MEDICALLABORATORY

SCIENCE 2 PHLEBOTOMY
2nd Sem (Cycle 1: 1:00-2:30 PM)

CHAPTER 2: SAFETY IN PHLEBOTOMY

INFECTION CONTROL CHAIN OF INFECTION

•Healthcare-
associated
•Hospital-acquired
Nosocomial •Develops 48 hours
after admission or
Infection
within 30 days after
discharge from a
hospital or health care
facility

EX. Pseudomonas
aeruginosa ( bacteria )
•SOURCE - health care associates, other
– very diffecult to kill
patients, visitors or a person who is
bacterium
aware/unaware he/she has an active acute
•Infection picked up
infection. (source and host can be one and the
Community- prior to admission
•Infection occurs same)
acquired infection
before 48 hours after
•SUSCEPTIBLE HOST-
admission
immunosuppressed, immunocompromised,
diabetic or burn patients [age, disease,
TYPES OF INFECTION medication, and immunosuppressive agents
often change a host’s susceptibility]
Local – Infection restricted
to one area of body
Systemic – Infection that
MEANS OF TRANSMISSION OF
affects entire body
INFECTION
Autogenous – Infection from
patient’s own flora Contact – Direct – physical
(normal flora) – can transfer of infective
be pathogenic – material from the
good source to susceptible
microorganisms that host. (not washing
will help to balance hands between
the body’s ph patients)
(opportunistic) – Indirect – transfer
of infective material
via an object (ex.
• Communicable capable
disease - of
Fomites –
spreading from person to person inanimated objects
contaminated with
EX: tuberculosis – direct contact with a
infective material
patient having TB
MEDICALLABORATORY
SCIENCE 2 PHLEBOTOMY
2nd Sem (Cycle 1: 1:00-2:30 PM)

such as bed linens, STANDARD PRECAUTIONS

clothing, chairs even
phones, etc. ) • Universal Precautions
Droplet – transfer of the - developed in 1985 by CDC (Center for
organism causing the Disease Control and Prevention) as
infection to the
nose, mouth, or eye
aresponse to the increase in blood-borne
by contact with the diseases such as AIDS and Hepatitis B, and is
mucous membrane the basis for what later became Standard
of a susceptible host Precautions.
(droplets that travel
1 meter or less from - evolved into a system called Body
the infected Substance Isolation (BSI) – assumed that
individual through each patient had the potential to spread
the air by sneezing, disease through body substances. (GLOVES
coughing or talking)
should beworn when in contact with any
(ex. COVID-19)
body substance)
Vehicle - transfer of infective
material through - CDC in 1996 revised universal precautions
contaminated items,
such as food (food
and released new set of guideline called
poisoning), water Standard Precautions (combines many of
(parasitic or cholera the basic principle of universal precautions
infections), blood with techniques from BSI)
(thru accidental
needlestick injury: – Assumes that all blood and most body
HIV or hepatitis), fluids are potentially infectious. (Goal: reduce
body fluids the risk of transmission of microorganisms from
Airborne - droplets of both recognized and unrecognized sources of
infectious material infection.)
that transfer on air
currents as a result – Personal protective equipment and
of coughing, barrier controls must be worn for contact with
sneezing or talking all body fluids whether blood is visible or not.
(ex. Mycobacterium
tuberculosis or TYPES OF MEANING
Ebola) BODY FLUIDS
Vector-borne - transmission by • Amniotic fluid surrounding an unborn
insects child
(ex. malaria • Pleural fluid from the lungs
transmitted by • Peritonea fluid from the abdominal area
mosquitoes is the • Edematous fluid that has built up in the body
most widely known) tissue
• Pericardial fluid surrounding the heart
• Seminal ejaculated fluid from the penis
• Synovial fluid from the joints
• Cerebrospinal fluid from the spinal column
MEDICALLABORATORY
SCIENCE 2 PHLEBOTOMY
2nd Sem (Cycle 1: 1:00-2:30 PM)

• Transport bags and containers

FIVE MAIN POINTS OF STANDARD - [place blood tubes in a self sealing plastic bag
PRECAUTIONS: after collection to prevent exposure to the
contaminated materials (blood splatters) and to
•Wash hands when changing contain any spillage from the blood tubes]
gloves and between patients
• Wear gloves when likely to touch body •
substances, mucous membranes, or
nonintact skin and during all blood
drawing
• Wear protective cover when clothing is
likely to be soiled
• Wear a mask and eye protection in
addition to a protective body cover when
likely to be splashed with body substances
• Place intact needle/syringe and sharps in
designated sharps containers. Do not
bend, break or cut needles

Tactics to Reduce Risk of Exposure to

*all samples and containers should have a
Blood-borne Pathogens
biohazard symbol to indicate potential
• Engineering controls infectiousness of the contents.

