1010 U1 Ch2A - Safety - Patient and Clinical Lab Practices PDF

Chapter 2 Safety: Patient and Clinical Laboratory Practices 1 Preamble PowerPoints are a general overview and are provided to help students take notes over the video lecture ONLY. PowerPoints...

Chapter 2 Safety: Patient and Clinical Laboratory Practices 1 Preamble PowerPoints are a general overview and are provided to help students take notes over the video lecture ONLY. PowerPoints DO NOT cover the details needed for the Unit exam Each student is responsible for READING the TEXTBOOK for details to answer the UNIT OBJECTIVES Unit Objectives are your study guide (not this PowerPoint) Test questions cover the details of UNIT OBJECTIVES found only in your Textbook! 1  Patient Safety A recent study of laboratory errors showed that the preanalytical phase is where 98% of the errors in the diagnostic process occur. Having recognized the role of preanalytical errors, the Joint Commission National Patient Safety Goals has several goal areas that have specific applications for clinical laboratories. 3 The Joint Commission National Patient Safety Goals Effective January 1, 2014 Goals Related to the Laboratory Goal 1: Improve the accuracy of patient identification. Use at least two patient identifiers when providing laboratory services. Name and DOB Name and PID# Goal 2: Improve the effectiveness of communication among caregivers. Report critical results of tests and diagnostic procedures on a timely basis. Policy “Called to _____and Read back by_____” Goal 7: Reduce the risk of health care–associated infections. Comply with either the current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines or the current World Health Organization (WHO) hand hygiene guidelines. 4 2 Six Goals of U.S. Health Care Delivery Patient Safety: 1. Safety avoiding injury to patient. 2. Timeliness Point of Care testing and reducing turn around times 3. Effectiveness Analysis testing methods for effectiveness 4. Efficiency Avoid waste 5. Equitable Treatment Consistent quality of care 6. Patient-Centered Focus Respectful Care 5 Laboratory Safety Most laboratory accidents are preventable by exercising good technique, staying alert, and using common sense. Laboratory safety includes Occupational Safety and Health Administration (OSHA) standards and CDC guidelines. Importance of Safety Cannot be overemphasized Constantly reminded of safety precautions Safety is PERSONAL – a matter of individual desire – built in concern 6 3 Safety Standards and Governing Agencies 1. OSHA - U.S. Department of Labor’s Occupational Safety and Health Administration 2. CLSI - Clinical and Laboratory Standards Institute 3. CDC - Centers for Disease Control and Prevention, part of the U.S. Department of Health and Human Services (DHHS), Public Health Service 4. CAP - College of American Pathologists 5. TJC - The Joint Commission 7 Safety Hazards in the Lab Biohazard Radiation Chemical Electrical/ Fire Mechanical 4 Safety Standards and Governing Agencies Occupational Safety and Health Administration Acts and Standards 1. Occupational Safety and Health Act of 1970 2. Hazard Communication Standard 3. Safety Officer 4. OSHA-Mandated Plans 9 OSHA-Mandated Plans 1. Chemical Hygiene Plan 2. Hazard Communication Standard 3. Occupational Exposure to Bloodborne Pathogens 10 5 Hazard Communication Standard Requires that the chemical manufacturer, distributor, or importer provide Safety Data Sheets (SDSs) (formerly MSDSs or Material Safety Data Sheets) for each hazardous chemical to downstream users to communicate information on these hazards. Major changes to the Standard include the following: Hazard classification Labels Safety Data Sheets 11 Exposure Control Plan Develop, implement and comply with a plan that ensures the protective safety of laboratory staff to potential infectious blood borne pathogens Manage and handle medical waste in a safe and effective manner 12 6 BIOHAZARDS Denotes infectious materials or agents that present a risk or even a potential risk to the health of humans or animals in the laboratory. Public Health Service (PHS) Biosafety Levels 1, 2, and 3 13 Avoiding Transmission of Infectious Diseases Laboratory-Acquired Infections Bloodborne Pathogens An occupational exposure is defined as a percutaneous injury (e.g., needlestick or cut with a sharp object) or contact by mucous membranes or nonintact skin (especially when the skin is chapped, abraded, or affected with dermatitis or the contact is prolonged or involves an extensive area) with blood, tissues, blood-stained body fluids, body fluids to which Standard Precautions apply, or concentrated virus. 