Safety, Infection Control

& Patient Interaction

Colette Schrank
Lecture #1
 Learning Objectives
• 1.1. Define the following terms/abbreviations: OSHA,
biohazard, universal precautions, nosocomial infection,
pathologist, medical technologist, medical laboratory
technician, phlebotomist, basal state, “Patient’s Bill of
Rights”.

• 1.2. Define “OSHA’s Bloodborne Pathogen Standard”

as it relates to blood specimen collection.
 
• 1.3. Compare and contrast OSHA’s Bloodborne
 Learning Objectives, con’t.
• 1.4. Relate handwashing techniques to the
spread of nosocomial infections.

• 1.5. Identify infection control equipment

required when performing routine
venipuncture, including gowns and gloves.

• 1.6. Identify appropriate waste

receptacles for biohazardous waste.
 Learning Objectives, con’t.
• .7. List the steps in proper needle disposal to
prevent the spread of bloodborne pathogens.

• 1.8. List the steps in the appropriate method of

disinfecting a site following a blood or body
fluid spill.
 
• 1.9. Identify the appropriate course of action a
phlebotomist should follow after accidental
self-puncture with a contaminated needle.
 Learning Objectives, con’t.
• 1.10. Identify the following categories of
isolation: strict, contact, respiratory, AFB,
drainage-secretion, enteric.

• 1.11. Identify the color of sign that may appear

on a patient’s door for each isolation category
listed above.
 
• 1.12. Identify the appropriate protective
clothing a phlebotomist would wear into each
 Learning Objectives, con’t.
• 1.13. Relate the Patient’s Bill of Rights to the
following situations: patient refusal,
confidentiality, patient inquiry regarding test
results.
 
• 1.14. Approach the patient in a professional
manner, consistent with the Patient’s Bill of
Rights.
 
• 1.15. Identify the patient, following the two-
step method of patient identification.
 Learning Objectives, con’t.
• 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 patient
prior to collecting a specimen for
analysis.
 Professional
• Pendergraph defines a “Professional”
Professional as
one who:
– has been extensively trained
– to render a particular service
– is governed by an organized body that
• regulates continued practice in the field
• assesses competency
• requires adherence to a code of ethics
 Professionalism
• Meticulous adherence to:
– undeviating courtesy, honesty, and
responsibility in one's dealings with
patients (clients) and colleagues,
colleagues plus
• A level of excellence that exceeds the
standard of care and legal
requirements.
 Video
• A Gift from Mrs. Timm
 Safety
• Mandated by OSHA (1970)
– Occupational Safety and Health Administration
• Implementation of policies and procedures to
ensure safe work practices for all employees
• Employers must eliminate or minimize
occupational risk
• Safety policies may vary from place to place
 OSHA Laws re: lab safety
• Hazardous Communication
– 29 CFR 1910.1200

• Bloodborne Pathogen Standard

– 29 CFR 1910.1030

• Needlestick Safety and Prevention Act

– 29 CFR 1910.1030
– 29 CFR 1910.1030 (d)(2)(i)
Hazard Communication Standard
• November, 1983
• Evaluate hazards of all chemicals used
in workplace
• Employee training
• Share information about chemicals is
with employees
 Haz Com Outcomes
– Label all chemicals
– Use NFPA label
– Identify hazard (0-4)
…..flammability

……combustibility, instability
health…………

……..radiation, water reactivity, other

 Haz Com Outcomes
– MSDS
• material safety data sheets
• must be in workplace at all times
• must be accessible to all staff
 Bloodborne Pathogen
Standard
• 1991
• Generated “Exposure Control Plan”
 Exposure Control Plan
• Implementation and compliance
• PPE
• Engineering controls
• Work practice controls
• Cleaning and disinfecting
• Waste disposal
• HBV vaccine
• Post exposure follow-up; records
• Training and education
• Labels and warning signs
 Lab Safety Practices
• Wear PPE

