1. Fingerstick Proficiency Training

2. Overview  Fingerstick waiver form  Background presentation  Universal Precautions  Demo  Participants do 5 sticks - 2 on an object (oranges, tennis balls, etc.) - 3 on fingers  No actual tests will be run

3. Requirements  Passed counselor training  Complete fingerstick proficiency training  Observed doing two finger sticks with no errors

4. California State Law  State law allows certified HIV test counselors to conduct finger sticks for the purpose of collecting blood samples for HIV and hepatitis C testing  This law does not allow you to do venipuncture

5. Universal Precautions T he universal practice of avoiding contact with patients' body fluids (blood), by means of the wearing of nonporous articles such as medical gloves

6. Gloves Wear them when handling blood or blood products, and…. TODAY – when you perform fingersticks and collect blood samples!!!! How often do you change them? How do you remove them?

7. Sharps Handling & Disposal  Medical instruments that are used to puncture the skin (syringes, lancets, needles)  Dispose of sharps immediately in a hard red plastic bio bin!  Do NOT dispose of sharps in a red bio hazard bag

8. Biohazard Bags Handling & Disposal  Bandages, used cotton and gauze, and gloves with body fluids on them are bio hazardous waste  Wear gloves when handling biohazard bags  Check where your organization wants you to dispose of filled biohazard bags

9. For Today’s Training  Place loops and lancets in the sharps container  Place gloves and all other trash in the brown paper bag

10. Universal Precautions All of the Universal Precautions that we talked about during the testing proficiency part of the training apply here, including:  Use of gloves  Handling and disposal of loops and lancets  Use of biohazard bags

11. Materials  Competency Assessment Test form (CAT)  Absorbent workspace cover (chux)  “Spill kit” for clean-up in the event of a spill  Gloves  Alcohol wipes  Gauze pads  Bandages  Lancets  Collection loops  Sharps container and bio hazard bag

12. The Workspace  Well lit  Sturdy chair  Sturdy testing surface  Away from traffic, opening doors, and other hazards and distractions

13. Technician Attributes  Good organizational skills  Projects competence  Manages unexpected situations  Follows Universal Precautions  Good interpersonal skills  Good eyesight  A steady hand

14. Lancets  Retractable needles or blades  Trigger release or contact activated  Low, medium, and high flow Trigger release Contact activated

15. Choosing a Finger Best Choices Do NOT stick Possibility of bone injury

16. Fingerprints  Notice the direction of fingerprints  Stick should be perpendicular to fingerprints

17. Where to Stick  Non-dominant hand  Inside the circles  Black lines show lancet position Do NOT stick  On the sides  On the tip  In the center

18. Cleaning the Finger  One firm swipe with alcohol wipe -Do not rub the alcohol wipe over the same area over and over again  Let alcohol air dry – don’t blow or fan -If alcohol is wet, the stick might sting -The sample should not be contaminated with alcohol

19. Feeling the Stick  Lancet type can affect pain level  Location of stick can determine pain level  Stick lasts for a fraction of a second

20. Roots of Anxiety  It’s normal  It happens before the stick  It’s not pleasant

21. Working with Anxious Clients  Reassure the client Check in with them: –How are they feeling? –Any questions? –Address the anxiety honestly

22. Positioning the Client  Feet firmly on the floor, or laying down (never standing)  Sitting back in the seat, supported by the seat- back

23. Positioning the Client  Arms are not crossed  Sharps container within easy reach

24. Positioning the Client  Who is comfortable here?

25. Framing the Process Informs the client what will be happening  “I’m going to collect a drop of blood by doing a fingerstick.”  “Which is your dominant hand?”  Ask, “Do you have any history of fainting or passing out when getting blood drawn?” The Process

26. Performing the Stick Contact-Activated Lancets  Remove protective cap (twist to break the seal or pull off)  Position firmly against puncture site  Press firmly against puncture site until you hear a “click”  Discard into a sharps container

27. Performing the Stick Trigger-Activated Lancets  Remove protective cap (twist to break the seal or pull cap off)  Position firmly against puncture site  Press trigger  Discard into sharps container

28. What’s Wrong Here? See if you can name 2 things wrong

29. Collecting the Blood Sample  Hold finger until sample has been taken  Wipe away first drop with sterile gauze pad  “Milk” the finger to get a second drop of blood  Touch loop to drop of blood  Dispense sample into testing device

30. Collecting the Blood Sample Touching the loop to the drop of blood

31. Dispensing Sample onto Absorbent Material  Touch open end of loop to center of absorbent material in sample well  If sample remains inside loop, gently twist loop against absorbent material allowing the sample to flow out.

32. Dispensing Sample into Buffer Solution Vial  Dispense sample into vial  Do not touch sides of vial  Stir loop into buffer solution  Dispose of loop

33. Model Fingerstick  Participant reads checklist  Trainer follows, pointing out combined steps where necessary  Participants watch

34. Debrief  Allow alcohol to air dry  The stick and the disposal are like one step  Importance of wiping away first drop (tissue juice)  Discuss specimen collection and dispensing into test device  Answer questions

35. Practice on Object  Follow checklist  Treat object like a person

36. Debrief  What was the experience like?  What was easy?  What was difficult?  Did you feel the lancet release and hear a click? So...

37. First Participant Fingerstick  Follow the checklist  Stick and dispose  Do not hold filled loop above your head  When you finish, switch roles and do again

38. Debrief  How did that go?  What were the easy parts?  What were the more challenging parts? Waddaya think?

39. Participant Final Fingersticks  Continue to practice fingersticks with new partners.  Use the checklist every time.  Do at least three fingersticks.  Two fingersticks will be observed.

40. Debrief  How did that go?  Did anything feel easier this time?  What were the more challenging parts? Better?

41. End of the Training Congratulations! You have just completed:  HIV Counselor Training  Rapid Test Proficiency Training  Fingerstick Training