Sunday, July 26, 2009

Use of Standard Precautions in Venipuncture

By Shahbaz Ahmed

The Centers for Disease Control and Prevention (CDC) recommends several disease-specific precautionary policies for patients known to be or suspected of being infected with certain pathogens. With strict following of standard precautions, all sources of specimens (patients) are considered to be potentially pathogenic or infectious.

It is assumed that every direct contact with body fluids is potentially infectious as per protocols for infection control in Standard precautions. Cross-transmission and exposure of the skin and mucous membranes to infectious microbes can be prevented by avoiding direct contact with patient specimens and every possible precaution for barrier protection are taken when contact cannot be avoided.

Every phlebotomist should exercise certain consistent precautions on a routine basis. These standard precautions recognize the infectious potential of any patient specimen and prevent cross-transmission of infectious disease to patients and the protect laboratory personnel from infected patients.

A licensed inactivated vaccine (HB) is recommended for the phlebotomist to prevent from getting infected from HBV. As a precautionary step for clinical laboratory workers, phlebotomists, pathologists, and other health care workers who are at a greater risk for Hepatitis B infection, are required to use Hep B vaccine following CDCs advisory committee recommended immunization practices.

Other safe work practices to eliminate the risk of transmitting infectious pathogens for phlebotomists working with blood specimens include:

- To prevent transmission of pathogens, practice hand washing every time after the handling of specimens. - Laboratory or clinics should be isolated from eating, drinking, or smoking areas. - Gloves, lab coats/gowns, masks, safety glasses are the required personal protective equipments. - In case of spills, cleaning up should be done as per protocol of the lab and blood spills should be cleaned immediately, aerosolization should be minimized. - Waste disposal should be done as per the OSHA and NCCLS guidelines. Sharp resistant container should be used for disposal of lancets, needles, scalpel blades and other contaminated waste should be disposed in biohazard marked containers. - Sharp needles and lancets, should not be handled by hand or bent, or broken. - Pre exposure and post exposure prophylactic guidelines for handling potential occupational transmission of certain pathogens should be followed by the phlebotomist.

The knowledge of general safety regulations governing the clinical laboratory, OSHA (Occupational Safety and Health Administration) mandated plans for chemical hygiene and for occupational exposure to blood-borne pathogens, the importance of safety manual, and general emergency procedures is mandatory for a professional phlebotomist.

The disposal of sharps has always been a hazardous procedure for all health care staff. It is important to be aware of the risks involved in venipuncture. It is recommended that all health care professionals who carry out the procedure should be properly trained and makes use of a closed system-letting device, e.g. Vacutainers.

Case of a needle stick injury should be handled by following:

- In the event of an injury, bleeding is encouraged from the affected site - Washing with water or normal saline - Appropriate bandaging is used for covering the site - Record should be kept for patients name, identification - It is also recommended that all needle stick injuries should be reported to immediate supervisor - Occupational Health, GP or Accident and Emergency Department should be consulted as appropriate

All the necessary techniques and procedures needed to be a competent and skilled phlebotomist are covered in accredited phlebotomist technician programs. Anatomy and physiology, Blood and cell composition, Blood sampling procedures, Laboratory safety, and CPR are some of the subjects in training courses for professional phlebotomist. Professional behavior, Quality control, Legal issues, Computer training are some other subjects which might be included in formal training programs. Phlebotomy schools customize and offer some differences in the training programs depending on the regulations and program geared for specific job.

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