Phlebotomy Essentials (6e)

Chapter 3 — Infection Control, Safety, First Aid, and Personal Wellness

Phlebotomy Essentials (6e)

Lesson Plan

Chapter 3 — Infection Control, Safety, First Aid, and Personal Wellness

Goals of the Lesson:

Cognitive: Students will understand how patients and healthcare workers acquire healthcare-associated infections (HAIs) and be able to identify the steps necessary to prevent them. Students will be able to identify warning labels. They will be able to list and explain isolation and other procedures used to minimize the spread of infection. They will be able to identify safety principles and how to maintain a safe environment for patients and healthcare workers. Students will be able to identify key components of personal wellness and explain how to maintain their own personal wellness.

Motor: Students will be able to properly don and remove protective attire and perform hand washing procedures. They will be able to demonstrate proper handling of an exposure incident and clean-up of spills of biohazardous materials. They will have a working knowledge of laboratory first aid procedures, CPR, and AHA’s chain of survival.

Affective: Students will understand the inherent risk involved when working with all patients in the healthcare environment and will take action to protect themselves, patients, and other individuals from excessive risk for infection and biohazard exposure.

Learning Objectives. The lesson plan for each objective starts on the page shown below:

Objective 3-1: Demonstrate knowledge of terminology and practices related to Infection Control and identify agencies associated with infection control precautions, procedures, and programs.. 3-3

Objective 3-2: Identify key elements of the Blood-Borne Pathogen Standard and the Needlestick Safety and Prevention Act, and identify associated organizations. 3-12

Objective 3-3: Identify hazards, warning symbols, and safety rules related to the laboratory, patient areas, and biological, electrical, fire, radiation, and chemical safety, and discuss actions to take if incidents occur.. 3-16

Objective 3-4: Recognize symptoms needing first aid and list the main points of the American Heart Association CPR and ECC guidelines.. 3-19

Objective 3-5: Describe the role of personal wellness as it relates to nutrition, rest, exercise, stress management, and back protection.. 3-20

You Will Need:

Suggested list of classroom materials and teaching aids for Chapter 3:

3-3 Blood agar plate; incubator; fluorescent lotion; UVA light

3-3, 3-4 True Confessions of a Filthy, Rotten, Germ. (Healthcare Professionals Version) Brevis Corp, Salt Lake City, UT. www.brevis.com.

3-3, 3-4 CLSI (2005). Preventing Bloodborne Pathogen Infection: Improved Practice Means Protection. [CLSI Document M29-A2-DVD].Wayne, PA.

Fake blood, gloves for each student, EPA-approved cleanup kit, biohazard container

3-5 Lab safety equipment

3-5 CLSI (2012). Clinical Laboratory Safety. Approved Guideline –3rd Edition [CLSI Document GP17-A3]. Wayne, PA.

3-5 CLSI (2014). Protection of Laboratory Workers from Occupationally Acquired Infections. Approved Guideline-4th Edition [CLSI Document M29-A4]. Wayne, PA.


Objective 3-1a: Demonstrate knowledge of terminology and practices related to Infection Control and identify agencies associated with infection control precautions, procedures, and programs

Lecture Outline — Objective 3-1a

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Figures, Tables, and Features

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Resources and

In-Class Activities

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Outside Assignments/ Evaluation

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Instructor’s Notes

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Content / Text / PPt /
Key Terms listed on p. 59 / 60-64 / All tables and figures are available in the Image Bank on the IRC. / In-Class Activities
IRC
Critical Thinking Question / Outside Assignments
SRC
Audio Glossary of key terms
Flashcards of key terms
Evaluation
WB
Matching 3-1: Key Terms and Descriptions
Knowledge Drill 3-2: Scrambled Words
Skills Drill 3-2: Word Building
Legend: PPt: PowerPoint; IRC: Instructor Resource Center (found at http://thepoint.lww.com/McCall6e); SRC: Student Resource Center (found at http://thepoint.lww.com/McCall6e); WB: Workbook.


Objective 3-1b: Identify the components of the chain of infection and give examples of each, describe infection-control procedures used to break the chain, and identify four functions of infection-control programs.

