MODULE 2.
INFECTION CONTROL, SAFETY, There are two types of infections:
FIRST AID, AND PERSONAL WELLNESS
-Introduction-
Although phlebotomy is considered one of the most
commonly performed procedures in the field of medicine,
there are still risks involved that can be hazardous to both
patient and healthcare personnel. When not done properly,
this procedure could result in injury of the patient, errors in
laboratory findings and exposure to infection, and other
safety hazards. Risk could be reduced if best practices in
prevention and control are followed.
-objectives-
Upon completion of this module, you should be able to:
1. identify the components of the chain of infection
and give examples of each, describe infection-
control procedures used to break the chain of
infection, and explain the four functions of infection-
control program;
2. perform proper procedures for hand hygiene,
putting on and removing protective clothing;
3. discuss the standard and transmission-based
precautions for blood-borne pathogens;
4. list examples of blood-borne pathogens and
describe their means of transmission in a
healthcare setting;
5. describe hazards, identify warning symbols, list
actions to -take if incidents occur, and specify rules
to follow for proper biological, electrical, fire,
radiation, and chemical safety;
6. identify symptoms of shock and first-aid
procedures; and
7. explain the role of personal hygiene, proper
nutrition, rest, exercise, back protection, and stress
management in personal wellness.
Definition of terms
Term Definition (Meriam Webster Dictionary)
Infection - the state produced by the establishment of
one or more pathogenic agents (such as a
bacteria, protozoans, or viruses) in or on the
body of a suitable host
Safety - the condition of being safe from undergoing
or causing hurt, injury, or loss
First Aid - emergency care or treatment given to an ill
or injured person before regular medical aid
can be obtained
Wellness - the quality or state of being in good health
especially as an actively sought goal
-discussion-
Infection - happens when a microorganism invades the
body, multiplies, and causes injury or disease.
Pathogen - is a disease-causing microbe which could be
classified as bacteria, fungi, protozoa, or virus.
(1) Communicable - infections can spread from
person to person
(2) Nosocomial and healthcare-associated
infections (HAis) - are usually caused by infected
personnel, patients, visitors, food, drug, or
equipment while a patient is in the hospital or other
healthcare facilities.
PART 1. COMPONENTS OF THE CHAIN
OF INFECTION
For the infection to escalate to an epidemic, all components
should be favorable to the pathogenic microbe. The
following table shows the link of the chain of infection and
their description.
Table 2.1 Six Components of Chain of Infection
Component Description
Infectious Pathogenic microbe such as virus,
bacteria, fungus, protozoa, and
(causative agent)
rickettsia
Reservoir Source of the agent of infection or place
where the microbe could grow, survive,
and multiply, which could be in humans,
animals, food, water, soil, or equipment
Exit pathway A way or manner wherein an infectious
agent can leave the reservoir host,
which could be through secretions and
exudates, tissue specimens, blood,
feces, or urine
Airborne, direct (touching or kissing) or
Means of
indirect contact (contaminated objects),
transmission
droplets (coughing or sneezing), vector
(insect, arthropod, or animal), and
vehicle (food, water, or drugs)
Entry pathway The way an infectious agent enters a
host, which includes body orifices,
mucous membranes, and breaks in the
skin
Susceptible host Someone who is prone to infection,
especially the elderly, newborn babies,
patients who are immune-suppressed
or unvaccinated, and those suffering
from acute or chronic illness
Student assessment question 1:
Using the COVID-19 as an example, illustrate creatively
the Chain of Infection and how it works. (20pts)
I. Infection Control Program
• A healthcare institution should have a set of procedures
to break the chain of infection. These measures include
effective hand hygiene procedure, good nutrition,
immunization against common pathogens, insect and
pest control, isolation and decontamination procedures,
use of proper safety devices, wearing of personal
protective equipment (PPE) when needed, and proper
disposal of sharp objects and other waste materials.
• An infection-control program has four main functions:
(1) to protect patients, employees, and visitors from
infection
(2) to screen employees for infectious diseases and to
require immunization when needed
 (3) to provide evaluation and treatment to health 8. Use the paper towel to close the faucet, except
workers who have been exposed to infections while when the latter is foot or motion-activated.
performing their duty
(4) to monitor employees and patients who are at risk
of infection and to collect data from patients and
health workers who have been exposed to such
danger

