1. Matching 3-1: Key Terms Asepsis: sterile or pathogen free BBP: Bloodborne Pathogen Biohazard: anything potentially harmful to health CDC: Center for Disease Control and Prevention Chain of infection: a series of events that lead to an infection Engineering controls: devices that isolate or remove a BBP hazard from the workplace – Sharps containers – Needles w/ safety features EPA: Environmental Protection Agency Fire tetrahedron: Added chemical reaction that produces fire added to the traditional fire triangle components of fuel, heat, oxygen Fomites: inanimate objects that harbor material containing pathogens HAI: Healthcare-associated infection

2. Matching 3-1: Key Terms HBV: Hepatitis B virus HCS: Hazard Communication Standard (OSHA) HCV: Hepatitis C virus HIV: Human Immunodeficiency virus Immune: protection from or resistant to a particular disease or infection through the development of antibodies from vaccination or having the disease Infectious/causative agent: pathogen causing an infection; first link in chain of infection Isolation precaution: procedures to separate patients with certain transmissible infections from contact with others Microbe: microorganism not visible to neked eye NIOSH: National Institute for Occupational Safety and Health Nosocomial Infection: hospital acquired infection OSHA: Occupation Safety and Health Administration

3. Matching 3-1: Key Terms Parenteral: administration by any route other than the digestive tract Pathogenic: capable of causing disease Percutaneous: through the skin Permucosal: through the mucous membranes PPE: Personal Protective Equipment (clothing) Reservoir: source of an infectious microorganism; second link in chain of infection Reverse isolation: protection of patient from others Standard precautions: minimize risk of infection transmission when caring for all patients regardless of their status – Blood, all body fluids, non-intact skin, mucous membranes Susceptible host: individual with little resistance to an infectious agent; last link of chain of infection Transmission-based precautions: used in addition to standard precautions for patients infected or colonized w/ highly transmissible pathogens

4. Matching 3-1: Key Terms Vector transmission: by an insect, arthropod, or aminal Vehicle transmission: through contaminated food, water, drugs or blood transfusion Work practice controls: alter manner in which a task is performed to reduce likelihood of BBP exposure

5. Matching 3-2: Means of Transmission Collecting a throat culture specimen from a coughing patient without wearing a mask: Droplet Entering a TB patient’s room without an N95 respirator: Airborne Filling a TB test syringe with antigen without first cleaning the top of the vial: Vehicle Handling a dead rodent: Vector Kissing someone with mononucleosis: Direct contact Rubbing your eye after touching a contaminated blood tube: Indirect contact

6. Matching 3-3: Fire Control Class A: wood or paper; cool with water or water-based solution Class B: flammable liquid; block oxygen source or smother Class C: electrical equipment; extinguish with non-conducting agent Class D: flammable metals; extinguish with dry powder agent or sand Class K: high tem cooking oils; cool and smother with splash prevention agent

7. Matching 3-4: Type of Spill and Cleanup Procedure Small spill: – Absorb with paper towel – Discard in biohazard waste container – Clean with disinfectant Large spill: – Absorb with special clay or chlorine-based powder – Scoop or weep absorbed material – Discard in biohazard container – Clean with disinfectant Dried spill – Moisten spill with disinfectant avoiding scraping – Absorb with paper towels – Discard in biohazard container – Clean with disinfectant

8. Matching 3-4: Type of Spill and Cleanup Procedure Spills involving broken glass: – Wear heavy-duty utility gloves – Scoop or sweep up material – Discard in sharps container – Clean with disinfectant

9. Matching 3-5: HCS Pictograms Hazard Communication Standard 1.Oxidizers 2.Flammables 3.Explosives 4.Acute (fatal) toxicity 5.Skin corrosion and eye damage 6.Gases under pressure 7.Carcinogen 8.Respiratory tract irritant 9.Aquatic toxicity

10. Labeling Exercise 3-1: NFPA Marking System Blue-3: Material that on short exposure could cause serious temporary injury even with prompt medical attention Red-1: Materials that must be pre- heated before ignition can occur Yellow-4: materials that in themselves are capable of detonating or exploding at normal temps White: other specific hazard; material that is radioactive

11. Labeling Exercise 3-2: Engineering Control and Work Practice Controls Engineering Controls: – Devices with safety features that isolate or remove a BBP hazard from the workplace – Sharps containers – Needles with safety features Work Practice Controls: – Alter the manner in which a task is performed to reduce likelihood of BBP exposure 1.Engineering Control 2.Work Practice Control 3.Engineering Control 4.Engineering Control 5.Engineering Control 6.Work Practice Control 7.Engineering Control 8.Engineering Control 9.Work Practice Control

12. Knowledge Drill 3-1: Caution and Key Point Recognition 1.The transmission of the Hepatitis viruses and HIV through blood transfusion is also considered vehicle transmission 2.Droplet transmission differs from airborne transmission in that droplets normally travel less than 10 feet and do not remain suspended in the air 3.Individuals who are exposed to HBV are less likely to contract the disease if they have previously completed an HBV vaccination series 4.OSHA regulations require employers to offer HBV vaccination free of charge to employees whose duties involve risk of exposure 5.The WHO consensus recommendations in the 2009 Guidelines on Hand Hygiene in Health Care are that HCWs do not wear artificial l fingernails or extenders when having direct contact with patients and natural nails should be kept short (0.5 cm long or approx ¼ inch long) 6.Wearing gloves during phlebotomy procedures is mandated by the OSHA BBP standard 7.The HCS is known as “the right to know law” because the labeling requirement gives employees the right to know about chemical hazards in the workplace

