[TRANS] [PMLS II] LESSON 2 : Safety in Phlebotomy

I Introduction 2. Reservoir - Source of an infectious agent

II Infection Control
● The reservoir must be a place where the
III Nosocomial Infections
IV Transmission Prevention Procedures infectious agent can live and possibly
V Donning of PPE multiply.
VI Proper Order of Wearing PPE ● Equipment and other soiled objects are
VII Doffing of PPE
called fomites.
VIII Proper Order of Removing PPE
IX Transmission-based Precautions ● Some microorganisms form spores or
X Phlebotomy Procedures in Isolation become inactive when conditions are
XI Protective/Reverse Isolation not ideal such as in dried blood
XII PPE in Laboratory
“Breaking the Chain”
XIII Biological Waste Disposal
XIV Sharp Hazard ● Disinfecting the work area kills the
XV Blood Borne Pathogens infectious agent and eliminates the
XVI Occupational Exposure to Blood-borne Pathogens Standard reservoir.
XVII Post-exposure Prophylaxis (PEP)
● Hand hygiene
XVIII Chemical Hazards
XIX Radioactive Hazards
XX Electrical Hazards 3. Portal of Exit
XXI Fire and Explosive Hazards ● The infectious agent must have a way to
XXII Hazardous Material Classification
exit the reservoir to continue the chain of
XXIII Physical Hazards
infection.
● When the reservoir is a human or an
INTRODUCTION
animal this can be through the nose,
mouth, and mucous membranes and in
Although important advances have been made in blood or other body fluids.
understanding and treating infections, still, the threat of “Breaking the Chain”
infection looms at large. As a phlebotomist, you will encounter ● Disposing of needles and lancets in
numerous patients every day, and you might be the one to sealed sharps containers and other
transfer these microorganisms. Measures to prevent the
spread of infection must be taken in the course of all patient
contaminated materials in biohazard
encounters. To prevent infection, it is necessary to understand containers and keeping tubes and
the components that make up the chain and the methods by sample containers sealed.
which the chain can be broken.
4. Mode of Transmission
INFECTION CONTROL ● Direct contact - unprotected host
touches or is touched by the reservoir
● The healthcare setting provides an abundant ● Droplet - the host inhales material from
source of potentially harmful microorganisms. the reservoir such as aerosol droplets
● Measures to prevent the spread of infection from an infected person
must be taken in the course of all patient ● Airborne - inhalation of dried aerosol
encounters. nuclei circulating on air currents or
attached to dust particles
CHAIN OF INFECTION ● Vehicle - ingestion of contaminated food
or water
1. Infectious Agents - Also known as the causative ● Vector - parasites such as malaria
agents of disease. transmitted by a mosquito bite
● Infectious agents consist of bacteria, “Breaking the Chain”
fungi, parasites, and viruses ● Proper PPE, Handwashing, Standard
“Breaking the Chain” precautions and transmission-based
● Early detection and treatment of precautions (patient isolation)
infectious agents.
5. Portal of Entry
● The portal of entry can be the same as
the portal of exit. This includes the nose,

