Infection Control and Safety
Which of the following equipment is used to draw blood on an infant? A. 21 gauge needle B. 2.0 mm lancet C. 18 gauge needle D. 2.5 mm lancet
2.0 mm lancet Rationale The lancet used for a heel puncture on a full term infant should not penetrate beyond 2.0 mm (1.8mm for a premature infant). If the blade were to go deeper, the heel bone (calcaneus) might be pierced leaving the child susceptible to a serious bone infection known as osteomyelitis. Insufficient depth will not yield adequate blood flow. A 21 gauge needle would be too large for venipuncture on an infant and is not used for dermal puncture. The 18 gauge needle might be used for collection of donor blood from an adult.
When mixing a 10% bleach disinfectant solution following OSHA guidelines, the solution ratio 1:10 should be mixed by adding A. 70 ml water to 30 ml bleach. B. 10 ml water to 90 ml bleach. C. 9 ml water to 10 ml bleach. D. 90 ml water to 10 ml bleach.
90 ml water to 10 ml bleach. Rationale A 10% solution of bleach requires the addition of 10 ml of bleach to 90 ml of water. This is the standard ratio used for surface disinfection purposes.
While in the processing area, the phlebotomist accidently breaks a vacuum tube filled with blood on the counter, spilling it on the patient requisition form and the laboratory floor. Which of the following actions should the phlebotomist take next? A. Assess the counter to determine if it would be damaged by bleach and water. B. Don gloves and gown. C. Absorb the spill using paper towels. D. Secure a biohazard container for disposal.
Absorb the spill using paper towels. Rationale A spill of blood or other body fluid represents a possible bloodborne pathogen exposure. Special chemical solutions and kits can be used. Gloves must be worn. Cleanup should concentrate on the absorption of fluid without spreading it around. Paper towels may be used but any glass or sharps involved must be placed in a sharps container. Non sharp cleanup materials should be disposed of in biohazard bags. The counter may be wiped down with a 10% bleach solution which will not damage the surface.
The phlebotomist is in the process of finishing the blood draw and has untied the tourniquet with removal of the tube from the tube holder. Upon taking the needle out of the skin, which of the following should the phlebotomist do next? A. Engage the safety, disassemble the tube holder with needle, and discard. B. Disassemble the tube holder with needle, engage the safety, and discard. C. Engage the safety and discard the tube holder with needle. D. Discard the tube holder with needle.
Engage the safety and discard the tube holder with needle. Rationale When discontinuing a venipuncture, it is crucial to immediately activate the needle safety device to prevent injury to the patient or the phlebotomist. The holder and needle are then discarded as a unit into a sharps container. The unit is not disassembled as this presents a safety risk.
Which of the following actions should the phlebotomist take first after coming into direct contact with a patient's blood via needlestick injury? A. Obtain the Hep B vaccine if not currently immunized. B. Apply pressure at the site to stop the bleeding. C. Flush the area with water and thoroughly wash it. D. Inform the patient about the incident.
Flush the area with water and thoroughly wash it. Rationale All heathcare facilities are required by OSHA to have a Bloodborne Pathogen exposure control plan. Part of this plan includes the steps to follow if a sharps injury occurs. The first step is to remove the sharp from the wound and wash the site with soap and water for at least 30 seconds. Then inform the immediate supervisor and report to a licensed healthcare provider for evaluation and treatment. It is very important to also document the event on an incident report form. The hepatitis B vaccine is offered to all healthcare workers within 10 days of beginning employment and the phlebotomist should not be working without it. These wounds usually do not require much pressure to stop bleeding although a bandage may be applied. Unless informed consent is needed to perform follow up testing for hepatitis B and HIV, the patient is not informed.
Which of the following indicates the correct order for donning PPE? A. Gloves, mask, gown B. Gown, mask, gloves C. Mask, gloves, gown D. Mask, gown, gloves
Gown, mask, gloves Rationale The term "don" means to put on. According to CDC and HICPAC Guideline for Isolation Precautions, the following PPE (personal protective equipment) donning (putting on/garbing) is recommended: Gown first, then Mask and Gloves last. All PPE must be donned in the appropriate aseptic manner. Gown must be put on in such a way as to only touch the inside surface and to avoid touching the outside of the gown. Mask must be donned so as to create protection around the airways including nose and mouth. Make sure to contour the upper portion of the mask around the nose bridge. Gloves must be donned over the cuff of the gown in order to create a seal and protect the wrist. The correct PPE doffing (taking off/removing) order is the following: Gloves first, then Gown and Mask last.
