Chapter 2 Safety: Patient And Cllinical Laboratory Practices

Question 1

LAI

Answer 1

Laboratory acquired infections

Question 2

(OSHA- mandate plans)
Chemical hygiene plan

Answer 2

The cores of the OSHA safety standard

Question 3

(Osha-mandated plans)
Hazard communication

Question 4

The Joint Commission National Patient Safety Goals 2017
◦ Correctly identify a patient

Answer 4

the using the patient’s name and birth date.
◦ Improve staff communication to ensure getting important test results to the right staff person on time. Prevent infection by using CDC or WHO guidelines.

Question 5

Six Goals of US Institute of Medicine (IOM) for Health Care Delivery

Answer 5

1.Safety - this goal focuses on avoiding injuries from care delivered to the patient (avoiding preanalytic, analytic, postanalytic errors).
2.Timeliness - reduction in the length of time or delays in providing or receiving care (POCT, TAT)
3.Effectiveness -stresses the avoidance of underuse, overuse, and misuse of laboratory testing.
4.Efficiency –aims to reduce or avoid waste (all testing phases). 5.Equitable treatment –the need to provide consistent quality of care
regardless of gender, ethnicity, socioeconomic class, or geographic location.
6.Patient-centered focus – the need to provide respectful care that is responsible to diversified patients (lab answering patient questions and communicating pertinent information to them

Question 6

ASCLS Patient Safety Indicators
Preanalytical

Answer 6

1.Patient identification
◦ Phlebotomy-associated negative events ◦ Specimen identification
◦ Order entry
◦ Specimen integrity
◦ Effective use of the clinical laboratory
2.Analytical
◦ Verification of the accuracy of abnormal results
3.Postanalytical
◦ Communication of test results ◦ Effective use of test results
◦ Outcomes of laboratory testing

Question 7

Communications

Answer 7

oThe need for clear communication is imperative.
oAvoiding direct communication of an error that harmed a patient is unacceptable. Avoidance lowers or removes the urgency for quality improvement.
oTaking time to communicate will help ensure patient safety.

Question 8

Mitigating Patient Risk

Answer 8

Preparation for information technology outages 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 a clear activation and communications plan with established guidelines for initiating downtime protocols.
◦ Share protocols with patient care areas.
◦ A single laboratory contact creates an organized approach. ◦ Focus on reporting critical information.
◦ Clear communication throughout is essential.
◦ Conduct a critique after the outage.

Question 9

Laboratory Safety
1. Most laboratory accidents are preventable by

Answer 9

by exercising good technique, staying alert, and using common sense.
➢

Question 10

Laboratory safety includes Occupational Safety and Health

Answer 10

Administration (OSHA) standards and CDC guidelines.

Question 11

Ergonomics is a .

Answer 11

safety issue.

Question 12

Safety Standards and Governing Agencies

Answer 12

Safety Standards
US Department of Labor’s Occupational Safety and Health Administration (OSHA)
Clinical and Laboratory Standards Institute (CLSI)
Centers for Disease Control and Prevention (CDC), part of the US Department of Health and Human Services (DHHS), US Public Health Service
College of American Pathologists (CAP) The Joint Commission (TJC)

Question 13

US Department of Labor’s Occupational Safety and Health Administration

Answer 13

(OSHA) = occupational safety and health administration

Question 14

Clinical and Laboratory Standards Institute

Answer 14

CLSI

Question 15

Centers for Disease Control and Prevention

Answer 15

, CDC part of the US
Department of Health and Human Services (DHHS), US Public Health Service

Question 16

College of American Pathologists

Answer 16

(CAP) The Joint Commission (TJC)

Question 17

TJC

Answer 17

The Joint Commission

Question 18

The Joint Commission

Answer 18

TJC

Question 19

Department of Health and Human Services

Answer 19

DHHS , US Public Health Service

Question 20

DHHS

Answer 20

Department of Health and Human Services

Question 21

Most laboratory accidents are preventable by exercising good technique, staying alert, and using common sense.

