c2-PATIENT AND EMPLOYEE SAFETY.docx

PATIENT AND EMPLOYEE SAFETY =========================== Sharps and biohazards according to the Bloodborne Pathogens Standard -------------------------------------------------------------------- The Bloodborne Pathogen Standard identifies sharps as any item that can easily break skin and therefore...

PATIENT AND EMPLOYEE SAFETY =========================== Sharps and biohazards according to the Bloodborne Pathogens Standard -------------------------------------------------------------------- The Bloodborne Pathogen Standard identifies sharps as any item that can easily break skin and therefore potentially transmit disease. Examples of sharps include venipuncture needles, double-sided needles for use with an evacuated tube system, lancets, butterfly needles, syringe needles, microscope slides, and glass capillary tubes. Use the safety devices on sharps immediately after blood collection. Do not recap them. Dispose of them immediately after use into a sharps container. The National Institute for Occupational Safety and Health (NIOSH) is a federal agency with the mission to develop new knowledge in the field of occupational safety and health and transfer that knowledge into practice. NIOSH updates regulations for workplace safety annually, including the handling and use of sharps containers. This organization has identified that incorrect sharps disposal is a significant cause of sharps injuries in the workplace. For that reason, it stresses the importance of four criteria: functionality, accessibility, visibility, and accommodation. Sharps containers must have the following: - **Functionality:** Be leak- and puncture-resistant, durable for transport, of the appropriate size and shape, and have a secure closure that protects against exposure during closing - **Accessibility:** Be upright and easy to operate, within easy reach, below eye level, and located away from obstructive areas or near doors or sinks - **Visibility:** Have the fill level and the biohazard symbol clearly visible - **Accommodation:** Require minimal training, be easy to operate (facilitating one-handed use), and have a mounting system that is safe, durable, and stable OSHA, through the Bloodborne Pathogen Standard, also provides regulations for handling sharps containers. Close them after each use, when in transport, and when not in use. Dispose of used strips, plastic blood tubes, gauze, and any other non-sharp items that are heavily contaminated with blood into a biohazard bag. These thick plastic bags are usually red or orange, display the biohazard symbol, and help retain fluids but are not necessarily leakproof. Do not place any item in a biohazard bag that could cause rips or tears, which would increase the risk for contamination and injury. NIOSH guidelines and regulations promote actions that maximize safety. - Implement the use of devices with safety features and evaluate their use to determine which are most effective and acceptable. - Set priorities and strategies for prevention by examining local and national information about risk factors for needlestick injuries and successful intervention efforts. - Modify work practices that pose a needlestick injury hazard to make them safer. - Promote safety awareness in the work environment. - Use devices with safety features provided by the employer. - Do not recap needles. - Plan for safe handling and disposal before beginning any procedure using needles. - Dispose of used needles promptly in appropriate sharps disposal containers. - Report all needlestick and other sharps-related injuries promptly to ensure that employees receive appropriate follow-up care. - Inform employers about any hazards from needles in the work environment. Exposure control plans in the event of occupational exposure ------------------------------------------------------------ Each facility must have an exposure-control plan in place that includes the level to which each employee is at risk, what precautions to take, and what to do after an accidental exposure to body fluids or other hazards. To prevent accidental exposure, employees must participate in annual bloodborne pathogen training. To reduce accidental exposures, employees must implement infection-control practices, use safeties on devices, properly dispose of potentially infectious material, and obtain hepatitis B immunizations. All staff should regularly review safety practices and precautions in the workplace safety manual, including clear explanations that describe the steps to take when an incident occurs. When an accidental exposure to blood or body fluids occurs (a needlestick with a used needle; a splash into the eyes, nose, or other orifice; or a cut or puncture from a used instrument) it is important for those involved to remain calm. Following the correct steps can often minimize the effect from the exposure. For an accidental needlestick, immediately decontaminate the puncture site with an antiseptic (such as iodine) or soap and water. Next, notify the immediate supervisor, providing information such as how the exposure occurred, the department or area where it occurred, and which equipment, PPE, and safety measures were used. Document this information in the sharps injury log and on the facility\'s incident report form. Have a medical examination as soon as possible from an urgent care, emergency department, or whatever health care support is available. The provider will ask which vaccines you have had and will likely test for HIV, hepatitis B, and hepatitis C. The patient should also undergo testing for infections but would have to provide consent