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Phlebotomy Today

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July, 2019


Ten Truths About Gloves

Hands shape heartGloves are an integral part of personal protective equipment for healthcare professionals assigned blood specimen collection responsibilities, and are a key component of every infection control program. But how much do you know about the quality and limitations of the gloves you wear? Do you inspect every pair that you don? Do you know the glove type that is most likely to leak? Do gloves have an expiration date? To test your knowledge, answer the true/false statements below:

  1. According to the U.S. Food and Drug Administration (FDA), manufacturing standards state that it's acceptable for patient examination gloves to have holes.

True The FDA lowered the defect rate for patient examination medical gloves is 2.5 percent.(1,2) This means that up to ten exam gloves in a lot of 500 can be defective and still  comply with the FDA's standard. Because defects may occur during the manufacturing process, every pair of gloves should be inspected before use.

  1. Hot, sweaty hands can compromise the integrity of latex gloves.

 True In approximately 50 minutes, heat and perspiration emitted by the hands can break down latex to the point that viruses such as hepatitis B and HIV can penetrate. To ensure uncompromised barrier protection, a latex glove should not be worn for more than 30 minutes.

  1. Compared to latex and nitrile, vinyl is less likely to leak and allow penetration of organisms.

False Vinyl gloves are more likely to leak and allow pathogens to pass through when compared to latex and nitrile. Nitrile is superior to latex and vinyl in terms of resisting perforation. But when holes do occur in nitrile gloves, they enlarge much quicker. From a material integrity standpoint, latex or nitrile gloves are preferable to vinyl for clinical procedures that require manual dexterity and/or involve more than brief patient contact.(3)

  1. Chemicals can dissolve gloves.

True The most common types of gloves used in clinical laboratories are susceptible to the effects of a variety of chemicals. No one glove material is resistant to all chemicals. For example, some petroleum-based hand lotions can dissolve latex. If unsure about a particular chemical's effect on the gloves you wear, check the chemical penetrance charts published by the glove manufacturer.

  1. Latex gloves should be dated when opened and discarded after three months.

True Latex can be compromised by a variety of environmental factors, including exposure to:

  • ozone;
  • x-rays;
  • UV light;
  • temperatures above 33 degrees Celsius;
  • humidity levels exceeding 40 percent.

To prevent latex degradation, gloves should be stored in a cool and dry environment, free from electrical equipment or light sources. Date individual boxes when they are opened and discard any remaining gloves after three months.(1)

  1. Latex gloves have been known to spontaneously combust.

True - In 1996, the FDA issued a public health advisory after the spontaneous combustion of latex gloves caused four fires in different states.(4) The fires occurred in warehouses where large quantities of non-sterile, powder-free, latex gloves that had been imported from China were stored on pallets. The most important contributing factors identified were extreme heat and the bulk of gloves stored, with the FDA making the following recommendations:

  • Avoid a large inventory of powder-free latex gloves.
  • Remove shrink wrap from pallets of stacked cartons.
  • Restack/reconfigure cartons to promote cooling ventilation.
  • Regularly check gloves for signs of deterioration, such as discoloration, brittleness, tackiness, or an acrid chemical odor.
  • Rotate glove stock using "first-in-first-out" practices.
  1. Latex particles can become airborne if powder is present in latex gloves.

True When powder is present in latex gloves, the protein responsible for latex allergies can attach to it. When gloves are removed, the particles can become airborne for up to five hours and serve as a route of exposure to others who are sensitive to latex. Because of the potential for respiratory reactions in allergic individuals, it is generally recommended that latex gloves containing powder be avoided. However, advancements with latex glove manufacturing technologies provide the option of powder-free latex with lower protein content.(3)

  1. The reactions associated with latex allergy are always mild.

False The reactions experienced in patients and healthcare workers sensitive to natural rubber latex can range from mild to life-threatening.(3) The number of healthcare workers experiencing latex allergies or hypersensitivity is estimated to be 2 to 17 percent.(3) The FDA has received reports of 15 healthcare worker deaths directly attributable to exposure to medical devices that contain latex.(5)

  1. The barrier integrity of any glove may be compromised by routine practices.

True Jewelry, long fingernails, and artificial nails may snag or puncture gloves and should be avoided. Incompatible hand lotions may compromise the glove's integrity and improper donning, such as pulling too hard on gloves, may tear them. If the fit is too loose, the glove may catch on equipment or other objects. If too tight, the glove is subject to tear due to excessive stress.(3)

  1. Gloves provide no protection against a needlestick.

False - Studies show that when a contaminated needle pierces a glove, the material of the glove wipes off up to 86 percent of the blood from the needle before it passes into your tissue. That means you have a lesser inoculation of whatever virus could be in the blood that you're exposed to.(6)

 

