LESSON 2 INFECTION CONTROL, SAFETY, FIRST AID, AND PERSONAL B59 LEARNING OUTCOMES. At the end of this lesson, the students must be able to: 1 5. identify symptoms of shock, firs 14 Read Information Sheet 2.0. Infection Control, Safety, First Ald, ‘and Personal Wellness 21. Components of the Chain of infection, Infection- 2.2. Proper Procedures of Hand Hygiene, Putting on 23. Standard and Transmission Based identify the components of the chain of infection and give examples of each, describe infection-control procedures used to break the chain of infection, and explain the four functions of infection-control program; perform proper procedures for hand hygiene, putting on and removing protective clothing, and entering the ORs and [CUS . discuss the standard and transmission-based precautions for blood-borne pathogens; list examples of blood-borne pathogens and describe their means of transmission in a healthcare settings describe hazards, identify warning symbols, list actions to take if incidents occur, and specify rules to follow for proper biological, electrical, fire, radiation, and chemical safety; procedures, and the main points of the international cardiopulmonary resuscitation (CPR); and . explain the role of personal hygiene, proper nutrition, rest, exercise, back protection, and stress management in personal wellness I LEARNING GUIDE Learning Steps Time Allotment Control Program, and Intection-Control Procedures. end Removal of Protective Coothing, and Entering the Operation Rooms (ORS) and intensive Care Units cus) Precaution for Blood-Bome Pathogens UERMMMCI LIBRARY 99 14592* co Rate tela. OC Information Sheet 2.016 Learning Guide for Principles of Medical Laboratory Science 2 4 Han ifineldonts Occur 15, Warning Symbo's, Actions to Tako 2.5. Symptoms of Shock, Fist ‘and Cardiopulmonary Resusctation (CPR) 26. Personal Wellness Resource 1nd Laboratory Safety Risks Procecure, 2, Suogested SeifDirected Loatning Activities: 30nours | instructor/rainer/ ‘Attend lecture session, reod related articles, and Speakor/Stucent Porta, ‘Watch porta-based presentation on "Understanding LUbrary/Simulated Phlebotomy” or observe the set-up and operations of a Clinical Laboratory ‘neorby clinica laboratory (optiona Laboratory Actwity Actnity #1 (Page 169) 3. Perform portal based Self: Chock Activity 2.0. Student Portel ‘4. Perform portal-based summative examination ‘Student Portal for Lesson 2. paces 5. Roport to and consult with your instructor regarding ‘Summaiive examination your examination results, rosuits 6. Proceed to Lesson Lesson 3 [BPS] INFORMATION SHEET 2.0 Although phlebotomy is considered one of the most commonly performed procedures in the field of medicine, there are still risks involved that can be hazardous to both patient and healthcare personnel. When not done properly, this procedure could result in injury of the patient, errors in laboratory findings and exposure to infection, and other safety hazards. Risk could be reduced if best practices in prevention and control are followed. An infection happens when a microorganism invades the body, multiplies, and causes injury or disease. A pathogen is a disease-causing microbe which could be classified as bacteria, fungi, protozoa, or Virus. There are two types of infections: communicable infections and ‘nosocomial and healthcare-associated infections (HAs). Communicable infections can spread from person to person while nosocomial and healthcare-associated infections (HAls) are usually caused by infected personnel, patients, visitors, food, drug, or equipment while a patient is in the hospital or other healthcare facilities. Components of the Chain of Infection For the infection to escalate to an epidemic, all components or links should be favorable to the pathogenic microbe. The following table shows the six links of the chain of infection and their description.Infection Control, Safety, First Ald, and Personal Wellness, Infectious Pathogenic microbe such os virus, Bacteria, fungus, protozoa, and ricketsia (causative agent | oer Reservoir Source of tre agent of infection or place where the microbe could grow, sunive. ‘and mutiply, which could be in humans, imal, food, water, sol or equipment Extpathway | Away or manner wherein an infectious agent can leave the reservoir host, which could be through secretions and enidatos, tesve specimens, Diood, feces, oF uring Means