Module 2: Safety and Compliance Flashcards
regulatory bodies
- Occupational Safety and Health Administration (OSHA)
- The Joint Commission
- College of American Pathologists
- Clinical Laboratory and Standards Institute (CLSI)
- Centers for Disease Control and Prevention (CDC)
goals of regulatory bodies
- create regulations and policies
- high-quality care
- accurate test results
- encourage the use of safety measures
- detect problem areas
- find solutions that create positive changes
regulations
- blood pathogens standard
- clinical laboratory improvement amendments (CLIA)
- needlestick safety and prevention act
- good laboratory practice
- national accrediting agency for clinical laboratory science
OSHA
- regulates workplace safety
- biologic hazards and hazardous chemicals
bloodborne pathogens standard
- protects phlebotomists from exposure to body fluids
- requires implementation of practices and engineering controls to prevent exposure incidents
- guidelines for training
- use of PPE
- availability of hep B immunization
- exposure control plan
when to perform hand washing
before and after direct contact with every pt
PPE for venipuncture
- gloves
- replace if they tear and between each pt
PPE for splash risk
- goggles
- face mask or full face shield
where to dispose of sharps
OSHA-approved, puncture-proof, leakproof sharps container
when to stop filling and lock the sharps container
3/4 full
steps after accidental exposure to body fluids
- administer first aid
- medical examination
- sign consent form (you and pt) to test for HIV, HBV, HCV
things to document in sharps log after needlestick
- date and time of the incident
- type of sharps used
- who was involved without names (pt or staff)
- location
- detailed description of how the incident occurred
things on safety data sheets (SDS)
- protective measures
- chemical name
- trade name
- manufacturers name, address, and emergency phone number
- handling and storage
- actions to take in case of accidental exposure
The Joint Commission
- accredits and certifies healthcare organizations in the US
- independent and nongovernmental
- pt safety and quality of care
- national pt safety goals (NPSG): two-factor pt identification
Clinical and Laboratory Standards Institute (CLSI)
- standards and guidelines to help labs achieve accreditation
- up-to-date info and safest measures for blood tests
- guidelines for venipuncture, dermal puncture, and phlebotomist safety
- establishes the order of draw
- quality control, pt care, risk reduction, time-saving measures, cost-saving measures
Centers for Disease Control and Prevention (CDC)
- identify and educate about infections, illnesses, and disease prevention
- guidelines for PPE, sharps handling, hand hygiene
CDC recommendations to improve safety and reduce disease transmission
- always wear gloves when handling any body fluid
- activate needle safety immediately after use
- dispose of sharps immediately into an approved container
- wash hands with soap and water before and after pt care
what increases accidental needlestick injuries
- use butterfly or syringe method
when do needlesticks most often occur
- disposing of the needle
- attempting to recap the needle
- removing the needle from adapter after use
HIPPA regulations
- pt protected health information (PHI) is confidential
- regulates the authorized release of PHI
what info does HIPAA protect
- pt demographic
- treatments
- medications
- disgnostic testing
what info does HIPAA not protect
- info without any way to identify the pt
who can get pt information
- those who have a direct need for info and legitimate involvement in pt care (requesting provider, medical specialists, nurses, billing, accounting)
- pt signs consent form to share info with someone else
inpatient identification
- two or three-factor identification
- identification band on the wrist or ankle
outpatient identification
- ID including a photo usually required
techniques for locating a good vein
- warming area
- wiping with alcohol
- lower limb below heart level
sites to avoid in venipuncture
- inside of wrist: potential ulnar nerve damage or inadvertent arterial access
- legs and feet of pt with diabetes: possible infection
- basilic vein: last choice if all other veins are inaccessible, close to brachial artery
how many attempts at venipuncture should you make
two attempts
when to stop the venipuncture procedure
- hematoma develops
- pt shows signs of seizure or loss of consciousness
slapping a pts vein could lead to what charge