DAVID. DEL ROSARIO. EBERO. FULLO. GELSANO. MIRALLES. NONES. PANTINO. SEÑARIS. SET | LEVEL 1 MT
 mouth, mucous membranes, and open When to wash hands?
wounds.
● Medical and surgical procedures provide Hands should always be washed:
a very convenient portal of entry for ● Before patient contact
infectious agents. ● When gloves are removed
“Breaking the Chain” ● Before leaving the work area
● Disinfection and sterilization and strict ● At any time when they have been
adherence to Standard Precautions and knowingly contaminated
transmission-based precautions are ● Before going to designated break areas
used to block the portal of entry ● Before and after using bathroom
facilities
6. Susceptible Host
● Patients are ideal susceptible hosts 2. Personal Protective Equipment (PPE)
because their immune systems that 2.1 Gloves
normally provide defense against ● To protect the health-care worker’s
infection are already involved with the hands from contamination by patient
patient’s illness. body substances
● Patients receiving chemotherapy and ● To protect the patient from possible
immunocompromised patients are very microorganisms on the health-care
susceptible hosts. worker’s hands.
● The immune system is still developing in ● Mandated by the National Institute of
newborns and infants and begins to Occupational Safety and Health
weaken as people age, making these (NIOSH) for phlebotomy procedures
groups of patients more susceptible to ● Varieties: sterile and nonsterile,
infection. powdered and unpowdered, and latex
● The immune system also is depressed and non-latex.
by stress, fatigue, and lack of proper Latex Allergy
nutrition. ● Irritant Contact Dermatitis
“Breaking the Chain” ● Produces patches of dry, itchy irritation
● Observation of special precautions on the hands, delayed hypersensitivity
when working in the nursery and in reactions resembling poison ivy that
isolation rooms designated for appear 24 to 48 hours following
protection of susceptible patients. exposure
● Workers must stay current with the ● True Immediate Hypersensitivity
required healthcare workers’ reactions often characterized by
immunizations and tests. respiratory difficulty
● Maintenance of a healthy lifestyle is very ● Hand washing immediately after
important for the healthcare worker. removal of gloves and avoiding
powdered gloves may aid in preventing
NOSOCOMIAL INFECTIONS the development of latex allergy.
● Replacing latex gloves with nitrile or
● An infection acquired by a patient during a vinyl gloves provides an acceptable
hospital stay alternative.
● A newer term health-care–acquired infection 2.2 Gowns
(HAI) refers to an infection acquired by a patient ● Protect the clothing and skin of health-
as the result of a health-care procedure that may care workers from contamination by
or may not require a hospital stay. patient body substances
● Prevent the transfer of microorganisms
TRANSMISSION PREVENTION PROCEDURES out of patient rooms
● Fluid-resistant gowns should be worn
1. Hand Hygiene when the possibility of encountering
● Hand contact represents the number splashes or large amounts of body fluids
one method of infection transmission is anticipated.
● Hand hygiene includes both hand ● Gowns tie in the back at the neck and
washing and the use of alcohol-based the waist and have tight- fitting cuffs.
antiseptic cleansers ● They should be large enough to provide
● Alcohol-based cleansers can be used full body coverage, including closing
when hands are not visibly completely at the back.
contaminated. 2.3 Mask/ Goggles/ Face Shields
DAVID. DEL ROSARIO. EBERO. FULLO. GELSANO. MIRALLES. NONES. PANTINO. SEÑARIS. SET | LEVEL 1 MT
 ● Masks are worn to protect against
inhalation of droplets containing
microorganisms from infective patients.
● Masks and goggles are worn to protect
the mucous membranes of the mouth,
nose, and eyes from splashing of body
substances.
● Face shields also protect the mucous
membranes from splashes
2.4 Respirators
● Respirators may be required when
collecting blood from patients who have
airborne diseases, such as tuberculosis.
● The NIOSH approved respirator is the
N95.
REMOVING OF PPE
Step 1. Gloves are the most contaminated. They are
removed first.
Step 2. The first glove is pulled off using the gloved
hand so that it will end up inside out in the still gloved
hand.
Step 3. Remove the second glove by sliding the
ungloved finger inside the glove of the other hand and
remove the glove without touching the outside of the
glove.
Step 4. Dispose of gloves in a biohazard container.

DONNING OF PPE Step 5. Untie the gown and remove it by touching only
the inside of the gown.
1. Gown
2. Maks Step 6. Dispose of the gown in a biohazard container.
3. Goggles (when necessary)
4. Face Shields (when necessary) Step 7. Remove the mask touching only the ties or
5. Respirators** (before entering the room) bands.
6. Gloves
Step 8. RESPIRATORS: Unfasten the lower tie first so
PROPER ORDER OF WEARING PPE that the mask will not fall forward while removing the
lower tie. Dispose of the mask in a biohazard container.
Step 1. The gown is put on first and tied at the neck and
waist. STANDARD PRECAUTIONS

Step 2. Place face protection over the nose and mouth.
Step 3. Masks with ties are fastened first at the top,
adjusted to the nose and mouth, tied at the neck and
refitted. Masks with straps are fitted to the nose and
mouth. The mask is held in place with one hand while
the other hand places the straps over the head and a
final adjustment is made.
Step 4. When needed, goggles and face shields are put
on after the mask and adjusted for fit.
*** Respirators are individually fitted for the wearer and
are donned just prior to entering the room.
Step 5. Gloves are donned last and securely pulled over
the cuffs of the gown.
● Standard Precautions (SP) were developed by
the CDC by combining the recommendations of
Universal Precautions and Body Substance
Isolation procedures.
● SP assumes that every person in the health-
care setting is potentially infected or colonized
by an organism that could be transmitted.
● SP applies to all blood and body fluids, mucous
membranes, and nonintact skin and stresses
hand washing.
TRANSMISSION-BASED PRECAUTIONS
● Spread of infection can be controlled by placing
highly infectious or highly susceptible patients in
private isolation rooms.
● Guidelines for isolation practices are published
by the CDC and have been periodically revised
to meet the ever-changing health-care
environment.