for blood tests. If the patient has any other infectious disease, you should undergo testing for those diseases as well. If the patient refuses testing, is unavailable for testing, or already has documentation of HIV, HCV or HBV, undergo postexposure prophylaxis. For HIV, the series of injections should begin within 2 hr. of the exposure. If the patient has HBV, the provider will determine your vaccine status. If you have not had HBV immunization, the postexposure prophylaxis will include that immunization. Currently, there is no prophylaxis for HCV, but you should still have a consultation with a health care professional. After the initial evaluation, undergo follow-up examinations at the discretion of the professional who provided the initial examination. After a splash of a body fluid or contaminated material into the eyes, nose, or mouth, immediately flush the areas with large amounts of water. An eye wash station is preferred, but you may use an accessible sink or a commercially prepared product, which is usually sterile saline solution. Report the exposure to the immediate supervisor, along with information such as how the incident occurred, the time and location of the incident, and the substance involved. Then seek an emergency medical examination to determine what further testing and treatment are necessary. If a cut or other break in the skin occurs with a contaminated piece of equipment, flush the area with water and then wash it with soap and water. Notify the immediate supervisor, detailing how and where in the facility the cut occurred, the time and date of the incident, and what type of equipment caused the cut. You will need prompt medical assessment and treatment. You or a witness should complete an incident report as soon as possible following the exposure. Even though most phlebotomists have reasonable concern about exposure to blood through a needlestick injury, remember that other body fluids can be contaminated. Consider any accidental encounter, splash, cut, or puncture involving body fluids a possible source of infection. Know the location of and have a thorough understanding of the resources you might need before accidental exposure incidents occur. Regularly reviewing the facility\'s accidental exposure policies and procedures will help you locate necessary supplies and understand the importance of the necessary documentation so you can take the proper steps in the event of an incident. Transmission-based precautions ------------------------------ Follow basic standard precautions when handling potentially infectious materials (blood, urine, other body fluids). The CDC recommends considering all body fluids from all patients as infectious and to use standard precautions when handling and treating them. In addition to this precaution, standard and transmission-based precautions identify measures to take to protect health care workers when they know a body fluid is infectious. These guidelines protect phlebotomists, patients, and other people who handle contaminated materials. Standard precautions are essential for all patient encounters and involve protection from blood, body fluids, mucous membranes, and nonintact skin. They include hand hygiene and wearing gloves, goggles, face masks, and gowns whenever necessary for protection from body fluids. Transmission-based precautions are used when interacting with and performing procedures on patients who have infections. They vary with the means of transmission (droplet, contact, airborne). Some infections (diphtheria, varicella) require more than one type of transmission-based precautions. Droplet precautions are required for patients who have infections that spread via droplets that are larger than 5 microns in diameter, including rubella, meningitis, diphtheria, mumps, pertussis (whooping cough), and influenza. This means wearing a mask when interacting with patients who have these illnesses. These infections spread via close respiratory interaction, especially when the patient coughs or sneezes. In outpatient settings or when transporting a patient who requires droplet precautions, make sure the patient wears a mask, especially when there is the possibility of encountering other patients, visitors, or staff. Contact precautions are required for patients who have infections that spread via direct contact or contact with the environment (indirect contact). These infections include diphtheria, herpes simplex, scabies, hepatitis A, respiratory syncytial virus, and wound and skin infections, especially with pathogens such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Clostridium difficile (C. diff). Because patients touch many items in their room, you should wear gloves and a gown when handling any items in the patient\'s room. In many facilities, nursing staff post a specific procedure for entering and exiting outside the room. It is important to read any sign outside a patient\'s room to determine which PPE to don when entering and remove before leaving the room. C. diff, MRSA, and VRE are virulent bacteria and difficult to treat, so it is critical to prevent any contamination from leaving the room on clothing, shoes, or skin. Airborne precautions are required for patients who have infections that spread via droplets that are smaller than 5 microns in diameter, including varicella (chickenpox), tuberculosis, and rubeola (measles). This means wearing respiratory protection, such as a mask or an N95 or N99 respirator, when interacting with these patients. Airborne transmission is similar to droplet transmission, but airborne particles span a larger distance of potential