battery
threatening to move forward with a procedure without consent could lead to what charge
assault
quality control
- measure of precision
- how well an instrument is functioning to produce consistent results
quality assurance
- ensuring a test is as accurate as possible
- adhering to policies/procedures, quality control testing, equipment maintenance
equipment log
monitors equipment maintenance and quality control testing
when to perform quality control procedures
- daily or when opening new lot of supplies
- after recording multiple errors
what to record after performing quality control procedure
- time and date procedure was run
- results
when to clean lab equipment
- several times a day
- according to guidelines
- if the equipment is visibly contaminated
what happens when the centrifuge is unbalanced
- makes weird noises
- is vibrating
- causes broken tubes and inaccurate results
how to balance centrifuge
- place tubes of same size and volume directly across from one another
first step when troubleshooting
check if the equipment is turned on and is connected to an outlet
what is included on a repair report
- date
- description of issue
- steps taken to try and fix the problem
quality control for CLIA-waived tests
- never reuse supplies or use beyond expiration date
- run external controls when opening new package of supplies, beginning of day, when several results are out of range
ways to ensure quality control for glucometers
- external controls
- matching test strip codes to glucometer codes
- reviewing expiration dates
what should you check every time you perform blood glucose testing
the code on the testing strips
what to do about defective strips
contact the manufacturer and follow the instructions for sending back the strips
National Institute for Occupational Safety and Health (NIOSH)
- federal agency
- develop new knowledge in occupational safety and health
- updates workplace safety regulations annually
- identified that incorrect sharps disposal is a significant cause of sharps injuries
NIOSH sharps container criteria
- functionality: leakproof and puncture-proof, durable for transport, secure closure
- accessibility: easy to operate, within easy reach, below eye level
- visibility: clearly visible fill level and biohazard symbol
- accommodation: minimal training, easy to operate, safe mounting system
how often should employees participate in bloodborne pathogen training
annually
steps after accidental needlestick
- clean with antiseptic (iodine, soap and water)
- notify immediate supervision
- document in sharps log and incident report form
- have medical exam asap
how long after exposure to HIV should postexposure prophylaxis occur
2 hours
steps after splash of body fluid into eyes, nose, or mouth
- flush with large amounts of water
- report exposure to immediate supervisor
- medical exam
standard precautions
- essential for all pt encounters
- hand hygiene, PPE
- consider all body fluids from all pts as infectious
- protect workers
droplet precautions
- droplets larger than 5 microns in diameter
- rubella, meningitis, diphtheria, mumps, pertussis, influenza
- wear a mask
contact precautions
- direct contact or contact with the environment (indirect)
- diphtheria, herpes simplex, scabies, hepatitis A, respiratory syncytial virus, wound/skin infections (MRSA, VRE, C. diff)
- gloves and gown
airborne precautions
- droplets smaller than 5 microns in diameter
- varicella, tuberculosis, measles
- wear mask or N95 respirator
- spans larger distance than droplet and longer time or virility
standard precautions regarding gloves
- wash hands before and after wearing gloves
- wear when handling body fluids
- replace between each pt and procedure
- nitrile or vinyl (not latex)
- fit properly
- check for holes or rips
examples of times to wear gloves
- handling specimen containers
- venipuncture
- dermal puncture
- any procedure with potential for interacting with body fluids
- processing specimens
how to remove gloves
- grab glove on palm of nondominant hand
- pull glove off by turning it inside out
- transfer to palm of dominant gloved hand
- slip non gloved hand under cuff of dominant hand glove
- pull two gloves off together and turn inside out
- dispose in biohazard container
used to clean area for venipuncture
- alcohol wipe, 70%
- benzalkonium chloride if allergic to alcohol
when to not use alcohol to cleanse skin and what to use instead
- determining blood alcohol levels
- povidone-iodine or soap and water