- Physical and mechanical devices available to • Autoclave

the health care associate to reduce or eliminate
– steam-sterilize contaminated materials.
the potential to transfer infectious diseases.

• Puncture-proof sharps containers – to

be filled 80% of capacity only [for needles (place
needles pointing down) and breakable
contaminated objects: glass blood collection
tubes, glass slides, etc]
MEDICALLABORATORY
SCIENCE 2 PHLEBOTOMY
2nd Sem (Cycle 1: 1:00-2:30 PM)

– Storing food and drink separate from

infectious materials
• Self-sheathing needles and holders
•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 virus (HBV) vaccination

– Must be available free of charge to

phlebotomist
Tactics to Reduce Risk of Exposure to – Effective for more than 15 years in
Blood-borne Pathogens protecting the phlebotomist from contracting
• Work Practice Controls the disease or becoming a carrier

– incorporated to all health care – Does not protect the phlebotomist

associates’ work habits to prevent the spread of from all types of hepatitis, only hepatitis B
infection. •Private rooms
– Hand washing (best way to break the chain of – Reduce possibility of transmission of
infection) or using antiseptic technique: Alcohol-based hand
cleaners [70% isopropyl alcohol, povidone iodine (blood cultures infection by separating patient with disease
& arterial punctures), 2% chlorhexidine gluconate & 70% isopropyl from other patients and health care associates
alcohol (blood culture), benzalkonium chloride (alcohol testing),
zephrin chloride, hydrogen peroxide (for persons allergic to
alcohol)
PERSONAL PROTECTIVE
*Antiseptic solution is safe to human skin while
EQUIPMENT (PPE)
a Disinfecting solution is too harsh on the skin
(ex. 10% household bleach solution in water, • Masks – prevent the transmission of
1:10 dilution, which should be made daily as it is infectious agents through the air; should be
only good for 24hrs) worn once and discarded appropriately (ex.
Paper masks – most economical and efficient &
– Proper disposal of sharps
Fluid-proof masks – used for work conditions
*OSHA standards contained in the Needle where spattering of body fluids is likely)
Safety Act state that needles must be covered
•Goggles & Face shields – needed anytime
with safety device immediately after use and
there is the potential for splattering of blood or
not recapped
body fluids.
– Avoiding eating, drinking, smoking,
handling contact lenses, or applying cosmetics
or lip balm in work areas
MEDICALLABORATORY
SCIENCE 2
2nd Sem (Cycle 1: 1:00-2:30 PM)
•Gowns – should be fluid-resistant to prevent
any blood or body fluids from soaking through
and on the health care associate (removal
should be from the inside out)
•Gloves – prevents health care associates’ from
transmitting their own microflora to the patient;
prevent transmission of microorganisms from
one patient to another; prevent the associate
from becoming infected with what is infecting
the patient.
EVOLUTION OF ISOLATION
TECHNIQUES
*a description of isolating patients to prevent
the spread of disease was first published in
1877
*as infectious patients were separated from
noninfectious patients, they were still prone to
nosocomial infections as aseptic techniques
were not practiced. By 1910 a cubical system of
isolation was introduced whereby patients were
separated, and hospital personnel were
instructed to wash hands and disinfect items
contaminated by the patients.
*by 1960, patients with infectious disease were
placed in single-patient isolation rooms or in
regular single rooms.
*in the 1970s, CDC recommended that hospitals
use one of seven isolation categories, a practice
called category-specific isolation.
CATEGORY-SPECIFIC ISOLATION
First Technique:
• Category-specific isolation - require knowing
that a patient needed to be isolated (often a
patient would come to the hospital with an
illness that was later determined to be a disease
requiring patient isolation.
PHLEBOTOMY
o Strict – a patient with a contagious
disease such as chickenpox, diphtheria, or
pneumonia is placed in strict isolation.
o Contact – a disease that is transmitted
by direct contact with the patient requires the
patient to be placed in contact isolation.
Scabies, caused by infestation with the mite
Sarcoptes scabiei, is an example. It is
transmitted primarily through direct contact
with the infested patient.
o Respiratory – a patient with a disease
transmitted through the air, such as mumps,
pertussis, or rubella. Anyone who is usceptible
to the infection mut wear a mask upon entering
the room.
o Tuberculosis – sometimes called
AFB(acid-fast bacillus) isolation. Tuberculosis is
opportunistic and infects individuals(HIV & old
patients) with weakened immune system
(similar to respiratory isolation)
o Drainage/Secretion – wound and skin
precautions (for patients with open wounds).
These are usually the result of abrasions,
accidental skin cuts, surgery incisions, or
bedsores that have become infected wherein
the fluid that oozes from the wound contains
the infection.
o Enteric – are for patients with severe
diarrhea due to contagious bacteria such as
Salmonella, Shigella, or Vibrio cholera
(infections transmitted by contact with the
infected patient’s feces).
o Protective or Reverse – protects the
patient from the health care worker (unlike the
six other examples of category-specific isolation