II. Infection Control Procedure

• Infection-control methods or procedures must be
followed at all times. These include ensuring that proper
hand hygiene is practiced consistently using alcohol- Figure 2.1 HANDWASHING
based antiseptic hand cleaners, and that the personal
protective equipment (PPE) is clean and properly III. Personal Protective Equipment (PPE)
donned and removed. The personal protective equipment (PPE) includes the
gloves, gowns, lab coats, masks, face shields, goggles, and
PART 2. PROPER PROCEDURES OF HAND HYGIENE, respirators.
PUTTING ON AND REMOVAL OF
PROTECTIVE CLOTHING

I. Hand Hygiene
• Hand hygiene is an essential part of standard
precautions in the healthcare setting because it is an
effective way to prevent infections that can be
transmitted from the patient and healthcare personnel
during the procedure.

• There are two methods for hand hygiene:

(1) Routine Hand washing
▪ uses plain soap andwater
▪ when hands are visibly dirty
▪ after known exposure to Clostridium
difficile, Bacillus anthracis, and infectious
diarrhea during norovirus outbreaks
▪ before eating
▪ after using the restroom
(2) Hand antisepsis
▪ an antimocrobial soap or alcohol-based
hand sanitizer to remove transient
microorganisms
▪ alcohol-based hand sanitizer is preferred
when hands are not visibly dirty
▪ put the sanitizer on hands, rub the hands
together for about 20 seconds or until it
feels dry
II. Steps in Performing the Routine Hand-washing
Technique
1. Stand a few inches from the sink to avoid
contamination.
2. Tum on the faucet and place hands under the
running water.
3. Use soap and work up lather to ensure that hand
surfaces are reached
4. Scrub for at least 15 seconds. Make sure to scrub
all surfaces especially between the fingers and the
knuckles.
5. Apply a little friction and rub hands together for at
least 15 seconds.
6. Rinse the hands from the wrist to fingertips using a
downward motion.
7. Dry hands using a clean paper towel.
MODULE 2 - INFECTION CONTROL. SAFETY, FIRST AID, AND PERSONAL WELLNESS
Figure 2.2 PPE
A. Gloves
• Phlebotomists should always wear gloves during blood
collection and when handling specimen. Gloves are
worn to prevent contamination of the hands and reduce
chances of transmission of microorganisms from
personnel to patients. They should be worn over the
cuffs of the lab gown to ensure protection.
Proper Removal of Gloves:
1. The wrist part of one glove is grasped by the
opposite hand.
2. The glove is pulled inside out and off the hand.
3. The recently removed glove must be placed in the
gloved hand. The
1. fingers of the non-gloved hand are slipped under
the wrist of the
2. remaining glove but make sure not to touch the
exterior surface.
3. The second glove is pulled inside out.
4. The gloves must be dropped in the proper
receptacle.
B. Donning and Doffing of PPE
The PPE is kept clean and is worn to protect the healthcare
worker from splashes of blood and specimen during the
patient-care activities. It includes the laboratory gown or
coat, face mask, and gloves. These items are removed at
the anteroom or before leaving the room of the patient in an
2
aseptic, sterile, and pathogen-free way to avoid • Can survive a mild fever,
contamination. Nowadays, disposable PPE is also available week on objects muscle/joint/
• Transmitted via abdominal pain,
in the market. needlesticks, nausea, vomiting
sexual contact
Donning of PPE Hepatitis None • Blood and Flu-like, fatigue,
1. Gown should be put on first. Make sure that it is C Virus serum; loss of appetite,
fastened, and the belt is tied. (HCV) sometimes mild fever,
saliva muscle/joint/
2. Mask should cover both the nose and mouth. • Infection
3. Gloves should be pulled over the gown cuff. primarily occurs
after large and
Doffing of PPE multiple
exposures
1. Gloves are removed first. The contaminated areas
• Transmitted via
should not be touched with ungloved hands. needlesticks,
2. Gown should be pulled from the shoulders towards sexual contact
the hand so it is turned inside out.
3. Mask should be removed by only touching the
Student assessment question 2:
string.
Note: Wash hands immediately after removal of the PPE. Aside from the examples above, give at least 2 more
blood-borne pathogens by making a table same as
above. (20 pts)

