Laboratory Testing and Safety for CLM

Types of Laboratories

1. Clinic Labs (Med Express, same clinic) 2. Private Labs (Quest Diagnostics) 3. Hospital Labs

US Chemical Safety and Hazard Investigative Board

CSB is an independent federal agency charged with investigating industrial chemical accidents

Work Practice Controls

HAND WASHING removal/disposal of PPE avoid needle recapping eliminate food and drinks in work areas

OSHA

Occupational Safety and Health Administration

Types of test times

STAT Routine

Benefits of clinic labs

patient not sent to another location quicker results treatment at time of office visit direct control of quality of testing

Post exposure evaluation

-confidential medical evaluation -document route of exposure identify source individual Test source individual's blood (with individual's consent) -provide results to exposed employee -provide post-exposure prophylaxis (PEP) when indicated

Importance of Lab Tests

1. Explore differential diagnoses-- biggest reason 2. Confirm a clinical diagnosis 3. Aid in treatment 4. Assess severity of a disease 5. Screen for diseases

Key Elements in Blood Borne Pathogen Standard

1. exposure determination 2. written exposure control plan 3. engineering and work practice controls 4. labels and signs (sharps, biohazard) 5. PPE 6. Employee information and training 7. Vaccinations 8. Post-exposure follow up 9. Record keeping

Sources of Infection for Hep C

60%- injecting drug use 15%- sexual 10%- transfusion 5%- other 10%- unknown

Exposure incident

A specific incident that involves contact with potentially infectious bodily fluid, must be reported to a supervisor, patient will often be tested, need to know details of exposure

PPE Rules

Always check PPE for any defects or tears If PPE becomes torn or defective- remove and replace immediately Remove PPE before leaving a contaminated area Do not reuse disposable equipment or use for multiple patients

CDC

Center for Disease Control tracks and attempts to control various pathogens and diseases

CAP

College of American Pathologists research better sampling techniques

Clinician Responsibilities when ordering tests

Know which tests to order Understand test times Know how to interpret

Common blood borne pathogen diseases

Malaria Brucellosis Syphilis Hep B Hep C HIV

Type of Exposure

Needle sticking (percutaneous injury) mucous membrane exposure non-intact skin exposure bites that involve blood

Safety Enforcement for lab standards

OSHA Clinical and Laboratory Standards Institute CDC CAP

Potentially Infectious bodily fluids

Peritoneal Fluid CSF Synovial Fluid Pleural Fluid Pericardial Fluid Blood and blood products Semen and Vaginal secretions Amniotic Fluid Wound/ulcer drainage

Hep B post-exposure prophylaxis Unvaccinated

Positive- HBIG x1 and initiate vaccine series Negative- initiate vaccine series Unknown- initiate vaccine series

Hep B PEP still undergoing vaccination

Positive- HBIG x1, complete series Negative- complete series Unknown- complete series

Hep B PEP Vaccinated- known non-responder

Positive- HBIG x1, initiate revaccination or HBIG x2 Negative- nothing Unknown- no treatment unless high risk, if high risk treat as if they were positive

Hep B PEP Vaccinated- responder

Positive- nothing Negative- nothing Unknown- nothing

Hep B PEP Vaccinated- unknown response

Positive- single vaccine booster dose Negative- nothing Unknown- no treatment unless high risk, if high risk treat as if they were positive

Exposure Considerations

Type of exposure Type and amount of fluid/tissue Infectious status of source Susceptibility of exposed person

Significant exposure

any exposure that involves infiltration of the mucous membranes or open skin surfaces

Personal Protective Equipment (PPE)

anything that is used to protect a person from exposure

Hepatitis B (HBV) Transmission

blood borne and sexually transmitted virus, acquired by percutaneous or mucousal exposure to blood or other bodily fluids, more often sexually transmitted one of the first vaccinations received after birth in the US (may not include everyone) can survive for at least 1 week in dried blood

Hep B symptoms

causes inflammation and scarring of the liver may lead to chronic liver disease, liver cancer, and death symptoms cocur 1-9 months after exposure (must be tested for up to one year if unvaccinated)

Lab safety manuals

contain newest info regarding lab safety practices, regulations for lab equipment, MSDS, how to react to exposures or accidents within the lab

Engineering controls

devices or technology designed to minimize potential exposure to infectious agents Ex: biohazard containers, surface and skin disinfectants, and safety needles

What to be familiar with for hospital labs

how to collect samples and label them properly how to access the system for ordering and retrieving results how to track down delayed results be aware of turn around times

Hep C post-exposure prophylaxis

immune globulin and antiviral agents are not recommended for PEP after exposure to HCV positive blood exposure risk is extremely small and the immune globulin can have intense side effects you are tested continuously until it is sure you are fine, and if you develop the disease you will begin treatment immediately

Biohazard material

infectious material or agent that presents a risk to the health of humans, other species, or the environment requires every person exposed to direct contact with bodily fluids be protected from potential infection

HIV post-exposure prophylaxis

initiate as soon as possible! 4 week anti-retroviral regimen (intense) antibody testing should be performed for at least 6 months post-exposure

Signs and Labels

labels must include the biohazard symbol and the term "biohazard" must be attached to containers of regulated biohazard waste, fridges or feezers containing blood or OPIM, and containers use to store or transport blood/OPIM

Regulated medical waste

liquid, semi-liquid blood or other potentially infectious material (OPIM) must be labelled on any biohazard containers

Material Safety Data Sheet (MSDS)

lists potential safety hazards in the lab provides employees with procedures for handling or working with substances in a safe manner what protective equipment is needed when collecting and testing samples

Hepatitis C

most common chronic blood borne infection in the US, no vaccination, almost strictly blood borne, symtpoms are the same as Hep B, may lead to chronic liver disease and death

Are vomit, urine, or saliva infectious for blood borne pathogens?

only if they contain blood

Private labs

privately owned usually offer more diverse tests (autoimmune disorders) often multiple locations usually have a wide range of hours of operation

STAT tests

right away, emergency

Transmission potential for healthcare professionals

skin (minimal), needle exposure (significant), splash exposure onto mucous membranes

Universal precautions

steps taken to prevent the spread of disease through blood and other body fluids when providing first aid or health care, universal rule for what we do to protect ourselves against exposure

Things to be familiar with clinic labs

tests that are done in house tests that are sent out how to perform in-house tests

HIV

the virus that causes AIDS, impairs immune system, does not survive well outside the body

Universal Precautions

treat all human blood or bodily fluid as if it is infectious use PPE perform proper clean up and decontamination after each procedure properly dispose of all contaminated material

Routine tests

you have time