Chapter 2 Flashcards
A study of lab errors showed that 98% of the errors in the diagnostic process occur in-
The preanalytical phase
Having recognized the role of preanalytical errors, The Joint Commission National Patient Safety Goals has-
Several goal areas that have specific applications for clinical labs
2 main areas of patient safety-
Communications & mitigating patient risk
3 goal areas by Joint Commission National Patient Safety-
-ID patient by using their name & DOB
-improve staff communication to ensure getting important test results to right staff person on time
-prevent infection by using CDC or WHO guidelines
ASCLS Patient Safety Indicators: Preanalytical- (6)
-patient identification
-phlebotomy-associated negative events
-specimen integrity
-order entry
-specimen identification
-effective use of the clinical lab
ASCLS Patient Safety Indicators: Analytical-
Verification of the accuracy of abnormal results
ASCLS Patient Safety Indicators: Postanalytical- (3)
-communication of test results
-effective use of test results
-outcomes of lab testing
The need for clear communication is-
Imperative
Avoiding direct communication of an error that harmed a patient is-
Unacceptable
Avoidance lowers or removes the urgency for-
Quality improvement
Medical euphemisms are commonly used in clinical labs to describe-
Medical errors that harm patients
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 information technology outages- (2)
-planned outages for updates or upgrades
-unexpectedted failures or impairments with an unknown length of downtime
The initial step toward managing IT downtime is to have a-
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 technique
-staying alert
-using common sense
Lab safety includes ___standards & ___ guidelines-
-OSHA Standards
-CDC Guidelines
_____ is a safety issue-
Ergonomics
Safety Standards & Governing Agencies- (5)
-US Department of Labor’s Occupational Safety & Health Administration (OSHA)
-Clinical & Lab Standards Institute (CLSI)
-Center for Disease Control (CDC), part of the US Department of Health & Human Services (DHHS), US Public Health Services
-College of American Pathologists (CAP)
-The Joint Commission
Major changes to the standard in 2012 include:
-Hazard Classification
-Labels
-Safety Data Sheet
Hazard Classification provides specific criteria to address-
health & physical hazards as well classification of chemical mixtures
Chemical manufacturers & imports 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- (2)
-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
Biohazards denote-
Infectious materials or 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 specific amount of hazard
Bioterrorism agents are divided into categories- (3)
-A
-B
-C
Biosafety is divided into levels- (4)
-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 biocontainment
Most frequent routes of lab-acquired infections & accidental inoculation are- (4)
-Inhalation
-percutaneous inoculation
-contact between mucous membranes & contaminated material
-ingestion
An occupational exposure is- (6)
-percutaneous injury
-contact by mucous membranes or non intact skin with blood
-tissues
-blood-stained body fluids
-body fluids to which Standard Precautions apply
-concentrated virus
The likelihood of infection after exposure to blood affected with HBV or HIV depends on- (4)
-the concentration of HBV or HIV virus; viral concentration is higher for HBV than for HIV
-the duration of contact
-the presence of skin lesions or abrasions on the hands or exposed skin of the healthcare worker
-the immune status of the healthcare worker for HBV
Most exposures do not result in-
Infection
Personal protective equipment- (3)
-selection & use of gloves
-facial barrier protection & occlusive bandages
-lab coats or gowns as barrier protection
Disinfection describes a process that-
Eliminates many or all pathogenic microorganisms, except bacterial spores, or inanimate objects
In healthcare settings, objects usually are disinfected by-
Liquid chemicals or wet pasturization, including hypochlorites
Disinfecting procudure is used on-
Nondisposable equipment
Disposable labware or supplies that have come in contact with blood should be-
Autoclaved or incinerated
general infection control safety practices- (4)
-pipetting safeguards: automatic devices
-safety manual
-sharps safety & needlestick prevention
-transport & handling of diagnostic specimens
use of the sharps container permits- (2)
-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 when 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/recipient must be-
sterile & nonreusable