Lecture Outline — Objective 3-1b

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Figures, Tables, and Features

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Resources and

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Outside Assignments/ Evaluation

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Instructor’s Notes

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Content / Text / PPt /
v  Infection Control
¨  Infection
o  Communicable infections
o  Nosocomial & healthcare-associated infections
v  The chain of infection
¨  Six key components
o  Infectious agent
o  Reservoir
o  Exit pathway
o  Means of transmission
o  Entry pathway
o  Susceptible host
¨  Infectious agent
o  Causative agent; microbe responsible for causing infection
¨  Reservoir
o  Source of infectious agent
·  Humans
·  Animals
·  Food
·  Water
·  Soil
·  Contaminated items
o  Viability
o  Virulence
¨  Exit pathway
o  Eyes
o  Nose
o  Mouth
o  Wounds
o  Tissue specimens
o  Blood
o  Feces, urine
¨  Means of transmission
o  Airborne
o  Contact
·  Direct
·  Indirect
o  Droplet
o  Vector: insect; arthropod; animal
o  Vehicle: food, water, drugs
¨  Entry pathway
o  Body orifices
o  Mucous membranes: eyes, nose, mouth
o  Breaks in skin
¨  Susceptible host
o  Decreased ability to resist infection
o  Immune
v  Breaking the chain of infection
¨  Stopping infections at the source
¨  Preventing contact with substances from exit pathways
¨  Eliminating means of transmission
¨  Blocking exposure to entry pathways
¨  Reducing host susceptibility
v  Infection control programs
¨  Employee screening and immunization
¨  Evaluation and treatment
¨  Surveillance / 64–69 / 4–11 / Figures
3-1: The chain of infection.
p. 62
3-2: The N95 respirator.
p. 63
Boxes
3-1: CDC List of Infectious Diseases That May Be Acquired in Healthcare Facilities
p. 61
3-2: Examples of Ways to Break the Chain of Infection
p. 65 / NA / Outside Assignments
WB
Matching 3-2: Activity Example and Means of Transmission
Knowledge Drill 3-3: Breaking the Chain of Infection
Legend: PPt: PowerPoint; IRC: Instructor Resource Center (found at http://thepoint.lww.com/McCall6e); SRC: Student Resource Center (found at http://thepoint.lww.com/McCall6e); WB: Workbook.


Objective 3-1c: Describe proper procedures for hand hygiene, putting on and removing protective clothing, and entering the nursery or neonatal ICU.

Lecture Outline — Objective 3-1c

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Figures, Tables, and Features

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Resources and

In-Class Activities

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Outside Assignments/ Evaluation

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Instructor’s Notes

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Content / Text / PPt /
v  Infection Control Practices
¨  Hand hygiene (Box 3-3) — single most important means of preventing infection spread
o  Antiseptic hand cleaners
o  Washing
¨  Personal protective equipment (PPE)
o  Gloves
o  Gowns
·  Properly worn with sleeves to wrist, belt tied, and gown overlapped and securely fastened
·  Removed from the inside by sliding arms out of sleeves
o  Lab coats
o  Masks, face shields, goggles
o  Respirators
¨  Correct order to put on and remove protective clothing should be followed
o  Gown first, mask next, then gloves
o  Removal: Gloves, gown, mask
¨  Nursery and Neonatal Intensive Care Unit (ICU) Infection-Control Technique
o  Wash hands thoroughly
o  Put on clean gloves, gown, and mask
o  Bring only necessary items into nursery
o  Remove gloves, wash hands, and put on new gloves after finishing with one patient and before going to next / 65-72 / 12–16 / Figures
3-3: Stop sign reminder to wash hands with soap and water.
p. 66
3-4: Glove removal.
p. 69
3-5: Protective clothing. A. Phlebotomist slips arms into a protective gown. B. A mask is applied by slipping the elastic band over the ears. C. Gloves are put on last and pulled over the gown cuffs.
p. 71
Boxes
3-3: Situations That Require Hand Hygiene Procedures
p. 66
Procedure
3-1: Hand-Washing Technique
pp. 67-78 / Resources
True Confessions of a Filthy, Rotten, Germ. (Healthcare Professionals Version) Brevis Corp, Salt Lake City, UT.
www.brevis.com
In-Class Activities
Discussion
Practice proper hand-washing procedures.
Touch your hand to a blood agar plate after touching various surfaces or before and after hand washing. Incubate the plates overnight and observe growth of microorganisms.
Simulate hand contamination with fluorescent lotion and view hands under UVA light before and after washing.
Practice the proper way to put on and remove gloves.
IRC
Video: “Donning and Removal of Protective Equipment”
Video: “Hand Washing / Hand Antisepsis”
Materials
blood agar plate
incubator
fluorescent lotion
UVA light
/ Outside Assignments
WB
Knowledge Drill 3-4: Situations That Require Hand Hygiene
Skills Drill 3-3: Hand-Washing Technique
Legend: PPt: PowerPoint; IRC: Instructor Resource Center (found at http://thepoint.lww.com/McCall6e); SRC: Student Resource Center (found at http://thepoint.lww.com/McCall6e); WB: Workbook.