Which of the following diseases is a healthcare worker at the greatest risk of developing following an exposure incident with blood from a needlestick injury? A. HIV B. HAV C. HPV D. HBV
HBV Rationale Hepatitis B is the most transmissible infection, and the only one preventable by immunization.
The phlebotomist encounters an unfamiliar chemical in the laboratory. Which of the following should she reference for guidance in handling this chemical? A. CDC B. OSHA C. NFPA D. MSDS
MSDS Rationale OSHA (Occupational Safety and Health Administration) is the federal agency responsible for reducing and preventing exposure to worker injuries. This agency requires that every chemical purchased or stored in a facility to have a MSDS (material safety data sheet), now called SDS (safety data sheet) to align with the international GHS (globally harmonized system). Information contained in these documents include: chemical identification, hazard identification, composition (ingredients), first aid measures, firefighting measures, accidental release (spill) measures and handling and storage. The NFPA (National Fire Protection Agency) has developed a labeling system to alert workers of exposure dangers of chemicals. The CDC (Centers for Disease Control and Prevention) is the federal agency responsible for identifying, monitoring and reporting diseases capable of becoming epidemic.
A large open container of isopropyl alcohol is spilled on the floor in the clinic waiting area. The phlebotomist should use which of the following resources for information about the chemical and any necessary procedure? A. Material Safety Data Sheet B. Clinical Laboratory Improvement Amendments C. Poison Control Center D. Physician's Desk Reference
Material Safety Data Sheet Rationale OSHA mandates that all chemicals have a Material Safety Data Sheet (MSDS). With implementation of GHS, now called Safety Data Sheet. Details provided must include: product identification, hazard(s) identification, composition (ingredients), first aid measures, firefighting measures, accidental release (spill) measures and handling and storage. Recently MSDS have been changed to Safety Data Sheets (SDS) in an effort to align with the new Globally Harmonized System (GHS) that is now being used worldwide. These documents contain all the information on how to safely handle each chemical including how to contain and clean up a spill. The Clinical Laboratory Improvement Amendments (CLIA) govern laboratory operations, the Poison Control Center assists with treatment of poisoning incidents and the Physician's Desk Reference (PDR) outlines pharmaceutical products.
Which of the following microorganisms is commonly associated with a hospital acquired infection? A. Staphylococcus epidermidis B. Group A Streptococcus C. Methicillin-resistant Staphylococcus aureus D. Neisseria gonorrhoeae
Methicillin-resistant Staphylococcus aureus Rationale Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. diff) are two of the most commonly nosocomial or healthcare associated infection pathogens. Staphylococcus epidermidis is one of the microorganisms that makes up normal flora on the skin is not considered to be pathogenic (able to cause disease) under normal conditions. Group A Sterptococcus is the pathogen that can cause common strep and individuals may carry this microorganism without having or showing or any symptoms. Neisseria gonorrhoeae is the pathogen that causes the sexually transmitted diseases gonorrhea.
In addition to standard PPE, what additional PPE should the phlebotomist don before entering a patient's room with airborne precautions? A. surgical mask B. N95 respirator C. mask with face shield D. full face/head mask
N95 respirator Rationale Precautions for airborne infections include negative pressure patient rooms and N95 respirators for healthcare workers. A surgical mask may not be sufficient. Masks with a face shield or a full face / head mask are used in cases of potential splashes or aerosols of body fluids.
The regulatory agencies for safety in health care settings include which of the following? (Select the three (3) correct answers.) A. OSHA B. NFPA C. CMS D.CDC E. CLIA
OSHA, NFPA, CDC Rationale OSHA (Occupational Safety and Health Administration) is the federal agency responsible for reducing and preventing exposure to worker injuries. The NFPA (National Fire Protection Agency) has developed a labeling system to alert workers of exposure dangers of chemicals. The CDC (Centers for Disease Control and Prevention) is the federal agency responsible for identifying, monitoring and reporting diseases capable of becoming epidemic. CMS (Centers for Medicare & Medicaid Services) oversees Medicare, Medicaid, CLIA'88 and COLA. CLIA (CLIA'88) is the federal law that regulates medical laboratory testing.
