Chapter 2 Flashcards
98% of lab errors in the diagnostic process occur in the-
Preanalytic phase
Who recognized the role of preanylitical errors & has several goal areas that have specific application for clinical labs?
The Joint Commission National Patient Safety Goal
2 main areas of patient safety-
-communications
-mitigating patient risk
2 ways to correctly identify a patient-
-name
-D.O.B
Improve staff communication to ensure-
Getting important test results to the right staff person on time
Prevent infection by using ___ or ___ guidelines-
-CDC
-WHO
6 goals of US Institute of Medicine for Healthcare delivery-
-safety
-timeliness
-effectiveness
-equitable treatment
-patient-centered focus
ASCLS Patient Safety Indicators in the preanalytical phase- (6)
-patient identification
-phlebotomy-associated negative events
-specimen identification
-order entry
-specimen integrity
-effective use of clinical lab
ASCLS Patient Safety Indicators in the analytical phase- (1)
Verification of the. Accuracy of abnormal results
ASCLS Patient Safety Indicators in the post analytical phase- (3)
-communication of test results
-effective use of test results
-outcomes of lab testing
ASCLS Procedure to Evaluate Patients Safety in Lab Testing (7 steps)-
-determine area of risk
-collect data
-determine the denominator to calculate the error rate
-capture data
-data analysis
-design intervention
-follow-up
The need for clear communications is-
Imperative
Avoiding direct communication of an error that harmed a patient is-
Unacceptable
Avoidance of an error that harmed a patient-
Lowers or removes urgency for quality improvement
Medical euphemisms are commonly used in clinic labs to-
Describe medical errors that harmed the patient
The use of euphemisms is a bad habit thought to be-
Rooted in the desire to avoid painful, complex quality improvement issues as well as the extra work that improvement strategies create
Taking time to communicate will help-
Ensure patient safety
Preparation for info technology outages- (2)
-planned outages for updates or upgrades
-unexpected failures or impairments with an unknown length of downtime
The initial step toward managing IT downtime is to have-
Clear activation & communications plan with established guidelines for initiating downtime protocols
IT downtime protocols- (5)
-share protocols with patient care areas
-a single lab contact creates an organized approach
-focus on reporting critical info
-clear communication throughout is essential
-conduct a critique after the outage
Most lab accidents are preventable by- (3)
-exercising good techniques
-staying alert
-using common sense
Lab safety includes-
-OSHA standards
-CDC Guidelines
Ex of a safety issue-
Ergonomics
OSHA stands for-
Occupational Safety & Health Administration
CLSI stands for-
Clinical & Laboratory Standards Institute
CDC stands for-
Center for Disease Control & Prevention
DHHS stands for-
Dept. of Health & Human Services
CAP stands for-
College of American Pathologists
National Health Care Safety Network (NHSN) is a voluntary system that-
Integrates a number of surveillance systems & provides dada on devices, patients, & staff
NHSN expands-
Legacy patient & healthcare personnel safety surveillance systems managed by the Division of Healthcare Quality Promotion (DHQP) at CDC
National Nosocomial Infections Surveillance System of the CDC survey showed-
That the highest rates of infection occurred in the burn ICU, neonatal ICU, & the pediatric ICU
Risk factors for the invasion of colonizing pathogens can be categorized into 3 areas-
-iatrogenic risk factors
-organizational risk factors
-patient risk factors
Nosocomial infections are estimated to occur in ___% of all acute care hospitalizations
5%
OSHA started in-
1970
Hazard Communication standard started in-
1988
Safety officer-
Staff oriented & periodic updating
Safety coaches are-
Volunteers who assume additional job responsibilities
All clinical labs must implement 2 kind of plans-
-chemical hygiene plan (CHP)
-Exposure Control Plan
A copy of the safety data sheet must be-
On file & readily accessible & available to all employees at all times
The core of the OSHA safety standard-
Chemical hygiene plan
Hazard Communication Standard requires that-
The chemical manufacturer, distributor, or importer provide SDSs, formerly material safety data sheets (MSDSs), for each hazardous chemical to downstream users to communicate info on these hazards
Occupational Exposure to Bloodborne Pathogens requires that labs-
-develope, implement, & comply with a plan that ensures the protective safety of laboratory staff to potential infectious bloodborne pathogens
-manage & handle medical waste safely & effectively
Major changes to the standard in 2012 include-
-hazard classification
-labels
-safety data sheets
Hazard classification provides-
Specific criteria to address health & physical hazards as well as classification of chemical mixtures
Chemical manufacturers & importers must provide a label that includes (4)-
-signal word
-pictographs
-hazard statement
-precautionary statement for each hazard class & category
SDS information is mostly the same as the MSDS, except the SDSs are required to-
