PHLEBOTOMY FINAL EXAM (Pages 1-31)

Phlebotomy (depending on where you work) - DUTIES

• assembles equipment

• verifies and records the patient’s identity

• conducts patient interviews

• takes vital signs

• screens donors

• blood extraction (for donation, testing of substances in blood, etc)

quality assurance - definition

• demands that ANY medical team member practicing phlebotomy must keep to the highest standards (MUST FOLLOW INDUSTRY-APPROVED PROCEDURES)

certification vs. licensure

• certification - granted when agencies use written and/or practice skills evaluations to determine if individual has met minimum requisites in specific technical areas

• licensure - granted by state or local government body, giving the license holder legal permission to practice in a particular health profession

professionalism - definition? characteristics that make it up?

• an attitude and a set of personal characteristics needed to succeed, such as:

  • dependability

  • honesty/integrity

  • empathy and compassion

  • professional appearance

  • interpersonal skills

GOOD PHRASE TO REMEMBER (regarding professionalism and establishing rapport?)

“pleasant with the patient and professional with the poke”

do ALL patients have rights? what rights do they have?

• ALL PATIENTS HAVE RIGHTS. PERIOD

  • right to privacy of medical records; ability to obtain a copy of them

  • right to give/remove consent during ANY portion of patient care procedures (ex: if patient says stop, and you continue to poke, you can be charged with assault and battery)

HIPAA - what is it?

• Health Insurance Portability and Accountability Act of 1996 requires providers to get written permission before disclosing healthcare information to anyone OUTSIDE of the provider team

Protected Health Information (PHI) - what is it? examples?

• any individually identifiable health information that is transmitted or stored electronically

  • ex: treatments, test results, medications, procedures, appointment times/dates

penalties for violating HIPAA/PHI

• disciplinary actions

• hefty fines

• possible jail times

many procedures require patient to read and sign WHAT? for what reason?

• an AFFIDAVIT, ensuring that they have been informed of their rights (PERMANENT PART OF THE MEDICAL RECORD AT EVERY VISIT)

illegal / unethical behaviors in healthcare (examples)

• negligence

• assault/battery (if patient says STOP, YOU MUST STOP!!)

• slander/libel

• duty of care

• breach of duty

• malpractice

if provider is unaware of the law and unintentionally breaks the law, is it still punishable?

YES YES YES!! (will have criminal court and/or civil court repercussions!!)

industry standards - what happens if broken?

• NOT legal cases; will NOT result in criminal charges, as they are not representative of a law passed by legislation; can result in CIVIL ACTIONS

ethical - what does it mean? do ethic breaches result in fine/jailtime?

• ethical = behavior that entails conforming to a standard of right and wrong to avoid harming the patient

• ethics breaches will NOT get a fine or jail time from local jurisdiction (HOWEVER, can result in dismissal or revocation of licensure)

can phlebotomists give patients results/explain what the tests check for?

NO, as they are not medically qualified

5 types of consent

• informed consent (competent person gives voluntary permission for medical procedure after receiving adequate information about risk of procedures methods/consequences)

• expressed consent (permission is given by patient VERBALLY or IN WRITING for a procedure)

• implied consent (patient’s actions permit the procedure WITHOUT verbal or written consent [ex: holding out your arm when told they need blood drawn])

• HIV testing consent (special permission is needed to administer a test that detects HIV)

• parental consent for minors (a parent/legal guardian must permit procedures administered to underage patients depending on state law, ranging from 18-21 years old)

what can providers request patient to sign to cover the provider/clinic from future litigation revolving around failure to provide care?

a refusal form (such as AMA)!!

sexual harassment - violates what? what else is illegal in this situation?

• violates Title VII of the Civil Rights Act of 1964

  • RETALIATION IS ALSO ILLEGAL!!

patient identification - OUTPATIENT vs INPATIENT

• outpatient - stated issued ID (confirming name/DOB)

• inpatient - ID band on wrist (MUST BE ON THE PATIENT, or else it is void, even if in their pocket)

handling mistakes - what do you do?

• do NOT hide a mistake (immediately report the incident to their supervisor so that corrective action can be taken to fix the mistake and help the patient)

OSHA - what does it stand for? what is it?