• Dispose of sharps
• Dispose of biohazardous materials
• Dispose of non-biohazardous waste
• Wash hands
 Waste Removal
• Biohazardous sharps
– lancets, needles, butterfly needles,
syringes, glass slides
– anything that can tear plastic
• Biohazardous material
– Contaminated with blood/body fluid
• Non-biohazardous waste
– Routine non-contaminated waste
 Personal Protective Equipment
(PPE)
• Protection from parenteral, mucous
membrane and non-intact skin contact
exposure to BBP
• Examples:
 Needlestick Safety and
Prevention Act
• 2001
– Safer needle devices
– Employees to participate in choosing
equipment
Accidental Exposure follow-up
• Flush site (mucus membrane 10 min.)
• Decontaminate area (iodine for 30sec.)
• Report incident
Be directed to employee health (medical
treatment, evaluation, and counseling)
 Employee tested for HIV/HBV
 Source 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 is
no HCV prophylaxis)
If source is positive for HCV, baseline
 Universal Precautions
• Mandated by OSHA for HCW
• Assumes that blood and certain body
fluids of all patients are contaminated
• HBV, HCV, HIV – infections of
greatest concern to HCW
• Disease transmission through contact
with blood and certain body fluids
 Bloodborne Pathogens
• HBV, HCV, HDV (hepatitis)
• HIV (AIDS)
• Cytomegalovirus (CMV)
• Creutzfeldt Jacob (CJ) virus
• Treponema pallidum (syphillis)
• Plasmodium (malaria)
 Body Substance Isolation
• Assumption that ANY body fluid is
contaminated
• Focuses on moist substances
– Blood, urine, saliva, feces, sputum, wound
drainage and other body fluids
• More encompassing than UP
• STOP sign outside patient’s door
 Standard Precautions
• Apply to blood and all body fluids,
fluids
except sweat
• Apply to non-intact skin
• Apply to mucous membranes
 Transmission-based Precautions
• Adjunct to Standard Precautions
• Category specific
– Airborne
– Droplet
– Contact
Transmission-based: Airborne
Transmission-based: Droplet
Transmission-based: Contact
 Infection
• Invasion of a body by a foreign
substance causing injury or disease

staff infection

yeast
infection

HPV infection
 What constitutes “Infection”
• Invasion of a body by a microorganism,
usually a pathogen, resulting in injury or
disease
• Micro-organisms include: bacteria, viruses,
fungi, protozoa
• Could be caused by non-pathogen if
systemic conditions are favorable to infection
• Could be local:
local restricted to a small area of
the body
• Could be systemic:
systemic entire body is affected
 Infection
• Source: pathogen or infectious microbe
• Mode of transmission: a way for the microbe
to get from one place to another
• Susceptible host
– Infants
– Elderly
– Immunocompromised
– Overmedicated
– Undernourished
 Source
• Escherichia coli, E. coli
 Mode of transmission
• Fecal/oral (unwashed fruit)
 Susceptible Host
• Most at risk: infants, children and
elderly

• Immunocompromised patients
– Surgical pts
– Debilitated pts
• Overmedicated patients
 Infection dependent on:
• Amount of contamination
• Viability of organism
• Virulence
• Time lapse between contact and
contamination of host
 Break chain of infection by:
• Eliminate the source
• Disrupt the means of transmission
• Reduce susceptibility (stay healthy, eat
right)
 Nosocomial Infection
• Where acquired? in a healthcare facility
• How Many? infecting ~10% of hospital
patients
• Deaths - 20,000 patients/year
• Sites: Urinary tract, surgical, respiratory
• Etiologic agents:
– Enterococcus
– E. coli
– Pseudomonas sp.
– Staph aureus
 Staphylococcus aureus
• Normal skin flora
• Can cause serious infection
• Surgical wounds, respiratory infections
 Methicillin Resistant Staphylococcus aureus:
MRSA
• “super staph”
• commonly on skin
• pathogenic when it becomes systemic
• more virulent strains in places of poor
hygiene
• Tx: vancomycin, teicoplanin and Rifampin
 Vancomycin-intermediate Staphylococcus aureus:

VISA
• Uncommon but emerging nosocomial
problem
• Treatment varies; may be susceptible to
gentamicin, tetracycline, and
quinupristin-dalfopristin
 Vancomycin resistant staphylococcus aureus:
VRSA
• Specific type of antimicrobial staph
• Not successfully treated with
vancomycin
• VISA and VRSA uncommon – rare at
this time
• Best prevention: handwashing
• Tx: trimethoprim/sulphmethoxazole,
minocycline, linezolid, quinupristin-
 Clostridium difficile: C diff

• gram positive anaerobic bacteria

• major cause if dysentery
• one of the most common world-wide
nosocomial infections
• susceptible: extended hospitalized
patients, patients on antibiotic therapy
or immunocompromised
• treatment is vancomycin or metronidazole
• best prevention is proper handwashing
 Definitions
• Communicable - infections that spread
from one person to another.

• Virulence - degree to which an organism

is capable of spreading infection.
 
