1. Methodologies and Regulations in Specimen Collection and Management Module 4: Safety and Infection Control

2. Objectives List the components of the chain of infection and the common precautions taken to break the chain. Demonstrate procedures for infection control, including hand washing and gloving Describe the proper hand washing procedure Discuss blood borne pathogens Discuss standard precautions Demonstrate usage of needle safety devices and safe disposal of sharps

3. Today’s Agenda Types of Safety Hazards – Biological Hazards Chain of Infection Breaking the Chain of Infection Standard (Universal )Precautions Blood Borne Pathogens – Sharp Hazards Sharps Safety General and Personal Hygiene Guidelines Additional Safety Practices

4. Types of Safety Hazards Biological: infectious agents Sharp: needles, lancets, broken glass Chemical: reagents (toxic) Radioactive: radiation exposure Electrical: burns or shock Fire: organic chemicals/burns Physical: wet floors, heavy boxes, falls

5. Biological Hazards Includes infectious agents with possible injury: – Bacterial – Fungal – Viral – Parasitic infections 5

6. Today’s Agenda 6 Types of Safety Hazards – Biological Hazards Chain of Infection Breaking the Chain of Infection Standard Universal Precautions Blood Borne Pathogens – Sharp Hazards Sharps Safety General and Personal Hygiene Guidelines Additional Safety Practices

7. Chain of Infection 7 Infectious Agent Reservoir Portal of Exit Mode of Transmission Portal of Entry Susceptible Host

8. Chain of Infection Source: – pathogen (potentially harmful) Method of Transmission: – direct contact, inhaling, droplet, ingesting contaminated food or vector Susceptible Host: – Anyone; now the host is the source 8

9. Today’s Agenda 9 Types of Safety Hazards – Biological Hazards Chain of Infection Breaking the Chain of Infection Standard Universal Precautions Blood Borne Pathogens – Sharp Hazards Sharps Safety General and Personal Hygiene Guidelines Additional Safety Practices

10. How to Break the Chain of Infection Handwashing: – hand contact represents the number one method of infection transmission – Essential to wash hands and change gloves between each patient 10

11. How to Break the Chain of Infection Isolation procedures: – isolating the source Use of barriers – gowns, masks, goggles and gloves 11

12. Decontamination Immunization Insect Control Sterilization Employee Screening Antibiotics Healthy Life Style 12 How to Break the Chain of Infection Chain of Infection Infectious Agent Reservoir Portal of Exit Mode of Transmission Portal of Entry Susceptible Host

13. Breaking the Chain of Infection Hand Washing Wearing Gloves Isolation Aseptictec Decontamination Immunization Sterilization Insect Control 13 Source Transmission Host

14. Hand Washing The single most important factor in preventing the spread of infection is hand washing! Hands should be washed: – Before and after patient contact – Between different procedures on the same patient – Before and after putting on gloves – Before leaving the lab 14

15. Procedure Wash hands for 15 seconds Soap with a good lather Rub hands to create friction, scrub between fingers 15

16. Procedure Rinse downward, dry with a clean towel Close faucet with a clean towel 16

17. ANY QUESTIONS? 17

18. Knowledge Check What is the best way to break the chain of infection?

19. Today’s Agenda Types of Safety Hazards – Biological Hazards Chain of Infection Breaking the Chain of Infection Standard Universal Precautions Blood Borne Pathogens – Sharp Hazards Sharps Safety General and Personal Hygiene Guidelines Additional Safety Practices

20. Standard (Universal) Precautions The primary biological hazard associated with phlebotomy is exposure to blood borne pathogens Transmission can occur by puncturing oneself with a contaminated needle or passive contact through open skin lesions or mucous membranes All patients should be assumed to be infectious for blood borne pathogens

21. Wash hands when changing gloves between patients Wear gloves during blood collection Wear protective lab coat over clothing Wear mask and eye protection when dealing with body fluids Place intact needle with holder in a biohazard container Standard (Universal) Precautions