Objective 3-1d: Describe standard and transmission-based precautions and identify the organizations that developed them.

Lecture Outline — Objective 3-1d

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Figures, Tables, and Features

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Resources and

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Outside Assignments/ Evaluation

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Instructor’s Notes

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Content / Text / PPt /
v  Isolation Procedures: doctor’s order; usually private room
¨  Protective or reverse isolation
o  Highly susceptible patients
¨  Traditional isolation systems
o  Category-specific
o  Disease-specific
¨  Universal precautions
o  Prevent patient-to-personnel transmission
¨  Body substance isolation
o  Requires that gloves must be worn when contacting any moist body substance
¨  Revised guideline for isolation precautions in hospitals
o  Standard precautions (Fig. 3-6)
o  Transmission-based precautions — to minimize the risk of infection transmission from both recognized and unrecognized sources
·  Airborne (Fig. 3-8)
·  Droplet (Fig. 3-9)
·  Contact (Fig. 3-10) / 72–75 / 17–19 / Figures
3-6: Standard precautions sign.
p. 73
37: Respiratory hygiene/cough etiquette
p. 74
3–8: Airborne precautions sign.
p. 77
3–9: Droplet precautions sign.
p. 78
3–10: Contact precautions sign.
p. 79
Tables
3–1: Clinical Conditions Warranting Transmission-Based Precautions Pending Confirmation of Diagnosis
p. 75
3–2: Transmission-Based Precautions for Common Diseases and Conditions
p. 76 / Resources
True Confessions of a Filthy, Rotten, Germ. (Healthcare Professionals Version) Brevis Corp, Salt Lake City, UT.
www.brevis.com
In-Class Activity
IRC
Critical Thinking Question
/ Evaluation
WB
Case Study 3-1: Airborne Precautions
Case Study 3-2: Work Restrictions (textbook Appendix D)
Legend: PPt: PowerPoint; IRC: Instructor Resource Center (found at http://thepoint.lww.com/McCall6e); SRC: Student Resource Center (found at http://thepoint.lww.com/McCall6e); WB: Workbook.


Objective 3-1e: State safety rules to follow when working in the laboratory and in patient areas.

Lecture Outline — Objective 3-1e

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Figures, Tables, and Features

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Resources and

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Outside Assignments/ Evaluation

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Instructor’s Notes

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Content / Text / PPt /
v  Safety
¨  Biosafety
o  Biohazard
o  Biohazard exposure routes
·  Airborne
·  Ingestion
·  Nonintact Skin
·  Percutaneous
·  Permucosal
v  General Lab Safety
(Box 3-4)
v  Patient Area Safety
(Box 3-5) / 75–80 / 20- / Figures
3–11: The biohazard symbol.
p. 79
Boxes
3-4: General Laboratory Safety Rules
p. 76
3-5: Safety Rules When in Patient Rooms and Other Patient Areas
p. 80 / Resources
CLSI. (2004). Clinical Laboratory Safety. Approved Guideline
[CLSI GP17-A2]. Wayne, PA.
In-Class Activities
Discussion
Examine safety equipment such as face shields, goggles, and splash guards.
Materials
Lab safety equipment
/ Outside Evaluation
WB
Knowledge Drill 3-5: Safety Rules When in Patient Rooms and Other Patient Areas
Legend: PPt: PowerPoint; IRC: Instructor Resource Center (found at http://thepoint.lww.com/McCall6e); SRC: Student Resource Center (found at http://thepoint.lww.com/McCall6e); WB: Workbook.