• Viability - the ability of an organism to
survive on the source.
 Antiseptics
• used to inhibit the growth and development of
microorganisms but not necessarily to kill them
- bacteriostatic
- should be used on living tissue
• - examples:
alcohol
hydrogen peroxide
iodine
chlorhexidene
hexachlorophene (surgery)
 Disinfectants
• used to remove or kill pathogenic
microorganisms
- should be used on surfaces and
instruments, inanimate objects
- examples:
bleach (10%)
formaldehyde (lab)
glutaraldehyde (equipment)
ethylene oxide (sterilant)
phenols
Fomites
 Infection Control
• a policy to separate the patient from
the mainstream
• procedures designed to protect
patients, or healthcare workers, from
other patients that have a transmissible
disease
• types of isolation: 3 basic types
recommended by the CDC
 Types of isolation
• Category specific

• Disease specific

• Standard precautions and Transmission-

based precautions
 Category specific
• Drainage/ secretion- skin infections, open
wounds, burn victims, sometimes following
surgery, * requires: masks, gowns, if warranted
• Enteric- intestinal infections that could be
transmitted fecal/oral, *requires: gloves, masks
and gowns if warranted
• Blood and Body Fluid- patients with disease
that can be transmitted through contact with
patients blood, body fluid; * requires: gloves,
universal precautions (i.e. HIV, HBV)
 Category specific
• Strict ( AKA Complete)- highly contagious
disease, 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, through
the air, * requires: masks, if come within close
contact, i.e. H. influenza
• AFB- active TB, * requires: masks or particulate
respirators , gowns, gloves (i.e. Resistant strain
 Disease specific
• a specific isolation procedure based
upon the mode of transmission for a
common disease. Each certain disease
may correspond to a specific precaution
needed, i.e. Chickenpox.
 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)
 Standard precautions and
Transmission-based precautions
• airborne precautions – reduce spread from
airborne droplet transmission of agents, i.e.
rubeola (measles), varicella (chickenpox),
Mycobacterium tuberculosis (TB).
• droplet precautions – reduce transmission of
diseases such as pertussis (Bordetella
pertussis), meningitis, pneumonia and German
measles (rubella)
• contact precautions – reduce transmission of
diseases as respiratory syncytial virus (RSV),
herpes simplex, wound infections and others
through direct and indirect contact
 Additional types of isolation
• Reverse-(also called protective) used on patients that are
highly susceptible to disease/ infection, the protection is
given to the patient, * requires: mask, i.e. this could be a
bone marrow recipient that was completely irradiated
prior to transplant

• Radiation- allow exposure to patients in short increments,

pregnant employees should not enter i.e. radiation implant
patients

• Creutzfeld/ Jacob Disease- (human equivalent to Mad Cow

disease)- a genetic disorder that causes prion proteins in
the brain to mutate, * requires: gloves, i.e. isolation is
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).
Other precautions
• Handwashing
– minimum of 15 seconds with soap;
– alternative is alcohol-based hand sanitizer.
 Isolation techniques and
procedures
• Wash hands
• Wear gowns or lab coats
• Wear gloves
• Wear mask, eye protection, face shield
• Patient care equipment (PCE)
• Environmental control- routine cleaning
• Linen
 During Clinical Experience
• No eating, drinking, smoking, gum chewing
• Use specific refrigerators
• Dress conservatively, no clumsy jewelry,
and don’t apply make-up
• Always wear lab coat, keep hair groomed
and tied back, keep fingernails short
• Always use PPE, close-toed, non-skid, non-
porous shoes, lab coat, wear gloves
 Safety Videos
• Fire Extinguisher and Lab Safety
Patient Approach and Contact
• Enter patient’s room-
– knock lightly, introduce yourself and explain
purpose
• Watch for signs-
– look for special instruction posted on door
(isolation), above the bed (right arm draw
only), DNR (do not resuscitate)
 Patient Identification
• Identify yourself-
– state your name and who you are, “Hi I’m
Jennifer, I’m from the lab and I’m here to
draw your blood; and your name is?”
 Special situations
• Patient is sleeping:
– Gently awaken them, explaining purpose,
never draw while still asleep.

• Patient is unconscious:
– Ask for help and explain purpose, patient
may still move.
 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.
 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 achieve
cooperation; explain importance of the lab
order, ask a nurse or doctor explain; if unable
to obtain specimen, document and let nurse
 Special situations
• Handling family or visitors
– ask family to be of assistance, it will keep
patient more at ease unless they are not
willing to cooperative or be helpful
 Preparation for testing
• Bedside manner- gain patient trust and
respect
• Handling difficult patient- remain calm
and professional, treat patient w/ care
and respect
• Explain procedure- give brief
explanation. If language barrier exist,
find translator or use sign language
• 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.
 Patient’s Bill of Rights
• passed in 1973 by American Hospital
Association
• A patient has the right to know your
name and purpose of visit. You can
answer simple questions but must refer
complex specific questions to their
physician.
 Patient’s Bill of Rights
• Have the right to be treated with
RESPECT.
RESPECT
• Have the right to their test RESULTS.
RESULTS
• Have the right to REFUSE treatment.
• Have the right to CONFIDENTIALITY.
CONFIDENTIALITY