14 7 Biological Safety Rules Observe Standard Precautions CDC guidelines for working with blood and body fluids. Recommend washing hands before, wearing gloves and gowns/coats and washing hands after touching a patient. Use PPE (personal protective equipment) appropriately Gloves Gowns Masks or face shields Plastic aprons Biological Safety Rules 1. All containers must be properly labeled Date and contents 2. Wash hands - MOST IMPORTANT SAFETY RULE TO PREVENT THE SPREAD OF INFECTION! After removing gloves Before leaving lab Anytime it may be needed 3. Dispose of needles in puncture-proof containers. 4. Do NOT break or bend needles 8 Biological Safety Rules 5. No eating, chewing gum, drinking, applying of make-up or lip balm in the laboratory 6. No food or drinks in refrigerators or freezers used for specimens, chemicals, or laboratory supplies 7. No personal articles on working surfaces. 8. Work areas kept clean and orderly at all times 9. Work areas or bench tops should be cleansed at the beginning and end of each day with 10% bleach. 10. Never pipette by mouth 11. Dispose of all broken glass in proper containers Biological Safety Rules 12. Clean up spills of blood or body fluids with appropriate disinfectant IMMEDIATELY 13. Cover all cuts, burns, or broken skin areas on hand prior to gloving. 14. All biological material must be discarded in appropriate containers Sharps Biohazard Trash 15. REPORT ALL ACCIDENTS OR INJURIES TO INSTRUCTOR IMMEDIATELY!!! 9 Safe Work Practices for Infection Control General Infection Control Safety Practices Pipetting Safeguards: Automatic Devices Safety Manual Sharps Safety and Needlestick Prevention 19 Safe Work Practices for Infection Control Specimen-Processing Protection Specimen-Handling and Shipping Requirements 20 10  Universal Precautions  Introduced in 1985  Replaced blood/body fluid precautions  All blood & certain body fluids are considered potentially infectious  Focus of infection control from patient-to-patient to patient-to- personnel  Must be part of overall infection control plan Revised Guideline for Isolation Precautions in Hospitals  Standard precautions First tier Identifies precautions for all hospital patients  Transmission-based precautions Second tier Identifies precautions for infected patients Additional precautions to prevent airborne, droplet, & contact transmission 11  Standard Precautions(1st Tier)  Used with all patients  Treat all patients as if they have an infectious disease  Wash hands before and after touching patient  Wear appropriate PPE’s  Wear gloves when performing phlebotomy  Dispose of materials appropriately Expanded Precautions (2nd Tier)  In some instances, healthcare personnel are required to wear additional PPE.  The four expanded precaution categories are: Airborne; Contact; Droplet and Reverse Isolation (Always Come Dressed Right!) 12 Expanded Precautions – Airborne Transmission  Airborne Pathogens are transmitted by spreading small airborne droplets or dust particles containing the infectious agent.  They are dispersed by air currents over long distances and then inhaled by or deposited on a susceptible host  Special air handling and ventilation are required to prevent airborne transmission.  Airborne Precautions apply to patients known or suspected to be infected with epidemiologically important pathogens that can be transmitted by the airborne route. Expanded Precautions – Airborne PRECAUTION Isolation  Protect the environment from the patient  Report to the nurse BEFORE entering the room  Keep door closed (air-flow)  Employees must wear respirator when entering the room  Wear coats/gowns and gloves  Wash hands before and after touching the patient  Articles discarded prior to leaving the patient’s room  Examples: Measles, Tuberculosis, SARS, Smallpox 13 Expanded Precautions – Contact Transmission  There are two major subgroups: direct and indirect, contact transmissions  Direct-contact: A direct person-to-person contact resulting in physical transfer of microorganisms between a susceptible host and an infected or colonized person.  Indirect-contact: Contact of a susceptible host with contaminated objects, such as instruments needles or dressings: hands that are not washed or gloves that are not changed between patients. Expanded Precautions – Contact PRECAUTION Isolation  Protecting the environment from the patient  Gowns & gloves are indicated per Standard Precautions  Hands must be washed after touching the patient or potentially contaminated articles and before taking care of another patient  Articles contaminated should be discarded or bagged and labeled ‘biohazard’  Masks are not indicated 14 Expanded Precautions – Droplet Transmission  Direct projection of droplet spray onto the conjunctiva or mucous membranes of the eyes, nose or mouth of a susceptible