spread and tend to have a longer time of virility. Airborne precautions also require patients to be in a negative-pressure room that restricts the airflow from the rest of the facility. Most hospitals have a respiratory isolation protocol in place that dictates patient access and exposure. These patients should also wear a mask when elsewhere in the facility. In the inpatient environment, phlebotomists occasionally perform venipuncture procedures for patients who are in a protective environment or reverse isolation due to their compromised immune status. The patient\'s disease is not necessarily contagious, but their immune system is weak, and therefore they need protection from potential infectious threats. Patients who have cancer, transplant recipients, and others who are immunocompromised are at a higher risk from infection from all sources. It is critical to prevent transmission of infectious agents to the patient by using hand hygiene and wearing PPE. Each facility has specific policies and procedures for access to these patients. Read any sign outside a reverse isolation room. The requirements for handling these patients can include handwashing with a specific antibacterial agent and wearing gloves, a gown, and shoe covers. Unlike isolation for disease, it is necessary to don PPE before entering the patient\'s room and remove it after leaving the room. In any setting, if you have any signs or symptoms of infection, it is in the best interests of the patients to stay home. If this is not possible, don a mask to prevent infecting patients through droplet or airborne transmission. It is unacceptable for a health care worker to transmit an infection to a patient. For some patients, it can be deadly. Standard precautions regarding PPE ---------------------------------- Standard precautions require different types of PPE, depending on the risk of exposure and the type of pathogens you might encounter. It is important to know which PPE to wear when interacting with patients or handling body fluids in the laboratory. Standard precautions require the following practices regarding gloves. - Wash hands before donning gloves and after removing them. - Wear them when handling body fluids. - Replace them between each patient encounter. - Replace them when performing different procedures for the same patient, such as wound care. - Make sure they are nitrile or vinyl and not latex, due to potential allergic reactions. - Make sure they fit properly. - Check them for holes or rips before performing procedures. Wear gloves when handling specimen containers, such as vacuum tubes or urine collection containers. It is unsafe to remove the tip of the glove to palpate for a vein during a venipuncture. Wear gloves during every venipuncture, dermal puncture, and procedure that has the potential for interaction with body fluids. Also wear gloves when processing specimens, such as when loading and unloading the centrifuge or testing urine or fecal specimens. Take specific measures to avoid personal contamination by safely removing gloves after use. First grab the glove on the palm of the nondominant hand and pull the glove off by turning it inside out and transferring it in the palm of the dominant gloved hand. Then slip the nongloved hand under the cuff of the dominant hand glove, pulling the two gloves off together and turning them inside-out. Dispose of the single-glove pouch in a trash can designated for biohazardous materials. Use eye protection while aliquoting blood specimens. At the very minimum, wear goggles or safety glasses. For better protection, wear a full-face shield. Some facilities have a standing shield that you can place between you and the specimen to prevent accidental exposure. Depending on the situation, you might have to wear a mask when interacting with patients who have infections. Masks should fit well and cover as much of the nose and mouth as possible. The mask should also fit tightly against the face so that it creates a seal around the nose and mouth. Use disposable masks, replace them between each patient encounter, and do not wear them from room to room. When wearing a mask to contain a possible communicable illness, replace it often or whenever it becomes wet or otherwise contaminated. When a gown is required, make sure it fits well and covers as much of t e body as possible. Replace gowns between each patient encounter. Do not wear them from room to room. Put on the gown before donning gloves, then make sure the gloves cover the opening of the sleeves completely. Remove the gown by folding the potentially infected area in and only touching the side that did not come in contact with the patient. You might also need to wear shoe and head covers when working with patients whose infection is extremely communicable-such as those that require airborne, droplet, or contact precautions. Aseptic and infection control techniques ---------------------------------------- Before performing any invasive procedure for a patient, cleanse the area. For most venipuncture and dermal puncture procedures, use an alcohol wipe or swab stick containing 70% isopropyl alcohol. If a patient is allergic to alcohol, use benzalkonium chloride instead. Always refer to the facility\>s procedure manual for antiseptic recommendations. Alcohol and most other antiseptic substitutes cleanse but do not sterilize the skin. If a provider orders a blood collection to determine a patient\'s alcohol level, never use alcohol to clean the site prior to the venipuncture. Use povidone-iodine instead, unless the patient is allergic to iodine. Verify that the iodine cleanser does