Precautions in the Workplace

During your studies to become a Phlebotomist, you will learn about PPE (personal protective equipment), as well as Universal precautions that are in place to protect you, your co-workers, as well as patients, against the spread of infection due to the exposure to blood or other body fluids. Along with greatly reducing your risk of exposure, it is also very important to protect the patient against infection.

It is important to treat any blood as possibly infectious. While drawing a patient’s blood, an invasive procedure, it is very important that the blood draw is conducted following proper procedures. This ensures there are no complications such as infection. To examine proper procedure, a hospital lab is used as an example. The area for drawing blood is used many times throughout the day. Containing the needed supplies for the Phlebotomist, this room is used throughout the day to draw the blood of ‘outpatients’. The chair used for blood draws must be properly cleaned after each patient, using hospital approved cleaning solutions.  This ensures no contamination of blood or other body fluids from one patient to the next.

It is important throughout the blood draw that the Phlebotomist inspects each supply as it is being used. Each item, from the needle to any bandaging, should be taken from a sterile package free of tears. Any item that is ripped or torn should not be used.

It is very important the Phlebotomist washes their hands thoroughly before beginning the procedure. Hand washing should be performed for twenty seconds (around the same length as a verse of Happy Birthday), and be performed under warm running water. Hand washing should be done before a procedure such as venipuncture as well as after touching a patient or patients’ belongings (for instance, moving their coat).

After washing the hands, gloves must be worn. The Phlebotomist will ask the patient if they have a latex sensitivity at this time. Gloves should be used by the Phlebotomist prior to the blood draw. The Phlebotomist should not remove these gloves until after the entire blood draw, as well as cleanup, is completed. This protects the Phlebotomist from possible contamination.  If the Phlebotomist maintained proper procedure throughout, removed their gloves…and yet reached for a bloody bandage they missed, this can lead to possible contamination.  The gloves worn for venipuncture can be made of disposable latex, vinyl, nitrile or polyethylene.  If a patient is hypersensitive to latex, latex free gloves must be worn to provide barrier protection.

Handwashing reduces bacterial count by up to 90%

Once the patient has been seated comfortably in the chair and a vein has been selected for the blood draw, the surface of the patient’s skin must be properly cleaned. Using a cotton ball, rubbing alcohol is thoroughly swabbed on the site as well as around it. It is advised to use a circular motion to clean the area of the blood draw, by starting in the middle and gradually moving down. It is important NOT to re-wipe an area as this could cause contamination, by bringing unsterile areas back into a sterile area. After cleaning the patient’s skin with rubbing alcohol, the area must be dried so blood does not lose its surface tension. To maintain this now sterile area, nothing is used to dry the area- it will dry quickly on its own.

Once the surface of the patients’ skin has fully dried, the blood draw can begin. If the Phlebotomist needs to feel the vein before beginning, an alcohol pad must be used to wipe to glove tip. This must be done each time the Phlebotomist needs to palpate the vein area.

After the blood draw has been completed, gauze is applied to the blood draw site and pressure is used to stop any bleeding. Once bleeding has stopped a new gauze and tape / bandage is used to cover the venipuncture site.  The Phlebotomist should only remove their gloves when all waste has been removed – the needle has been properly discarded in the Sharps container, any gauze has been discarded and after the patient has been bandaged.

The single most important strategy to prevent healthcare-associated infections (HIA) is handwashing

Drawing a blood culture requires additional sterile procedures to be followed. A blood culture is used to determine if a patient has blood pathogens. To determine this, after the blood is drawn the culture is, in essence, grown, in a process that may take several weeks.

For the Phlebotomist, drawing a blood culture requires the use of Betadine or other sterile solution, rather than traditional alcohol, to clean the venipuncture site. The Phlebotomist also uses sterile gloves during this procedure. Along with using Betadine, the skin is abraded in the area of blood draw, removing any dead skin as well as any contaminating bacteria that could be found on that skin. It is important that the tops of each container should also be disinfected. Some hospitals use iodine, while others believe iodine may affect the rubber stopper, which could allow contamination to occur.

It is very important that a strictly sterile process is followed in drawing blood for a blood culture. Any contamination that occurs could be identified later as just that – a contaminant. Or, contamination could possibly lead to a lab result that erroneously indicates endocarditis.

OSHA requires employees in the medical field, such as Phlebotomists, to use PPE, personal protective equipment. This can include face shields, gloves or masks. These measures protect the Phlebotomist while they work around blood, body fluids or other contaminates. These measures also reduce the risk of contamination for other healthcare workers as well as patients.  Revised in January 2001, the Bloodborne Pathogens Standard requires employers to provide PPE for their employees.

Healthcare workers can become directly exposed to blood, putting them at risk for contracting blood borne infections. These can include hepatitis B (HBV) as well as other pathogens. Over 8,000 healthcare workers are infected with HBV annually. Wearing personal protective equipment, PPE, as well as following sterile procedure, can greatly reduce exposure to these pathogens.

 

 

 

 

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