Which of the following interventions is required by an employer, at no cost to the employee, following a needlestick exposure? A. Offer Hepatitis B vaccine if the needle was contaminated. B. Place exposed personnel on antiviral medications. C. Offer HIV testing to the employee's spouse or significant other. D. Provide a confidential medical evaluation.
Provide a confidential medical evaluation. Rationale Counseling, education, and follow-up should be provided by an employer for up to one year after exposure.
Which of the following measures is applicable when drawing blood on patients who have not been identified as potentially infectious? A. Contact Precautions B. Standard Precautions C. Droplet Precautions D. Airborne Precautions
Standard Precautions Rationale Standard precaution is an approach to infection control that treats all patients, regardless of their disease and/or infection status, as potentially infectious. All blood, body fluids, secretions, and excretions, except for sweat are considered to be contaminated with bloodborne pathogens and capable of transmitting the infection. Healthcare professionals must use Standard Precautions with all patients at all times whenever contact with blood or body fluids is anticipated. Standard Precautions include wearing gloves and using proper hand hygiene before and after each patient contact. Contact, Droplet, and Airborne Precautions are all part of Transmission-Based Precaution, which is always used in addition to Standard Precaution and only when the patient is suspected of or has been diagnosed with a highly transmissible and infectious agent. The need for Transmission-Based Precaution will be determined by a physician.
After a venipuncture, a patient experienced severe nerve damage and lost feeling in his fingers. Which of the following actions by the phlebotomist most likely led to this event? A. The incorrect needle angle was used. B. The needle was inserted with bevel down. C. The needle was inserted too shallow. D. The cephalic vein was used.
The incorrect needle angle was used. Rationale Nerve damage typically occurs during a venipuncture when nerves are accidentally pierced. This may happen if the basilic vein is chosen and the correct angle of needle insertion (< 30 degrees) is not followed. The basilic vein is always chosen last as it is located in an area of the antecubital fossa that contains an artery and many nerves. If possible, the veins should be chosen in the following order: median cubital which is well anchored in tissue, cephalic on the outside and basilic if neither of the first two options is viable after examining both arms. Inserting the needle with the bevel down may cause it to settle on the vein wall and obstruct blood flow. Placing the needle too shallowly will miss the vein.
A phlebotomist completes a blood collection using the evacuated system with a safety needle. The needle safety device is activated immediately following the collection. The needle is removed from the tube holder/adapter and discarded in a sharps container. Which of the following correctly describes the phlebotomist's actions? A. The phlebotomist activated the needle safety device too soon, but removing the needle was acceptable. B. The phlebotomist activated the needle safety device too soon and the needle and tube holder/adapter should not be separated. C. The phlebotomist activated the needle safety device appropriately and removing the needle was acceptable. D. The phlebotomist activated the needle safety device appropriately, but the needle and tube holder/adapter should not be separated.
The phlebotomist activated the needle safety device appropriately, but the needle and tube holder/adapter should not be separated. Rationale Upon completing a blood draw by venipucture, the needle safety device is immediately activated to prevent an accidental needlestick injury to the phlebotomist or the patient. OSHA then advises that the holder and needle be placed into a sharps (puncture proof) container as a unit. Both pieces of phlebotomy equipment are "single use".
The phlebotomist has successfully found a vein and is drawing the blood. Suddenly the blood flow stops. Which of the following is the most likely cause? A. The tube has lost vacuum. B. The wrong gauge needle was used. C. There is an occlusion in the vein. D. The patient suffers from chronic venous insufficiency.
The tube has lost vacuum. Rationale Evacuated blood collection tubes are a manufactured item. Despite good quality control measures, tubes can become faulty due to production, transport or storage issues and may lose all or part of the vacuum. It is good practice for the phlebotomist to carry extra tubes for the requested tests in case a tube will not fill. Trying a new tube is the first thing to do to recover the draw. If this doesn't work, slight repositioning the needle forward or backward may relocate the needle in the vein. If these measures fail, the draw may have to be discontinued and an attempt made to draw from another site. If the vein has an occlusion, it is doubtful the first tube would have filled. The patient's diagnosis, such as chronic venous insufficiency should not affect the draw.