22. Types of Standard Precautions Wash hands Wear gloves Wear lab coat Wear mask and eye protection Wear face shield Wear gowns

23. Removing Contaminated Gloves

24. Standard Precautions in Patient Care Includes blood and any body fluids 1. Wash hands before and after patient care 2. Wear gloves when likely to touch body substances, mucous membranes or non-intact skin 3. Wear gown when clothing is likely to become soiled 4. Wear mask and protective eyewear or face shield when likely to be splashed with body fluids 5. Place intact needle/syringe units and sharps in designated disposal container. DO NOT BEND OR BREAK NEEDLES. Do Not Recap

25. Today’s Agenda Types of Safety Hazards – Biological Hazards Chain of Infection Breaking the Chain of Infection Standard Universal Precautions Blood Borne Pathogens – Sharp Hazards Sharps Safety General and Personal Hygiene Guidelines Additional Safety Practices

26. Occupational Exposure to Blood-Borne Pathogens Require all employees to practice Standard Precautions If possible, provide lab coats, gowns, gloves, face and respiratory protection Provide sharps disposal containers Prohibit eating, drinking, smoking and applying cosmetics in the lab Label all biohazardous material

27. Standards Provide immunizations for HBV Establish a daily work surface disinfection protocol (Bleach 1:10 or Biosite or Jik) Provide medical follow ups Regular training sessions

28. Blood Borne Pathogens All blood and most body fluids are potentially infectious Health care worker treat all patients with standard precautions for infection Microorganisms in the blood or other potentially infectious material that can transmit disease

29. Blood Borne Pathogens Hepatitis B Hepatitis C HIV TB

30. Pathogens: Routes of Transmission The 3 main routes of entry into the body: Non-intact skin – Intact skin provides a good barrier Mucous membrane exposure – Eyes, nose, mouth Percutaneous injury or through the skin – Needlestick, cut, and puncture

31. Personal Protective Equipment The following equipment should be used before entering a room of a patient with suspected tuberculosis infection: – Fluid resistant gown – N95 respirator mask – Shoe covers – Head cover – Face shield – Gloves 31

32. N95 Respirator Mask Health care workers should be fit tested for the brand of mask used in order to determine whether the mask will be effective Fit testing will determine how well the seal of the mask is when being worn on an individual The effectiveness of each brand of mask will vary from person to person

33. ANY QUESTIONS?

34. Today’s Agenda Types of Safety Hazards – Biological Hazards Chain of Infection Breaking the Chain of Infection Standard Universal Precautions – Sharp Hazards Sharps Safety General and Personal Hygiene Guidelines Additional Safety Practices

35. Sharps Hazards Always use a safety needle/safety equipment Dispose of needle and holder immediately after blood collection Never recap needles or cut needles Never re-use needles All needles, lancets, etc., must be disposed of in a puncture resistant container immediately after use Puncture resistant containers with a biohazard label should be conveniently located

36. Sharps Safety Sharps injury – The riskiest route of exposure Sharps include: needles, pipettes, razors, broken test tubes, scalpels, suture needles Use biohazard-labeled sharps containers, which are leak proof

37. Sharps Safety When possible use single-use disposable needles and scalpels Use phlebotomy equipment with built-in safety features Before Use After Use

38. Unsafe Practices

39. Sharps Safety 39 Needles and Sharps Precautions Don’t place needles or sharps in office waste containers

40. Sharps Safety 40 Needles and Sharps Precautions Don’t touch broken glass with hands

41. Safety Needles Do’s and Don’ts Don’t: – Recap needles – Use a syringe and needle for drawing blood if a safer method is possible 41

42. Best or Worst Practice?

43. Safety Needles Do’s and Don’ts Do: – Use vacuum tubes and safety needles – Dispose of needles and syringes in puncture-proof containers designed for this 43