which protect the health care worker from the
infected patient).
• Based on seven isolation categories
MEDICALLABORATORY
SCIENCE 2
2nd Sem (Cycle 1: 1:00-2:30 PM)
*Changed to disease-specific isolation
• Disease-Specific Isolation –
established in 1983 to overcome the
shortcomings of category-specific isolation;
category of blood and body fluid precaution was
added, protective or reverse isolation category
was eliminated(not efficient), tuberculosis
isolation was updated to recommend the use of
a private room with negative air pressure &
high-efficiency particulate air (HEPA) filter
respirators.
• Strict
• Contact
•Respiratory
•Tuberculosis
•Drainage/Secretion
•Enteric
•Blood and body fluid
– Blood and body fluid precaution added
TRANSMISSION-BASED ISOLATION
• Airborne – for patients known or suspected to
have illness transmitted through small-particle
(5 micrometers or smaller) airborne droplets,
which may remain suspended in the air, or dust
particles containing the infectious agent.
• Droplet – for patients known or suspected to
have illness transmitted through LARGER
droplets (larger than 5 micrometers in size)
containing microorganisms. These droplets
travel only short distances of 1 meter or less
(involves contact with the conjunctivae or the
mucous membrane of nose or mouth).
• Contact – Direct (skin-to-skin contact) &
Indirect (transfer of microorganisms from one
person to another via something the infectious
person had contacted)
PHLEBOTOMY
• Agency of the federal government;
OSHA was a result of Occupational Safety and
Health Act of 1970
• Investigates the possibility of unsafe
practices in the work environment
• Develop and promote standards for
all occupations
• Develop and issue regulations
• Determine level of compliance with
health and safety regulations
• Level fines for noncompliance with
health and safety regulations
OSHA DEFINITIONS:
• Blood – human blood components
refer to plasma, platelets, and
serosanguineous fluid (e.g.,
exudates from wounds). Also
included are medications
derived from blood, such as
immune globulins, albumin,
and factors 8 and 9.
• Blood- while Hepatitis B virus (HBV)
borne and HIV are specially
pathogens identified in the standard, the
term includes any pathogenic
microorganism that is present
in human blood or other
potentially infectious material
(OPIM) and can infect and
cause disease in persons who
are exposed to blood
containing the pathogen.
*Other Potentially Infectious Material (OPIM)
MEDICALLABORATORY
SCIENCE 2
2nd Sem (Cycle 1: 1:00-2:30 PM)
Occupational Safety and Health
Administration (OSHA) Standards
OSHA definitions:
• Exposure Incident – an exposure can include
nonintact skin, which consists of skin with
dermatitis, hangnails, cuts, abrasions, chafing,
acne, and so on.
• Exposure Control Plan – requires the
employer to identify those tasks and procedures
in which
occupational exposure may occur and to
identify the positions with duties that include
those tasks and procedures identified as having
occupational exposure.
• Engineering controls – controls that isolate or
remove blood-borne pathogen hazards from
the
workplace. Examples include safer medical
devices such as sharps with engineered sharp
injury protection (SESIPs) and needleless
systems.
• Needleless systems – refers to a device that
does not use needles for
(a)the collection of bodily fluids
after initial venous or arterial access is
established;
(b)the administration of medication or
fluids; or
(c) any other procedure involving the
potential for occupational exposure to blood-
borne pathogens due to
percutaneous injuries from contaminated
sharps. (ex. Intravenous medication delivery
systems that administer medications or fluids
through a catheter port or connector site using
a blunt cannula or other nonneedle connection ,
and jet injection systems that deliver
subcutaneous or intramuscular injections of
liquid medication through the skin without the
use of a needle)
PHLEBOTOMY
• Occupational Exposure – the term reasonably
anticipated contact refers to the potential for
contact as well as actual contact with blood or
OPIM (and also needlesticks)
• Sharps with Engineered Sharps Injury
Protections – SESIPs are defined as “a
nonneedle sharp or a needle device used for
withdrawing body fluids, accessing a vein or
artery, or administering medications or other
fluids, with a built-in safety feature or
mechanism that effectively reduces the risk of
an exposure incident.” It encompasses a broad
array of devices that make injury involving a
contaminated sharp less likely (includes syringes
with guards or sliding sheaths that shield the
attached needle after use, needles that retract
into a syringe after use, shielded or retracting
catheters, intravenous medication delivery
systems, blunt suture needles, and plastic
instead of glass capillary tubes)
OSHA Basic Requirements
• Exposure control plan must be developed
(should be reviewed and updated annually)
• 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
•Contaminated needles and other
contaminated sharps should not be recapped,
bent, cut, broken, or removed.
• Biohazard labels must be fluorescent orange
or orange-red with lettering or symbols in a
contrasting color.
• Blood must be transported in a leakproof
container (self-sealing bags are the most
convenient)
MEDICALLABORATORY
SCIENCE 2 PHLEBOTOMY
2nd Sem (Cycle 1: 1:00-2:30 PM)