After drawing a patient for an HIV, HBV and HCV antibody test, the phlebotomist accidentally sticks his finger when discontinuing the venipuncture. Which of the following would the phlebotomist do next? A. Report the incident to the immediate supervisor. B. Wash the site with a disinfectant for a minimum of 30 seconds. C. Wash the site with soap and water for a minimum of 30 seconds. D. Report directly to a licensed healthcare provider for treatment.
Wash the site with soap and water for a minimum of 30 seconds. Rationale All healthcare facilities are required by OSHA to have a Bloodborne Pathogen exposure control plan. Part of this plan includes the steps to follow if a sharps injury occurs. The first step is to remove the sharp from the wound and wash the site with soap and water for at least 30 seconds. Disinfectant is not necessary. Then inform the immediate supervisor and report to a licensed healthcare provider for evaluation and treatment. It is very important to also document the event on an incident report form.
A phlebotomist must collect a blood specimen from a patient with contact transmission precautions. Which of the following is the best type of tourniquet the phlebotomist should use? A. a disposable tourniquet B. a blood pressure cuff C. a pediatric tourniquet D. a velcro tourniquet
a disposable tourniquet Rationale Contact precautions are used in combination with standard precautions for patients known to have or suspected of having infections that are transmitted by direct contact with the patient or indirect contact with surfaces of patient care items. In this case, it is best to use a single use disposable tourniquet. Reusable tourniquets, such as blood pressure cuffs or Velcro types would risk spreading the infection. The size of the tourniquet is governed by the size of the patient.
Which of the following illnesses fall under airborne transmission precautions? (Select the three (3) correct answers.) A. adenovirus B. varicella C. respiratory syncytial virus (RSV) D. measles E. MRSA
adenovirus, varicella, measles Rationale Airborne infections (requiring a mask or respirator) are carried by droplet nuclei particles smaller than 5 um and include tuberculosis, measles, chickenpox, adenovirus (common cold) and mumps. RSV (respiratory syncytial virus) is categorized as droplet transmission and MRSA (methcillin resistant staphlococcus aureus) is considered a contact transmission.
When using a Vacutainer the needle guard should be engaged immediately A. before applying the pressure bandage. B. after removing the needle. C. after removing the tourniquet. D. before discarding in a biohazard bag.
after removing the needle. Rationale To prevent accidental needlesticks and exposure incidents, the needle safety device should be activated immediately upon removal from the venipuncture site. This is done after the tourniquet is removed and before bandaging the patient. All used needles and venipuncture equipment should be disposed of in a sharps container.
A phlebotomist in a hospital setting must perform a venipuncture on a patient who has been diagnosed with varicella. Which of the following is the minimum precaution level the phlebotomist must take? A. isolation B. droplet C. airborne D. contact
airborne Rationale Transmission based precautions are followed when a patient is known or suspected of having a specific disease. Varicella (chickenpox) can be dangerous for pregnant women, premature infants and immunocompromised patients. Airborne protocols are followed including negative flow rooms and care provided by staff with proven immunity.
When in the laboratory area, the phlebotomist should wear face shields when A. receiving tests. B. batching specimens. C. aliquoting specimens. D. centrifuging specimens.
aliquoting specimens. Rationale When uncapping tubes an aerosol of blood or body fluid may be created so face shields are used to prevent these samples from being splashed onto the mucous membranes of the face. An alternative to a face shield is a Clear Acrylic Biohazard Shield which sits on a countertop or a hood with a barrier between the specimen and the processor. Receiving, centrifuging, and batching specimens will not create splashes or aerosols until the caps are removed. Gloves should be worn whenever handling any bodily specimen.
While performing a venipuncture the patient has a seizure and the needle accidentally sticks the phlebotomist's gloved hand. The phlebotomist should clean the site with A. disinfectant for a minimum of 30 seconds. B. antimicrobial soap and water for a minimum of 30 seconds. C. 70% isopropyl alcohol for a minimum of 10 minutes. D. sterile saline for a minimum of 10 minutes.
antimicrobial soap and water for a minimum of 30 seconds. Rationale The first step to take after a sharps injury is to wash the area with soap and water for a minimum of 30 seconds. Most soap solutions available in healthcare facilities are antimicrobial. Sterile saline or 70% alcohol are not necessary. Disinfectants are used for surfaces, not on skin.