of ‘Aroome, direct touching oF kissing) or indirect contact (contaminated objects). transmission | droplets (coughing or sneezing), vector insect, anthropod, or animal, and vehicle (food, water, or drugs) were Ca Entry pathway | The way an infectious agent enters a host, which includes body orfices, mucous membrones, end breaks inthe skin Susceptible host | Someone who is prone to infecton, expec the elderly, newborn babies, eteents who ave immune-suppressed or unvaccinated, and those suffering from acute 0 cone iiness| - Infection Control Program A healthcare institution should have a set of procedures to break the chain of infection. These measures include effective hand hygiene procedure, good nutrition, immunization against common pathogens, insect and pest control, isolation and decontamination procedures, use of proper safety-devices, wearing of personal protective equipment (PPE) when needed, and proper disposal of sharp objects and other waste materials. An infection-control program has four main functions: 1. to protect patients, employees, and visitors from infection 2. to screen employees for infectious diseases and to require immunization when needed 3. to provide cvaluation and treatment to health workers who have been exposed to infections while performing their duty 4. to monitor employees and patients who are at risk of infection and to collect data from patients and health workers who have bbeen exposed to such danger Infection-control Procedures Infection-control methods or procedures must be followed at all times. These include ensuring that proper hand hygiene is practiced consistently using alcohol-based antiseptic hand cleaners, and that the Personal protective equipment (PPE) is clean and properly donned and removed. 748 Leaming Guide for Principles of Medical Laboratory Science 2 Proper Procedures of Hand Hygiene, Putting on and Removal of Protective Clothing, and Entering the Operating Rooms (ORs) and Intensive Care Units (ICUs) Hand Hygiene Hand hygiene is an essential part of standard precautions in the healthcare setting because it is an effective way to prevent infections that can be transmitted from the patient and healthcare personnel during the procedure, There are tivo methods for hand hygiene: 1, routine hand washing + uses plain soap and water + when hands are visibly dirty + after known exposure to Clostridium difficile, Bacillus anthracis, and infectious diarrhea during norovirus outbreaks «+ before eating + after using the restroom 2, hand antisepsis ‘+ an antimocrobial soap or alcohol-based hand sanitizer to remove transient microorganisms x + alcohol-based hand sanitizer is preferred when hands are not visibly dirty * put the sanitizer on hands, rub the hands together for about 20 seconds or until it feels dryInfection Control, Safety, First Aid, and Personal Wellness 19 Steps in Performing the Routine Hand-washing Technique 1, Stand a few inches from the sink to avoid contamination. 2. Turn on the faucet and place hands under the running water. 3. Use soap and work up lather to ensure that hand surfaces are reached, 4, Scrub for at least 15 seconds. Make sure to scrub all surfaces especially between the fingers and the knuckles. 5. Apply alittle friction and rub hands together for atleast 15 seconds. 6. Rinse the hands from the wrist to fingertips using a downward motion, 7. Dry hands using a clean paper towel. 8, Use the paper towel to cose the faucet, except when the latter is foot- or motion-activated. Personal Protective Equipment (PPE) ‘The personal protective equipment (PPE) includes the gloves, gowns, lab coats, masks, face shields, goggles, and respirators. Gloves Phlebotomists should always wear gloves during blood collection and ‘when handling specimen. Gloves are worn to prevent contamination of the hands and reduce chances of transmission of microorganisms from personnel to patients. They should be worn over the cuffs of the ab gown to ensure protection. Proper Removal of Gloves 1. The wrist part of one glove is grasped by the opposite hand. 2, The glove is pulled inside out and off the hand. 3. The recently removed glove must be placed in the gloved hand. The fingers of the non-gloved hand are slipped under the wrist of the remaining glove but make sure not to touch the exterior surface. 