Answer 21

➢Laboratory safety includes Occupational Safety and Health Administration (OSHA) standards and CDC guidelines.
➢Ergonomics is a safety issue.

Question 22

US Department of Labor’s Occupational Safety and Health Administration (OSHA)

Answer 22

Clinical and Laboratory Standards Institute (CLSI)
Centers for Disease Control and Prevention (CDC), part of the US Department of Health and Human Services (DHHS), US Public Health Service
College of American Pathologists (CAP) The Joint Commission (TJC)

Question 23

Safety Standards and Governing Agencies
National Health Care Safety Network (NHSN)

Answer 23

Safety Standards and Governing Agencies
National Health Care Safety Network (NHSN)
◦ This new voluntary system integrates a number of surveillance systems and provides data on devices, patients, and staff.
◦ The NHSN expands legacy patient and health care personnel safety surveillance systems managed by the Division of Health care Quality Promotion (DHQP) at CDC.

Question 24

National Health Care Safety Network (NHSN)

Answer 24

NHSN

Question 25

The National Nosocomial Infections Surveillance System of the CDC survey showed that the highest rates of infection

Answer 25

occurred in the burn ICU, the neonatal ICU, and the pediatric ICU.

Question 26

Risk factors for the invasion of colonizing pathogens can be categorized into the following three areas:

Answer 26

◦ Iatrogenic risk factors
◦ Organizational risk factors ◦ Patient risk factors
Nosocomial infections are estimated to occur in 5% of all acute care hospitalizations.

Question 27

Occupational Safety and Health Administration Acts and Standards

Answer 27

ccupational Safety and Health Administration Acts and Standards
◦ Occupational Safety and Health Act of 1970
◦ Hazard Communication Standard (1988)
◦ Safety officer: staff orientation and periodic updating
◦ Safety coaches are volunteers who assume additional job responsibilities. ◦ OSHA-Mandated Plans
◦ All clinical laboratories must implement a chemical hygiene plan (CHP) and an exposure control plan. A copy of the safety data sheet (SDS) must be on file and readily accessible and available to all employees at all times.

Question 28

Chemical Hygiene Plan
◦ The core of the OSHA safety standard Hazard Communication Standard

Answer 28

◦ 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 information on these hazards
Occupational Exposure to Bloodborne Pathogens
◦ Requires that laboratories:
◦ Develop, implement, and comply with a plan that ensures the protective safety of
laboratory staff to potential infectious bloodborne pathogens ◦ Manage and handle medical waste safely and effectively

Question 29

Major changes to the standard in 2012 include: Hazard classification
Provides specific criteria to address health and physical hazards as well as classification of chemical mixtures
Labels

Answer 29

Chemical manufacturers and importers must provide a label that includes a signal word, pictogram, hazard statement, and precautionary statement for each hazard class and category.
Safety data sheets
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.

Question 30

The OSHA-mandated program, Occupational Exposure to Bloodborne Pathogens, requires that laboratories:

Answer 30

◦ Manage and handle medical waste in a safe and effective manner
◦ Develop, implement, and comply with a plan that ensures the protective safety of laboratory staff to potential infectious bloodborne pathogens
◦ All employees who handle hazardous material and waste must be trained to use and handle these materials. Chemical hazard education sessions must be presented to new employees and conducted annually for all employees.
◦ Each laboratory is required to evaluate the effectiveness of its plan at least annually and to update it as necessary.

Question 31

The CDC also recommends safety precautions concerning the

Answer 31

handling of all patient specimens, known as Standard Precautions.

Question 32

OSHA has also issued guidelines for the laboratory worker in regard

Answer 32

to protection from bloodborne diseases spread through contact with patient specimens.

