OSHA Announces New Educational Materials
Clinical laboratories in search of comprehensive and user-friendly information on OSHA compliance now have new resources available. Last month, the Occupational Safety and Health Administration (OSHA) announced in an OSHA Trade News Release, the publication of new educational materials aimed at assisting laboratory managers in protecting workers from exposure to chemical, biological and physical hazards. One of the documents, Laboratory Safety Guidance, contains recommendations and well as descriptions of mandatory safety and health standards, including the Bloodborne Pathogens Standard (29 CFR 1910.1030), and the Personal Protective Equipment Standard (29 CFR 1910.132) applicable to clinical laboratories subject to Federal OSHA. Select passages from the document are highlighted below:
OSHA estimates that 5.6 million workers in healthcare and related fields are at risk for occupational exposure to bloodborne pathogens.(1) The Centers for Disease Control and Prevention notes that over 200 diseases can be transmitted via blood exposure, with the most serious infections being hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV).(1)
In providing a safe work environment, the “hierarchy of controls” is defined as a systematic method of addressing workplace hazards, rather than relying on employees to reduce their exposure. Measures that may be used to protect laboratory workers are ranked from most effective to least effective below:
In terms of personal protective equipment, it’s important that PPE be:(1)
The symptoms of latex allergy and the employer’s responsibility to provide appropriate PPE alternatives to affected individuals are also addressed.
In addition to the Bloodborne Pathogens Standard and PPE Standard, OSHA’s Laboratory Safety Guidance document covers chemical hazards, physical hazards related to ergonomics, noise and radiation, safety hazards associated with centrifuges and autoclaves, trips, slips and falls, fire and electrical safety, and much more. The detailed Appendices provide supplemental information, listing numerous links and resources on a variety of laboratory safety topics.
Center Offers Facility-Wide P.A.C.E.® CE Credits
The Center for Phlebotomy Education, a leading provider of continuing education (CE) exercises for blood collection personnel, is making facility-wide continuing education credits available to employers looking for a turn-key solution to maintaining their staff's certification and competency.
The Center currently has three To the Point® exercises for immediate implementation, each worth from 3.0 to 6.0 continuing education credits. For more information on the content of each available exercise, visit http://www.phlebotomy.com/category/TTPDownload-PACE.cpe. To set up facility-wide CE credit, contact the Center toll free at 866-657-9857 or send an email to firstname.lastname@example.org.
This Month in Phlebotomy Today
Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 12th year of publication, are reading about this month:
For subscription rates and to subscribe to Phlebotomy Today, click here. The current month’s issue will be emailed to you immediately upon subscribing.
Ernst to Speak at Dark Intelligence Conference
Dennis J. Ernst MT(ASCP), Executive Director of the Center for Phlebotomy Education, will be presenting at this year's Lab Quality Confab and Process Improvement Institute in San Antonio, Texas. The event is part of The Dark Intelligence Group, Inc. and is dedicated to bringing business and management intelligence to managers and administrators of clinical diagnostic services, pathologists, radiologists, and industry executives.
Ernst will co-present "Attacking Pre-analytical's Three Biggest Sources of Error" with Patrick Maul, a Lean Six Sigma Black Belt and BD consultant. The two will discuss industry benchmarks and Lean strategies to reduce patient/sample identification errors, hemolysis rates, and blood culture contamination.
Scheduled for November 15–16, the objective of the Lab Quality Confab is to advance the knowledge, skills, and effectiveness of process improvement and quality management practitioners in diagnostic medicine. Each of the 50+ presentations at this year's event are designed to provide information, and training on process improvement and quality management methods and systems designed to advance the knowledge and skills for senior executives and administrators, managers, and quality team members.
The Dark Intelligence Group, publisher of the DARK Daily and THE DARK REPORT, also conducts the annual Executive War College on Laboratory and Pathology Management and the Molecular Summit. To register for the Lab Quality Confab and Process Improvement or for more information, visit http://www.labqualityconfab.com.
Last Month on Facebook
During the month of October, fans and visitors to our Facebook page shared their thoughts on the following topics:
Looking for an online community to post questions or to simply satisfy your hunger for phlebotomy talk between newsletter issues? Visit and “Like” our Facebook page and you’ll never miss out on another discussion. Your peers need your input, and you need theirs. www.facebook.com/CPEInc
Q: What is the common practice for drawing coagulation specimens from venous access devices? I know CLSI has issued guidelines for this procedure that recommend flushing with 5 mL of saline and discarding the first 5 mL of blood or 6 times the dead space of the catheter. Is it appropriate to follow these standards routinely, or only when no other venipuncture site can be found? Phlebotomists are put in a challenging position when patients request their line be used, but nurses insist specimens be drawn by venipuncture.