4. The second glove is pulled inside out. 5. The gloves must be dropped in the proper receptacle. Figure 2.1 Proper Personal Protective Equipment (PPE) @Head cap, @: gogglesiglasses, @Face coat, @Gioves, @Long pants, @ciosed-toe shoes [Counesy of he Scxoot of Medical Technology, Contr Eecolar Universty)20 Leaming Guide for Principles of Medical Laboratory Science 2 Figure 2.2 Disposable Mask Figure 2.3 Disposable Gloves Figure 2.4 Disposable Laboratory Gown Figure 2.5 PPE Worn Inthe Operating Room Donning and Doffing of PPE The PPE is kept clean and is worn to protect the healthcare worker from splashes of blood and specimen during the patient-care activities. It includes the laboratory gown or coat, face mask, and gloves. These items are removed at the anteroom or before leaving the room of the patient in an aseptic, sterile, and pathogen-free way to avoid contamination. Nowadays, disposable PPE is also available in the market, Donning of PPE 1. Gown should be put on first. Make sure that it is fastened, and the belt is tied. 2, Mask should cover both the nose and mouth. 3. Gloves should be pulled over the gown cuff Doffing of PPE 1. Gloves are removed first. The contaminated areas should not be touched with ungloved hands. 2. Gown should be pulled from the shoulders towards the hand so it is turned inside out 3. Mask should be removed by only touching the string. Note: Wash hands immediately ater removal of the PPE. Adltional information oa sae ‘When te colored porton ofthe mask is exposed, you ate protecting yourset from infection. ve ‘white portion Is the one exposed then hi you are protecting others from boing i so | ‘you mightbe acariorofadsease.‘i Infection Control, Safety, First Aid, and Personal Wellness 21 Nursery and Neonatal ICU Infection-control Technique Since newborns are most susceptible to infections because of their underdeveloped immune system, anyone who enters the nursery area or neonatal ICU should follow the infection-control procedure: 1, Proper hand washing procedure should be done before putting on the PPE. 2. The phlebotomists should only bring items necessary for the specimen collection. 3. Blood collection tray should be left outside the nursery, preferably the anteroom. 4. Gloves should be removed; hands should be washed; and a new pair of gloves should be used between patients. ‘Standard and Transmission-based Precaution for Blood-borne Pathogens In the clinical laboratory, health workers may be exposed to blood- borne pathogens (BBP) by needlestick or other injuries caused by sharp objects. BBP are microorganisms in the human blood that are infectious and can cause diseases. The most common pathogens include hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV). Table 2.2 Defense, Hazards, and Symptoms of Biood-borne Pathogens eee Se Hepatitis 8 | HEV Blood and other body fulds | Futke fatgve, loss of Virus (H8V) | vaccination | - Can sunive @ week on objects | aPpette, mid fover, muscle/ “Transmitted via neeciesticks, | jeiabdominal pain, nausea, senualconact | vomiting Hopattis | None Blood and other body fulds | Fuk fatigue, loss of Virus Can sunive @ week on objects | appetite, mild fever, muscle/ Tronsmitied via needlestiks, | oinVabdominel pein, nausea, sexual contact voutmng [Hepatitis ¢ | None Blood end serum: sometimes | Putte fatigue, loss of | vius ey save ‘appette, mic! fever, muscte/ | Infection primarily occurs ater | joinvabdominal pain, nausea, | large and multiple exposures: vomiting | Tronsmited vaneedestits, | | | ‘sexual contact22 _Learing Guide for Principles of Mecical Laboratory Science 2 Exposure Control Plan Healthcare workers are at risk of being exposed to blood-borne pathogens as they perform their duties. Exposure can occur when the following happens: a. A contaminated needle or sharp object pierces the skin of the health worker », Body fluid or blood splashes in the eyes, nose, or mouth of the health worker ¢. Cut, scratch, or abrasion of the health worker has made contact with blood or body fluid of an infected patient d. Human bite cuts the skin of the health worker During BBP exposure, this procedure should be followed: 1, BBP Exposure Caused by Needlestick or Any Sharp Objects 1, Carefully remove the sharp ot foreign object. 2. Wash the site thoroughly with soap and water for at least 30 seconds, b, BBP Exposure through Mucous Membrane 1. Flash with water or saline for at least 10 minutes. 