Question 33

CDC provides recommendations for treatment afte

Answer 33

.
occupational exposure to potentially infectious material.
These agencies are working to reduce the risk of exposure of health care workers to bloodborne pathogens

Question 34

Category A:

Answer 34

Pathogens that are rarely seen in the US. These agents have the highest priority; organisms in this category pose a risk to national security .

Question 35

Category B:

Answer 35

: These agents have the second-highest priority and include pathogens that are moderately easy to disseminate.
Category C: These agents have the third-highest priority and include emerging pathogens that could be engineered for mass dissemination in the future.

Question 36

Category C:

Answer 36

These agents have the third-highest priority and include emerging pathogens that could be engineered for mass dissemination in the future.

Question 37

Laboratory-acquired infections

Answer 37

◦ Most frequent routes of exposure and accidental inoculation are inhalation, percutaneous inoculation, contact between mucous membranes and contaminated material, and ingestion.
Bloodborne pathogens

Question 38

An occupational exposure is a percutaneous injury

Answer 38

(e.g., needlestick or cut with a sharp object) 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.

Question 39

The likelihood of infection after exposure to blood infected with

Answer 39

hepatitis B virus (HBV) or human immunodeficiency virus (HIV) depends on a variety of factors:
◦

Question 40

The concentration of HBV or HIV virus; viral concentration is higher for HBV than for HIV.

Answer 40

◦ The duration of the contact
◦ The presence of skin lesions or abrasions on the hands or exposed skin of the
health care worker
◦ The immune status of the health care worker for HBV
Most exposures do not result in infection.

Question 41

Safety Audit

Answer 41

Laboratory coats. Clean coats must be separated from coats that are being used.
➢Fire extinguishers should be in date and not expired.
➢Biosafety cabinets and hoods need to be certified annually.
➢Eyewash stations and safety shower equipment need to be within 100 feet or no more than a 10-second walk from hazardous chemicals.
➢Chemicals must be inventoried annually.
➢Safety data sheets need to be available as hard copy or electronically within 5 minutes of a request.

Question 42

Infectious waste

Answer 42

◦ Must be discarded in proper biohazard containers, which should have the following characteristics:
◦ Conspicuously marked “Biohazard” and bear the universal

Question 43

Radioactive waste

Answer 43

◦ The Nuclear Regulatory Commission regulates radioactive waste disposal. Waste associated with the radioimmunoassay (RIA) laboratory must be disposed of with special caution.

Question 44

biohazard symbol..

Answer 44

Display the universal color: orange, orange and black, or red.
◦ Rigid, leakproof, and puncture resistant; cardboard boxes lined with leakproof plastic bags are available. Used for blood, certain body fluids, and for disposable materials contaminated with blood and fluids.

Question 45

Most laboratories generate at least three major types of waste streams:

Answer 45

◦ Nonregulated waste
◦ Regulated medical waste (RMW) ◦ Chemical waste

Question 46

The RMW is divided into two groups: ◦ Biohazard waste

Answer 46

◦ Biohazard sharps
The control of infectious, chemical, and radioactive waste is regulated by various government agencies, including OSHA and the US FDA.

Question 47

OSHA regulations apply to human blood, human infectious waste, and human pathologic waste.

Answer 47

◦ States often expand the definition of medical waste or blood to include animals.
Biohazard containers

◦

Question 48

Plastic bags are appropriate for disposal of most infectious waste materials,

Answer 48

but rigid, impermeable containers should be used for disposal of sharps and broken labware.

Question 49

Body fluid specimens, including blood, must be placed

Answer 49

in well-constructed biohazard containers with secure lids to prevent leakage during transport and for future disposal.
Biohazard bags
◦

Question 50

Most laboratories generate at least three major types of waste streams:

Answer 50

◦ Nonregulated waste
◦ Regulated medical waste (RMW) ◦ Chemical waste

Question 51

The RMW is divided into two groups: ◦ Biohazard waste
◦ Biohazard sharps

Answer 51

The control of infectious, chemical, and radioactive waste is regulated by various government agencies, including OSHA and the US FDA.