• stands for: Occupational Safety and Health Administration

  • responsible for overseeing the Occupational Safety and Health ACT

  • mandates safety regulations across every workplace; works hard to prevent safety issues by investigating hazardous workplaces or on-the-job injuries

OSHA lab rules

• NEVER

  • eat/drink/smoke/chew gum

  • place pens/pencils in mouth

  • put food/drinks in specimen refrigerator

  • wear long chains, large earrings, loose bracelets

  • apply cosmetics, perfume/cologne in lab

  • wear lab attire outside of the lab

  • bite fingernails

• ALWAYS

  • wear fully buttoned lab coat

  • wear comfortable, non-slip shoes made of impenetrable materials

  • tie back long hair

  • keep fingernails short

  • wear PPE

OSHA patient care rooms

• report unresponsive patients immediately (NO PASS ZONE!!)

• avoid running

• be careful entering/exiting patient’s rooms

• do NOT touch electrical equipment in patient care rooms while drawing blood

• follow standard precautions when handling specimens

• properly dispose of contaminated materials

• replace bed rails to exact setting as when you came in

• report infiltrated IV catheters and lines or other IV problems

• report unusual orders in patient’s room

• watch out for and report spilled food and liquid on the floor

2 bloodborne pathogens? how are they transmitted?

• Hepatitis B Virus (HBV) and HIV

  • sexual contact

  • sharing of hypodermic needles

  • mom to baby before/at birth

  • accidental puncture of contaminated needles/broken glass/sharps

  • contact between mucus membranes/infected body fluids

  • contact between broken/damaged skin and infected body fluids

  • blood-to-blood contact with infected blood or bodily fluids

  • through the eyes, nose, and mouth mucus membranes

portal of entry - what is it? 4 agents (infectious microorganisms)

• allows the infectious agent access to the susceptible host (BREAK THE CHAIN BEFORE THE PORTAL OF ENTRY)!!

  • viruses

  • bacteria

  • fungi

  • parasites

7 modes of transmission

• direct contact (pathogen transmitted directly from infected individual to another person or creature; SKIN TO SKIN)

• indirect contact (when fomite (inanimate object) serves as temporary reservoir for agent; ex: contaminated clothing)

• droplet (infectious agent traveling in saliva/mucus as it leaves reservoir; ex: sneezing/coughing)

• airborne (infectious agent SO SMALL it can suspend in air and travel across vast space; ex: TB)

• vehicle transmission (agent contained in bodily fluid that susceptible host contacts; ex: doorknob, faucet, public telephone)

• vector-borne (agent transmits through an invertebrate, such as an insect; ex: malaria, lyme disease)

• parenteral (disease/infection transmitted other than by mouth, nose, eyes; ex: needle stick, open wound)

exit portal - what is it?

• infectious microorganism leaves its reservoir (standard precautions/transmission based precautions are implemented to prevent spread of disease agents that EXIT THE RESERVOIR)

nosocomial infection - what is it?

• any infection used to define any infection contracted in a healthcare setting; MOST COMMON = RESPIRATORY!!

vaccination - employer responsibility (based off OSHA)

• OSHA requires that all healthcare personnel who will potentially be exposed to bodily fluids receive to vaccination series (FREE OF COST) against hepatitis B WITHIN 10 DAYS OF BEGINNING EMPLOYMENT or sign a declination form

HBV vaccine - contraindications

• previously receive the vaccine series

• antibody testing indicates immunity

• MEDICAL REASONS / conditions prevent them / does not recommend it

HBV vaccine - how many shots? how often?

• 3 SHOTS

  • 2nd one given ONE MONTH after the first

  • 3rd shot given SIX MONTHS after the first

can you give Hep B vaccine immediately after exposure?

YES YES YES (exceptionally effective at preventing disease, if not already immune)

#1 infection prevent method?

• HANDWASHING!!!

  • form a lather on hands

  • use soft, antibacterial soap (AVOID HARSH SOAPS)

    • DO ASAP AFTER EXPOSURE!!

PPE - examples

• masks

• goggles / safety glasses

• face shields

• respirators

• gloves

• gowns

PPE - ORDER OF REMOVAL

• gloves

• goggles/glasses

• gown

• mask

medical asepsis - what is it?

• the destruction of pathogenic microorganisms after leaving the body (involves environmental hygiene measures, such as handwashing, equipment cleaning, and disinfection procedures)

isolation procedures - what is PROTECTIVE/ REVERSE ISOLATION?

• keeps the PATIENT safe from the world around them; used with immunocompromised patients/burn patients

  • KEEP THE ENTIRE ROOM STERILE (may need to wear shoe covers, breathing apparatus, etc)

Needlestick Safety and Prevention Act (NSPA) (2000) - what is it?