what to use to clean skin for bacterial testing of blood
- povidone-iodine and alcohol
- chlorhexidine gluconate rubbed on skin for 30 seconds
how to clean blood spills
- 1:10 solution of sodium hypochlorite (bleach) and water
- let the solution sit for 20 mins before cleaning up with paper towels
- dispose of towels in a biohazard bin
how long to scrub hands when handwashing
20 seconds
% alcohol concentration for hand sanitizer
60%
how long to rub hand sanitizer in
- 30 seconds
- until hands are dry
what to do if pt shows signs of syncope or loses consciousness during blood collection
- stop procedure
- place pressure at venipuncture site
- protect pt, assist to floor or to reclining position
- monitor pt breathing
- place cold cloth on back of pt neck or wrists
CAB
- AHA recommendation for priority when pt is unresponsive
- chest compressions, airway assessment, rescue breathing
steps for adult CPR
- call 911
- find defibrillator
- begin CPR: compressions at 100 to 120 bpm at 3.8 to 5 cm (1.5 to 2 in) depth
- 30 compressions to 2 breaths
- place pt in recovery position (lateral recumbent) and monitor breathing
when does irreversible brain damage occur after a lack of oxygen
4 to 6 minutes
steps for infant CPR
- call 911
- begin CPR: use two fingers to provide 30 compressions at 100 to 120 bpm and 3.8 cm (1.5 in) depth
- 30 compressions to 2 breaths
steps if pt starts seizing
- stop blood draw
- call for assistance
- gently lower to floor or leave them if they’re in a safe position
- do not lift or restrain pt
steps if pt reports nausea during blood collection
- stop procedure
- cold washcloth on forehead
- provide emesis bin or trash can
- place vomit in biohazard container
- offer to rinse mouth and clean face
- notify nurse or provider
symptoms of shock
- cold and clammy hands
- blurry vision
- rapid and weak pulse
steps if pt is in shock
- call for help
- remain with pt
- shock position: pt lying flat with legs elevated 12 in
- keep pt warm
- loosen tight clothing
steps for general excessive bleeding
- apply pressure
- call for assistance
- elevate limb if bleeding from the limb
steps for excessive bleeding after venipuncture
- hold pressure for at least 5 minutes or until the bleeding stops
- add more gauze if needed (do not remove gauze already on site)
- call for assistance if bleeding continues
- apply pressure bandage
- advise pt to keep the bandage on for at least 1 hour and avoid heavy lifting
- monitor for other issues
- document to provide guidance for future blood collections
what to do if pt experiences severe pain during blood collection
- indicates nerve involvement
- stop procedure
- pt needs medical evaluation if pain doesn’t stop
petechiae
- small red dots
- do not need to stop procedure
- indicates platelet issues
- apply adequate pressure after procedure
info needed for accidental exposure log
- how exposure happened
- by what means it occurred (eye splash, needlestick)
- equipment involved
- safety measures on equipment
- PPE used
- where incident occurred
- type of procedure being performed
- situation surrounding exposure
info needed for sharps injury log
- date
- type of equipment involved and brand name
- where exposure took place
- brief description of how exposure occurred
chain of custody
- used when specimen is evidence in legal case
- record of all steps that took place
- who handled the specimen
- time, date, and name of collector
- every person who handles specimen should sign and date the form
classes of fires
- A: materials like wood, paper, cloth
- B: liquids like paints, oils, gasoline
- C: electrical equipment like appliances, wiring, electronic
- D: metals like sodium, magnesium, titanium
when should you dispose of PPE
before leaving pt room
type of precaution for streptococcal pharyngitis
droplet
things causing inaccurate glucometer readings
- too much blood used: inaccurately high levels
- too little blood used: inaccurately low levels
- first drop used: contains tissue fluid, inaccurately low levels
- test strip left open: strips absorb moisture, inaccurately low levels
glucose tolerance test (GTT)
- timed test
- requires multiple blood draws at set intervals
minimal PPE required when aliquoting blood specimens
- face shield
- gloves
greatest risk of exposure to what pathogen from needlestick injury
- hep B: 6-30%
- hep C: 1.8%
- HIV: 0.3%
department that processes cholesterol, troponin, and HDL
chemistry
steps of PPE removal
- gloves
- goggles
- gown
- mask
PPE for pneumonia
- gloves
- mask