person as a result of sneezing, coughing, spitting, singing or talking by an infected person  This is considered droplet rather than airborne transmission due to the large size of the droplets and the short distance of travel. Expanded Precautions – Droplet PRECAUTION Isolation  Protecting the environment from the patient  Gowns & gloves are indicated per Standard Precautions  Hands must be washed after touching the patient or potentially contaminated articles and before taking care of another patient  Articles contaminated should be discarded or bagged and labeled ‘biohazard’  Masks are indicated 15  Expanded Precautions – Droplet PRECAUTION Isolation  Examples: Influenza, Mumps, Diphtheria Pertussis, Pneumonic plague, Strep Throat, Rubella and Meningitides  NOTE: SARS can be spread by droplet or airborne – Always take the highest precaution level when uncertain Expanded Precautions – Reverse PRECAUTION Isolation  Reverse or Protective isolation is used for Chemo, AIDS or any patient whose immune system is weak  Protect the patient from the environment  Gown & gloves are indicated  Air-flow is reversed  Masks are indicated 16 Precaution Signs Prevention of Disease Transmission The first line of defense or first barrier to infection is unbroken skin and mucous membranes. There are two ways the body resists infection if microorganisms have penetrated the first line of defense.  Immunity:  Natural Immunity  Characterized as a nonspecific mechanism- consists of particular cells and soluble substances in the blood Such as neutrophils, macrophages, and complement  Acquired/Adaptive  Allows the body to recognize, remember and respond to a specific stimulus, an antigen.  Active can result from natural exposure in response to an infection or from an intentional vaccination.  Leads to immune memory and a permanently altered pattern of response  Passive can be a transfer of antibodies in vivo or via colostrum to newborn or can be a transfer of antibodies via infusion of serum or plasma Pre-employment health profiles with baseline screening of students and laboratory staff should include an immune status evaluation for the following:  Immunization Hepatitis B Influenza Measles Mumps Rubella Varicella 34 17 Prevention of Disease Transmission Optional Immunizations Hepatitis A Meningococcal Disease Pertussis Typhoid Vaccinia Other Immunizations Other vaccine-preventable diseases include diphtheria, pneumococcal disease, and tetanus. 35 Prevention of Disease Transmission Screening Tests Tuberculosis: Purified Protein Derivative (PPD, Mantoux) Skin Test Rubella Hepatitis B Surface Antigen Prophylaxis, Medical Follow-up, and Records of Accidental Exposure Hepatitis B Virus Exposure Hepatitis C Virus Exposure Human Immunodeficiency Virus 36 18 Prevention of Disease Transmission Respirators or Masks for Tuberculosis Control Protection from Aerosols Biosafety Cabinets Negative-Pressure Isolation Rooms Additional Laboratory Hazards 37 Additional Laboratory Hazards Chemical Hazards Electrical Hazards Fire Hazards Infectious Waste 38 19 Chemical Safety Rules 1. Wear protective eye wear when working with acids and caustic, explosive material 2. Use fume hood when working with fume producing agents 3. Never grasp bottles of acid, caustic materials, or any other reagents by the neck. Hold firmly around the body with both hands. 4. Use large amounts of water when pouring chemical reagents into a drain 5. When diluting acids, always add acid slowly to water 6. All chemical/reagents are labeled, indicating Contents Date of preparation Expiration date Initials of the person having made it Chemical Safety Rules 7. Store flammable solvents in a steel cabinet marked “Flammable” 8. Keep open flames, incinerators, and hot plates away from flammable solvents 9. Sodium azide forms an accumulation of lead and copper azide which is explosive. Flush solutions with sodium azide with copious amounts of water. 10. Store acids and caustic materials in cabinets below waist level. 11. Be familiar with eye wash stations and how to use them. 20 Electrical and Mechanical Safety Rules 1. Be sure centrifuges are balanced when operating 2. Report any frayed or worn wires to instructor 3. Do not touch electrical equipment and connections with wet hands 4. Unplug equipment before attempting to do maintenance or repair work 5. Take precautions to avoid spilling reagents on electrical equipment If spillage occurs, the instrument must be turned off, unplugged, and cleaned immediately 6. Keep dangling objects (jewelry, ties, etc.) and long hair away from equipment. Fire Safety 1. Components of fire Fuel Heat Oxygen Chemical reaction 2. Classes of fire 3. Fire extinguishers 21 Fire and Fire Extinguishers Classes of Fire