13. Knowledge Drill 3-1: Caution and Key Point Recognition 8.The original compress should not be removed when adding additional ones because removal can disrupt the clotting process 9.Never give fluids if the patient is unconscious or semiconscious or has injuries likely to require surgery and anesthesia 10.According to the American Heart Association, if activity during work is low to moderate a 30 minute brisk walk or similar exercise daily can improved blood pressure and reduce the risk of heart disease and type 2 diabetes 11.In addition, if hands are heavily contaminated with organic material and hand washing facilities are not available, it is recommended that hands be cleaned with detergent containing wipes, followed by the use of an alc0hol-bases antiseptic hand cleaner 12.The most common type of HAI reported to NHSN is urinary tract infection (UTI), accounting for over 30% of all HAIs

14. Knowledge Drill 3-3: Breaking the Chain of Infection Effective hand hygiene procedures Good nutrition, adequate rest, and reduction of stress Immunization against common pathogens Proper decontamination of surfaces and instruments Proper disposal of sharps and infectious waste Use of gloves and other PPE when indicated Use of needle safety devices during blood collection

15. Knowledge Drill 3-4: Situations Requiring Hand Hygiene Before and after each patient contact Between unrelated procedures on a patient such as wound care and drawing blood Before putting on gloves and after taking them off Before leaving the laboratory Before going to lunch or on break Before and after going to the restroom Whenever hands become visibly or knowingly contaminated

16. Knowledge Drill 3-5: Safety Rules When In Patient Rooms and Other Patient Areas 1.Avoid running. Alarming to patients and visitors 2.Be careful entering and exiting patient rooms. Various types of equipment may be just inside the door or outside in the hallway. 3.Do not touch electrical equipment in patient rooms while drawing blood. Electrical shock can pass through phlebotomist and needle and shock patient. 4.Follow standard precautions when handling specimens. Use proper PPE to avoid transmission of pathogens 5.Replace bed rails that were let down during patient procedures. Patient may fall from the bed resulting in injury.

17. Knowledge Drill 3-6: Pathogen Transmission and Precautions 1.Bordetella pertussis: Droplet 2.C. difficile: Contact 3.CMV (Cytomegalovirus): Droplet 4.Group A Strep (draining wound): Contact 5.HBV: Standard; BBP 6.HCV: Standard; BBP 7.HIV: Standard; BBP 8.HDV: Standard, BBP 9.Impetigo: Contact 10.Influenza: Droplet

18. Knowledge Drill 3-6: Pathogen Transmission and Precautions 11.Malaria-causing microbe: Standard; BBP 12.Mycoplasma pneumoniae: Droplet 13.Neisseria meningitides: Droplet 14.RSV: Contact 15.Rubella virus (congenital): Contact 16.Rubeola virus: Airborne 17.Staph aureus (draining wound): Contact 18.Syphilis-causing microbe: Contact 19.Mycobacterium tuberculosis: Airborne 20.Varicella virus: Airborne

19. Knowledge Drill 3-7 1.Asepsis is a condition of being free of contamination with microorganisms that can cause disease. 2.Healthcare-associated infection is a relatively new term applied…. 3.The HCS was developed to protect employees from exposure to hazardous chemicals 4.The source of an infectious agent is called a reservoir 5.OSHA regulations require employer to offer free HBV vaccinations… 6.Studies have shown that artificial nails harbor more pathogenic microbes than natural nails 7.The spores of C. difficile are not killed by alcohol-based hand cleaners. 8.Scrubs must be 1 to 1 ½ inches off floor 9.Except for a respiratory, protective clothing worn in isolation rooms….

20. Knowledge Drill 3-7 10.Standard precautions are to be used in the care of all patients 11.A yellow diamond with a number specifies the reactivity of a hazard. 12.Pictograms are diamond shaped with a red border

21. First Aid For The Phlebotomist External Hemorrhage – Pressure applies using cloth or gauze – Apply additional material if bleeding continues. Do not remove original dressing and bandage. – Acceptable to use an elastic bandage to hold compress in place Shock – Fainting: mini-shock – Symptoms include pale, clammy skin; rapid pulse; increased shallow breathing, expressionless – If patient goes into shock, stop blood draw and care for shock – Watch patient after draw for symptoms of shock; care if needed

22. CPR For The Phlebotomist New guidelines call for early chest compressions for victims of sudden cardiac arrest. Compression rate: 100 per minute Compression depth: – Adult at least 2 inches – Children about 2 inches – Infants 1 ½ inches If a patient goes into sudden cardiac arrest, call for help before initiating care

23. Personal Wellness Requires a holistic approach – Must meet physical, emotional, social, spiritual, and economic needs Serious health threats: – Heart disease – Cancer Nutrition – Provides what body needs for energy and day-to-day functioning – To reduce risk of cancer choose predominantly plant-based diet and minimally processed starchy staple foods

24. Personal Wellness Rest – Busy pace of healthcare requires adequate sleep – Studies show at least 7-8 hours per night – Unplug! Exercise – Staying physically fit increases chances of staying healthy and living longer – Strengthens immune system – Increases energy – Reduces stress – Reduces symptoms of depression and anxiety – Increases ability to perform daily tasks

25. Personal Wellness Personal Hygiene – Phlebotomists should pay special attention to personal hygiene not only for optimal health, but also because the job involves close patient contact Back Protection – Back injuries account for 20% of all workplace injuries – Remember body mechanics and proper lifting techniques – Stress can make a person vulnerable to back problems Stress Management – Physical, chemical or emotional factors cause mental or bodily tension – Eustress: keeps people alert and increases energy when needed – Chronic: has damaging effect on mental and bodily functions – If not controlled: Immune system weakened, hypertension, ulcers, depression