CDC guidelines require a blood glucose meter to be disinfected A. between patient use. B. daily. C. weekly. D. hourly.
between patient use. Rationale If blood glucose meters must be shared, the device should be cleaned and disinfected after every use, per manufacturer's instructions, to prevent carry-over of blood and infectious agents.
Which of the following chemicals is most commonly used to disinfect work surfaces and the bottom of the phlebotomy tray? A. benzalkonium chloride B. chlorhexidine gluconate C. isopropanol D. bleach
bleach Rationale Antiseptics such as benzalkonium chloride (BZK), chlorhexidine gluconate and isopropanol are used on skin. Bleach (sodium hypochlorite) is used as a disinfectant to decontaminate surfaces and has been shown to be a highly effective germicide. Most commonly used is a 10% bleach solution (100 ml bleach + 900 ml water).
Which of the following should the phlebotomist use to disinfect equipment and facilities? A. alcohol B. antiseptic C. iodine D. bleach
bleach Rationale OSHA requires surfaces in specimen collection and processing areas to be decontaminated with a 1:10 bleach solution or other EPA approved disinfectant. This should be done at the end of each shift and gloves should be worn. An antiseptic such an alcohol or iodine differs from a disinfectant in that it is used to clean skin and not surfaces.
Which of the following actions by the phlebotomist caring for a patient in isolation is contraindicated? A. limiting the supplies in the room to only those necessary for the draw B. bringing a phlebotomy tray into the room C. leaving unused phlebotomy supplies in the room D. removing PPE before completely exiting the room
bringing a phlebotomy tray into the room Rationale If a patient is in an isolation environment, it is imperative to limit and control exposure of staff and visitors to the contagious agent. This can be accomplished by only bringing in the supplies the phlebotomist needs for a blood draw and leaving any extras in the room. Bringing a phlebotomy tray into the room would require taking it back out which would risk spreading infection. Isolation rooms typically have an area between the room and the exit to the hallway in which PPE can be removed and bagged. Hand washing facilities are also located in this space.
Which of the following devices has the highest potential for a needlestick injury? A. single sample needle B. butterfly winged infusion set C. lancets D. syringes
butterfly winged infusion set Rationale Of the equipment commonly used for venipuncture, the butterfly winged infusion set is considered the most likely to cause a needlestick injury. Although required to have safety devices, the small size can make these sets more awkward to handle than the ETS or syringe system. Lancets have an automatic, spring loaded withdrawal system that prevent the sharp from being exposed once activated.
OSHA requires that a sharps container be A. changed every thirty days. B. changed when it is ¾ full. C. placed inside a locked container. D. placed out of reach of children.
changed when it is ¾ full. Rationale Sharps containers are designed to be puncture proof for the disposal of needles, lancets and objects that pose a "sharps" injury risk. OSHA states they are to be closed and locked for disposal at ¾ full. The lid will self lock when full. The length of time is governed by the amount of sharps waste being generated. All medical equipment should be kept out of reach of children.
Which of the following is the most common means of transmission of Hepatitis A? A. sexual contact B. contact with contaminated needles C. contact with fecal contaminated food/water D. forceful coughing
contact with fecal contaminated food/water Rationale Infectious disease of the liver caused by the Hepatitis A virus. All other hepatitis virus (B, C, D, E) are bloodborne pathogens.
An unbalanced centrifuge causes a specimen collection tube to break inside of the device. The phlebotomist should A. sterilize the equipment. B. discard the equipment. C. disinfect the equipment. D. sanitize the equipment.
disinfect the equipment. Rationale The breakage of a tube of body fluid in a centrifuge creates a possible bloodborne pathogen exposure. The equipment should be disinfected with an approved disinfectant or 10% bleach. Gloves must be worn. There is no need to discard or sterilize the equipment.
A phlebotomist in a doctor's office needs to perform a venipuncture on a patient who has been diagnosed with Severe Acute Respiratory Syndrome. Which of the following is the transmission based precaution the phlebotomist must take? A. standard B. droplet C. airborne D. contact
droplet Rationale : Severe Acute Respiratory Syndrome (SARS) is spread by droplets from coughing or sneezing. A phlebotomist would use droplet transmission based precautions for this disease. Transmission based precautions are used when a patient is known to have or is suspected of having a specific disease. The three categories are airborne, droplet and contact. Droplet precautions are used for SARS. Standard precautions are based on the assumption that all patients may be infective and are used with all patients.
