removal Gown removal Figure 5.20 The gown is removed by first breaking the paper tie or untying Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions 6. Isolation Item Removal Glove removal Figure 5.21 Next, the gloves are removed Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions 6. Isolation Item Removal Gown disposal Figure 5.22 The gown should be taken off by pulling down from shoulders first and then pulling arms out Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions 6. Isolation Item Removal Gown disposal Figure 5.23 Gowns are used only once to prevent contamination Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions 6. Isolation Item Removal Mask removal Figure 5.24 The mask can be removed by carefully untying the lower tie first, then the upper one Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions 6. Isolation Item Removal Handwashing Figure 5.25 Wash hands in the room and again at nearest sink after exiting the room Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Double Bagging • All items in isolation removed by double bagging technique which requires 2 people to perform, one person in the room, one outside the room. – Person outside holds clean, impermeable bag with ends of bag covering their hands. – Person inside the room seals the bag and places into the clean bag. – Person outside the room seals and labels with appropriate warnings. • The bag is disposed of in a designated area/container for biohazardous waste. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions 7. Disposing of Contaminated Items Figure 5.26 Put contaminated material in one bag and seal the bag inside the room Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Standard Precautions 7. Disposing of Contaminated Items Figure 5.27 Another person should stand outside the room with another opened, clean impermeable bag Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Prevention of Laboratory Acquired Infections • The occurrence of an infection from a biohazardous specimen depends upon the virulence of the infecting organism and the susceptibility of the host. • The following are possible routes of infection from collected specimens and, therefore, should be considered when collecting or processing specimens for laboratory assays. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Skin Contact • Organisms may enter through abrasions, cuts or conjunctiva of eye. • Avoid needles and never handle broken glass with your hands. • Wear PPE and cover all cuts appropriately. • Avoid rubbing eyes or mouth. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Ingestion • Caused by failure to wash contaminated hands prior to eating, drinking or smoking. • Comply with lab safety rules. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Airborne • Aerosols may be created by careless handling or centrifugation. • Popping stoppers off of vacuum tubes can create aerosols. • Use correct procedures for processing and separating patient specimens. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Phlebotomists Responsibilities • Must realize bacteria and other microorganisms can be found everywhere. • All hospital personnel are responsible for cleanliness, including: – Maintain sterility when handling instrument or equipment that contact the patient. – Clean up small messes when noticed, or notify appropriate personnel in a timely fashion if you are unable to handle it. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Site Preparation • Use sterile supplies for skin and venipuncture. • Rubbing alcohol (70% isopropyl) for routine destruction of organisms on the site. • Blood cultures has more complex site preparation, requires sterile site. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Disinfectants and Antiseptics • Disinfectant – is a chemical compound used or remove or kill pathogenic organisms, they are regulated by the EPA. – is used on surfaces and instruments, but are too caustic for direct use on human skin. • Antiseptics – are chemicals used to inhibit the growth and development of microorganisms, but not necessarily kill them. – may be used on human skin. • Intermediate level disinfectants which are HIV-cidal or TB-cidal should be used to cleanse tourniquets and other contaminated articles. Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride Disinfectants and Antiseptics Table 5.10 Common Antiseptics and Disinfectants for the Health Care Setting Pearson Education Copyright 2005 Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition Diana Garza • Kathleen Becan-McBride