Any healthcare setting contains a variety of hazards to your health and safety, but as a phlebotomist, you and your patients are exposed to a broad range of hazards. It’s important that you know the necessary safety precautions to take to protect yourself and your patients.
As a professional phlebotomist, you should know how to protect yourself and others (patients and other healthcare workers) in the work environment.
An important part of this task requires you to know and follow standard precautions when collecting and transporting specimens.
You should also understand the dangers to health and safety represented by blood borne pathogens, biohazards, and nosocomial infections and take steps to avoid the transmission and spread of disease.
Protect yourself and others by diligently using the recommended Personal Protective Equipment (PPE) and practice good workplace hygiene, disinfecting practices and safety precautions.
Finally, you should regularly use proper techniques for washing hands, donning and removing gloves, and when working in isolation settings use the appropriate gowns, masks, and double bagging.
First, let’s define what a phlebotomist is.
Phlebotomy is derived from the Greek term “phlebos” for veins and “tome” for incision. Put the two together and the meaning is “to incise a vein.”
If you were to look at a phlebotomist’s multi-sample needle under a microscope, you’d see that the tip is actually a scalpel blade.
So don’t overthink it – when asked what you do for a living, just tell them you incise patient veins to collect samples for laboratory analysis.
It is especially important for a phlebotomist to think and work with safety in mind, especially to prevent infection and biological hazards for the patient, and personal safety.
To illustrate the importance of safety precautions, consider that all it takes to become infected, or contract a virus, bacteria, or disease, can be by simply touching the patient’s bed rail, or taking a breath while in an airborne precaution setting. Understanding the importance of safety and infection control can save your life, and keep your friends and family safe as well.
There are many terms you need to know that are defined in your textbook readings and in this presentation. The worksheet for Module A lists these terms, requiring you to provide definitions and examples.
For example, a “biohazard” can mean many things but for the phlebotomist it refers to anything that is contaminated with blood or body fluids, as well as used needles. These items must be deposited in a specific biohazard box to comply with safety standards.
It’s a good idea to have that worksheet handy while you listen to this presentation and do your readings. Remember that you’ll be able to find some of these terms in the glossary in the back of your textbook, and in Chapter 5, beginning on page 136.
Every workplace environment has some type of hazard, but healthcare environments have a range of hazards that must be monitored and minimized through standard precautions and safety practices. These include:
- Biological: infections from exposure to bacteria, fungi, viruses and parasites
- Sharps: cuts, punctures & exposure to bloodborne pathogens from needles, lancets, and broken glass.
- Chemical: exposure to poisons, caustic & carcinogenic preservatives, laboratory reagents, and cleaning supplies
- Radioactive: Exposure to radiation from equipment
- Electrical, Fire & Explosive: Burns, shocks, trauma. Note that if there are any frayed or pulled apart electrical cords you should not use them.
- Physical: Falls, strains & sprains from wet floors & lifting challenges
Chapter 5 in your textbook, phlebotomy handbook, ninth edition, covers each of these safety hazards in greater detail. Be sure to read and be aware of the safety risk and how to manage them.
Bloodborne Pathogens are Infectious organisms found in blood & other body fluids. Some examples are Hepatitis B virus, HIV, syphilis, malaria, and many more.
Nosocomial infections are those that are acquired by patients after their admission to a healthcare facility such as a hospital, clinic, or nursing home.
The most common nosocomial infection is MRSA which is nicknamed “mersa,” but stands for Methylene Resistant Staph …
$1,100 per dose of treatment for MRSA that has to be covered by the hospital because government regulations state that you cannot charge a patient for treatment of a disease they contracted at the hospital. Remember the importance of hygiene – high costs to the hospital translate into costs to the employees, as well.
Nosocomial infections and contamination can be discouraged through the use of ASEPTIC TECHNIQUES. Aseptic techniques are Techniques that provide a degree of cleanliness that prevents infection and keeps the environment free of contamination by microorganisms.
There are several general precautions that you should observe when interacting with patients.
All personal protective equipment (or PPE) should be well-fitting and thoroughly cover the portion of your body that it was designed to protect. This includes non-sterile gloves, safety glasses, gowns, shoe covers, and other PPE.
You should carry out regular hand hygiene before and after each patient procedure, both before putting on gloves and after removing them.
To remove the risk of environmental contamination from pathogens you should also clean all work surfaces with disinfectant at the start of each shift, as well as when counter, work surfaces and chair arms are visibly dirty.
Of course you can also prevent infection and other adverse effects by following the recommended guidelines for all procedures, including guidelines on patient identification, hand hygiene, use of gloves, skin disinfection, use of appropriate blood-sampling devices and the safe storage and transportation of laboratory samples.
