Chapter 2: Safety; Patient and Clinical Lab Practices

what percentage of errors in the diagnostic process occurs in the pre-analytic phase?

98%

Where do 98% of the errors in diagnostic processes occur?

In the pre-analytic phase

Which organization made goals that have specific applications for clinical laboratories?

Joint Commission National Patient Safety Goals

What are the two main areas of patient safety?

Communications and mitigating patient risk

What is the correct way to identify a patient?

By using the patient's name and birth date.

What are the Joint Commission National Patient Safety Goals of 2017?

Correctly identify the patient, Improve staff communication, Prevent infection using CDC or WHO guidelines.

Why should staff communication be improved?

To ensure getting important test results to the right staff person on time.

What are the 6 goals of US Institute of Medicine for Health care delivery?

Safety, Timeliness, Effectiveness, Efficiency, Equitable treatment, Patient-centered focus.

What are the ASCLS patient safety indicators for the pre-analytic phase

Patient identification, Phlebotomy-associated negative events, specimen identification, order entry, specimen integrity, effective use of the clinical lab

What are the ASCLS patient safety indicators for the analytical phase?

Verification of the accuracy of abnormal results

What are the ASCLS patient safety indicators for the post-analytical phase?

Communication of test results, Effective use of test results, and outcomes of laboratory testing.

What are the 7 steps to evaluate patient safety in lab test (According to ASCLS)

1. Determine areas of risk

2. Collect data

3. Determine the denominator to calculate the error rate

4. Capture data

5. Data analysis

6. Design intervention

7. Follow-up

When it comes to communication, what is imperitive?

clear communication

T/F: Avoiding direct communication of an error that harmed a patient is unacceptable

True

How does avoidance affect quality improvement?

Avoidance lowers or removes the urgency for quality improvement

What is commonly used to describe medical error?

Medical Euphemisms

Should euphemisms be used in the lab?

NO

What is the initial step to IT downtime?

Have a clear activation and communications plan with established guidelines

What are some examples of IT outages?

Planned outages for updates or upgrades, and unexpected failures or impairments

Example of a downtown plan

Share protocols with patient care areas, a single lab contact creates an organized approach, focus on reporting critical info, clear communication throughout, conduct a critique after the outage.

Are most lab accidents preventable?

yes

How are most lab accidents preventable?

By exercising good technique, staying alert, and using common sense

What standards and guidelines does lab safety include?

Occupational Safety and Health Administration (OSHA) standards, and CDC guidelines

What is another safety issue?

Ergonomics

What are some safety governing agencies?

OSHA, CLSI, CDC, DHHS, CAP, The Joint Commission

What is the NHSN?

The National Health Care Safety Network

What does the NHSN do?

integrates a number of surveillance systems and provides data on devices, patients, and staff.

Who manages the legacy patient and health care personnel safety surveillance systems expanded by the NHSN?

the Division of Health care Quality Promotion (DHQP) at CDC.

Which organization showed that the highest rates of infection occurred in the burn ICU, the neonatal ICU, and the pediatric ICU?

National Nosocomial Infections Surveillance System

Where did the highest rates of infection occur according to the National Nosocomial Infections Surveillance System?

burn ICU, neonatal ICU, and pediatric ICU

What categories can risk factors for the invasion of colonizing pathogens be in?

Iatrogenic risk factors, Organizational risk factors, and Patient risk factors

What percent of all cute care hospitals do nosocomial infections occur?

5%

What's the difference between a safety coach and a safety officer?

Safety coaches are volunteers who assume extra responsibilities. Safety officers require staff orientation and periodic updating

What is the OSHA mandated plans?

All clinical labs must implement a chemical hygiene plan and an exposure control plan. Safety data sheet must be on file and accessible to all employees always.

What is the core of the OSHA safety standard?

Chemical Hygiene Plan

What does the hazard communication standard requre?

Requires that the chemical manufacturer, distributor or importer provide SDSs for each hazardaous chemical

What was the previous name for safety data sheets?

Material safety data sheets

What does the Occupational Exposure to Bloodborne Pathogens require?

That laboratories develop, implement, and comply with a plan that ensures the protective safety of lab staff to potential infectious bloodborne pathogens. & to manage and handle medical waste safely and effectively.

What was a major change to the Hazard Communication Standard in 2012?

Hazard Classification; Provides specific criteria to address health and physical hazards as well as classification of chemical mixtures

What was a major change to the Hazard Communication standard in 2012, regarding labels?

Chemical manufacturers and imposters must provide a label that includes a signal word, pictogram, hazard statement, and precautionary statement for each hazard class and category.

What was a major change to the Hazard Communication standard in 2012, regarding Safety data sheets

SDSs are quired to be presented in a consistent, user-friendly, 16-section format.

What does the OSHA-mandated program, Occupational Exposure to Bloodborne Pathogens require?

That labs manage and handle waste in a safe effective way. And they develop a plan that ensures the protective safety of lab staff to potential infectious bloodborne pathogens.

What must all employees who handle waste and materials be trained in?

Trained to use and handle the materials, Chemical hazard education sessions must be presented to new employees.

What must each lab be required to evaluate?

The effectiveness of its plan at least annually and to update it as necessary.

What are Standard Precautions?

