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