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Safety, Infection ControlSafety, Infection Control
& Patient Interaction& Patient Interaction
Colette SchrankColette Schrank
Lecture #1Lecture #1
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Learning Objectives
1.1. Define the following terms/abbreviations: OSHA,
biohazard, universal precautions, nosocomial infection,
pathologist, medical technologist, medical laboratory
technician, phlebotomist, basal state, Patients Bill ofRights.
1.2. Define OSHAs Bloodborne Pathogen Standard
as it relates to blood specimen collection.
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Learning Objectives, cont.
1.4. Relate handwashing techniques to thespread of nosocomial infections.
1.5. Identify infection control equipmentrequired when performing routinevenipuncture, including gowns and gloves.
1.6. Identify appropriate waste
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Learning Objectives, cont.
.7. List the steps in proper needle disposal toprevent the spread of bloodborne pathogens.
1.8. List the steps in the appropriate method ofdisinfecting a site following a blood or bodyfluid spill.
1.9. Identify the appropriate course of action a
phlebotomist should follow after accidental
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Learning Objectives, cont.
1.10. Identify the following categories ofisolation: strict, contact, respiratory, AFB,drainage-secretion, enteric.
1.11. Identify the color of sign that may appearon a patients door for each isolation category
listed above.
1.12. Identify the appropriate protective
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Learning Objectives, cont.
1.13. Relate the Patients Bill of Rights to thefollowing situations: patient refusal,confidentiality, patient inquiry regarding test
results. 1.14. Approach the patient in a professional
manner, consistent with the Patients Bill of
Rights. 1.15. Identify the patient, following the two-
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Learning Objectives, cont.
1.16. Discuss the importance of proper
patient identification (and specimen
labeling) for quality laboratory results.
1.17. Discuss at least two possible legal
ramifications of misidentifying a patientprior to collecting a specimen for
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Professionalism
Meticulous adherenceMeticulous adherence to:
undeviating courtesy, honesty, and
responsibility in one's dealings withpatients (clients)patients (clients) and colleaguescolleagues, plus
A level of excellencelevel of excellence that exceeds the
standard of care and legalrequirements.
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Safety
Mandated by OSHA (1970) Occupational Safety and Health Administration
Implementation of policies and procedures totoensure safe work practicesensure safe work practices for all employeesall employees
Employers must eliminate or minimizeeliminate or minimize
occupational riskoccupational risk Safety policies may vary from place to place
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OSHA Laws re: lab safety
Hazardous CommunicationHazardous Communication 29 CFR 1910.1200
Bloodborne Pathogen StandardBloodborne Pathogen Standard 29 CFR 1910.1030
Needlestick Safety and Prevention ActNeedlestick Safety and Prevention Act 29 CFR 1910.1030
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Hazard Communication StandardHazard Communication Standard
November, 1983
Evaluate hazards of all chemicals used
in workplace Employee training
Share information about chemicals is
with employees
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Haz Com Outcomes
Label all chemicalsLabel all chemicals
Use NFPA labelUse NFPA label
Identify hazard (0-4)Identify hazard (0-4)..flammabilit
combustibilit , instabilithealth
..radiation, water reactivit , other
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Exposure Control Plan
Implementation and complianceImplementation and compliance PPEPPE
EngineeringEngineering controls
Work practiceWork practice controls Cleaning and disinfectingCleaning and disinfecting WasteWaste disposal HBV vaccinevaccine Post exposurePost exposure follow-up; records Training and educationTraining and education
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Lab Safety Practices
Wear PPE
Dispose of sharps Dispose of biohazardous materials
Dispose of non-biohazardous waste Wash hands
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Waste Removal
Biohazardous sharpsBiohazardous sharps
lancets, needles, butterfly needles,
syringes, glass slides anything that can tear plastic
Biohazardous materialBiohazardous material
Contaminated with blood/body fluid Non-biohazardous wasteNon-biohazardous waste
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Personal Protective Equipment
Protection fromProtection from parenteral, mucous
membrane and non-intact skin contact
exposure to BBPexposure to BBP Examples:
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Needlestick Safety andNeedlestick Safety and
20012001
Safer needle devicesSafer needle devices
Employees to participate in choosingEmployees to participate in choosingequipmentequipment
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Accidental Exposure follow-up
Flush siteFlush site (mucus membrane 10 min.)
Decontaminate areaDecontaminate area (iodine for 30sec.)