Extinguishers 1. Class A – contains pressurized water Combustibles such as paper, cloth, and wood 2. Class B – contains carbon dioxide that smothers fire Gasoline, oil, paint, liquid, grease Fire spreads if use water 3. Class C – dry-chemical, non-conducting type Electrical fires, burning liquids 4. Class ABC – graphite type chemical Used on all fires – irritates the skin Using a Fire Extinguisher 1. Check extinguisher 2. Locate pin and pull it out 3. Hold firmly in upright position 4. Stand 6 to 10 feet from fire 5. Aim nozzle at base of fire 6. Discharge 7. Sweep nozzle back and forth across fire 22  Fire Safety Procedure Rules  Be familiar with location of alarm, fire blankets, fire extinguisher, and shower in the lab.  KNOW the procedure to be followed is case of fire RESCUE R Remove anyone in immediate danger ALARM A Pull the alarm to sound signal for help CONFINE C Close doors and windows EXTINGUISH OR EVACUATE E Put out fire or evacuate the building National Fire Protection Association’s Diamond 23  Radiation Safety 1. Label radioactive material 2. Dispose of radioactive waste in the properly designated manner 3. Never dispose of any radioactive waste down the drain 4. Wash hands and fingernails carefully with soap and water after working with radioactive materials Dressing for Safety 1. Pin long hair away from face and neck to avoid contact with chemicals, equipment, or flames 2. Wear closed-toe shoes 3. Avoid wearing chains, bracelets, rings, or other loose hanging jewelry 4. Remove all acrylic nails 5. Wear laboratory coats 24 Engineering Safety 1. Facility has responsibility to make work area safe 2. Engineering safety is any device in place that prevents worker being exposed to biohazard contamination 3. Example: 1. Shields in front of centrifuges Three Types of Waste Biohazard – orange or red bags Any material with contamination of blood or body fluids Sharps – impermeable, hard plastic boxes Any instrument that possesses the possibility to puncture Trash – brown, green, clear, white plastic bags Paper, paper towels, etc 25 How To Get Rid of Waste 1. Sharps Permanently seal boxes and place in biohazard box to be picked-up by a Biohazard Pick-Up Service 2. Biohazard Secure top of small bags closed and place in large biohazard box to be picked- up by a Biohazard Pick-Up Service 3. Trash Place in trash can WHAT IS TRASH? ANYTHING WITHOUT BLOOD OR BODY FLUIDS GLOVES THAT HAVE NOT BE CONTAMINATED NOTEBOOK PAPER PAPER TOWELS NAME SOME!!!! 26 WHAT IS A SHARP? A NEEDLE A LANCET ANYTHING THAT CAN PUNCTURE YOUR SKIN IF IT CAN’T PUNCTURE YOUR SKIN, IT IS NOT A SHARP! A paper towel is not a sharp A tube of blood is not a sharp WHAT IS BIOHAZARD? TUBES OF BLOOD ANYTHING SOAKED IN BLOOD IT IS NOT A Gloves BIOHAZARD Gauze UNLESS SOAKED IN Band aid paper BLOOD 27 WHERE SHOULD THE FOLLOWING BE PUT Broken glass without blood Broken tube containing blood Broken pencil Lab apron without contamination Lab coat with blood on front Gloves that have been worn during lab Paper towels from drying hands How To Clean Up Biohazard 1. Decontaminate with 10% bleach Must be made up DAILY 2. If broken glass Use small brush and dust pan to and scoop up glass Place in sharps container 3. If no broken glass Clean area with paper towels 28 WHERE ARE THE FOLLOWING? 1. FIRE EXTINGUISHER 2. EYE WASH STATIONS 3. FIRE BLANKET 4. EMERGENCY SHOWER 5. EMERGENCY ESCAPE PLAN POST EXPOSURE PLAN 58 29 Post Exposure Plan for Students  Exposure is defined as a needle stick, splashing mucous membranes, or contamination of ANY break in the skin with contaminated fluids. STEPS FOR POST EXPOSURE 1. Wash the wound thoroughly and immediately. 2. Contact the instructor or clinical supervisor and fill out an Incident Report Form detailing event on the SAME DAY as the event. 3. If possible, have the person’s blood with whom you have been exposed tested for HIV, hepatitis B (HBV) and hepatitis C (HCV). 4. Bring the Incident Report to the CTC instructor on the SAME DAY as the exposure! 5. Instructor will forward the report to the Infection Control Officer, Dr. Christine Yarbrough 30 STEPS FOR POST EXPOSURE 6. Fill out Student Consent Form for Testing and the instructor will forward to Infection Control Officer 7. Go to a designated insurance accepted health care facility to have your baseline laboratory testing done for the following tests: Hepatitis B; Hepatitis C and HIV 8. Infection Control Officer, Dr. Yarbrough will follow-up with student for further testing Postamble READ the TEXTBOOK for the details to answer the UNIT OBJECTIVES. USE THE UNIT OBJECTIVES AS A STUDY GUIDE All test questions come from detailed material found in the TEXTBOOK (Not this PowerPoint) and relate back to the Unit Objectives 31