Safety in Phlebotomy

Chapter 2
Objectives

• Identify rules that promote safety of the

individual and patient.
• Explain the principle of and procedures for
infection control.
• Describe the proper handwashing technique
and when to use it.
Objectives (cont.)

• Explain the infection concept.

• Explain the differences between disease-
specific and category-specific isolation.
• List the three types of transmission-based
precautions.
Objectives (cont.)

• Explain the purpose and scope of Standard

Precautions.
• State the six major tactics to reduce the risk
of exposure to blood-borne pathogens.
Objectives (cont.)

• Explain the concerns regarding latex gloves.

• Describe precautionary measures and
actions to be taken with accidental needle
punctures.
• Explain the purpose of material safety data
sheets (MSDSs).
Infection Control

• Nosocomial infection
• Community-acquired infection
Nosocomial Infection

• Healthcare-associated
• Hospital-acquired
• Develops 48 hours after admission or within
30 days after discharge from a hospital or
health care facility
Community-Acquired
Infection
• Infection picked up prior to admission
– Infection occurs before 48 hours after
admission
Types of Infection

• Local
– Infection restricted to one area of body
• Systemic
– Infection that affects entire body
• Autogenous
– Infection from patient’s own flora
Infection Control
• Communicable
disease
– Capable of
spreading from
person to person
Means of Transmission of Infection

• Contact
– Direct and indirect
• Droplet
• Vehicle
• Airborne
• Vector-borne
Transmission of infection

• direct contact: physical transfer of infective

material from the source to susceptible host

• Indirect contact: transfer of infective

materials via an object, such as bed linens

• Droplet: travel 1 meter or less from the

infected individual
Transmission of infection

• Vehicle: transfer of infective material through

contaminated items, such as food

• Airborne: droplets that transfer on air

currents, such as TB

• Vector: transmission by insects, such as

anopheles mosquito for malaria
Standard Precautions or
Universal Precautions (CDC)
• Assumes that all blood and most body fluids
are potentially infectious.
• Personal protective equipment must be worn
for contact with all body fluids whether blood
is visible or not.
 Types of Body Fluids
• Amniotic • Pleural
• Peritoneal • Edematous
• Pericardial • Seminal
• Synovial • Cerebrospinal
Five Points of Standard Precautions

• Wash hands
• Wear gloves
• Wear protective covering
• Wear a mask and eye protection when
appropriate
• Use designated sharps containers
Tactics to Reduce Risk of Exposure
to Blood-borne Pathogens

•Engineering controls
•Work practices
•Housekeeping
•Hepatitis B virus (HBV) vaccination
•Private rooms
•Personal protective equipment
Engineering Controls

• Physical and mechanical devices available to

the health care associate to reduce or
eliminate the potential to transfer infectious
diseases
– Sharps containers
– Transport bags and containers
– Self-sheathing needles and holders
 Types of Engineering
Controls
• Sharps containers
Types of Engineering Controls (cont.)
• Transport bags and
containers
Work Practice Controls

• Handwashing
• Proper disposal of sharps
• Avoiding eating, drinking, smoking, handling
contact lenses, or applying cosmetics or lip
balm in work areas
• Storing food and drink separate from
infectious materials
 Housekeeping
• Clean up spills
• Decontaminate soiled areas immediately with a
disinfectant such as 10 percent bleach made up
fresh daily
• Avoid picking up broken glass with hands
 Hepatitis B Vaccination
• Must be available free of charge to phlebotomist
• Effective for more than 15 years in protecting the
phlebotomist from contracting the disease or
becoming a carrier
• Does not protect the phlebotomist from all types of
hepatitis, only hepatitis B
Private Rooms

• Reduce possibility of transmission of

infection by separating patient with disease
from other patients and health care
associates
Personal Protective Equipment

• Masks
• Goggles
• Face shields
• Gowns
• Gloves
Evolution of Isolation Techniques
• First technique:
– Category-specific isolation
– Based on seven isolation categories
• Changed to disease-specific isolation
– Blood and body fluid precaution added
• Evolved into transmission-based isolation
Category-Specific Isolation

• Strict
• Contact
• Respiratory
• Tuberculosis
• Drainage/Secretion
• Enteric
• Protective or Reverse
Disease-Specific Isolation

• Strict
• Contact
• Respiratory
• Tuberculosis
• Enteric
• Drainage
• Blood and body fluid
Transmission-Based Precautions

• Based on method of transmission of

infection:
– Airborne
– Droplet
– Contact
Occupational Safety and Health
Administration (OSHA) Standards
• Agency of the federal government
• Investigates the possibility of unsafe
practices in the work environment
• Develop and promote standards for all
occupations
• Develop and issue regulations
OSHA Standards (cont.)