Be presented in a consistent, user-friendly, 16-section format
The OSHA-mandated program, Occupational Exposure to Bloodborne Pathogens requires that labs-
-manage & handle medical waste in a safe & effective manner
-develop, implement, & comply with a plan that ensures the protective safety of lab staff to potential infectious bloodborne pathogens
All employees who handle hazardous material & waste must be trained to-
Use & handle these materials
Chemical hazard education sessions must be-
Presented to new employees & conducted annually for all employees
Each lab is required to-
Evaluate the effectiveness of its plan at least annually & to update it as necessary
The CDC also recommends safety precautions concerning-
The handling of all patient specimens, known as standard precautions
OSHA has also issued guidelines for the lab worker in regard to-
Protection from bloodborne diseases spread through contact with patient specimens
CDC provides recommendations for treatment after-
Occupational exposure to potentially infectious material
These agencies are working to reduce-
The risk of exposure to healthcare workers to bloodborne pathogens
Biohazards denotes infectious materials/agents that present-
A risk or even a potential risk to the health of humans or animals in the lab
Risk is defined as-
The probability that a health effect will occur after an individual has been exposed to a specified amount of hazard
Bioterrorism agents are divided into 3 categories-
-A
-B
-C
Biosafety levels are divided into levels-
-1
-2
-3
-4
Risk assessment is an important part of-
Biosafety
Labs should perform a risk assessment to determine-
If there are certain procedures or specimens that may require higher levels of bio contamination
Most frequent routes of exposure & accidental inoculation are-
Inhalation, percutaneous inoculation, contact between mucous membranes & contaminated material, & ingestion
Ex of occupational exposure-
Needlestick or cut with a sharp object
Occupational exposure is a-
percutaneous injury or contact by mucous membranes or nonintact skin (especially when the skin is chapped, abraded, or affected with dermatitis or the contact is prolonged or involves an extensive area) with blood, tissues, blood-stained body fluids, body fluids to which Standard Precautions apply, or concentrated virus.
The likelihood of infection after exposure to blood infected with HBV or HIV depends on- (4)
-the concentration of HBV or HIV virus; viral concentration is higher for HBV than HIV
-duration of contact
-presence of skin lesions or abrasions on the hands or exposed skin of the health care worker
-immune status of the health care worker for HBV
Most exposures do not result in-
Infection
PPE- (6)
-selection & use of gloves
-facial barrier protection & occlusive bandages
-lab coats or gowns as barrier protection
-nail are, shoes, & electronic devices
-handwashing
-decontamination of work surfaces, equipment, & spills
Disinfection describes a process that eliminates-
Many or all pathogenic microorganisms, except bacterial spores on inanimate objects
In health care settings, objects are usually disinfected by-
Liquid chemicals or wet pasturization (includes hypochlorites)
Disinfection procedure is used on ___ equipment-
Nondisposable equipment
Disposable lab ware or supplies that have come in contact with blood should be-
Autoclaved or incinerated
Use of the sharps container permits-
Quick disposal of a needle without recapping & safe disposal of other sharp devices that may be contaminated with blood
Specimens should be transported to the lab in-
Plastic leakproof bags
Protective gloves should always be worn for handling-
Any type of biological specimen
Zika-
Within the US as category B biological substances
All devices in contact with blood & capable of transmitting infection to the donor or recipient must be-
Sterile & nonreusable
Containers, refrigerators, or freezers used for specimens should be-
Marked as containing a biohazard
Specimens needing centrifuging should be-
Capped & placed into a centrifuge with a sealed dome
Rubber-stoppered test tubes must be-
Opened slowly & carefully with a gauze square over the stopper to minimize aerosolize production
Autodilutors or safety bulbs should be used in-
The lab
Proper handling of blood & body fluids is critical to-
The accuracy of lab test results, & the safety of all individuals who come in contact with specimens must be guaranteed
If a blood specimen is to be transported, the shipping container must meet-
OSHA requirements for shipping clinical specimens
Shipping containers must meet the packaging requirements of-
Major couriers & US department of transportation hazardous materials regulations
Immunizations- (6)
-Hep B
-influenza
-measles
-mumps
-rubella
-varicella
Optional immunizations- (5)
-Hep A
-Meningococcal disease
-Pertussis
-Typhoid
-Vaccinia
Other vaccine-preventable diseases include- (3)
-diphtheria
-pneumococcal disease
-tetanus
Screening tests- (3)
-Tuberculosis: purified protein derivative (PPD, Mantoux) skin test
-Rubella
Hepatitis. B surface antigen
Prophylaxis, medical follow-up, & records of accidental exposure- (3)