A phlebotomist has been asked to collect a specimen from a patient with bacterial meningitis. Which of the following transmission-based precautions should be used? A. contact B. complete isolation C. airborne D. droplet
droplet Rationale In 1996 the CDC implemented two new levels of infectious control standards. The first, Standard Precautions, replaced Universal Precautions, and stated that all blood and body fluids are to be presumed infectious. The second, Transmission Based Precautions, are established by how infectious agents are spread and are used in addition to Standard Precautions when a specific disease is suspected or known in a patient. Three categories are provided: Airborne, Droplet and Contact. Airborne infections (requiring a mask or respirator) are carried by droplet nuclei particles smaller than 5 um and include tuberculosis, measles, chickenpox and mumps. Droplet infections (requiring a mask) are dispersed by coughing and sneezing and include meningitis, whooping cough, influenza and respiratory synctial virus. Examples of contagious agents spread by Contact mode (requiring gown and gloves) are Clostridium difficile, rotavirus, antibiotic resistant infections, and herpes simplex. See the following link: http://www.cdc.gov/HAI/settings/outpatient/basic-infection-control-prevention-plan-2011/transmission-based-precautions.html Complete isolation is a category of former isolation procedures that have been replaced by Transmission Based Precautions. (Basic Medical Laboratory Techniques, Estridge, 2002, 4th Ed., pg 471, Table 7-11)
A patient presents to the emergency department coughing up blood. Which of the following safety equipment should be used to protect from droplets or airborne pathogens? A. gloves B. face shield C. gown D. mask
face shield Rationale In this case, a face shield would be used to protect the healthcare worker from splashes of body fluid. A mask would not cover the eyes which could be a potential entry point for infectious material. A gown is used in contact precautions and gloves are always worn as part of standard precautions.
The most important thing to do if the phlebotomist sustains a sharps injury is to A. inform the patient. B. look up her medical history. C. file an incident report. D. change gloves immediately.
file an incident report. Rationale After a bloodborne pathogen exposure event such as a needlestick injury, the area must be washed with soap and water. The phlebotomist should then immediately report the event to the supervisor and to employee health. An incident report should also be filled out. All healthcare facilities are required to have an exposure control plan and the elements of this policy should be followed and documented. Unless informed consent is required to test the involved patient's blood for bloodborne pathogens, there is no reason to inform the patient. Looking up the patient's medical history would be a HIPAA infraction. A glove change is required after each patient and would not contribute to the phlebotomist's safety after the needlestick. The important thing is to be proactive in reporting and following up on the exposure and to assess how to prevent future such accidents.
The phlebotomist is entering a room marked with Contact Precautions. Which of the following items must be worn? (Select the two (2) correct answers.) A. gloves B. mask C. gown D. N95 respirator E. goggles
gloves, gown Rationale Transmission based isolation precautions are a subset of Standard Precautions designed by how infectious agents are spread. There are three categories. Contact requires gloves and gown, droplet requires a mask and eye protection (goggles), and airborne requires an N95 respirator.
Which of the following is the proper order for removing PPE? A. gloves, gown, mask B. gown, mask, gloves C. gloves, mask, gown D. mask, gloves, gown
gloves, gown, mask Rationale To remove PPE (personal protective equipment), the gloves are removed first as these are considered likely to be most contaminated. Using a gloved hand, grasp the palm area of the other gloved hand and peel off first glove. Hold removed glove in gloved hand. Slide fingers of ungloved hand under remaining glove at wrist and peel off second glove over first glove. Discard gloves in a waste container. The gown is then removed by pulling it from the shoulders, turning it inside out and then rolling it into a bundle before disposal. The mask is removed last by touching only the ties.
The phlebotomist has a requisition to collect blood from a pediatric patient in a contact isolation unit. The necessary PPE includes gloves and A. face shield. B. gown. C. mask. D. bonnet.
gown. Rationale Standard precautions (1996) combine the use of PPE (personal protective equipment) with hand hygiene and apply to blood, all body fluids, non-intact skin or mucous membranes. Transmission based isolation precautions are a subset of Standard Precautions designed by how infectious agents are spread. There are three categories. Contact requires gloves and gown and are used in any case in which the healthcare worker may be exposed to body fluids. Droplet requires a mask and eye protection (goggles), and airborne requires an N95 respirator with the patient placed in a negative airflow environment. Bonnets are used to keep hair from falling into and contaminating surgical sites and are not typically used by phlebotomists.
