Module 2 Study Guide

Phlebotomy Safety & Compliance

💉 Bloodborne Pathogens Standard

This standard, mandated by OSHA, protects healthcare workers from exposure to infectious agents present in blood and other bodily fluids. Key components include:

• Engineering Controls: Physical modifications to the workplace to minimize exposure (e.g., sharps disposal containers, safety-engineered needles). Advanced Concept: Understanding the hierarchy of controls (elimination, substitution, engineering, administrative, PPE).

• Work Practice Controls: Procedures to reduce exposure risk (e.g., proper hand hygiene, avoiding recapping needles). Advanced Concept: Developing and implementing a comprehensive exposure control plan specific to a phlebotomy setting.

• Personal Protective Equipment (PPE): Barrier devices worn to prevent contact with infectious materials (e.g., gloves, gowns, masks, eye protection). Advanced Concept: Selecting appropriate PPE based on the specific task and anticipated level of exposure. Knowing the limitations of different PPE types.

• Hepatitis B Vaccination: OSHA mandates free Hepatitis B vaccination for at-risk employees. Advanced Concept: Understanding the implications of declining the vaccination and the potential legal ramifications.

• Exposure Incident Response: Procedures to follow after an accidental exposure (e.g., first aid, medical evaluation, reporting). Advanced Concept: Understanding the post-exposure prophylaxis (PEP) protocols for HIV, HBV, and HCV. Knowing the differences in treatment protocols.

• Record Keeping: Maintaining accurate records of exposure incidents, employee training, and vaccination status. Advanced Concept: Understanding OSHA's record-keeping requirements and the potential penalties for non-compliance.

• Employee Involvement: Providing employees with opportunities to participate in the development and implementation of the exposure control plan. Advanced Concept: Understanding the role of employee input in creating a safe and effective work environment.

🏥 Regulatory Bodies and Their Goals

Several agencies play a crucial role in ensuring safety and compliance in phlebotomy:

• OSHA (Occupational Safety and Health Administration): Sets and enforces workplace safety standards, including the Bloodborne Pathogens Standard and regulations for hazardous chemicals. Advanced Concept: Understanding OSHA's inspection process and the potential penalties for violations.

• The Joint Commission: Accredits and certifies healthcare organizations, setting standards for patient safety and quality of care. Advanced Concept: Understanding the Joint Commission's accreditation process and the implications for healthcare facilities.

• CAP (College of American Pathologists): Develops standards and guidelines for laboratory practices. Advanced Concept: Understanding CAP's accreditation process and its role in ensuring the quality of laboratory testing.

• CLSI (Clinical and Laboratory Standards Institute): Develops standards and guidelines for laboratory procedures, including phlebotomy techniques. Advanced Concept: Understanding CLSI's role in developing best practices for phlebotomy and laboratory testing.

• CDC (Centers for Disease Control and Prevention): Provides guidelines for infection control and disease prevention. Advanced Concept: Understanding the CDC's role in public health and its influence on healthcare practices.

🧤 Personal Protective Equipment (PPE) and its Use

Appropriate PPE is crucial for preventing exposure to infectious agents. Understanding the types of PPE and when to use them is essential:

• Gloves: Always wear gloves when handling blood or other bodily fluids. Advanced Concept: Understanding the different types of gloves (nitrile, latex, vinyl) and their properties. Knowing when to change gloves.

• Gowns: Wear gowns when there is a risk of splashing or spraying of body fluids. Advanced Concept: Understanding the different types of gowns and their levels of protection.

• Masks: Wear masks to protect against airborne pathogens. Advanced Concept: Understanding the different types of masks (surgical masks, N95 respirators) and their levels of protection. Knowing when each type is appropriate.

• Eye Protection: Wear goggles or a face shield to protect eyes from splashes. Advanced Concept: Understanding the importance of proper fit and seal for eye protection.

• Shoe Covers: Wear shoe covers in situations where there is a high risk of contamination. Advanced Concept: Understanding the importance of proper disposal of contaminated PPE.

💉 Sharps Safety

Safe handling and disposal of sharps are critical to prevent needlestick injuries:

• Never Recap Needles: This is a major source of needlestick injuries. Advanced Concept: Understanding the engineering controls designed to prevent needle recapping.

• Sharps Containers: Dispose of used needles and other sharps immediately into an approved, puncture-resistant container. Advanced Concept: Understanding the requirements for sharps containers (e.g., color, labeling, capacity). Knowing the proper disposal procedures.

• Needle Safety Devices: Use safety-engineered needles and other devices whenever possible. Advanced Concept: Evaluating the effectiveness of different needle safety devices.