• revised the bloodborne pathogens standard to include safer medical devices

• employer MUST establish sharps injury log for percutaneous injury from contaminated sharps

7 types of hazards

• biologic - infectious agents (bacterial, viral, fungal, parasitic infections)

• sharps - needles, lancets, broken glass (bloodborne pathogen exposure)

• chemical - preservatives and chemicals used in the lab can create possible exposure to toxic, carcinogenic, or caustic substances

• electrical - high-voltage equipment can cause burns or electrical shock

• fire or explosive - bunsen burners, oxygen, and chemicals can cause burns/dismemberment

• physical - wet floors and heavy lifting can cause falls, sprains, and strains

• allergic reaction - latex sensitivity can cause allergic reactions ranging from superficial dermatitis to anaphylaxis; use NITRILE GLOVES!!!!

Hep B - exceptionally durable and can survive in dried blood for HOW MANY DAYS?

7 days !!

what is the most commonly occurring nosocomial infection for LAB EMPLOYEES?

HEPATITIS B!! - approximately 300,000 infected annually

Hep B - THINGS TO REMEMBER (3)

• initially causes liver inflammation, but can lead to cirrhosis/liver cancer

• there ARE different types of hepatitis, and infection with Hep B will NOT stop someone from getting another type

• although there is no specific cure, treatment options ARE available

Hep B - symptoms

• mild flu-like symptoms

• can be ASYMPTOMATIC for some time

  • after exposure, can take 1-9 months for symptoms to appear

• within 1-3 months (can occur sooner or later), sense of fatigue, possible stomach pain, loss of appetite, and even nausea commonly occur

• progression → JAUNDICE and darkened urine color!!

CDC recommends UNIVERSAL precautions. what does this mean?

• WHETHER OR NOT YOU THINK THE BLOOD OR BODILY FLUID IS INFECTED WITH BLOODBORNE PATHOGENS, TREAT IT AS IF IT IS!!!!

standard precautions should be implemented when there is a possibility of contact with WHAT 2 THINGS?

• BLOOD

• non-intact skin

standard precautions are to always…. (4)

• wear gloves when collecting and handling blood, bodily fluids, or tissue specimen; NEVER DOUBLE GLOVE

• wear face shields if danger of splashing onto mucus membranes

• dispose of all needles / sharps in puncture-resistant containers WITHOUT recapping (USE THE SAFETY MECHANISM INSTEAD!!)

• be aware that disinfectants are used to clean fluid spills, thus killing pathogenic organisms

3 types of transmission based precautions? (examples of diseases spread by each?)

• contact isolation (clothing, lice, scabies, RSV, diarrhea, herpes, impetigo)

• airborne precautions (TB, measles, chicken pox, shingles, norovirus)

• droplet precautions (group A strep, rubella, mumps, pneumonic plague, influenza A, pneumonia)

coughing/sneezing etiquette

• cough/sneeze into the bend of your elbow; THEN wash / sanitize your hands immediately, and sanitize the bend in your elbow!!

EXPOSURE TO BODY FLUIDS (needlestick, splash) - WHAT DO I DO? (steps)

1. IMMEDIATELY WASH THE EXPOSED AREA with soap and running water; soft antibacterial soap (NONabrasive)

   1. splash into eyes? flush eye with running water for 15 minutes at least

2. report exposure to supervisor ASAP

3. refer to an MSDS (material safety data sheet), which provide workers with procedures for handling/safely working with substances

4. fill out exposure report form (kept in personnel file for 40 years!!!)

   1. document route of exposure/circumstances

   2. source individual (unless prohibited by law)

   3. test source for HBV and HIV ASAP (seropositive = positive)

   4. collect your OWN blood and test it

5. apart from exposure, all other findings/diagnoses by testing facility will remain entirely confidential

blood spill? what do you do ?

• pour 10% bleach solution over blood and leave for 10 min (ensuring all bloodborne pathogens are killed)

  • sodium hypochlorite solution [HOUSEHOLD BLEACH] (diluted with water)

  • Lysol / other brand

body fluids need to be disinfected with a ______ ratio solution

1:10 (STRONG!!!)

4 methods of safe disposal of needles/sharps

• needles should NEVER be recapped (use safety mechanism)

• never break or shear needles

• needles should be disposed of in labeled sharps containers ONLY

• containers should be LOCKED and disposed when the fill level reaches 2/3 full, as indicated by fill line outside of the container; REPLACE WHEN THEY HAVE REACHED THIS FILL LINE!!

if the sharps container is OVERFLOWING, phlebotomist should do what?

• LEAVE CONTAINER ALONE; report this violation to the supervisor!!

broken glass - contaminated vs. not contaminated (how to dispose)

• contaminated - appropriate sharps container!

• not contaminated - closable, puncture resistant container such as a CARDBOARD BOX