To reduce the hazards and risks and realize the goal of produce a safer healthcare workplace environment, the Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention (CDC) have developed safe working guidelines.
OSHA’s 1991 Bloodborne Pathogens standard and the amendments to it from the Needlestick Safety & Prevention act that passed in 2000, prescribes safeguards to protect workers against the health hazards caused by bloodborne pathogens.
Its requirements address items such as exposure control plans, universal precautions, engineering and work practice controls, personal protective equipment, housekeeping, laboratories, hepatitis B vaccination, post-exposure follow-up, hazard communication and training, and recordkeeping. Well cover safety measures related to some of these items in this presentation.
These regulations and guidelines are specific about employer responsibilities to help keep healthcare workers safe. For example, employers must provide:
– gloves in multiple sizes, single-use disposable needles, and syringes or lancing devices in sufficient numbers to ensure that each patient has a sterile needle and collection device or equivalent for each blood sampling;
– And sufficient laboratory sample tubes to prevent reuse and manual washing.
Nosocomial or health care-associated infections result when the chain of infection is complete, meaning that there is a pathogen, or disease-causing bacteria, fungi, virus, or parasite, in the environment, and there is a mode of transmission that the pathogen is able to utilize to infect a susceptible host.
You can break this chain to disarm the pathogen by….
Hindering the source of the disease with immunizations and transfusions, good nutrition and proper exercise, and medications to treat disease.
You should also seek to interrupt the mode of transmission with proper hand hygiene and decontamination of your equipment, use of disposable equipment and by limiting the use of common facilities, and through use of isolation techniques, insect and rodent controls.
Finally, you can control your susceptibility and that of the patients in your care by observing aseptic or sterile techniques, using proper hand hygiene, utilizing housekeeping services and laundry services at the point of care, and properly disposing of all biohazard waste.
PPE is the abbreviation used to refer to personal protective equipment. That, along with engineering controls that make the equipment safer, can go a long way to keeping you and your patients safe.
Examples of PPE include:
- Gloves
- Lab coats, gowns, scrub suits
- Goggles, safety glasses
- Examples of engineering safety controls include:
- Leakproof containers
- Sharps containers
- Biohazard containers & labels
- Needle safety caps
Take a minute to watch this brief video on Personal Protective Equipment.
When you return, use the controls at the bottom of the screen to advance to the next slide.
The current routine infection control policy developed by the Centers for Disease Control and followed in all healthcare settings is referred to as Standard Precautions.
Standard precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in health care facilities.
One set of precautions involves reducing the spread of disease through managing the means of transmission. It includes airborne precautions, droplet precautions and contact precautions.
Keys of Respiratory Hygiene/Cough Etiquette
–Covering the mouth and nose during coughing and sneezing
–Using tissues to avoid spreading respiratory secretions to others
–Offering a mask to persons who are coughing
–Turning the head away from others and maintaining separation when coughing
– Use of Standard Precautions
- Before entering a patient’s room, make sure to:
- Read any posted instructions that can inform you of potential health hazards,
- Put on appropriate PPE
- Announce your presence as you enter the room to respect your patient
- Scan the room for any potential hazards before entering. Especially for any spills or body fluids that can be a physical hazard.
Exposure controls are designed to reduce the risks of infection after a healthcare employee has been exposed to potentially harmful or infectious substances, as when an employee suffers a needle stick. The exposed employee should immediately cleanse affected area with alcohol & apply a bandage, then report it with the blood collection device involved.
Infection control programs are an attempt to control nosocomial infections. Isolating hospital breakouts, educating both employees and patients, and managing infections are an important means of regulating nosocomial infections. In addition, maintaining a degree of cleanliness that prevents or discourages the growth of microorganisms is another way to regulate the infections. Aseptic techniques are those that promote a cleanly environment and they include proper hand hygiene, use of PPE, contaminated waste management, use of proper cleaning solutions, following standard precautions, & using sterile procedures.
PPE is used to prevent skin and mucous membrane exposure when contact with blood or other body fluids of any patient is anticipated.
Personal protective equipment can reduce skin and mucous membrane exposure when contact with blood or other body fluids of any patient is anticipated.
Exposure can also be reduced by taking precautions to prevent injuries caused by needles, scalpels, and other sharp instruments or devices. This includes during procedures, during disposal of used needles, and when handling sharp instruments after procedures. For example, use safety-engineered needles and sharps devices; do not recap needles, purposely bend or break them by hand, remove them from disposable syringes, or handle them for any reason; immediately dispose of the blood tube holder and safety needle as a single unit after blood collection; place disposable syringes and needles, lancets, and other sharp items, after they are used, in puncture-resistant containers for transport to the biohazardous waste center.
