Despite careful technique, spills do occur. Careful and thorough cleanup protects you and your co- workers from exposure to infectious agents and potential infection. Although each laboratory has its own detailed procedures, general guidelines include the following:
• Wear gloves.
• Use 10% bleach as a disinfectant. Bleach solu- tions must be made fresh once a week from concentrated bleach. When you make a fresh solution, label the container as “10% bleach” and indicate the date it was made.
• Clean up the visible blood first, then disinfect the entire area of potential contamination.
• Allow the bleach to remain in contact with the contaminated area for 20 to 30 minutes to ensure complete disinfection.
Kits that contain powder or gels for absorption are available in all laboratories and work well for large spills.
REVIEW FOR CERTIFICATION
Infection transmission can occur by contact (either direct or indirect), droplet, air, common vehicle, or vector. Hand hygiene is the most important means
of preventing the spread of infection and should be done before and after coming in contact with pa- tients, before donning and after removing gloves, before performing procedures, after removing PPE, after touching potentially contaminated equipment, before eating, after eating and before coming back to work, and whenever you enter or leave a patient’s room, as well as at other times.
Breaking the chain of infection is accomplished through the use of Standard Precautions and EPs and by following practices outlined in your facility’s exposure control plan. The goal of Standard Precau- tions is to protect both the health care worker and the patient from infectious agents through hand hygiene, use of PPE (gowns, gloves, and face protection), engineering controls, and respiratory etiquette. EPs are used to guard against the transmission of specific organisms or types of diseases or conditions that re- quire more than Standard Precautions.
Phlebotomists are at a high risk for exposure to infection from BBPs, which can occur by an acci- dental needle stick or other routes of exposure to blood. Use of appropriate PPE, engineering con- trols, and safe work practices can reduce your ex- posure to BBPs and other infectious agents. Clean- ing up spills properly and according to protocol reduces the risk of infection transmission should a spill occur.
BI BLIOG R AP HY
Association for Professionals in Infection Control and Epidemi- ology: APIC text of infection control & epidemiology, ed. 2, Washington, DC, 2005, The Association.
Centers for Disease Control and Prevention: Guideline for disinfection and sterilization in healthcare facilities, 2008. Re- trieved from www.cdc.gov/hicpac/pdf/guidelines/Disinfection_
Nov_2008.pdf.
Centers for Disease Control and Prevention: Workplace safety and health topics: Model Plans and Programs for the OSHA Bloodborne Pathogens and Hazard Communications Stan- dards. OSHA 3186-06R 2003, 2010. Retrieved from www.cdc.
gov/niosh/topics/correctionalhcw/plan.html.
CLSI: Protection of laboratory workers from occupationally acquired infections; Approved guideline—fourth edition. CLSI document M29-A4. Wayne, Pa., 2014, Clinical and Laboratory Standards Institute.
Siegel JD, Rhinehart E, Jackson M, Chiarello L: The Healthcare Infection Control Practices Advisory Committee, Guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings, 2010. Retrieved from www.cdc.
gov/hicpac/2007ip/2007isolationprecautions.html.
World Health Organization: How to put on and take off personal protective equipment (PPE), 2010. Retrieved from www.who.
int/csr/resources/publications/PPE_EN_A1sl.pdf.
WHAT WOULD YOU DO?
You should sanitize your hands in front of the patient and thank the patient for the reminder. It is pos- sible that you touched an infectious agent on the way to the room. Regardless of whether or not you did, performing hand hygiene in front of the patient instills confidence that you are doing all you can to keep the patient free from a health care–associated infection. You may explain to the patient you cleaned your hands just before entering the room, but that is not a reason not to do so again once in the room. Hand hygiene is the most important step in breaking the chain of infection, and it should be practiced both after you enter the room and before you leave it.
STUDY QUESTIONS
CERTIFICATION EXAMINATION PREPARATION
See answers in Appendix F.
1. Which of the following would not be consid- ered a pathogen?
a. Bacteria b. Viruses c. Fungi d. Vectors
2. Varicella-zoster is the cause of a. syphilis.
b. chickenpox.
c. malaria.
d. hepatitis.
3. HIV is the causative agent of a. gonorrhea.
b. food poisoning.
c. AIDS.
d. hepatitis B.
4. Vectors include a. doorknobs.
b. medical instruments.
c. needles.
d. insects.
See answers in Appendix F.
1. Define infection.
2. Name four classes of pathogens.
3. List the infectious organisms that cause each of the following diseases:
a. Acquired immunodeficiency
syndrome (AIDS) __________________
b. Gonorrhea __________________
c. Hepatitis __________________
d. Malaria __________________
e. Oral and genital herpes __________________
f. Strep throat __________________
g. Syphilis __________________
h. Trichomoniasis __________________
i. Tuberculosis __________________
4. What are health care–associated infections, and how are they typically caused?
5. What three main elements make up the chain of infection?
6. List three ways in which you can break the chain of infection.
7. Explain the difference between direct and indirect contact transmission.
8. What is the difference between a vector and a fomite?
9. What is the most important and effective way of preventing the spread of infection?
10. Name four items included among PPE.
11. Explain what Standard Precautions are and why they are used.
12. Name three BBPs.
13. HBV may be stable in dried blood for at least ______ days.
14. Bleach should be in contact with a contaminated area for ______ minutes for complete disinfection.
15. Explain the possible reasons behind the 1992 OSHA standards, and give the policies set within this standard.
5. Some types of E. coli are normal flora of the a. urinary tract.
b. respiratory tract.
c. colon.
d. circulatory system.
6. The most important way to stop the spread of infection is through
a. isolation procedures.
b. Standard Precautions.
c. hand hygiene.
d. PPE.
7. In putting on PPE, the first article that is put on is the
a. mask.
b. face shield.
c. gown.
d. pair of gloves.
8. Which of the following is not an OSHA standard?
a. All biohazard material must be labeled.
b. Employees must practice Standard Precautions.
c. Employers must have written airborne pathogen exposure control plans in the workplace.
d. Employers must provide their employees with immunization against HBV free of charge.
9. Although Standard Precautions apply to all potentially infectious situations, EPs are chosen based on
a. whether isolation is employed.
b. the potential means of transmission of the disease or condition.
c. airborne transmission.
d. the risk to the health care worker from accidental needle sticks.
10. Ten percent bleach used as a cleaning agent should be made fresh every
a. week.
b. 3 hours.
c. day.
d. 6 hours.
11. The continuous links in the chain of infection are, in order,
a. means of transmission, susceptible host, and source.
b. source, means of transmission, and susceptible host.
c. susceptible host, source, and means of transmission.
d. none of these.
12. The purpose of a PE for highly immunosup- pressed patients is to
a. prevent transmission of infection to the patient.
b. protect the public from disease.
c. prevent transmission of infection from the patient.
d. protect the patient from spores in the environment.
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