Report incidentReport incident
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Be directed to employee healthdirected to employee health (medical
treatment, evaluation, and counseling)
Employee tested for HIV/HBVEmployee tested for HIV/HBV
Source tested for HIV, HBV, HCVSource tested for HIV, HBV, HCV
If source is positive for HIV or HBV,evaluation takes place at following intervals: 6
weeks, 12 weeks, 6 months
ZT administration & HBIG (there isno HCV prophylaxis)
I source is ositi e or HCV base ine
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Universal Precautions
Mandated by OSHAOSHA for HCW
Assumes that blood and certain bodyblood and certain body
fluids of all patients are contaminatedfluids of all patients are contaminated HBV, HCV, HIVHBV, HCV, HIV infections of
greatest concern to HCW
Disease transmissionDisease transmission through contact
with blood and certain body fluids
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Standard Precautions
Apply to bloodblood and all body fluidsall body fluids,
except sweatexcept sweat
Apply to non-intact skinnon-intact skin Apply to mucous membranesmucous membranes
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Transmission-based: Airborne
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Transmission-based: Droplet
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Transmission-based: Contact
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What constitutes Infection
Invasion of a bodyInvasion of a body by a microorganism,usually a pathogen, resulting in injury ordisease
Micro-organisms include: bacteria, viruses,bacteria, viruses,fungi, protozoafungi, protozoa
Could be caused by non-pathogenCould be caused by non-pathogen if
systemic conditions are favorable to infection Could be localCould be local: restricted to a small area of
the body
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Infection
Source:Source: pathogen or infectious microbe Mode of transmission:Mode of transmission: a way for the microbe
to get from one place to another
Susceptible hostSusceptible host Infants
Elderly
Immunocompromised
Overmedicated
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Source
Escherichia coli, E. coli
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Mode of transmission
Fecal/oral (unwashed fruit)
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Susceptible Host
Most at risk: infants, children and
elderly
Immunocompromised patients
Surgical pts
Debilitated pts
Overmedicated patients
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Nosocomial Infection
Where acquired?Where acquired? in a healthcare facility How Many?How Many? infecting ~10% of hospital
patients DeathsDeaths - 20,000 patients/year Sites:Sites: Urinary tract, surgical, respiratory Etiologic agents:Etiologic agents:
Enterococcus E. coli Pseudomonassp.
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Staphylococcus aureus
Normal skin flora
Can cause serious infection
Surgical wounds, respiratory infections
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Methicillin Resistant Staphylococcus aureus:
super staphsuper staph
commonly on skin
pathogenic when it becomes systemic
more virulent strains in places of poor
hygiene
Tx: vancomycin, teicoplanin and Rifampin
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Vancomycin-intermediate Staphylococcus aureus:
VISA
UncommonUncommon but emerging nosocomial
problem
Treatment varies; may be susceptible togentamicin, tetracycline, and
quinupristin-dalfopristin
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Vancomycin resistant staphylococcus aureus:
VRSA Specific type of antimicrobial staph
Not successfully treated with
vancomycin VISA and VRSA uncommon rare atuncommon rare at
this timethis time
Best prevention: handwashing Tx: trimethoprim/sulphmethoxazole,
minoc cline linezolid uinu ristin-
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Clostridium difficile: C diff
gram positive anaerobic bacteria
major cause if dysenterymajor cause if dysentery
one of the most common world-widenosocomial infections
susceptible: extended hospitalizedsusceptible: extended hospitalizedpatients, patients on antibiotic therapypatients, patients on antibiotic therapyor immunocompromisedor immunocompromised
treatment is vancomycin or metronidazole
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Disinfectants
used to remove or killremove or kill pathogenicmicroorganisms- should be used on surfaces andsurfaces and
instruments, inanimate objectsinstruments, inanimate objects- examples:bleach (10%)bleach (10%)
formaldehyde (lab)formaldehyde (lab)glutaraldehyde (equipment)glutaraldehyde (equipment)ethylene oxide (sterilant)ethylene oxide (sterilant)henolshenols
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Fomites
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Infection Control
a policy to separate the patient fromthe mainstream
procedures designed to protectpatients, or healthcare workers, fromother patients that have a transmissibledisease
types of isolation: 3 basic typesrecommended by the CDC
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Types of isolation
Category specific
Disease specific
Standard precautions and Transmission-
based precautions
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Category specific
Drainage/ secretion-skin infections, openwounds, burn victims, sometimes followingsurgery, * requires: masks, gowns, if warranted
Enteric-intestinal infections that could betransmitted fecal/oral, *requires: gloves, masksand gowns if warranted
Blood and Body Fluid- patients with diseasethat can be transmitted through contact withpatients blood, body fluid; * requires: gloves,
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Category specific
Strict ( AKA Complete)- highly contagiousdisease, requires: gowns, gloves, mask
Contact isolation-spread by direct patient
contact, * requires: gloves, gowns if needed, i.e.Flu, antibiotic resistant bacteria
Respiratory-spread via droplet nuclei, throughthe air, * requires: masks, if come within closecontact, i.e. H. influenza
AFB- active TB, * requires: masks or particulate
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Disease specific
a specific isolation procedure based
upon the mode of transmission for a
common disease. Each certain diseasemay correspond to a specific precaution
needed, i.e. Chickenpox.