not contain alcohol. If there is any question about the cleanser\'s alcohol content, use soap and water to cleanse the site. Many facilities have a kit available for blood-alcohol testing that contains an alcohol-free antiseptic. When using a blood-alcohol testing kit, review the information within the kit and follow the instructions. Prepare the skin carefully for bacterial testing of blood. Proper skin preparation is imperative to ensure that bacteria do not contaminate the specimen that will undergo bacterial culturing. Most facilities require that phlebotomists use both povidone-iodine and alcohol to prepare the skin for venipuncture for blood culture collection. The alcohol removes oils and dirt, and the povidone­ iodine kills the bacteria on the skin. Chlorhexidine gluconate is usually available for this procedure and only requires a one\--step process. This solution comes in a vial with a sponge attachment. After dispensing it, rub it firmly on the skin for 30 seconds. To cleanse puncture areas for venipuncture in general, use gauze or an antiseptic-soaked pad. Do not use cotton balls, which can leave behind small fibers. Cleanse the site with friction, using back-and-forth strokes. Refer to the study guide addendum on the NHA website for details on CLSI guidelines on venipuncture site preparation. Make sure the alcohol has time to air-dry before inserting the needle or using the lancet. Alcohol can only complete its antiseptic action when completely dry. In addition, alcohol that has not fully dried can cause hemolysis of the specimen and additional discomfort for the patient. Never blow on the injection site, fan it, or blot it dry. These techniques might speed up the procedure, but they can lead to contamination or inadequate disinfection of the site. After cleaning the site, treat it carefully, using only sterile items (such as single-use needles and lancets) for the collection. Never reuse needles or lancets. If any items drop to the floor, discard them immediately in a sharps container. Refrain from retouching the prepared site, even while wearing gloves, because this can lead to contamination. If blood splatters on the phlebotomy chair or wherever you are collecting the specimen, thoroughly disinfect the area. Don gloves and use paper towels or other absorbent material to soak up the blood. Gauze pads might not be absorbent enough to soak up a large spill and can actually spread the blood around. Facilities usually have prepared solutions available for blood-spill cleanups. When using these, it is important to read all the instructions thoroughly to understand how to remove pathogens from the site. When there are no prepared solutions available, use a 1:10 mixture of sodium hypochlorite (household bleach) to water. This solution should sit on the spill for 20 min prior to cleaning it up with paper towels while wearing gloves. For a large spill, wear goggles and a face mask. After the cleanup, dispose of all contaminated material into a biohazard bag and then promptly wash your hands. Hand hygiene guidelines ----------------------- Hand hygiene is the most effective means of preventing infection. Perform hand hygiene when entering or leaving work areas; after contact with any bodily fluid (even if wearing gloves); and before and after patient procedures, eating, and using the restroom. Infection control begins even before turning on the water by not touching any possibly contaminated sink or nearby surface. After turning on the water, make sure the water is not too cold or too hot. Either extreme of water temperatures can lead to drying and chapping of the skin. Wet the hands first, then apply an effective soap or hand cleanser. Some facilities require the use of antimicrobial soap. Scrub the hands vigorously, creating suds with the soap and paying attention to nails, nail beds, knuckles, and the skin between the fingers. The CDC recommends scrubbing hands for at least 20 seconds (usually the length of singing or humming \"Happy Birthday\" twice). Next, rinse the hands thoroughly, paying attention to removing all of the soap. Then dry the hands completely, using a disposable towel or an air dryer. Turn off the faucet with a paper towel and then dispose of the towel into a waste can. The combination of water and friction are the most effective means of achieving hand hygiene, or medical asepsis. When hands are not visibly soiled, you may use an alcohol-based hand sanitizer that has at least a 60% concentration of alcohol. To use a hand sanitizer, dispense the solution into one hand and rub it over both hands, paying special attention to the nails, nail beds, knuckles, and the skin between the fingers. Rub hand sanitizer onto the hands until the hands are dry. Hand sanitizers do not remove all microbes; for example, they do not remove norovirus, C. difficile, or Escherichia coli. Many hospitals, clinics, and other facilities provide wall-mounted or stand-alone sanitizer dispensers to promote regular attention to hand hygiene. First aid and CPR ----------------- Every phlebotomist is responsible for safeguarding the well-being and welfare of the patients in their care. At times, this responsibility extends to performing basic first aid. It is important to be able to recognize potential problems with patients and know what to do in case of an emergency. In all situations, remain calm. Maintaining composure and remembering what to do in an emergency can be the most important step in keeping an emergency from becoming a disaster. If a patient loses consciousness during a blood collection or begins to show signs of syncope (fainting), immediately