• Reporting Needlestick Injuries: Report all needlestick injuries immediately to your supervisor. Advanced Concept: Understanding the procedures for reporting needlestick injuries and the importance of post-exposure follow-up.

🔒 HIPAA Regulations

Protecting patient privacy is paramount. HIPAA (Health Insurance Portability and Accountability Act) regulations govern the handling of Protected Health Information (PHI):

• PHI: Any individually identifiable health information. Advanced Concept: Understanding the different categories of PHI and the specific regulations that apply to each.

• Confidentiality: Maintain the confidentiality of all PHI. Advanced Concept: Understanding the legal and ethical implications of violating HIPAA regulations.

• Authorized Disclosure: Only disclose PHI to individuals or organizations with a legitimate need to know. Advanced Concept: Understanding the process for obtaining patient consent for the release of PHI.

• Security Measures: Implement appropriate security measures to protect PHI from unauthorized access or disclosure. Advanced Concept: Understanding the different types of security measures (physical, technical, administrative) and their application in a healthcare setting.

🧪 Quality Control and Quality Assurance

Maintaining the quality of laboratory testing is essential. This involves both quality control (QC) and quality assurance (QA):

• Quality Control (QC): Procedures to ensure the accuracy and precision of laboratory tests. Advanced Concept: Understanding the different types of QC procedures (e.g., using controls, calibrating equipment).

• Quality Assurance (QA): A broader system to ensure the overall quality of laboratory services. Advanced Concept: Understanding the different components of a QA program (e.g., standard operating procedures, proficiency testing).

• CLIA-Waived Tests: Tests that meet certain criteria and are exempt from some CLIA regulations. Advanced Concept: Understanding the requirements for CLIA-waived tests and the importance of following manufacturer's instructions.

• Equipment Maintenance: Regular maintenance of laboratory equipment is crucial for accurate results. Advanced Concept: Understanding the importance of preventative maintenance and the procedures for troubleshooting equipment malfunctions.

🦠 Infection Control and Aseptic Techniques

Preventing the spread of infection is a top priority. This involves following standard precautions and aseptic techniques:

• Standard Precautions: Treat all blood and body fluids as potentially infectious. Advanced Concept: Understanding the rationale behind standard precautions and their application in various healthcare settings.

• Hand Hygiene: Frequent handwashing is the most effective way to prevent infection. Advanced Concept: Understanding the different methods of hand hygiene (e.g., handwashing with soap and water, using alcohol-based hand sanitizer).

• Aseptic Technique: Procedures to minimize contamination during blood collection. Advanced Concept: Understanding the principles of aseptic technique and their application in various phlebotomy procedures.

• Disinfection: Cleaning and disinfecting surfaces and equipment to remove pathogens. Advanced Concept: Understanding the different types of disinfectants and their effectiveness against various pathogens.

• Transmission-Based Precautions: Additional precautions for patients with known or suspected infections (e.g., airborne, droplet, contact). Advanced Concept: Understanding the different types of transmission-based precautions and the appropriate PPE to use in each situation.

🚨 Emergency Procedures

Knowing how to respond to medical emergencies is crucial:

• Syncope (Fainting): Procedures to follow if a patient faints during a blood draw. Advanced Concept: Understanding the underlying causes of syncope and the appropriate interventions.

• Seizures: Procedures to follow if a patient has a seizure. Advanced Concept: Understanding the different types of seizures and the appropriate interventions.

• Hematoma: Procedures to follow if a hematoma develops during a blood draw. Advanced Concept: Understanding the underlying causes of hematomas and the appropriate interventions.

• Excessive Bleeding: Procedures to follow if a patient experiences excessive bleeding after a blood draw. Advanced Concept: Understanding the different methods of controlling bleeding and the importance of applying pressure.

• CPR (Cardiopulmonary Resuscitation): Basic life support techniques. Advanced Concept: Understanding the different steps of CPR for adults, children, and infants. Knowing the importance of proper technique and timing.

• First Aid: Basic first aid procedures. Advanced Concept: Understanding the different types of first aid and the appropriate interventions for various injuries and illnesses.

🩹 Differences Between Infant, Child, and Adult CPR

Understanding the differences in CPR techniques for infants, children, and adults is crucial for effective resuscitation. Here are the key distinctions:

1. Compression Technique

• Infants (0-1 year): Use two fingers to perform chest compressions in the center of the chest, just below the nipple line. Compressions should be about 1.5 inches deep at a rate of 100-120 compressions per minute.