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 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- (2)
-major couriers
-US department of transportation hazardous materials regulations
prevention of disease transmission required immunizations- (6)
-Hep B
-influenza
-measles
-mumps
-rubella
-varicella
prevention of disease transmission optional immunizations- (8)
-hep A
-meningococcal disease
-pertussis
-typhoid
-vaccinia
-diptheria
-pneumococcal disease
-tetanus
prevention of disease transmission screening tests- (3)
-tuberculosis: purified protein derivative (PPD Mantoux) skin test
-rubella
-hep B surface antigen
prophylaxis, medical follow up, & records of accidental exposure- (3)
-Hep B
-Hep C
-HIV
prevention of disease transmission for tuberculosis control-
respirators or masks
prevention of disease transmission for protection from aerosols- (2)
-biosafety cabinets
-negative-pressure isolation rooms
specific hazardous chemicals- (9)
-sulfuric acid
-nitric acid
-acetic acid
-hydrochloric acid
-sodium hydroxide
-phenol
-carbon tetrachloride
-trichloroacetic acid
-ethers
carcinogens are any substance that causes-
the development of cancerous growths in living tissue
when a potentially hazardous solution or chemical is being used, protective equipment for- (5)
-eyes
-face
-head
-extremities
-protective clothing or barriers
volatile or fuming solutions should be used under-
a fume hood
quick action is essential in case of-
accidental contact with a contaminated substance
shock or fire can result from-
electrical apparatus
OSHA regulations stipulate 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 approve
regular inspection of electrical equipment decreases-
the likelihood of electrical accidents
grounding of all electrical equipment is-
essentially
any equipment used in an area where organic solvents are present must be equipped with-
explosion-free fittings
for fire safety, personnel need to be trained in-
the use of safety equipment & procedures
acronym for the use of a fire extinguisher-
PASS: Pull, Aim, Squeeze, Sweep
fire classifications- (5)
-A
-B
-C
-D
-E
fire classification A-
ordinary combustules
fire classification B-
flammable liquids & gasses
fire classification C-
electrical equipment
fire classification D-
powdered metal (combustible) material
fire classification E-
cannot be extinguished
any broken/cracked labware should be discarded in-
special container for broken glass
proper storage of labware-
heavy pieces on lower shelves & tall pieces placed behind smaller pieces
OSHA regulations apply to- (3)
-human blood
-human infectious waste
-human pathologic waste
body fluid specimens must be placed in-
well constructed biohazard containers with secure lids to prevent leakage during transport & future disposal
plastic bags are appropriate for disposal of-
most infectious waste materials
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
-chemical waste
regulated medical waste is divided into 2 groups-
-biohazard waste
-biohazard sharps
control of infectious. chemical, & radioactive waste is regulated by- (2)
-OSHA
-US FDA
infectious waste being discarded in proper biohazard containers should be conspicuously marked-
“biohazard” & bear the universal biohazard symbol
infectious waste being discarded in proper biohazard containers should display the universal color- (3)
-orange
-orange & black
-red
infectious waste being discarded in proper biohazard containers should be used for- (3)
-blood
-certain body fluids
-disposable materials contaminated with blood & fluids
who regulated radioactive waste disposal?
The Nuclear Regulatory Commission
eyewash stations & safety shower equipment need to be within-
100 feet or no more than a 10 second walk from hazardous chemicals
the first priority in basic first aid procedures-
removal of accident victim from further injury, followed by definitive action or first aid to victim
because many injuries may be extreme & because immediate care is critical with such injuries, all lab personnel must thoroughly understand the application of-
the proper first-aid procedure
safety audit incase 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 a bandage securely but not tightly
safety audit incase of third degree burns-
consult a physician immediately
safety audit incase of serious cuts-(2)
-apply direct pressure to the wound area to control bleeding, using the hand over a clean compress covering the wound
-call for a physician immediately
safety audit incase of minor cuts- (3)
-wash the wound carefully & thoroughly with soap & water
-remove all foreign material that projects from the wound by careful washing, but do not gouge for embedded material
-apply a clean bandage if necessary
