Section 10: Infection Control Practices

Personal Protective EQUIPMENT

Personal Protective Equipment (PPE) is essential and required when working as a phlebotomist. When PPE is properly worn it helps protect you from bloodborne pathogens, bloodily fluids, disease, and illness. Protective clothing and other items worn by an individual to protect mucous membranes, airways, skin, and clothing from contact with infectious substances are called personal protective equipment (PPE).

Commonly used Personal Protective Equipment includes:

Gloves
Masks
Goggles
Face Shields
Respirators
Foot Coverings
Aprons, body coverings

In every situation, especially situations where you may be exposed to bloodborne pathogens, evaluate the amount of PPE necessary for your personal protection. You never know what illness or disease a patient or a sample might carry or contain! BE WISE. PLAY IT SAFE. It's better to be protected and prepared in any scenario if possible. If PPE is torn, punctured, or not functioning properly, remove and replace it. Remove the PPE before you leave the work area. Change the PPE between every patient! If you get blood or any bodily fluids on your clothing, remove it as soon as possible to avoid contact with your skin. Remember, it is ESSENTIAL to have a barrier between you and infectious material AND you are responsible for putting it on and using it.

The amount of PPE you wear directly correlates to the amount of exposure you anticipate.

Learn the proper way to put on and take off PPE reviewing these 3 pages of this PDF from the CDC.

PPE-Sequence.pdf

Gloves

As a phlebotomist, gloves will be the most common PPE you will use. Masks are often used as well as you will work in close proximity to a patient. Even when wearing gloves, washing your hands and using hand sanitizer between patients is recommended. You may have seen a phlebotomist tear off the finger tip to a glove to aid them in finding a vein. This is a risk and not advised. This breaks that protection barrier. It is better to refine your skills to finding and feeling veins with gloves on. On occasion, you will have a difficult patient. If you feel the need to feel the vein with a bare finger, that is a risk you can choose to take. If possible, put a glove on before using the needle and creating the potential exposure to blood/bodily fluids. Again, it is NOT recommended to perform any of the procedures without PPE. It is less and less common to see latex gloves or latex products in the medical world as there are many people with an allergy to latex. Most gloves are made with vinyl or nitrile. But always be aware of this and your patient's allergies to avoid causing them allergic reactions.

Please watch this video.

Work Practice Controls

Along with using PPE to protect yourself from infectious exposure, work practice controls will also aid in contamination prevention. Here are some vital but simple rules to protect you and others in the lab work areas:

Do not eat or drink in the lab. (This is a direct OSHA violation).
Store food away from work areas or potentially infectious areas. Food and drink should be kept in refrigerators, freezers, shelves, cabinets and countertops in a separate room than the lab, designated for food and eating.
Do not apply cosmetics, or lip balm in the lab areas (don't touch your mouth)
Do not put contact lenses in your eyes in the lab area
Never pipette or suction with your mouth.
Minimize the amount of splashing, spraying, splattering and spilling with working with blood or potentially infectious materials.
Avoid touching your face with gloves on.
Wash your hands frequently and always before eating.

Hand Washing and Hand Hygiene

Handwashing is one of the most important and easiest work practices to prevent the spread of disease.

Hands should be be washed:

Before and after each patient contact
Between unrelated procedures on a patient (for example: between wound care and drawing blood)
Before putting on gloves and after taking them off (and other PPE)
Before leaving the laboratory
Before going to lunch or on a break
Before and after going to the restroom
Whenever hands become visibly or knowingly contaminated
Immediately after any exposure incident

Hand washing should take at least 20 seconds, which is the time it takes to hum the “Happy Birthday” song or "ABCs" twice. Use soft antibacterial soap if possible. Avoid harsh, abrasive soaps that may dry out your hands and cause scrapes and sores. Warm or cold water is fine as long as it is clean. Clean under your fingernails and between all your fingers. Familiarize yourself with the locations of sinks in your facility for hand washing. If unable to wash hands frequently, the use of hand sanitizer is also acceptable. Use an alcohol based hand-sanitizer that contains at least 60% alcohol. Be aware that while most hand sanitizers kill most types of germs on the hands, they may not kill certain bacteria and viruses that can cause diarrhea. Be sure you wash your hands before eating and after using the restroom.

According to the World Health Organization, hand hygiene guidelines, health care workers should not wear artificial fingernails or extenders when having direct contact with patients, and natural nails should be kept short. Nails can allow for harboring bacteria and germs between the layers that are harder to keep clean.

Please watch this video.

clothing, shoes, and accessories

Lab coats are worn to protect the skin and prevent soiling of clothing during patient-care activities in which splashes or sprays of blood or body fluids are possible. They are required attire for most phlebotomy situations. Lab coats used for specimen collection and handling are generally made of fluid-resistant cotton or synthetic material, have long sleeves with knit cuffs, and come in both reusable and disposable styles.

**Lab coats worn as PPE must not be worn on breaks, in the cafeteria or other non-patient areas. **

Scrubs are considered street clothes and not PPE unless they are put on at work and removed before leaving work. Scrubs worn at home can carry microbes with them, including C. difficile spores, which can survive for months on surfaces.

Scrub bottoms or other pants that touch the floor can easily pick up infectious material. According to the CLSI Clinical Laboratory Safety guideline, pants worn by laboratory personnel should be 1 to 1 ½ inches off the floor to prevent contamination.

Open toed shoes should not be worn as a healthcare worker. Hair should be pulled back, nails kept short. Do not wear long chains or necklaces, large dangly earrings, or loose bracelets. All of these things increase the risk of picking up potential diseases in the workplace.

Decontamination and Sterilization

Keeping your work area decontaminated and sterilized will decrease the risk of disease transmission and infection. All the surfaces (table tops, counter tops, tray, desks), tools, equipment and other objects that may come in contact with potentially infectious material must be decontaminated and sterilized as soon as possible. Do not use any equipment or tools before cleaning them first.

Decontamination can be done with:

A 5.25% sodium hypochlorite solution (or household bleach) diluted 1:10 and 1:100 with water. The standard recommendation is to use one cup of bleach to one gallon of water.
Lysol or another EPA-registered Tuberculocidal Disinfectant can also be used. Always read the labels of the disinfectants to be sure they meet requirements.

Wear PPE when decontaminating. The chemicals can irritate the skin and mucous membranes. Always label any bottles or spray bottles you used to mix or dilute in.

If you need to clean up a blood spill, carefully cover the spill with paper towels and then pour 10% bleach solution over the spill. Leave for 10 minutes. This will kill the bloodborne pathogens in the blood before you clean it up. Covering it with a paper towel or rags prevents splashing when you gently pour the bleach over it.

If you need to decontaminate tools or equipment or other objects with blood on them, leave the disinfectant in place for at least 10 minutes before continuing the cleaning process. Do this for the same reason as above, to kill the bloodborne pathogens before handling further.

Don't forget! If you used mops, sponges, reusable work gloves, buckets or pails to clean up blood spills or infectious materials, all of these tools also need to be decontaminated as well before reusing. If it is not possible to decontaminate and reuse, they should be disposed of in proper biohazard containers.

RETURN TO THE GOOGLE CLASSROOM AND DO THE PRACTICE WORKSHEET.

For more information and references on the reading material found in Section 10: Infection Control Practices, click the link below. Test questions will be based on the reading in the sections and not from more information found in external references and website links.

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