1. Laboratory Training for Field Epidemiologists Best infection control measures for sampling venous and capillary blood WHO intermediate recommendations February 2004 Best infection control measures for sampling venous and capillary blood WHO intermediate recommendations February 2004 May 2007 Adapted sample taking

2. Laboratory Training for Field Epidemiologists Best practices Ensure blood is sampled safely, no exposure to bloodborne pathogens to patients, health care workers, environment Scope of best practices restricted to infection control Do not address other routine practices: labelling selecting the right equipment for the right patient containers protecting the sample from contamination

3. Laboratory Training for Field Epidemiologists Steps of safe blood sampling Step 1: select equipment, prepare area Step 2: prepare patient, collect blood sample Step 3: t ransfer blood sample Step 4: waste management Other practice issues: type of phlebotomy equipment

4. Laboratory Training for Field Epidemiologists Step 1 Select equipment, prepare area Provide an appropriate environment for blood collection

5. Laboratory Training for Field Epidemiologists Step 1 Select equipment, prepare area Wash and/or disinfect your hands first Avoid collecting blood if local infection or other skin condition (e.g., weeping dermatitis, skin lesions) compromises the skin integrity of your hands. Cover any small cuts on your hands (e.g., with a bandaid/plaster).

6. Laboratory Training for Field Epidemiologists Step 1 Select equipment, prepare area Prepare a clean, designated and if possible, dedicated area for collecting blood samples.

7. Laboratory Training for Field Epidemiologists Step 1 Select equipment, prepare area Wear a new pair of gloves for each patient Use a sterile single-use lancet or phlebotomy set for each patient Inspect packaging for breaches in integrity Do not use equipment that may not be sterile (punctured, torn or damaged).

8. Laboratory Training for Field Epidemiologists Step 2: Prepare patient, collect blood sample Wash visibly soiled/dirty skin Swab Antiseptic - clean, single use swab and maintain product-specific recommended contact time. Do not use cotton balls stored wet in a multi-use container. Unnecessary to swab clean skin before blood sampling Don’t touch the puncture site after skin disinfection or before blood sampling.

9. Laboratory Training for Field Epidemiologists Step 2: Preparation of the patient and collection of the blood sample Discard in an appropriate sharps disposal container any needle or lancet that has touched a non-sterile surface prior to sampling. When the use of a tourniquet is indicated, use a clean device that has not been contaminated with blood or body fluids.

10. Laboratory Training for Field Epidemiologists Step 2: Preparation of the patient and collection of the blood sample Anticipate and take measures such as appropriate patient restraint to prevent sudden patient movement during and after blood sampling.

11. Laboratory Training for Field Epidemiologists Step 2: Prepare the patient and collect the blood sample After sampling, minimize bleeding by applying gentle pressure on the sampling site with a dry, clean cotton ball or other similar material. Apply clean dressing to the wound after bleeding has stopped.

12. Laboratory Training for Field Epidemiologists Step 3. Transfer blood sample When using a syringe and a needle to perform phlebotomy, transfer the collected blood slowly and directly into the collection tubes without removing the needle to prevent spillage or splashing Cover the tubes

13. Laboratory Training for Field Epidemiologists Step 3. Transfer the blood sample Avoid recapping needles and other manipulations of used needles. If recapping is necessary, use one hand only to avoid puncturing the hand holding the cap.

14. Laboratory Training for Field Epidemiologists Step 3. Transfer the blood sample Collect used sharps at the point of use in puncture resistant and leak-proof sharps containers.

15. Laboratory Training for Field Epidemiologists Step 3. Transfer the blood sample Prepare blood collection tubes for storage or transport according to recommended national and/or international packaging requirements.

16. Laboratory Training for Field Epidemiologists Step 3. Transfer of the blood sample Disinfect the sampling area to eliminate the risk of contamination of equipment with blood or body fluids for future use, particularly if spillage or splashing of blood occurred. Wash hands after removing gloves.

17. Laboratory Training for Field Epidemiologists Step 4. Waste management Seal sharps containers before they are completely full for transport to a secure area in preparation for disposal.

18. Laboratory Training for Field Epidemiologists Step 4. Waste management Manage waste in an efficient, safe and environment- friendly way to protect people from voluntary and accidental exposure to used equipment.

19. Laboratory Training for Field Epidemiologists Type of phlebotomy equipment Single-use, vacuum-based phlebotomy equipment is available to reduce the risk of environmental contamination. Safer injection devices are increasingly available to prevent reuse of injection equipment and needle-stick injuries.

20. Laboratory Training for Field Epidemiologists Developed by the Department of Epidemic and Pandemic Alert and Response of the World Health Organization with assistance from: European Program for Intervention Epidemiology Training Canadian Field Epidemiology Program Thailand Ministry of Health Institut Pasteur Module 2: Adapted sample taking