2. For the eyes, use eyewash station for flushing, if available. Remember to remove the contact lenses (if there are any) and make sure to disinfect them. 3. Report the incident to the immediate supervisor so that evaluation, treatment, and counseling can be provided. For surface decontamination, use 1:10 bleach solution or other disinfectants for the specimen collection and processing areas. Remember to wear gloves and use an absorbent material when cleaning the area to avoid spreading the spills over a wider area. As a precaution, all non-reusable items contaminated by blood or other body fluids should be placed in biohazard waste containers for proper disposal.Infection Control, Safety, First Ald, and Personal Wellness | 23 Hazards, Warning Symbols, Actions to Take if Incidents Occur, and Laboratory Safety Risks Biohazard Biohazard refers to any material that could be harmful to one’s health. Biosafety is used to prevent and protect clinical laboratorics from harmful incidents caused by laboratory specimens that are potential biohazards. A health worker could be exposed to a biohazard in various ways. ‘These ways are called the biohazard exposure routes. 1, Airborne ~ from splashes and aerosols during centrifuge and aliquot; patients with airborne diseases. a. Observe proper handling practices. 'b. Wear PPE properly. ¢. Use safety shield and guards 2. Ingestion — hands are not sanitized before handling food. ‘a. Wash hands frequently. b, Avoid hand-to-mouth activities. . Avoid placing items in the mouth. Figure 2.6 Biohazard Symbol 3. Non-intact skin ~ contamination through breaks or cuts in the skin, ‘a. Cover skin breaks or cuts with non-permeable bandages 4, Percutaneous - exposure through the skin due to injuries from needlesticks and other sharp objects. a. Use needle safety devices. >. Wear heavy-duty utility gloves when cleaning broken glass. ¢. Never handle broken glass with bare hands. 5. Permucosal - infection through mucous membranes of the mouth and nose and the conjunctiva of the eyes. a. Observe proper handling to avoid aerosols and splashes. », Avoid rubbing and touching the eyes, nose, and mouth.24 Learning Guide for Principles of Medical Laboratory Science 2 Electric Shock Another potential hazard that a health worker faces in the workplace is electric shock especially when dealing with electrical equipment. ‘The following actions should be taken if electric shock occurs: 1, Remove the source of electricity using a non-conductive object or simply turn off the source of electricity. 2. Ask for medical assistance. 3, Start cardiopulmonary resuscitation (CPR) if necessary. 4. Keep the victim warm. Fire Fire is another potential work hazard. Regular fire drills should be conducted so employees know what to do in case of fire. They should also be familiar with the location of emergency exits and evacuation plans or routes. The location of fire extinguishers and heavy blankets should be posted, and the staff should know how to use them. Fire extinguishers are classified by the type of fire that they are designed to extinguish. The classification is listed in Table 2.3. Table 2:3 Five Classes of Fire This refers to fire caused by ordinary combustible materials such as wood or paper, which A | requice water of water-based solutions to extinguish. = p_| This refers to fire caused by flammable iquids and vapors such as paint, ol, grease, and _gasoline which require blocking oxygen to snuff out. ‘¢__| Thistefersto fre coused by live electrical equipment, which requires the use ‘of non-conducting agents to extinguish. This refers to fire caused by combustible and reactive metals such as sodium, potassium, magnesium, and lithium which need powder agents or sand to put out x __ | Th8stefers to fre caused by cooking oll, grease, or fats with high temperature which require agents that prevent splashing, cooling, and smothering the fire. Radiation Radiation safety is another consideration of the phlebotomists. Radiation exposure depends on time, distance, and protection or shielding. The length of time of the exposure and the distance of theInfection Control, Safety. First Aid, and Personal Wellness 25 individual from the source of radiation matter because the effect is cumulative. The protection worn at the time also has a bearing on the intensity of exposure. It is a must that a radiation symbol (Figure 2.7) be posted in areas where radioactive materials are used