stop the procedure by removing the tourniquet and needle, place pressure on the venipuncture site, and protect the patient from injury by assisting them to the floor or to a reclining position. For any loss of consciousness before, during, or after the collection, it is essential to monitor the patient\'s breathing by watching their chest to check for movement in and out or listening for 5 to 10 seconds. If the patient is breathing, remove or loosen any restricting items (tie, scarf). Even if the patient is unresponsive, continue speaking to them, stating what you are doing and why. Sometimes, unresponsive patients can hear but are not able to respond. With most cases of syncope, the patient recovers quickly. Nevertheless, note how long the patient was unconscious. Never leave the patient alone until they recover fully. Do not give the patient anything to eat or drink right away, to reduce the risk of choking. You may place a cold cloth on the back of the patient\'s neck or wrists. If the patient is unresponsive for an extended period, call for medical help or emergency services. Stay with the patient until help has arrived. When a patient in an inpatient setting is not breathing, note the exact time of collapse or when you found the patient in this condition. Immediately call for assistance from the nursing or medical staff. Do not leave the patient alone until help arrives. If the patient is not breathing and does not have a pulse, and you are unaware of the patient\'s wishes for resuscitation or the patient does not have a do-not-resuscitate (DNR) order, initiate first aid, including cardiopulmonary resuscitation (CPR). For adults, the American Heart Association (AHA) recommends \"CAB,\" meaning that chest compressions are the priority, then airway assessment, and then rescue breathing. For adults, follow these steps to maintain basic life support: - Activate the emergency response system by calling 911 or the local emergency number or have someone else do so. - Find a defibrillator and follow the instructions on the device. (Office defibrillators are portable and use either batteries or standard 110-volt current.) - Begin CPR by placing the heel of one hand on the patient\'s sternum between the nipples and placing the other hand over the first, interlacing the fingers. Give chest compressions at a rate of 100 to 120 per minute, at least 3.8 to 5 cm (1.5 to 2 in) in depth. Allow the chest to fully recoil between compressions. After 30 compressions, provide two rescue breaths and continue until the patient regains consciousness or the EMS arrives. - If the patient responds, place them in the recovery position (lateral recumbent or three-quarters prone), monitoring their breathing until a nursing, medical, or emergency medical services (EMS) professional takes over. Chest compressions provide adequate blood circulation to the brain. Faster compressions (of adequate depth) result in a higher survival rate than slower, shallower compressions. Compressions create an increase in intrathoracic pressure, which then results in blood flow to the brain and other organs. The efficiency, speed, and proper application of CPR directly affect its success. For a patient who is unconscious, it is important to determine the state of ventilation and circulation quickly. Irreversible brain damage or death can result from a lack of oxygen that lasts for more than 4 to 6 min. For children or infants, the AHA recommends checking the patient for unconsciousness by tapping the patient and loudly asking "Are you alright?\" When an infant or child is unresponsive, have someone call emergency services while beginning CPR. If there is no one else who can call for help, perform five sets of 30 compressions to two breaths, and then call emergency services. Steps for infant and child CPR include the following. - Provide compressions. - For a child, place one hand on top of the other, interlacing the fingers and pressing down 5 cm (2 in) on the center of the child\'s chest 30 times, aiming for a rate of 100 to 120 compressions per minute. - For an infant, use two fingers to provide 30 quick compressions on the center of the chest, 3.8 cm (1.5 in) deep, aiming at 100 to 120 compressions per minute. - Provide rescue breaths. - For a child, pinch the nose, cover the entire mouth with your mouth, and give two breaths. - For an infant, cover the nose and mouth, and give two breaths. Be careful not to overinflate. - Follow the same sequence of compressions-to-ventilations until the patient recovers or the EMS arrives. - When an AED arrives for a child, turn it on and follow the prompts. Keep in mind that CPR instructions change, so it is important to keep up to date on current advances in providing this lifesaving procedure. It is important for all health care staff to keep certifications up to date when working in the health care field. Seizures can occur with epilepsy, medication reactions, fever, unconsciousness, or for unknown reasons. When a patient begins to seize, immediately stop the blood collection and take steps to ensure the patient\'s safety. Call for assistance and stay with the patient until help arrives. To keep the patient from falling, gently lower them to the floor. If the patient is in a safe place, such as in a bed, leave the patient there. Do not lift or restrain the patient, because you could injure them and yourself. In addition, do not attempt to insert anything into the patient\'s mouth during a seizure. As with any emergency, remain with the patient until they recover fully, or help arrives. If a patient reports acute nausea during a blood collection, stop