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Modes of transmission
Contact transmission
Airborne transmission (less than 5 um)
Droplet transmission (larger than 5 um) Vector transmission (mosquito, tick,
animal)
Vehicle transmission (food, water)
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Standard precautions and
airborne precautions reduce spread fromairborne droplet transmission of agents, i.e.rubeola (measles), varicella (chickenpox),Mycobacterium tuberculosis(TB).
droplet precautions reduce transmission ofdiseases such as pertussis (Bordetellapertussis), meningitis, pneumonia and Germanmeasles (rubella)
contact precautions reduce transmission ofdiseases as respiratory syncytial virus (RSV),herpes simplex, wound infections and othersthrough direct and indirect contact
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Additional types of isolation
Reverse-(also called protective) used on patients that arehighly susceptible to disease/ infection, the protection isgiven to the patient, * requires: mask, i.e. this could be abone marrow recipient that was completely irradiatedprior to transplant
Radiation-allow exposure to patients in short increments,pregnant employees should not enter i.e. radiation implantpatients
Creutzfeld/ Jacob Disease-(human equivalent to Mad Cowdisease)- a genetic disorder that causes prion proteins inthe brain to mutate * re uires: loves i.e. isolation is
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Other precautions
Doublebagging
putting contaminated material(s)
into a bag and sealing it;
then, placing the sealed bag (before leaving
the isolation room) into another bag after
leaving the room;
must be labeled BIOHAZARD).
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l h d
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Isolation techniques and
Wash hands
Wear gowns or lab coats
Wear gloves Wear mask, eye protection, face shield
Patient care equipment (PCE)
Environmental control- routine cleaning
i
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During Clinical Experience
No eating, drinking, smoking, gum chewing
Use specific refrigerators
Dress conservatively, no clumsy jewelry,and dont apply make-up
Always wear lab coat, keep hair groomed
and tied back, keep fingernails short Always use PPE, close-toed, non-skid, non-
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Safety Videos
Fire Extinguisher and Lab Safety
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Patient Approach and Contact
Enter patients room-
knock lightly, introduce yourself and explain
purpose
Watch for signs-
look for special instruction posted on door
(isolation), above the bed (right arm drawonly), DNR (do not resuscitate)
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Patient IdentificationPatient Identification
Identify yourself-
state your name and who you are, Hi Im
Jennifer, Im from the lab and Im here to
draw your blood; and your name is?
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Special situations
Patient is sleeping:
Gently awaken them, explaining purpose,
never draw while still asleep.
Patient is unconscious:
Ask for help and explain purpose, patientmay still move.
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Special situations
Patient is with doctor or clergy:
plan to come back later since time with
these individuals is limited unless a timed
test or stat then ask permission to obtain
sample.
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Special situations
Patient not in room: Attempt to find the patient, especially timed
tests or stat must be searched out if possible
or document. Patient refusal:
even though the patient has the right to
refuse, gentle persuasion may possibly achievecooperation; explain importance of the laborder, ask a nurse or doctor explain; if unable
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Preparation for testing
Bedside manner- gain patient trust and
respect
Handling difficult patient- remain calmand professional, treat patient w/ care
and respect
Explain procedure- give briefexplanation. If language barrier exist,
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Handling inquiries- refer patient to
doctor.
Refusal, see above, try to convince
patient but never force them.
Verify restrictions, diet, movement,requirements for med (i.e. Digoxin-6hrs
post dose).
Proceed with collection.
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