Safety precautions concerning the handling of all patient specimens

What agencies are working to reduce the risk of exposure of health care workers to bloodborne pathogens?

CDC and OSHA

How has the CDC contributed towards the exposure control plan?

Provides recommendations for treatment after exposure, and they recommend safety precautions when handling them.

How has OSHA contributed towards the Exposure Control Plan?

issued guidelines for the lab worker in regard to protection

What are biohazards?

Infectious material or agents that present a risk or even a potential risk to the health of humans or animals in the lab.

What is risk defined as?

The probability that a health effect will occur after an individual has been exposed to a specific amount of hazard

Why should labs perform risk assessment?

To determine if there are certain procedures or specimens that may require higher levels of biocontainment

How many biosafety levels are there?

4

What 3 categories are bioterrorism divided in?

A,B, and C

What is an important part of biosafety?

Risk assessment

What is the most frequent rout of exposure and accidental inoculation?

Inhalation, percutaneous inoculation, contact between mucous membranes and contaminated material, and ingestion.

What is an occupational exposure?

a percutaneous injury, or contact by mucous membranes or nonintact skin with blood, tissues, blood-stained body fluids, body fluids to which Standard Precautions apply, or concentrated virus.

What does the likelihood of infection after exposure to blood infected with HBV or HIV depend on?

The concentration of the virus, duration of contact, presence of skin lesions or abrasions on exposed skin of the healthcare worker, the immune status of the healthcare worker for HBV.

Do most exposures result in infection?

NO

Is the viral concentration higher in HBV or HIV?

HBV

What are examples of PPE?

gloves, facial barrier protection, occlusive bandages, lab coats/gowns

What are some safe work practices for infection control?

PPE, nail care, shoes, no electronic devices, handwashing, decontamination of work surfaces, equipment, and spills

What does disinfection describe?

A process that eliminates many or all pathogenic microorganisms, except bacterial spores on inanimate objects.

What is an example of a disinfection solution?

hypocholrites

What are disinfecting procedures used on ?

Nondisposable equipment

What should be done to disposable labware or supplies that have come in contact with blood?

Be autoclaved or incinerated.

What is a pipetting safeguard?

automatic devices

What does the use of a sharps container permit?

Quick disposal of a needle without recapping and safe disposal of other sharp devices that may not be contaminated with blood

What should you not do with any sharp needle or lancet device by hand?

Recap, bend, break, or manipulate

How should specimen be transported to the lab?

In plastic leakproof bags, while wearing protective gloves

What category is Zika in?

Category B biological substance.

What requirements must all devices in contact with blood and capable of transmitting infection to the donor or recipient meet?

Must be sterile and non-reusable

Should food and drinks be consumed in the work areas or stored in the same area as specimen?

no

What should containers, refrigerators, or freezers used for specimens be marked as?

Marked as containing a biohazard.

Specimens needing centrifugation should be?

Should be capped and placed into a centrifuge with a sealed dome.

How should rubber-stopped tubes be opened?

slowly and carefully with a gauze square over the stopper to minimize aerosol production

What should be used for pipetting?

Autodilutors or safety bulbs

Can tobacco products be used in lab?

no

All personnel should be familiar with the location of what two stations in lab?

eyewash station and safety showers

What is critical to the accuracy of laboratory test results?

Proper handling of blood and body fluids

If a blood specimen is to be transported, The shipping container must meet who's standards?

OSHA. and the packaging requirements of major couriers and the Department of transportation

What are the list of required immunizations?

Hepatitis B, Influenza, Measles, Mumps, Rubella, Varicella

Which immunizations are optional?

Hep A, Meningococcal disease, pertussis, typhoid, vaccinia, diphtheria, pneumococcal disease, and tetanus.

Which viruses require prophylaxis, medical follow-up, and records of accidental exposure?

Hepatitis B virus exposure, Hepatitis C virus exposure, and HIV

What are some disease screening tests?

Tb ( purified protein derivative, Mantoux skin test), Rubella, Hep B surface antigen

What must be worn for tuberculosis control?

Respirators or masks

What protects from aerosols?

Biosafety cabinets, negative-pressure isolation rooms

What are some additional laboratory hazards?

Chemical, electrical, fire, and labware hazards. and infections waste

What are some specific hazardous chemicals

sulfuric acid, nitric acid, acetic acid, hydrochloric acid, sodium hydroxide, phenol, carbon tetrachloride, trichloroacetic acid, ethers

What are carcinogens?

Any substances that can cause the development of cancerous growths in living tissue

What is worn when any potential hazardous solution or chemical is being used?

Protective equipment for the eyes, face, head, and extremities, protective clothing or barriers

Where should volatiles fuming solutions be used?

under a fume hood

What is essential in case of contact with hazardous solution or contaminated substance?

quick action

What organization must approve all electrical equipment?

Underwriters Laboratories

What decreases the likelihood of electrical accidents?

regular inspection of electrical equipment

What must be present when using any equipment where organic solvents are present

Explosion-free fittings.

Is grounding of all electrical equipment essential?

Yes

What is fire class A?

Ordinary combustibles

What is fire class B?

Flammable liquids and gases

What is fire class c?

Electrical equipment

What is fire class D

Powdered metal (combustible) material