The phlebotomist is performing blood collection and an accidental arterial puncture occurs. Which of the following actions by the phlebotomist is likely to have caused this accident? (Select the two (2) correct answers.) A. probing to find a vein B. prolonged tourniquet application C. inserting the needle near the basilic vein D. vigorous fist pumping E. using too large a needle
probing to find a vein, inserting the needle near the basilic vein Rationale If blood flow is not established immediately, especially if using the basilic vein, advancing the needle further may result in entering the brachial artery. Also, probing to find a vein can cause an arterial puncture. If the facility allows, the venipuncture may be continued but extra direct pressure must be kept on the site for at least 5 minutes (10 minutes if patient is on anticoagulant therapy) or until bleeding has stopped. A pressure bandage with Coban should then be applied. The tubes collected should be labeled as "arterial" blood, as some analyte values are different in arterial and venous blood samples. Some facilities policies state to immediately discontinue the draw if an artery is punctured, as this is considered a risk for the patient. It is crucial to know and follow your facility protocol. Prolonged tourniquet application and vigorous fist pumping may cause hemoconcentration. Using too large a needle may cause the patient discomfort but does not, in and of itself, cause arterial puncture.
The Needlestick Safety and Prevention Act, in conjunction with OSHA, mandates employers to A. provide immediate medical evaluation and scheduled surveillance. B. protect access to medical records of the potential source individual. C. provide educational inservices yearly on safe needle re-capping and disposal. D. have source individuals tested for blood borne pathogens.
provide immediate medical evaluation and scheduled surveillance. Rationale The Needlestick Safety and Prevention Act passed in 2001 outlines steps that employers must take in case of employees' sharps injuries. Among these is the provision of immediate access to medical evaluation and treatment. This includes having source individuals tested for bloodborne pathogens. Yearly educational inservices are also part of this plan. Confidentiality and management of protected health information (PHI) are mandated by the HIPAA law.
Upon arriving to work the phlebotomist notices all the sharp containers are full. The phlebotomist should A. gently shake the containers to settle the contents. B. seal the containers in biohazard bags and replace. C. put the containers in a biohazard box and replace. D. carefully empty the containers into a biohazard box and refill.
put the containers in a biohazard box and replace. Rationale In an effort to reduce needlestick injuries, the needlestick Safety and Prevention Act of 2001 mandates that all sharps (needles, lancets, broken glass, etc.) be deposited into a puncture proof, lockable sharps container. When the container is ¾ full, the top is sealed and placed into a biohazard box for appropriate disposal. The containers are not shaken down or placed into biohazard bags and never emptied for reuse.
The syringe method has been used to draw an oncology patient. In the process of transferring the blood from the syringe to evacuated tube, the top of the tube pops off and blood is splattered into the phlebotomist's eyes. The first course of action is to flush the eyes and then immediately A. go to the ER. B. report the incident to supervisor/manager. C. have source blood tested for HBV and HIV. D. have the phlebotomist's blood tested for HBV and HIV.
report the incident to supervisor/manager. Rationale All healthcare facilities are required by OSHA to have an exposure control plan in place in case of sharps injuries or blood borne pathogen exposures. When an incident occurs, the first step is to wash the injured area with soap and water. Then report to the supervisor who will oversee and document the occurrence. Both the phlebotomist and the source will be tested for HBV & HIV.
A phlebotomist fails to activate the needle guard after the draw, which results in an accidental needle stick. Which of the following should immediately be used to cleanse the site? A. disinfecting alcohol B. soap and tap water C. sterile saline D. sanitizing agent
soap and tap water Rationale After a bloodborne pathogen exposure event such as a needlestick injury, the area must be washed with soap and water. The phlebotomist should then immediately report the event to the supervisor and to employee health. An incident report should also be filled out. All healthcare facilities are required to have an exposure control plan and the elements of this policy should be followed and documented. Alcohol, sterile saline or a sanitizing agent are not typically used. The important thing is to be proactive in reporting and following up on the exposure and to assess how to prevent future such accidents.