DOFFING OF PPE PHLEBOTOMY PROCEDURES IN ISOLATION

1. Gloves ● Bring only necessary equipment (not the

2. Gown phlebotomy tray) into isolation rooms.
3. Face Shields ● All equipment, including PPE, taken into the
4. Goggles room must be left in the room and, when
5. Mask/Respirator appropriate, deposited in labeled waste

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 containers. Tourniquets, gauze, alcohol pads,
and pens may already be present in the room.
● Samples taken from the room should be cleaned
of any blood contamination and placed in plastic
bags located near or just outside the door.
● Bags should be folded open to allow tubes to be
added to the bag without touching the outside of
the bag with contaminated gloves or tubes.
● If double bagging is required, a clean open bag
must be available immediately outside the room.
PROTECTIVE/REVERSE ISOLATION
Protective isolation procedures may be required for:
● severely burned patients
● patients receiving chemotherapy
● organ and bone marrow transplant patients
● in the nursery
● Only necessary equipment is brought into the
room and all equipment brought into the room is
taken out of the room. PPE is removed after
leaving the room.
PPE IN THE LABORATORY
● Gloves
- When samples are collected, gloves
must be changed between every
patient.
● Fluid-Resistant Gowns
- Fluid-resistant laboratory coats with
wrist cuffs are worn to protect clothing
and skin from exposure to patients’ body
substances.
● Eye and Face Shields
● Plexiglas Countertop Shields
BIOLOGICAL WASTE DISPOSAL
● Phlebotomy equipment and supplies
contaminated with blood and body fluids must
be disposed of in containers clearly marked with
the biohazard symbol or red or yellow color
coding
DISINFECTION
● Contaminated non-disposable equipment, blood
spills, and blood and body fluid processing areas
must be disinfected.
● The most commonly used disinfectant is a 1:10
dilution of sodium hypochlorite
SHARP HAZARDS
● The number one personal safety rule when
using needles is to never recap a needle.
DAVID. DEL ROSARIO. EBERO. FULLO. GELSANO. MIRALLES. NONES. PANTINO. SEÑARIS. SET | LEVEL 1 MT
● All sharps must be disposed of in puncture-
resistant, leak-proof containers labeled with the
biohazard symbol.
BLOOD-BORNE PATHOGENS
Primary concerns are:
● human immunodeficiency virus (HIV)
● hepatitis B virus (HBV)
● hepatitis C virus (HCV)
● other blood-borne pathogens including those
causing syphilis, malaria, and other viral
diseases
OCCUPATIONAL EXPOSURE TO BLOOD-BORNE
PATHOGENS STANDARD
● First published by OSHA in 1991 to protect
health-care workers from exposure to the blood-
borne pathogens
● In 1999, OSHA issued a new compliance
directive, called the Enforcement Procedures for
the Occupational Exposure to Blood-borne
Pathogens Standard
● Needlestick Safety and Prevention Act signed
into law in 2001.
● June 2002, OSHA issued a revision to the
Blood-borne Pathogens Standard compliance
● directive.
● The agency requires that all blood holders with
needles attached be immediately discarded into
a sharps container after the device’s safety
feature is activated.
POST-EXPOSURE PROPHYLAXIS (PEP)
● Any accidental exposure to blood through
needle-stick, mucous membranes, or non-intact
skin must be reported to a supervisor and a
confidential medical examination must be
started immediately.
● Evaluation of the incident must begin
immediately to ensure appropriate post-
exposure prophylaxis (PEP) is initiated within 24
hours.
● Needlesticks are the most frequently
encountered exposure in phlebotomy and place
the phlebotomist in danger of contracting HIV,
HBV, and HCV.
CHEMICAL HAZARDS
General rules for safe handling of chemicals include:
● Taking precautions to avoid getting chemicals
on the body, clothes, and work area.
● Wearing PPE such as safety goggles when
pouring chemicals.
● Observing strict labeling practices.
● Carefully following instructions.
 ● When skin or eye contact occurs, the best first 5. Wear comfortable, closed-toe shoes with non-
aid is to flush the area immediately with water skid soles that provide maximum support.
for at least 15 minutes and then seek medical 6. Maintain a clean, organized work area.
attention.
● Phlebotomists must know the location of and
how to use the emergency shower and eyewash
station in the laboratory

RADIOACTIVE HAZARDS

● Phlebotomists may come in contact with

radioactivity while drawing blood from patients in
the radiology department or from patients
receiving radioactive treatments and in the
laboratory when procedures using radioisotopes
are performed.

ELECTRICAL HAZARDS

● Equipment that has become wet should be

unplugged and allowed to dry completely before
reusing.
● Equipment should also be unplugged before
cleaning.
● It is required that all electrical equipment is
grounded with a three-pronged plug
● When a situation involving electrical shock
occurs, it is important to remove the electrical
source immediately.
● Turning off the circuit breaker and moving the
equipment using a nonconductive glass or wood
object are safe procedures to follow.

FIRE AND EXPLOSIVE HAZARDS

● Rescue—anyone in immediate danger

● Alarm—activate the institutional fire alarm
system
● Contain—close all doors to potentially affected
areas
● Extinguish/Evacuate—extinguish the fire, if
possible, or evacuate, closing the door
Phlebotomists should be thoroughly familiar with the
operation of the fire extinguishers.
● Pull pin
● Aim at base of fire
● Squeeze handles
● Sweep nozzle, side to side

PHYSICAL HAZARDS

1. Avoid running in rooms and hallways.

2. Be alert for wet floors.
3. Bend the knees when lifting heavy objects or
patients.
4. Keep long hair tied back and remove dangling
jewelry to avoid contact with equipment and
patients.
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