If an employee is exposed, he or she should immediately wash his or her hands and other skin surfaces if contaminated with blood or other body fluids. In addition, hands should be washed immediately after gloves are removed.
In addition to reporting the incident, if exposed through needlestick, mucous membranes or non-intact skin, a confidential medical exam is started immediately to ensure appropriate post-exposure prophylaxis, abbreviated as PEP, is initiated within 24 hours.
If a hospital outbreak occurs, any health care worker entering or exiting these areas should be made aware of the special circumstances and the infected individuals should be isolated. There are some situations when reverse isolation is advised and a protective environment needs to be set up for the patient. In these situations, all food and articles are sterilized before they are taken into the patient’s room.
Be sure to know the infection control protocols your facility has, especially in specific units, such as the: Nursery Unit, Burn Unit, ICU or a Postoperative Care Unit
Your text provides several good procedures for donning, using and discarding personal protective equipment or PPE, and this sequence for removing PPE provided by the CDC should also help.
Some patients have mild to severe allergic reactions to the many latex products used in healthcare settings. There are many items that contain latex in the work environment, the most common being disposable gloves. In recent years, latex based products have been phased out by safer products which reduce the risks for allergic reactions in most of the populace, nitrile gloves are the most common and used by most healthcare providers. Other supplies that are typically made of or contain latex include tourniquets, adhesive tape, rubber bands, goggles, surgical masks, syringes, IV tubing, and urinary catheters, so be sure to consult your patient about any allergies and insure you are using proper equipment when treating a patient.
Allergic reactions to these items can range from skin rashes or hives, to more severe symptoms such as sinus distress or even shock.
If you know that a patient is allergic to latex products or tape adhesive, consider using Coban or Colfex self-adherent elastic wrap, pictured here along with regular tape. Avoid using silk tape on a patient, especially on geriatric patients who have more delicate skin because silk tape is generally the roughest tape to use on a patient’s skin.
Patients don’t always know they have a latex allergy, so healthcare workers must be aware of the symptoms and act immediately to report any reactions to a supervisor.
Your text addresses other topics that provide you with a broader picture of the dangers and safety practices you should be aware of in the healthcare work environment, including Fire Safety, Electrical Safety, Radiation Safety, Chemical Safety, and emergency disaster plans.
The information is important to be aware of for your own safety as well as for the safety of those around you, both patients and co-workers. Take note of the handy memory aids designed to help you remember the important aspects of this information.
The MSDS is the Material Safety Data Sheet
It is required by OSHA to be on any chemical with a hazardous warning label
– Should list general information, precautionary measures, and emergency information on the chemical.
The acronym “PASS” to help you remember how to use a fire extinguisher: Pull Pin, Aim nozzle, Squeeze handle, and Sweep side to side. You should also know the different types of fire extinguishers available in your workplace, remembering that the ABC fire extinguisher is a multi-purpose extinguisher that can put out any type of flame
Routine safety precautions that apply in other settings often apply to the healthcare environment, as well. There are some basic safety best practices that you can observe to reduce your risk of injury. For example,
- Wear comfortable clothing and close-toed shoes with good support and nonskid soles.
- Protect your back by using and bending your knees when lifting heavy objects or patients.
- If you have long hair, keep it tied back completely and securely and avoid wearing hanging jewelry that represents a potential hazard around equipment and patients. Any jewelry or hanging hair can also be used as a weapon by confused patients. Only wear one set of earrings and limit the type to stud earrings.
- Always walk, do not run, and be aware of and cautious around spills and wet floors.
- Maintain a clean and organized workspace.
Personal safety is always first. If you do not follow safe practices, you will become another victim, or patient. You are not able to help anyone if you get hurt while trying to help. So any time that you are confronted with a potentially unsafe situation, think before you act.
When you are lifting patients, there are a few key rules to keep in mind.
First, ask for help early. You should never have to lift or move a patient on your own.
Second, lift with your Legs, NOT your back, and keep the weight close to your body, do not extend your arms or shoulders to try and lift.
Never risk personal safety to help someone else, be smart and choose the most appropriate action for the situation.
To summarize a few important points:
- One of the most important things you can do on a consistent basis to avoid the spread of disease is to regularly use proper hand hygiene practices.
- In addition, always sanitize and clean your equipment after each use. And finally,
- Protect yourself through contact isolation to avoid taking germs home to your family, and avoid wearing dangling jewelry or hanging hair so that you do not provide a weapon for confused or combative patients.
- Use proper practice in Personal Safety, and lifting or moving patients.