I. Exposure Control Plan

Healthcare workers are at risk of being exposed to blood-
borne pathogens as they perform their duties. Exposure
Figure 2.3 GLOVES
can occur when the following happens:
a. A contaminated needle or sharp object pierces the
skin of the health worker
b. Body fluid or blood splashes in the eyes, nose, or
mouth of the health worker
c. Cut, scratch, or abrasion of the health worker has
made contact with blood or body fluid of an infected
patient
d. Human bite cuts the skin of the health worker
Figure 2.4 Disposable Mask
Figure 2.5 Disposable Lab Gown
During BBP exposure, this procedure should be followed:
a. BBP Exposure Caused by Needlestick or Any
When the colored portion of the mask is exposed,
Sharp Objects
you are protecting yourself from infection. 1. Carefully remove the sharp or foreign object.
However, if the white portion is the one exposed 2. Wash the site thoroughly with soap and water for
then that means you are protecting others from at least 30 seconds.
being infected because you might be a carrier of a
b. BBP Exposure through Mucous Membrane
disease.
1. Flush with water or saline. for at least 10
minutes.
PART 3. STANDARD AND TRANSMISSION-BASED 2. For the eyes, use eyewash station for flushing,
PRECAUTION FOR BLOOD-BORNE PATHOGENS if available. Remember to remove the contact
lenses (if there are any) and make sure to
In the clinical laboratory, health workers may be exposed to disinfect them.
blood-borne pathogens (BBP) by needlestick or other 3. Report the incident to the immediate supervisor
injuries caused by sharp objects. BBP are microorganisms so that evaluation, treatment, and counseling can
in the human blood that are infectious and can cause be provided.
diseases. The most common pathogens include hepatitis B
(HBV), hepatitis C (HCV), and human immunodeficiency For surface decontamination, use 1:10 bleach solution or
virus (HIV). other disinfectants for the specimen collection and
processing areas. Remember to wear gloves and use an
Table 2.2 Defense, Hazards and Symptoms of BBP absorbent material when cleaning the area to avoid
Pathogen Best Exposure Hazards Symptoms spreading the spills over a wider area. As a precaution, all
Defense
non-reusable items contaminated by blood or other body
Hepatitis HBV • Blood and other Flu-like, fatigue,
B Virus Vaccination body fluids loss of appetite, fluids should be placed in biohazard waste containers for
(HBV) • Can survive a mild fever, proper disposal.
week on objects muscle/joint/
• Transmitted via abdominal pain, Student assessment question 3:
needlesticks, nausea, vomiting Compute the 1:10 dilution of sodium hypochlorite
sexual contact (bleach solution) if you need to prepare 1000mL.
Hepatitis None • Blood and other Flu-like, fatigue,
D Virus body fluids loss of appetite, Show your solution. (10 pts)

MODULE 2 - INFECTION CONTROL. SAFETY, FIRST AID, AND PERSONAL WELLNESS 3

PART 4. HAZARDS, WARNING SYMBOLS, ACTIONS They should also have continuing education and should
TO TAKE IF INCIDENTS OCCUR, AND LABORATORY attend trainings and seminars to keep them updated on the
SAFETY RISKS changes, in the practice of their profession.