the procedure. Sometimes a cold washcloth or towel on the forehead helps the feeling of nausea subside. However, if the nausea continues or the patient says they are going to vomit, provide an emesis basin or a trash can with a liner. Any receptacle that contains vomit or body fluids is biohazardous material, and you must decontaminate it or dispose of it properly. After a patient vomits, offer water to rinse out their mouth and tissues to wipe their face. Again, do not leave the patient alone until they recover. If they do not recover fully, it might be necessary to reschedule the procedure. Notify the nurse or provider of the situation in case the procedure is time-sensitive, or the patient needs further assessment and care. Symptoms of shock often start with cold, clammy skin; blurry vision; and a rapid, weak pulse. For shock, call for help immediately. Remain with the patient until help arrives. Put the patient in the shock position, which involves the patient lying flat with the legs elevated approximately 30-5 cm (12 in). Keep the patient warm and loosen any tight clothing. For excessive bleeding, apply pressure and call for assistance. Working quickly is crucial to prevent a health care crisis due to loss of blood. It is essential to use standard precautions, such as donning gloves. When there is no time to put on gloves, use bed sheets, gauze, a towel, or any immediately accessible material. If the hemorrhage is in a limb, elevate the extremity and continue applying pressure until help arrives. If excessive bleeding occurs after a venipuncture or dermal puncture, hold pressure on the site with gauze for at least 5 min or until the bleeding stops. If the gauze fills with blood, add more gauze (instead of removing the gauze already on the site). If the bleeding continues, continue to hold pressure and call for additional assistance. Once the bleeding has stopped, apply a pressure bandage. Advise the patient to keep the bandage in place for at least 1 hour and avoid heavy lifting. Monitor for any other issues (nausea, lightheadedness) that could cause additional complications. When the bleeding has stopped completely and there are no signs of syncope or other complications, the patient may leave. Document the excessive bleeding to provide guidance for future blood collections. Pain is another complication that can occur during blood collection. Some degree of pain is expected with most blood collections, but excessive pain could indicate a problem such as nerve involvement. If a patient reports severe pain, pain that radiates up and down the arm, or a loss of feeling anywhere in the area over the venipuncture, stop the blood collection. If the pain doesn\'t subside after removing the needle, the patient needs a medical evaluation. If petechiae (small red dots), appear on a patient\'s skin during a blood collection, you do not have to stop the procedure. The petechiae might indicate that the patient has platelet issues, so be sure to apply adequate pressure after the procedure to prevent excessive bleeding. A seemingly healthy patient can develop complications in a matter of minutes. Therefore, it is important to observe patients before, during, and after every blood collection. Quick action can keep a bad situation from becoming worse. Remain calm and continue talking to the patient during an emergency situation. Document any unusual incident during a blood collection, including the time it occurred, what happened, and what actions were taken. Documentation and reporting --------------------------- Every health care facility has individual requirements for documentation as well as when and to whom to report in case of an emergency, when an accidental needlestick occurs, or for any other unusual situation. These guidelines and requirements are in the facility\'s procedure manual. All staff members should read, review, and be familiar with these requirements. When completing the required documentation, write the essential information legibly (in ink if using paper) and fill out all forms completely. HIPAA privacy rules apply to any form of documentation that contains PHI. When using electronic documentation, follow all documentation requirements and save the data before closing any documents or logging off of the device. For the accidental exposure log, OSHA requires the following information. - How the exposure happened - By what means it occurred (splash into an eye, needlestick) - Type of equipment involved - Safety measures on the equipment - Type of PPE the phlebotomist was using - Where the incident occurred (patient\'s room, outpatient area, provider\'s office) - Type of procedure the phlebotomist was performing - Situation surrounding the exposure If the incident involves an accidental needlestick or an injury from any other sharp instrument (lancet, broken capillary tube), make an entry in the sharps injury log, including the following. - Date the event happened - Type of equipment involved and the brand name - Where the exposure took place, such as the workplace\'s department - Brief description of how the exposure occurred This sharps injury log is confidential, so information such as the patient\'s or phlebotomist\'s name should not appear on the report. If a chain of custody form is required, it is likely that the specimen collected will become evidence in a legal case, so there must be a record of all of the steps that took place and who handled the specimen. Write the time, date, and name of the collector of the specimen on the form in ink. Every person who handles or transports the specimen should sign and date the form.