be readily accessible to all associates (new

employees must receive training in the chemical
hazards; and an annual training of each
associate must also occur).

HAZARD IDENTIFICATION

• Hazard Identification – hazards can be

LABORATORY TECHNIQUES
• All procedures involving blood or potentially
infectious materials are to be performed to
minimize splashing, splattering, or generation of
droplets (Hemogard –type blood tube meets
this requirement)
• Mouth pipetting or mouth suctioning is
prohibited. Pens, pencils, and fingers should not
be placed in the mouth.
• Health care associate must wear gloves and
protective clothing when working with any
potentially infectious material
identified on the container by a hazard emblem
designed by the National Fire Protection
Association (consists of a diamond-shaped
diagram further subdivided into smaller
diamonds. Health hazard are identified on the
left, flammability at the top, and reactivity on
the right. The bottom space is used to identify
other hazards or to alert fire-fighting personnel
to the possible hazard of using water. The
hazards are identified by color: blue for health
hazards, red for flammability, and yellow for
reactivity. The diamonds are identified by
number on a scale of 0-4 to indicate the severity
of the hazard. Containers labeled “0” have no
unusual hazard, and those labeled “4” are
extremely dangerous.

MATERIAL SAFETY DATA SHEETS

• Material Safety Data Sheets (MSDS) – first

introduced in the passage of the Hazard
Communication Act. (OSHA focused on chemical
hazard awareness since 1987)

• Information sheets that must be on file to

indicate hazards of chemicals used in
laboratory. FIRE SAFETY : FIRE EXTINGUISHERS

o Does not need to be a paper file; most Type of Fire Extinguisher

healthcare facilities have these as Class A Fire Wood, Class A:
Internet-assessable forms plastics, Foam,
o Chemicals used in the laboratory must papers loaded-
(ordinary stream, and
also contain labels indicating identity of
combustibles); multipurpose
the chemical and showing warnings
elements that dry chemical
appropriate for employee protection. require extinguishers
• Hazard Communication Act – known as the cooling action
of water to
“Right To Know” Law: requires that the MSDS
extinguish the
MEDICALLABORATORY
SCIENCE 2 PHLEBOTOMY
2nd Sem (Cycle 1: 1:00-2:30 PM)