A phlebotomist has received a requisition to collect a blood specimen on patient infected with influenza. The phlebotomist must be sure to follow A. standard precautions and droplet precautions B. droplet precautions and contact precautions C. standard precautions and contact precautions D. droplet precautions and airborne precautions
standard precautions and droplet precautions Rationale In 1996 the CDC implemented two new levels of infectious control standards. The first, Standard Precautions, replaced Universal Precautions, and stated that all blood and body fluids are to be presumed infectious. The second, Transmission Based Precautions, are established by how infectious agents are spread and are used in addition to Standard Precautions when a specific disease is suspected or known in a patient. Three categories are provided: Airborne, Droplet and Contact. Airborne infections (requiring a mask or respirator) are carried by droplet nuclei particles smaller than 5 um and include tuberculosis, measles, chickenpox and mumps. Droplet infections (requiring a mask) are dispersed by coughing and sneezing and include meningitis, whooping cough, influenza and respiratory syncytial virus. Examples of contagious agents spread by Contact mode (requiring gown and gloves) are Clostridium difficile, rotavirus, antibiotic resistant infections, and herpes simplex.
The phlebotomist arrives at the room of a patient on droplet precautions due to whooping cough. Which of the following personal protective equipment must be used? A. surgical mask B. fluid resistant gown C. N95 respirator D. sterile gloves
surgical mask Rationale Droplet precautions are used in addition to standard precautions for patients known to or suspected of having a disease transmitted by droplets (particles larger then 5 um) generated by sneezing or coughing. Whooping cough (pertussis) is one such infection. A surgical mask is part of PPE for these precautions. A fluid resistant gown is used for contact precautions and an N95 respirator for TB. Sterile gloves are not necessary unless an invasive procedure is being performed.
Which of the following must be included when completing a phlebotomy related exposure incident report? A. the type of device used to collect the specimen B. the type of tube used for the collection C. the requisitioned test D. the medical condition of the patient
the type of device used to collect the specimen Rationale In completing a phlebotomy related exposure incident report, it is imperative to include the type of device used that malfunctioned during the collection of the specimen and failed to protect the healthcare professional. The type of tube used for the collection and the requisition test will not affect the exposure control protocols and will play no role in assessing the injured employee. The physician or the nurse must obtain consent from the source patient to test for bloodborne pathogens. The patient, however, is under no obligation to consent and cannot be compelled to divulge his or her medical condition under HIPAA. If the patient does not consent, the exposed employee will be offered existing prophylactic treatment options for known and/or suspected bloodborne pathogens.
Which of the following is the correct type of glove to wear when performing phlebotomy? A. one size smaller than phlebotomist correct size B. tight fitting gloves that are not irritable to the hands C. loose fitting and latex free D. one size larger than phlebotomist correct size
tight fitting gloves that are not irritable to the hands Rationale Glove size has a large impact on the tactile sensitivity of the phlebotomist's ability to palpate a vein. The glove should fit snuggly but not so tight as to inhibit movement of the fingers. Too loose a fit makes the glove awkward to use. Most gloves used in phlebotomy today are latex free to prevent allergic reactions in either the patient or the phlebotomist. It is very important for the phlebotomist to ask the patient about any latex allergy before beginning the procedure.
If accidentally exposed to bloodborne pathogens, the phlebotomist's first course of action should be to A. call the CDC to report the exposure. B. report to an immediate supervisor. C. wash the site with soap and water. D. report directly to a healthcare provider for medical evaluation and treatment.
wash the site with soap and water. Rationale After a bloodborne pathogen exposure event such as a needlestick injury, the wound must be washed with soap and water. The phlebotomist should then immediately report the event to the supervisor and to employee health. An incident report should also be filled out. All healthcare facilities are required to have an exposure control plan and the elements of this policy should be followed and documented. The important thing is to be proactive in reporting and following up on the exposure and to assess how to prevent future such accidents. Any reports to the CDC are handled by administration.
Which of the following is the proper point at which a sharps container should be disposed of? A. ¾ full B. full C. ½ full D. at the discretion of the facility
¾ full Rationale The needlestick Safety and Prevention Act (2001) was passed to reduce sharps injuries in the healthcare field. Part of this law dictates that a puncture proof and self closing container be used for the disposal of needles and other sharps. These containers are closed when ¾ full and placed into biohazard waste boxes for disposal.