• Children (1-8 years): Use one hand (or two hands for larger children) to perform compressions in the center of the chest. Compressions should be about 2 inches deep at a rate of 100-120 compressions per minute.

• Adults (8 years and older): Use two hands to perform compressions in the center of the chest. Compressions should be at least 2 inches deep at a rate of 100-120 compressions per minute.

2. Ventilation Technique

• Infants: After 30 compressions, give 2 gentle breaths, ensuring the mouth and nose are covered. Be careful not to overinflate.

• Children: After 30 compressions, give 2 breaths, covering the mouth completely with your mouth and pinching the nose.

• Adults: After 30 compressions, give 2 breaths, ensuring a good seal over the mouth and pinching the nose.

3. Call for Help

• Infants and Children: If alone, perform CPR for about 2 minutes before calling emergency services. If someone else is present, have them call for help immediately.

• Adults: If alone, call emergency services immediately before starting CPR.

4. Use of AED

• Infants and Children: Use pediatric pads if available. If not, use adult pads, placing one on the front and one on the back of the child.

• Adults: Use adult pads and follow the AED prompts.

5. Recovery Position

• Infants and Children: If the child or infant is breathing normally after CPR, place them in a safe position on their side to maintain an open airway.

• Adults: Place the adult in the recovery position on their side to keep the airway clear.

📄 Documentation and Reporting

Accurate and complete documentation is essential:

• Incident Reports: Report all accidents, incidents, and near misses. Advanced Concept: Understanding the importance of thorough and accurate incident reporting.

• Sharps Injury Log: Maintain a log of all sharps injuries. Advanced Concept: Understanding the requirements for sharps injury logs and the importance of confidentiality.

• Exposure Control Plan: Document the exposure control plan and employee training. Advanced Concept: Understanding the requirements for exposure control plans and the importance of regular review and updates.

• HIPAA Compliance: Ensure all documentation complies with HIPAA regulations. Advanced Concept: Understanding the implications of non-compliance with HIPAA regulations.

Order of Draw Table

Tube Color Additive Order Test(s) Yellow SPS (Sodium Polyanethol Sulfonate) 1 Blood Cultures Light Blue Sodium Citrate 2 Coagulation Studies Red (Glass) None 3 Serum Chemistry, Serology Red (Plastic) Clot Activator 3 Serum Chemistry, Serology Gold/Tiger Top Serum Separator Tube (SST) 3 Serum Chemistry, Serology Green Heparin 4 Plasma Chemistry, Ammonia Lavender/Purple EDTA (Ethylenediaminetetraacetic acid) 5 Hematology, Blood Bank Gray Sodium Fluoride/Potassium Oxalate 6 Glucose Testing

Facts to Memorize:

1. OSHA's Bloodborne Pathogens Standard: Mandates engineering controls, work practice controls, PPE, Hepatitis B vaccination, and exposure incident response procedures.

2. Needle Recapping: Never recap needles; it's a major source of needlestick injuries.

3. Sharps Disposal: Dispose of sharps immediately into an approved, puncture-resistant container.

4. Order of Draw: Follow the CLSI order of draw to prevent cross-contamination. (See table above)

5. Standard Precautions: Treat all blood and body fluids as potentially infectious.

6. Hand Hygiene: Perform hand hygiene before and after patient contact and after glove removal.

7. PPE: Use appropriate PPE based on the anticipated level of exposure.

8. HIPAA: Protect patient privacy and confidentiality.

9. Quality Control (QC): Regularly perform QC procedures to ensure accurate test results.

10. Quality Assurance (QA): Implement a comprehensive QA program to ensure the overall quality of laboratory services.

11. Syncope Response: If a patient faints, remove the tourniquet and needle, apply pressure, and place the patient in a reclining position.

12. Seizure Response: Protect the patient from injury during a seizure; do not restrain them.

13. Hematoma Formation: Apply pressure to the venipuncture site to prevent hematoma formation.

14. Excessive Bleeding: Apply direct pressure to the site and seek assistance if bleeding is excessive.

15. Incident Reporting: Report all accidents, incidents, and near misses according to facility policy.

16. CLIA-Waived Tests: Follow manufacturer's instructions precisely for CLIA-waived tests. Run controls regularly.

17. Aseptic Technique: Use proper aseptic techniques to prevent contamination during blood collection.

18. Transmission-Based Precautions: Follow appropriate transmission-based precautions (airborne, droplet, contact) for patients with infectious diseases.

19. Exposure Control Plan: Familiarize yourself with your facility's exposure control plan and follow its procedures.

20. Hepatitis B Vaccination: Healthcare workers are offered free Hepatitis B vaccination.