44. Needle Stick Risks

45. ANY QUESTIONS?

46. Knowledge Check What is the proper way to dispose of contaminated needles?

47. Needle Stick Exposures The likelihood of a needle stick following a blood draw is 7 times greater than any other point during the procedure What to do… Decontamination Report incident to supervisor Medical evaluation Counseling

48. If Needle Stick Occurs Personal hygiene and preventive measures - Wash, wash, wash… – Mucous membranes: flush thoroughly – Skin: soap and water for 5 minutes – Percutaneous: soap and water for 5 minutes Notify supervisor immediately Complete Exposure Report Evaluate the source patient Consult with local senior management regarding possible treatment and follow- up

49. ANY QUESTIONS?

50. Knowledge Check After drawing blood from a patient, you stick yourself with a contaminated needle. What action should you take?

51. Post-exposure Prophylaxis (PEP) Antiretroviral medications, which may reduce the risk of HIV seroconversion in an exposed employee, are taken for 4 weeks To be most effective, the medications must be taken as soon as possible after exposure, preferably within 6 hours and usually no later than 48 hours after exposure

52. When PEP Might be Indicated When source patient is known to be HIV+ When source patient is at high risk for HIV When the HIV status of source is unknown Often the exposed individual will begin the PEP medications until HIV status of source patient is clarified

53. PEP PEP is not indicated for low risk exposures or in persons already HIV infected Indications for PEP drugs are determined on a case by case basis PEP drugs are powerful and can have side effects Strict adherence to doctor’s orders and follow up is necessary

54. PEP: A Sample Protocol Confidential testing may be offered at baseline, 3, and 6 months Status of source patient, if known, will be communicated Individuals with high risk exposures may be advised for the next 6 months to: – Avoid sharing body fluids (e.g., have only protected sex) – Stop breastfeeding – Avoid pregnancy

55. ANY QUESTIONS?

56. Today’s Agenda Types of Safety Hazards – Biological Hazards Chain of Infection Breaking the Chain of Infection Standard Universal Precautions – Sharp Hazards Sharps Safety General and Personal Hygiene Guidelines Additional Safety Practices

57. General & Personal Hygiene Guidelines No nail biting, eating, drinking or smoking in the lab, clinic, or ward No mouth pipetting Wash hands frequently 57

58. General & Personal Hygiene Guidelines Wear a buttoned lab coat at all times. Never wear coat to lunch or home Keep hair tired back Always wear a face shield when performing specimen processing 58

59. Always wear comfortable shoes, never wear open toe shoes in the lab Always wear gloves for phlebotomy and specimen handling 59 General & Personal Hygiene Guidelines

60. If you stick yourself, decontaminate, report to supervisor, and fill out incident reports Never place food or beverages in a refrigerator used for storing specimens Application of cosmetics is not permitted in the clinical laboratory 60 General & Personal Hygiene Guidelines

61. Today’s Agenda Types of Safety Hazards – Biological Hazards Chain of Infection Breaking the Chain of Infection Standard Universal Precautions – Sharp Hazards Sharps Safety General and Personal Hygiene Guidelines Additional Safety Practices

62. Disinfect spills with chlorine based disinfectant or an appropriate dilution of microbicidal disinfectant For use on all surfaces, use 0.5% solution of bleach Prepare bleach solutions fresh daily

63. Accident Documentation Report all accidents to the supervisor Maintain records of all work related injuries or illness Accurate details a must Seek medical treatment

64. Knowledge Check Name the 3 main routes of entry of blood- borne pathogens into the body.

65. Summary After this module you can now: List the components of the chain of infection and the common precautions taken to break the chain. Demonstrate procedures for infection control, including hand washing and gloving Describe the proper hand washing procedure Discuss blood borne pathogens Discuss standard precautions Demonstrate usage of needle safety devices and safe disposal of sharps

66. ANY QUESTIONS? THANK YOU!