and kept. Radiation hazard can be encountered by the phlebotomists when collecting specimens from patients who have been injected with radioactive dyes or from the nuclear medicine department or simply when delivering specimens to the radioimmunoassay sections of the laboratory. Chemicals are used as cleaning reagents, in adding preservatives in urine container (24-hour), or in delivering specimens to the laboratory. Inappropriate handling can pose a problem not only to the phlebotomists but also to other health workers. As a general rule, the phlebotomists should always wear the PPE when working with chemicals, Chemical clean-up materials should be properly used in case of chemical spills. The following practices should NEVER be done: 1. Storing chemicals above eye level 2. Adding water to acid 3. Mixing chemicals indiscriminately 4, Storing chemicals in unlabeled containers 5, Pouring chemicals into used or dirty containers 6. Using chemicals in ways other than their intended uses The healthcare worker should be informed where the safety showers and eyewash stations are located, in the event of chemical spill or splash in the eyes or body. The personnel exposed to chemical spill or splash should flush the affected part with water for at least 15 minutes and visit the emergency room (ER) for evaluation. Symptoms of Shock Shock is a condition when there is not enough blood that circulates back to the heart, which results in inadequate supply of oxygen in the body. It may be caused by hemorrhage, heart attack, trauma, and drug reactions. The common symptoms of shock are as follows: pale, cold and clammy skin; rapid and weak pulse; increased and shallow breathing; and expressionless face with a blank stare. Figure 27 Radiation Symbol Figure 2.8 Safety Shower and Eyewash Station Figure 2.9 Performing CPR26 _Leaming Guide for Principles of Medical Laboratory Science 2 First-aid Procedures When the patient is in shock, perform the following steps as first aid: 1. Keep the airway open. 2. Call for medical assistance. 3. Keep the patient lying down. 4, Control any bleeding or other cause of shock. 5, Keep the patient warm. Cardiopulmonary Resuscitation (CPR) Cardiopulmonary resuscitation (CPR) is a procedure done on a person who is suffering from cardiac arrest. Being able to perform CPR ‘on a patient increases his/her chance of survival. Performing CPR Properly 1, While the patient is lying on his/her back on a steady surface, kneel beside the patient and place your hands in the middle of the patient's chest. 2. Cover the first hand with the heel of the other hand, interlocking the fingers. The fingers should be raised so they do not touch the ribcage. 3. Lean forward (shoulders directly over the patients chest) and press down on the chest for about two inches. Release the pressure to allow the chest to come back up. Do not release your hands. Repeat. Give 30 compressions at a rate of 100 compressions per minute. 4, Tilt the patient’s head and lift the chin to open the airway allowing the mouth to fall open slightly. 5. Using your hands, pinch the nostrils and support the chin with the other hand. Take a normal breath, place your mouth over the patient's, and blow until you see the chest rise. 6. Remove your mouth and watch the chest fall. Repeat steps five and six once, 7. Replicate the cycle of 30 chest compressions, to be followed by two rescue breaths. Repeat this cycle until the patient becomes stable and/ or a medical professional has arrived to help.Infection Control, Safety, First Aid, and Personal Wellness 27. Personal Welln: Personal wellness begins with personal hygiene, which includes bathing regularly, using deodorant, brushing one’ teeth after eating, keeping one’s hair neat and clean, trimming and cleaning one’s fingernails, and avoiding the use of heavy lotions and colognes. One should have proper nutrition and have a balanced diet consisting of vegetables, fruits, and legumes. Getting enough sleep and staying fit by having a regular exercise routine are also necessary. It is important to maintain proper posture and to keep one’s back safe from any injury by using proper techniques and equipment when lifting heavy objects, One must achieve and maintain work-life balance by finding time to relax and to relieve oneself of stress from work. Figure 240 Components of Personal Wellness ‘Source: Quad IT Solutions, Inc.