A: The standards promoted by the Clinical and Laboratory Standards Institute (CLSI, formerly NCCLS) discusses how to draw from a vascular access device (VAD), not when. It’s best to avoid VAD draws because of the increased potential for preanalytical error from contamination, hemolysis, etc., and to draw from them only when no veins are accessible. When doctors tell patients that their VAD will prevent them from having to endure venipunctures, it becomes a problem for those with blood collection responsibilities who know the risk line draws pose to accurate results. There’s no easy answer for this dilemma except to explain to the physician the problem that such a comment to the patient presents.
Each month, PT-STAT! will publish one of the hundreds of phlebotomy FAQs in the growing database of questions and answers available in Phlebotomy Central, the members-only section of the Center for Phlebotomy Education's website. For information on joining Phlebotomy Central, click here.
Website Answers Blood-Collection Questions
"The next best thing to knowing something is knowing where to find it," so says 18th century English author Samuel Johnson. When it comes to answers to questions on blood sample collection, finding them at www.phlebotomy.com is often the first and last place healthcare professionals need to look.
"First and foremost, our website must be a place where visitors find answers to their questions," says Dennis J. Ernst MT(ASCP), Executive Director of the Center for Phlebotomy Education. "Type "MRSA" into the search window in the upper left corner of our home page and no fewer than ten search results appear with links to articles we've written on MRSA as it pertains to phlebotomy. Type in "hematoma" and you get eight returns. 'Hemolysis,' over sixty."
Perhaps the most comprehensive source of answers to preanalytical questions resides in Phlebotomy Central, the members-only area of phlebotomy.com. There, subscribers have access to hundreds of back Phlebotomy Today back issues, hundreds of FAQs, and dozens of lengthy articles, all searchable by keyword.
If visitors still can't find an answer to what they're looking for, Ernst offers the personal touch. "My staff and I spend many hours each week taking calls and answering technical questions submitted by email through our 'contact us' page," says Ernst." There aren't many questions we haven't been asked over the last 13 years, but every now and then we get stumped." When that happens, Ernst says they are not ashamed to say they don't know, and then resolve to go out and find the answer. "After all, the next best thing to knowing something is knowing where to find it."
On a Personal Note...
Throughout my working life, I've held a grand total of 15 jobs before this one, which I can't really count as a job since it's too much fun. Eight were in healthcare, three in the food-service industry, one in education, one with a utility contractor, one at a tractors store, and one at a laundromat. How would I rate them in terms of job satisfaction?.If you have a moment, follow me.
Last month, we asked visitors to our website and our Facebook page about what their facility’s written procedure says about when to glove in relation to drawing blood, and at what point they actually put on their gloves.
Chart 1 illustrates the responses received, with the majority of survey participants indicating that their facility policy requires gloving to occur after identifying the patient (42%). Ten percent of respondents reported that no written instruction is provided by their facility. Of this group, only 20 percent represent facilities outside the U.S. Facilities outside the U.S. also comprise the two percent that indicated gloves are not required during phlebotomy procedures.
We also asked survey participants to share their actual gloving practices with us, with the results shown in Chart 2.
Overall, the actual gloving habits reported by survey participants mirror facility policy. Interestingly, approximately 6 percent of respondents whose policies call for gloving before the cleansing step reported they choose to glove earlier in the procedure, after identifying the patient. Of the 4 percent who responded that they do not wear gloves, 3 percent represent facilities outside the U.S.
The Clinical and Laboratory Standards Institute (CLSI) in its venipuncture standard states that the phlebotomist must put new gloves on before the venipuncture is performed. It also defers to institutional policy for isolation patients or other situations that may require donning of gloves earlier in the procedure.(1)
In the sequence of routine blood sample collection, CLSI instructs the collector to put on gloves after the vein has been selected, and before cleansing the site.(1) This placement allows the collector the option to palpate for a suitable vein before gloving, and remain in compliance with the standard.
Employees in the U.S. who choose to draw blood without gloves or compromise their integrity by tearing off the fingertips are in violation of OSHA’s Bloodborne Pathogens Standard and place their employers at risk for fines and citations.(2) They also place themselves at risk for contracting any of the 200-plus diseases that may be transmitted via blood exposure.
This month’s survey question:
What Should We Do?
[Editor’s Note: "What Should We Do?" gives you the opportunity to ask our team of technical experts for advice on your most pressing phlebotomy challenges. Whether technical or management in nature, we'll carefully consider solutions and suggestions based on the industry's best practices so that you and those in other facilities with the same problem can benefit, all the while maintaining your facility's anonymity. What Should We Do? is your opportunity to ask us for suggestions on the best way to handle your real-life dilemmas.]
Our response: You are doing exactly what we would recommend: defending the patients' right to be properly identified. Many would buckle under the pressure, but we commend you for taking a stand as the patients' last line of defense against medical mistakes. The standards and guidelines are on your side.
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