With the COVID-19 resurgence, Phlebotomy Career Training realizes that phlebotomists, medical assistants and medical professionals are finding it more important than ever to use the proper techniques of infection control for protecting themselves and the patients’ health. This article is here as a reference for any phlebotomists in the field who need a quick reminder, or for those who are in countries without access to proper isolation room protocol.
Step 1: Before entering patient room, assemble all equipment
Step 1a: Assemble equipment for collecting blood
• CT Laboratory sample tubes for blood collection (sterile glass or plastic tubes with rubber caps, vacuum- extraction blood tubes, or glass tubes with screw caps). EDTA tubes are preferred
• CT Blood sampling systems (Needle and syringe system, vacuum extraction system with holder, winged butterfly system (vacuum extraction) or winged butterfly system (syringe)
• CT Tourniquet (single-use)
• CT Skin antiseptic solution: 70% isopropyl alcohol
-CT Gauze pads
-CT Adhesive bandage
-CT Tray for assembling blood collection tools
-CT Rack for holding blood tubes
-CT Durable marker for writing on laboratory samples
Step 1b: Assemble equipment for preventing infections
• CT Clean running water, soap and disposable (paper) towel Personal Protective Equipment (PPE)
• CT Several pairs of disposable gloves (non-sterile, ambidextrous, single layer)
One pair for blood collection; Additional pairs as a replacement if they become damaged or contaminated
• CT Footwear: Rubber boots (wear socks in order to remove easily) or shoes with puncture-resistant soles with disposable overshoes secured around the shoes to prevent direct contact with ground and infected bodily fluid spills
Waste management
• CT Leak-proof and puncture resistant sharps container
• CT Two leak-proof infectious waste bags
one for disposable material (destruction) one for reusable materials (disinfection)
• CT Long-sleeved, cuffed gowns (if in hospital) or disposable coverall suit (if in rural area)
Note: For tasks where contact with blood or body fluid could happen, an impermeable gown or a plastic apron over the non-impermeable gown are recommended. Face protection: Face mask + [face shield OR goggles]
Step 1c: Fill out patient documentation
• CT Label blood collection tubes with date of collection, patient name, and his/her identifier number
• CT Do NOT forget to fill out necessary laboratory form and epidemiological questionnaire.
• CT If several patients have to be sampled in the same place or during the same investigation, create a line list. One patient per line. The list should include: patient name, identifier number, sex, age (birthdate), clinical information: symptoms, date of onset, date specimen was collected, type of sample taken.
Step 1d: Assemble materials for packaging of samples
• CT Plastic leak-proof packaging container
• CT Disposable (paper) towels
• CT Cooler or cold box, if sample requires refrigeration
For the shipment of samples to the National Central Laboratory follow Sample Shipment packaging requirements (see document “How to safely ship Emerging and Dangerous Pathogen samples”)
Primary container, secondary container, tertiary container
Important: A designated Assistant wearing gloves should be available to help you. This person should stand outside the patient room. He/She will help you prepare the sample for transport. He/She will assist you with putting on the personal protective equipment. He/She will provide any additional equipment you may need.
Step 2: Put on all personal protective equipment (PPE)
DO NOT ENTER THE PATIENT AREA IF YOU DO NOT HAVE ALL PROTECTIVE GEAR ON
Step 2a: Perform hand hygiene.
Duration of the entire procedure: 40-60 sec if handwashing with soap and water; 20-30 sec if handrubbing with an alcohol-based solution.
- Wet hands with water and enough soap to cover all hand surfaces Back of fingers to opposing palms with fingers interlocked
- Rub hands, palm to palm Rotational rubbing of
left thumb clasped in right palm and vice versa - Right palm over left dorsum with interlaced fingers and vice versa Rinse hands with water
- Palm to palm with fingers interlaced
- Dry hands thoroughly with single use towel
Step 2b: Put on a gown
Step 2c: Put on face protection
- Put on a medical mask
- Put on eye protection (face shield OR goggles)
Step 2d: Put on gloves (over gown cuffs)
Step 3: Collect blood sample from patient
Step 3a: Prepare room
• CT Put infectious waste bags and leak-proof and puncture resistant sharps container into patient room and make sure they are ready for use
• CT Place all blood collection equipment in a place that is easy to access
• Destruction Disinfection
Step 3b: Identify and prepare the patient
• CT Introduce yourself to the patient and explain what you will do with the blood sample and why
• CT Make sure that this is the correct patient from whom you wish to take the blood sample
Step 3c: Select the site, preferably at the bend of the elbow
• CT Palpate the area; locate a vein of good size that is visible, straight and clear
• CT The vein should be visible without applying a tourniquet
Step 3d: Apply a tourniquet around the arm
• CT Tie approximately 4–5 finger widths above the selected site
Step 3e: Ask the patient to form a fist so that the veins are more prominent
Step 3f: Disinfect the area where you will put the needle.