BIOHAZARD II. Fire Hazards

Figure 2.6 Biohazard Symbol Fire is another potential work hazard. Regular fire drills
Biohazard refers to any material that should be conducted so employees know what to do in case
could be harmful to one's health. of fire. They should also be familiar with the location of
Biosafety is used to prevent and emergency exits and evacuation plans or routes. The
protect clinical laboratories from location of fire extinguishers and heavy blankets should be
harmful incidents caused by posted, and, the staff should know how to use them.
laboratory specimens that are
potential biohazards. Table 2.3 Types of Fires and Fire Extinguishers

A health worker could be exposed to a biohazard in various

ways. These ways are called the biohazard exposure
routes.
1. Airborne – from splashes and aerosols during
centrifuge and aliquot; patients with airborne diseases.
a. Observe proper handling practices.
b. Wear PPE properly.
c. Use safety shield and guards.
When a fire is discovered, all employees are to take the
2. Ingestion – hands are not sanitized before handling actions in the acronym RACE:
food.
a. Wash hands frequently.
b. Avoid hand-to-mouth activities.
c. Avoid placing items in the mouth.

3. Non-intact skin – contamination through breaks or

cuts in the skin.
a. Cover skin breaks or cuts with non-permeable
bandages

4. Percutaneous – exposure through the skin due to

injuries from needlesticks and other sharp objects.
a. Use needle safety devices.
b. Wear heavy-duty utility gloves when cleaning
broken glass.
c. Never handle broken glass with bare hands.
Figure 2.7 RACE
5. Permucosal – infection through mucous
membranes of the mouth and nose and the conjunctiva It is important to be able to operate the expected fire
of the eyes. extinguishers. The acronym PASS can be used to
a. Observe proper handling to avoid aerosols and remember the steps in the operation:
splashes. Figure 2.9 FIRE
Figure 2.8 PASS EXTINGUISHER
b. Avoid rubbing and touching the eyes, nose, and
mouth.

I. Electric Hazard
Another potential hazard that a health worker faces in the
workplace is electric shock especially when dealing with
electrical equipment. The following actions should be taken
if electricity shoch occurs:

1. Remove the source of electricity using a non-

conductive object or simply turn off the source of
electricity.
2. Ask for medical assistance.
3. Start cardiopulmonary resuscitation (CPR) if III. Radioactive Hazards
necessary. • Radiation safety is another consideration of the
4. Keep the victim warm. phlebotomists. Radiation exposure depends on time,
distance, and protection or shielding. The length of
time of the exposure and the distance of the individual
MODULE 2 - INFECTION CONTROL. SAFETY, FIRST AID, AND PERSONAL WELLNESS 4
 from the source of radiation matter because the effect • One should have proper nutrition and have a balanced
is cumulative. The protection worn at the time also has diet consisting of vegetables, fruits, and legumes. Getting
a bearing on the intensity of exposure. It is a must that enough sleep and staying fit by having a regular exercise
a radiation symbol (Figure 2.10) be posted in areas routine are also necessary.
where radioactive materials are used and kept.
• It is important to maintain
• Radiation hazard can be proper posture and to keep
encountered by the phlebotomists one's back safe from any
when collecting specimens from injury by using proper
patients who have been injected techniques and equipment
with radioactive dyes or from the when lifting heavy objects.
nuclear medicine department or One must achieve and
simply when delivering specimens maintain work-Hf e
to the radioimmunoassay sections balance by finding time to
of the laboratory. Figure 2.10 relax and to relieve oneself
RADIATION SYMBOL of stress from work.
Figure 2.11
Components of Personal Wellness
IV. Chemical Hazards
• Chemicals are used as cleaning reagents, in adding
preservatives in urine container (24-hour), or in
delivering specimens to the laboratory. Inappropriate -SUMMARY-
handling can pose a problem not only to the
phlebotomists but also to other health workers. This chapter covered infection control, safety, first aid, and
personal wellness. A thorough knowledge in these areas is
• As a general rule, the phlebotomists should always necessary for phlebotomists to protect themselves,
wear the PPE when working with chemicals. Chemical patients, coworkers, and others from infection or injury,
clean-up materials should be properly used in case of react quickly and skillfully in emergency situations, and stay
chemical spills. healthy both physically and emotionally, all without
compromising the quality of patient care. This chapter
The following practices should NEVER be done: explains the process of infection, identifies the components
1. Storing chemicals above eye level of the chain of infection, lists required safety equipment,
2. Adding water to acid and describes infection control procedures. Also covered
3. Mixing chemicals indiscriminately are biological, electrical, fire, radiation, and chemical
4. Storing chemicals in unlabeled containers hazards and the safety precautions, rules, and procedures
5. Pouring chemicals into used or dirty containers necessary to eliminate or minimize them. First aid issues
6. Using chemicals in ways other than their intended covered include control of external hemorrhage and how to
uses recognize and treat shock victims. Wellness issues
addressed include the prevention of back injury, benefits of
SYMPTOMS OF SHOCK exercise, and dealing with stress.
Shock is a condition when there is not enough blood that
circulates back to the heart, which results in inadequate -reference-
supply of oxygen in the body. It may be caused by
hemorrhage, heart attack, trauma, and drug reactions. • Learning Guide for Principles of Medical
Laboratory Sciences 2
The common symptoms of shock are as follows: pale, cold Copyright 2020 by C&E Publishing Inc.,
and clammy skin, rapid and weak pulse; increased and Bernard U. Ebuen, Nini F. Lim, Edliberto P.
shallow breathing and expressionless face with a blank Manahan, Jose Jurel M. Nuevo, Maria Luisa R.
stare. Olano, and Aileen C. Patron
FIRST-AID PROCEDURES
When the patient is in shock, perform the following steps as -evaluation-
first aid:
1. Keep the airway open. MULTIPLE CHOICE. Select the correct answer.
2. Call for medical assistance.
3. Keep the patient lying down. 1. The single most important means of preventing the
4. Control any bleeding or other cause of shock. spread of infection is:
5. Keep the patient warm. a. proper hand antisepsis
b. keeping clothes clean
PART 5. PERSONAL WELLNESS c. wearing a mask
• Personal wellness begins with personal hygiene, which d. wearing gloves
includes bathing regularly, using deodorant, brushing
one’s teeth after eating, keeping one’s hair neat and 2. The most frequently occurring lab-acquired infection is
clean, trimming and cleaning one's fingernails, and a. hepatitis B
avoiding the use of heavy lotions and colognes. b. HIV infection
MODULE 2 - INFECTION CONTROL. SAFETY, FIRST AID, AND PERSONAL WELLNESS 5
 c. syphilis
d. tuberculosis

3. Which of the following items is PPE?

a. Biohazard bag
b. Countertop shield
c. Nonlatex gloves
d. Sharps container

4. Surfaces in the specimen collection and processing

area should be cleaned with
a. 70% isopropyl alcohol.
b. 1:10 bleach solution.
c. soap and water.
d. any of the above

5. Which of the following examples of potential

exposure to blood-borne pathogens involves a
parenteral route of transmission?
a. Chewing gum while collecting blood specimens
b. Eating a snack while accessing specimens
c. Licking fingers while turning lab manual
pages
d. Rubbing the eyes while processing specimens

6. All of the following are components of personal wellness

except:
a. personal hygiene
b. regular exercise
c. enough sleep
d. overtime at work

7. The common symptoms of shock are as follow, except:

a. pale, cold and clammy skin
b. rapid and fast pulse
c. increased and shallow breathing
d. expressionless face with a blank stare

8. It is a must that a radiation symbol be posted in areas

where radioactive materials are used and kept.
a. TRUE
b. FALSE

9. When FIRE is discovered, remember to execute PASS.

a. TRUE
b. FALSE

10. In operating the fire extinguisher, follow the steps

“RACE”.
a. TRUE
b. FALSE

Prepared by:

Ruth Abigail S. Contante, RMT, LPT

Instructor

MODULE 2 - INFECTION CONTROL. SAFETY, FIRST AID, AND PERSONAL WELLNESS 6