-Hep B exposure
-Hep C virus
-human immunodeficiency virus
Protection from aerosols- (2)
-Biosafety cabinets
-negative-pressure isolation rooms
Additional lab hazards- (5)
-chemical hazards
Electrical hazards
-labware hazards
-infectious waste
Specific hazardous chemicals- (9)
-sulfuric acid
-nitric acid
-acetic acid
-hydrochloric acid
-sodium hydroxide
-phenol
-Carbon tetrachloride
-trichloroacetic acid
-ethers
Carcinogens are-
Any substances that cause the development of cancerous growths in living tissue
When any potentially hazardous solution or chemical is being used, protective equipment for the-
Eyes, face, head, & extremities, as well as protective clothing or barriers, should be used
Volatile or fuming solutions should be used under-
A fume hood
In case of accidental contact with a hazardous solution or a contaminated substance, quick action is-
Essential
Shock or fire can result from-
Electrical apparatus
OSHA regulations stipulate that-
The requirements for grounding electrical equipment published in the National Fire Protection Association’s National Electrical Code must be met
All electrical equipment must be-
Underwriters labs approved
Regular inspection of electrical equipment decreases the-
Likelihood of electrical accidents
Grounding of all electrical equipment is-
Essential
Personnel should not handle electrical equipment & connections with-
Wet hands & electrical equipment should not be used after liquid has been spilled on it
Any equipment used in an area where organic solvents are present must be equipped with-
Explosion-free fittings
An easy acronym for use of fire extinguishers-
PASS- Pull, Aim, Squeeze, & sweep
Fire classifications- (5)
-Class A- ordinary combustibles
-Class B- Flammable Liquids & Gases
-Class C- Electrical Equipment
-Class D- Powdered Metal (Combustible) Material
-Class E- Cannot be extinguished
OSHA regulations apply to-
Human blood, human infectious waste, & human pathological waste
Body fluid specimens, including blood, must be placed in-
Well constructed biohazard containers with secure lids to prevent leakage during transport & for future disposal
Rigid, impermeable containers should be used for disposal of-
Sharps & broken labware
Most labs generate at least 3 major types of waste streams-
-nonregulated waste
-regulated medical waste (RMW)
-chemical waste
RMW is divided into 2 groups-
-Biohazard waste
-biohazard sharps
The control of infectious, chemical, & radioactive waste is regulated by various government agencies, including-
OSHA & the US FD
Infectious waste must be discarded in proper biohazard containers, which should have the following characteristics- (4)
-conspicuously marked “biohazard” & bare the universal biohazard symbol
-display the universal color: orange, orange & black, or red
-rigid, leakproof, & puncture resistant: cardboard boxes lined with leakproof plastic bags are available
-used for blood, certain body fluids, & for disposable materials contaminated with blood & fluids
Who regulates radioactive waste disposal?
Nuclear Regulatory Comission
Waste associated the radioimmunoassay (RIA) lab must be disposed of with-
Special caution
Biosafety cabinets & hoods need to be certified-
Annually
Eyewash stations & safety shower equipment need to be within-
100 feet, or no more than a 10-second walk from hazardous chemicals
SDSs need to be available as-
A hard copy or electronically within 5 minutes of a request
The first priority in basic first-aid procedures should be-
Removal of the accident victim from further injury, followed by definitive action or first aid to the victim
Because many injuries may be extreme, & because immediate care is critical with such injuries, all lab personnel must-
Thouroghly understand the application of the proper first-aid procedures
What should you do if alkali or acid burst appear on the skin or in the mouth-
-rinse thoroughly with large amounts of running tap water
-if serious, call a physician
What should you do if alkali or acid burst appear in the eye- (5)
-wash out eye thoroughly with running water for a minimum of 15 minutes
-help the victim by holding the eyelid open so water can make contact with the eye
-eye fountain is recommended, but any running water will suffice
-use of an eyecup is discouraged
-physician should be notified immediately, while the eye is being washed
What should you do in case of heat burns- (3)
-apply cold running water (or ice water) to relieve pain & stop further tissue damage
-use a wet dressing of 2 tablespoons of sodium bicarbonate in 1 quart of warm water
-apply bandage securely but not tightly
What should you do in case of 3rd degree burns-
Consult a physician IMMEDIATELY
What should you do in case of serious cuts? (2)
-apply direct pressure to the wound area to control the bleeding, using the hand over a clean compress covering the wound
-call for a physician IMMEDIATELY
What should you do in case of minor cuts- (3)
-Wash the wound carefully & thoroughly with soap & water
-remove all foreign matter that projects from the wound by careful washing, but do not gouge for embedded material
-apply a clean bandage if necessary