• Determine level of compliance with health

and safety regulations
• Level fines for noncompliance with health
and safety regulations
OSHA Standards: Basic Requirements

• Exposure control plan must be developed

• Engineering controls specific to a safer
device must be used when feasible.
• Employee input must be sought when
choosing safer devices.
• Must be recordkeeping of any injuries
 Needles and Sharps
• Biohazard labels
must be fluorescent
orange or orange-
red with lettering or
symbols in a
contrasting color.
Laboratory Techniques

• All procedures involving blood or potentially

infectious materials are to be performed to
minimize splashing, splattering, or
generation of droplets
• Health care associate must wear gloves and
protective clothing when working with any
potentially infectious material
Material Safety Data Sheets

• Information that must be on file to indicate

hazards of chemicals used in laboratory
– Does not need to be a paper file
• Most healthcare facilities have these as
Internet-assessable forms
Hazard identification
Fire Safety

• Fire extinguishers
– Class A
– Class B
– Class C
– Class D
– ABC type
Class A fire extinguishers

• include foam, loaded-stream and

multipurpose dry chemical extinguishers
• Includes fires of ordinary combustible
materials in the lab like wood, plastics, paper

• used for elements that require the cooling

action of water to extinguish the fire
Class B fire extinguishers

• Includes flammable liquids and gases-

elements that require the blockage of oxygen
from fire to extinguish it.

• Include carbon dioxide, dry chemical, foam,

& loaded-stream extinguishers
Class C fire extinguishers

• Fires in energized electrical equipment

• Include carbon dioxide and dry chemical

• Carbon dioxide : best universal fire

extinguisher for computer equipment
Class D fire extinguishers

• Includes fires of combustible and reactive

metals such as sodium, potassium,
magnesium, lithium
• Contain dry powder medium that does not
react or combine with the burning materials
Class ABC fire extinguishers

• Most common used type of extinguisher in

the lab
Fire Safety

• National Fire Protection Association’s key

word for action: RACE
– Rescue anyone in danger.
– Sound the Alarm.
– Contain the fire by closing doors and/or
windows.
– Extinguish/Evacuate.
Chemical Safety

• Chemicals that produce a toxic or irritant

vapor must be used only in an approved
chemical hood.
• A chemical-resistant apron and face shield
should be worn if there’s a danger of
splashing.
• Eye wash station and safety shower
Radiation Exposure

• Phlebotomists must be aware of the

institution’s radiation safety procedures.
• Phlebotomist may need to be shielded with a
special apron or cover gown
• Monitoring devices for exposure may include
a badge to detect exposure to radioactivity.
Electrical Safety

• Most common electrical equipment a

phlebotomist uses is a centrifuge
• Other electrical equipment includes
computers, fans, and space heaters.
• Equipment must be tested for safety and
proper operation.
 Latex Allergy
• Growing concern in healthcare
• Allergic reactions to latex
– Type IV latex allergy
• Irritant contact dermatitis resulting in skin irritation
• Symptoms begin 24 to 72 hours after exposure
– Type I latex allergy
• More serious (symptoms: nausea, low BP, respiratory
distress)
• Immunologic reaction up to anaphylactic shock (life
threatening)
Requirements for disposal of
waste
• Alter the product so no one can remove used
needles or syringes or other devices for their
own personal use or be injured by an
exposed sharp

• The waste must be rendered noninfectious

so people handling it will not become
infected and the environment will not be
contaminated
Disposal of Infectious Materials

• Must be by:
– Incineration
– Chemical treatment
– Autoclave
incinerator

• Waste is burned to ashes- potentially kills

microorganisms, makes items nonusable
Chemical treatment

• Waste is grinded or chopped into smaller

pellets then treated with disinfectant
autoclave

• Steam sterilization technique

Prevention of Needlestick
Injuries
• Eliminate use of needles when safe and
effective alternatives are available.
• Implement the use of devices with safety
features and evaluate their use.
Prevention of Needlestick
Injuries (cont.)
• Identify hazards and injury trends.
• Set priorities and strategies for prevention.
• Ensure health care workers are properly
trained in safe use and disposal of needles
and sharps.
 Response to Accidental
• Biohazard Exposure
Wash exposed area with soap and water
• Report incident to supervisor immediately
• Exposed associate must be tested for HIV and
HBV if consent is given
• Source individual’s blood is tested for HIV and
HBV if consent is given
 Response to Accidental
Biohazard Exposure
• If source patient refuses testing, is HIV or HBV
positive, or is in a high-risk category, associate
may elect to receive prophylactic treatment