fire
Class B Fire Flammable Class B: CHEMICAL SAFETY
liquids and Carbon • Chemicals that produce a toxic or irritant
gases; dioxide, dry vapor must be used only in an approved
elements that chemical, chemical hood.
require the foam and • A chemical-resistant apron and face shield
blockage of loaded should be worn if there’s a danger of splashing.
oxygen from stream • Eye wash station and safety shower (chemical
the fire to extinguishers spill or splash to the eyes or other body parts) *
extinguish it affected body part should be flushed with water
Class C Fire Energized Class C: for 15 minutes
electrical Carbon • Spills or splatters that only contaminate
equipment; dioxide (best surfaces and do not contact an individual’s skin
nonconductive universal fire or clothing can be handled with a spill cleanup
media is extinguisher procedure using a commercial spill kit (best way
needed to for computer to clean the contamination for the specific
prevent equipment; chemical spilled)
electrical doesn’t
shock damage RADIATION EXPOSURE
computer
circuits) and • Phlebotomists must be aware of the
dry chemical institution’s radiation safety procedures.
extinguishers *Radiation is present in nuclear medicine,
radiology and patients with radioactive
Class D Fire Combustive Class D: implants.
and reactive Extinguishers • Phlebotomist may need to be shielded with a
metals such as containing special apron or cover gown
sodium, dry powder • Monitoring devices for exposure may include
potassium, medium that a badge to detect exposure to radioactivity.
magnesium does not
and lithium combine
(explosion and with the
spreading can burning
easily occur) materials
*Most fire extinguishers found in the laboratory
are of a universal ABC type
National Fire Protection Association’s key
word for action(in case of fire):
RACE

• Rescue anyone in danger.

• Sound the Alarm.
• Contain the fire by closing doors and/or
windows. ELECTRICAL SAFETY
• Extinguish/Evacuate. Extinguish the fire if
possible; if the fire is too large to extinguish,
start to evacuate anyone in the fire’s path.
MEDICALLABORATORY
SCIENCE 2
2nd Sem (Cycle 1: 1:00-2:30 PM)
• 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. Hazards to look for with any
electrical equipment are frayed cords, a
removed grounding prong on the plug, and any
type of shock when the equipment is used.
LATEX ALLERGY
*latex (made from the natural rubber of trees)
• Growing concern in healthcare; increased
sensitivity to latex from patients and health care
associates
Allergic reactions to latex
• Type IV latex allergy (less serious)
o Irritant contact dermatitis resulting in
skin irritation: itchy irritation to redness
and swelling that progress to thickened
skin, pimples, or skin blisters that ooze.
(symptoms begin 24 to 72 hours after
exposure and continue for several days;
with each additional exposure, the
symptoms become more advanced.
• Type I latex allergy (more serious)
o Immunologic reaction (caused by
penetration of the natural latex
proteins into the skin; these proteins
produce antibodies against latex which
increase with each subsequent
exposure; as the allergy becomes more
severe, the symptoms may include
nausea, low blood pressure, and
respiratory distress) up to anaphylactic
shock (life-threatening) if the latex
allergen is introduced directly to the
blood.
DISPOSAL OF INFECTIOUS MATERIALS
*two requirements of disposal of medical waste
1. 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.
PHLEBOTOMY
2. waste must be rendered
noninfectious so that people handling
the waste will not become infected and
the environment will not be
contaminated.
• Must be by:
• Incineration (most common method
of disposal) – waste is burned to an ash and
then ash is taken to the municipal disposal area;
this method kills any potentially infectious
organisms and makes the items within the
waste nonusable; most large hospitals have
incinerators to destroy waste and generate
steam as a by-product
• Chemical treatment – method
consists of grinding or chopping the waste into
small pellets and then treating the pellets with a
disinfectant chemical to kill any infectious
organisms.
• Autoclave (similar to a pressure
cooker) – used in small operations where only
small amount of waste is generated. *control
tapes are placed to ensure adequacy in the
sterilization as it changes color. *once sealed,
autoclave is injected with steam under high
pressure for 15 mins; plastics in the waste melts
and infectious organisms are killed.
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.
• 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
MEDICALLABORATORY
SCIENCE 2 PHLEBOTOMY
2nd Sem (Cycle 1: 1:00-2:30 PM)

• 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
• If source patient refuses testing, is HIV or HBV
positive, or is in a high-risk category, associate
may elect to receive prophylactic treatment