• CT Use 70% isopropyl alcohol
• CT Wait 30 seconds for the alcohol to dry
• CT DO NOT touch the site once disinfected
Step 3g: When using vacuum extraction system with holder, insert the blood collector tube into the holder
• CT Avoid pushing the collector tube past the recessed line on the needle holder or you may release the vacuum
Step 3h: Anchor the vein by holding the patient’s arm and placing a thumb BELOW the place where you want to place the needle
• CT DO NOT touch the disinfected site
• CT DO NOT place a finger over the vein to guide the needle
Step 3i: Perform the blood draw
• CT Enter the vein swiftly at a 30CT angle
Step 3j: When blood starts to flow, ask patient to open his/her hand
Step 3k: Once sufficient blood has been collected (minimum 5ml), release the tourniquet BEFORE withdrawing the needle
Step 3l: Withdraw the needle gently
• CT Give the patient a clean gauze or dry cotton wool ball to press gently on the site
• CT Ask the patient NOT to bend the arm
Step 3m: Remove blood collector tube from holder and put in rack
Step 3n: Put needle into leak-proof and puncture resistant sharps container
If the sharps container DOES NOT HAVE a needle remover:
• CT Put the needle and holder into a sharps container
• CT Do not remove the needle from the holder
• CT Do not reuse the needle
• CT Remove the needle following instructions on the sharps container
• CT Put the holder into the infectious waste bag for disinfection
Step 3o: Stop the bleeding and clean the skin
• CT Do not leave patient until bleeding has stopped
• CT Put an adhesive bandage on the site, if necessary
Step 3p: Put items that drip blood or have body fluids on them into the infectious waste bag for destruction
Quick Tips:
• CT The blood holder tray and rack will need to be disinfected after use
• CT A minimum of 5ml of blood should be collected for each patient
Step 4: Prepare blood sample for transport
Step 4a: Take the blood tube from the tray and wipe the blood tube with a disposable paper towel
Step 4b: Place all items that came into contact with blood into the infectious waste bag for destruction
Step 4c: Protect the sample from breaking or leaking during transport by wrapping the tube of blood in a paper towel
Step 4d: Ask the designated assistant to approach the patient room, without entering
• CT This person should have gloves on
• CT This person should come close to you holding the open plastic leak- proof packaging container.
• CT This person should not enter the patient room
Step 4e: The person who has collected the blood sample should put the wrapped tube of blood into the plastic leak-proof packaging container
• CT Be careful not to touch outside of leak-proof packaging container with gloves
Step 4f: Have the gloved assistant tightly close the top of the plastic leak-proof packaging container
• CT Disinfectant the outer side of the plastic leak-proof packaging container with a disinfectant
Step 4g: The assistant removes gloves and performs hand hygiene
Note: The sample is now ready for shipment to the National Central Laboratory. Follow Sample Shipment packaging requirements for infectious substances.
• CT Store samples at room temperature for up to 24 hours. If you need to store the sample for one week before shipping, store between 0-5° Celsius.
• CT If you need to store the sample for more than one week before shipping, store at -20 ° Celsius (or better at -70 ° Celsius if available). Avoid freeze-thaw cycles.
Step 5: Remove Personal Protective Equipment (PPE) Step 5a: Remove the gloves
1.Hold the outer edge of the first glove and peel it off
2.Hold the first glove in the gloved hand and drag a bare finger under the second glove
3.Remove second glove from the inside, creating a “bag” for both gloves and put in the infectious waste bag for disposal
Step 5b: Remove the gown
1.Untie the gown
2.Remove the gown from behind starting at the neck and shoulders
3.Put the gown in the infectious waste bag for destruction
Step 5c: Perform hand hygiene
CT Alcohol-based handrub solution (20-30 sec) OR
CT Soap and water (40-60 sec)
Step 5d: Take off face protection
When wearing a face shield:
• CT Remove face shield from behind
• CT If it is a reusable face shield, place it in an infectious waste bag for disinfection
• CT If it is a disposable face shield, place it in an infectious waste bag for destruction
• CT Remove the medical mask from behind, starting with the bottom strap, and place it in a infectious waste bag for destruction
When wearing goggles and mask:
• CT Remove goggles from behind
• CT If reusable goggles, place it in an infectious waste bag for disinfection
• CT If disposable goggles, place it in an infectious waste bag for destruction
• CT Remove the medical mask from behind, starting with the bottom strap, and place it in an infectious waste bag for destruction
Quick Tips:
• CT Place all reusable equipment into a separate infectious waste bag for disinfection
When collecting blood samples from multiple patients:
• CT Change gloves between each patient
• CT Wash hands between each patient
• CT DO NOT WASH GLOVED HANDS
• CT DO NOT REUSE GLOVES
It is imperative that phlebotomists, medical assistants and medical professionals use the proper techniques of infection control for protecting themselves and the patients’ health. Phlebotomy Career Training is the Nation’s Leader in Medical Health Care careers and certification. Our classes and programs are nationally accredited and offered both on-line and in-class. They include: Phlebotomy Technician, Pharmacy Technician, Electrocardiogram Technician, Dialysis Technician, Medical Assistant and more! If you are interested in a rewarding career in the medical health, visit phlebotomycareertraining.com or call 888-410-6416 to learn more.
Article shared from the WHO guide on infection control/ PPE procedures