Objective 3-2a: Identify key elements of the Blood-Borne Pathogen Standard and the Needlestick Safety and Prevention Act, and identify associated organizations

Lecture Outline — Objective 3-2a

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Figures, Tables, and Features

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Resources and

In-Class Activities

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Outside Assignments/ Evaluation

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Instructor’s Notes

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Content / Text / PPt /
v  Blood-Borne Pathogens
¨  Infectious microorganisms
¨  HBV and Hepatitis D Virus
o  Vaccination is best defense
o  HBV exposure hazards — transmitted through:
·  Needlesticks
·  Contact with contaminated equipment, objects, and surfaces
·  Contact with infectious material through aerosols, spills, and splashing
·  Sexual contact
·  Sharing of dirty needles
o  Symptoms of HBV infection
·  Resemble flu symptoms, but generally last longer
·  Fatigue
·  Loss of appetite
·  Mild fever
·  Muscle, joint, and abdominal pain
·  Nausea
·  Vomiting
¨  HCV: Hepatitis C
o  HCV exposure hazards
·  Can enter the body in same manner as HBV, only usually after large or multiple exposures
o  Symptoms of HCV infection
·  Similar to HBV, although only 25% to 30% of infections display symptoms
¨  HIV
o  Virus that causes AIDS
o  HIV exposure hazards
o  Symptoms of infection
·  Mild to severe flu symptoms / 80-81 / 21–23 / NA / Resources
CLSI (2005). Preventing Bloodborne Pathogen Infection: Improved Practice Means Protection. CLSI M29-A2-V or DVD. Wayne. PA
http://www.osha.gov
In-Class Activities
Discussion
Write an exposure control plan for the student laboratory. / Outside Assignments
WB
Knowledge Drill 3-6: Pathogen Transmission and Precautions
Legend: PPt: PowerPoint; IRC: Instructor Resource Center (found at http://thepoint.lww.com/McCall6e); SRC: Student Resource Center (found at http://thepoint.lww.com/McCall6e); WB: Workbook.


Objective 3-2b: Discuss the major points of the blood-borne pathogens (BBP) standard, including changes required by the Needlestick Safety and Prevention Act, and identify key elements of a BBP exposure control plan.

Lecture Outline — Objective 3-2b

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Figures, Tables, and Features

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Resources and

In-Class Activities

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Outside Assignments/ Evaluation

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Instructor’s Notes

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Content / Text / PPt /
v  OSHA Blood-Borne Pathogens Standard
¨  Engineering and work practice controls
¨  PPE
¨  Needlestick Safety and Prevention Act of 2000
¨  Exposure Control Plan
o  Determination
o  Implementation and compliance
o  Hepatitis B vaccine and postexposure follow-up
o  Employee hazard communication
o  Record keeping
¨  BBP Exposure Routes
o  The skin is pierced by a contaminated needle or sharp object
o  Blood or other body fluid splashes into the eyes, nose, or mouth
o  Blood or other body fluid comes in contact with a cut, scratch, or abrasion
o  A human bite breaks the skin
¨  Exposure Incident Procedure
o  Needlesticks
o  Mucous membrane
o  Incident reports
¨  Surface Decontamination
o  With a 1:10 bleach solution or other EPA-approved disinfectant
¨  Cleanup of body fluid spills
o  Special EPA-approved chemical solutions available for cleanup of blood and other body fluid spills and for disinfecting surfaces
¨  Biohazard Waste Disposal
o  All discarded items contaminated with blood or other body fluids are considered biohazardous waste and must be disposed of in special containers or bags marked with a biohazard symbol / 81-84 / 24–28 / Figures
3-12: Eyewash basin.
p. 82
Boxes
3-6: Key Elements of an Exposure Control Plan
p. 83
3-7: Key Elements of a Postexposure Medical Evaluation
p. 83
Procedure
3-2: Cleanup Procedures for Blood and Other Body Fluid Spills
p. 84 / Resources
CLSI (2005). Preventing Bloodborne Pathogen Infection: Improved Practice Means Protection. M29-A2-V or DVD.
http://www.osha.gov
In-Class Activity
Discussion

Bring in some fake “blood” and spill it on the floor. Demonstrate proper precautions and steps to take in cleaning up the spill. Then have students practice cleaning up their spills.

Materials
Fake blood, gloves for each student, EPA-approved cleanup kit, biohazard container / Outside Assignments
WB
Matching 3-4: Type of Spill and Cleanup Procedure
Labeling Exercise 3-2: Engineering Controls and Work Practice Controls
Legend: PPt: PowerPoint; IRC: Instructor Resource Center (found at http://thepoint.lww.com/McCall6e); SRC: Student Resource Center (found at http://thepoint.lww.com/McCall6e); WB: Workbook.


Objective 3-3a: Identify hazards, warning symbols, and safety rules related to the laboratory, patient areas, and biological, electrical, fire, radiation, and chemical safety, and discuss actions to take if incidents occur