References

  1. Davis, D. Gloves: Lab Safety: Uncommon Knowledge About Common Objects. Lab Med 2008;39(9):576.
  2. S. Department of Health and Human Services. Food and Drug Administration. 21CFR800.20; Subpart B--Requirements for Specific Medical Devices; Patient examination gloves and surgeons' gloves; sample plans and test method for leakage defects; adulteration. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=800.20. Accessed 6/18/2019.
  3. Experts Address Glove-Related Latex Allergies. Inf Cntrl Today. http://www.infectioncontroltoday.com/articles/2008/10/experts-address-glove-related-latex-allergies.aspx. Accessed 6/18/2019.
  4. S. Department of Health and Human Services. Food and Drug Administration. FDA Public Health Advisory: Potential risk of spontaneous combustion in large quantities of patient examination gloves. June 27, 1996. https://wayback.archive-it.org/7993/20170111190754/http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PublicHealthNotifications/ucm062588.htm. Accessed 6/18/2019.
  5. Latex Allergy. Occupational Safety and Health Administration, U.S. Department of Labor.  https://www.osha.gov/SLTC/latexallergy/index.html. Accessed 6/18/2019.
  6. Ernst D. Ernst C. (ed) The Lab Draw Answer Book. Center for Phlebotomy Education. Corydon, Indiana. 2017.

 


Become Your Facility's Phlebotomy Guru

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What Should We Do?: Locking up the needles

Dear Center for Phlebotomy Education:

Good morning! We recently had some inspectors come through our outpatient draw sites and were concerned with our needle storage. We have patient draw rooms where the patient is rarely left  alone and never left alone with the door shut. The maximum amount of time patients could be left alone with the door open in approximately 2 minutes. The inspectors felt that we should lock up our needles and adapters as well as our butterfly needles at all times. Does this sound like a patient safety concern or do you think they're going too far? What should we do?

Our response:

Generally speaking, needle theft by patients is highly unusual and a rare occurrence. Of course, if you're in an area of the country or a part of the city where IV drug abuse is rampant, the potential for needle theft increases proportionately. It seems that there are easier sources for addicts to obtain free needles than to go to a lab or outpatient drawing station with an order for lab work and hope the phlebotomist leaves the room.

You didn't mention the nature of the inspection agency, but we're going to assume it was for laboratory or hospital accreditation. OSHA would not be concerned with needle theft. Regardless, it seems to us the inspector's concerns are being overplayed. Locking up your phlebotomy supplies in case a phlebotomist leaves the room is a significant impediment to the workflow. The easier solution would be to establish a policy that patients are not allowed to be in the drawing area without a phlebotomist or other member of the staff. That should satisfy the inspectors if the issue continues to be a cause for their concern. 

 


"Summit" Exclusive for Phlebotomy Today Subscribers

2019SummitLogo with Dates_600wThe Center for Phlebotomy Education and Greiner Bio-One want to see you at the Global Summit on Best Practices in Preanalytics this fall. So we've teamed up for an exclusive offer for Phlebotomy Today readers only. If you receive this newsletter, we're extending early-bird registration for you through September 1.

The Global Summit on Best Practices in Preanalytics is a 3-day educational conference for Laboratory Directors, Phlebotomists, Medical Technologists, and Phlebotomy Educators that artfully combines educational content regarding proper phlebotomy technique while also teaching attendees about the nuances of laboratory and staff management.

Being held in Las Vegas in October, this year's conference includes speakers from some of the country's most well-known and well-respected healthcare-based companies. This includes LabCorp's Chief Medical Officer, Dot Adcock, who will be providing an impactful session regarding coagulation testing.  Alongside Dr. Adcock, the speaker line-up has a new face in 2019 with Dr. David Grenache, Medical Director of ARUP Laboratories, who will be providing his expertise to attendees on how to provide value-based care in an ever-changing hospital environment.

Attendees of this conference will not only have the opportunity to learn from experts from companies like Tricore, Catholic Health System, and University Hospitals Cleveland Medical Center but will also have the opportunity in 2019 to learn from Six-Sigma Black Belts and experts in employee relations to increase the effectiveness of their teams and facilities. Just listen to what one of the previous attendees had to say:

"The Global Summit on Best Practices for Preanalytics is the one conference every Manager/Supervisor needs to attend!  The wealth of knowledge of the speakers and the information you will gain is outstanding.  It is well worth your time and money. "

Jim Harrington, Cape Cod Hospital

in the The 2019 Global Summit on Best Practices in Preanalytics is truly the #1 educational conference for those in this sector of the healthcare sphere and is not one to miss. Information on registration, speakers, and the full agenda can be found at bit.ly/GlobalSummit2019.

To take advantage of this exclusive offer, use the promotional code "GREINER" when registering online.

 


Product Spotlight: Basic Venipuncture DVD

Since its release in October, the third edition of Basic Venipuncture has been adopted into the curricula and training programs of industry's most prestigious institutions. 

BV3_Cover&Disc_DCL_1000wOur most recent revision replaces the Second Edition, which was released in 2010 and has since become the most widely used venipuncture training video in the industry. Facilities and academic institutions in 20 countries around the world use Basic Venipuncture to train their staff and students to perform venipunctures. The title was released in streaming format in August on the Phlebotomy Channel.

Features of the 3rd edition include:

  • Completely updated to reflect the newly revised CLSI venipuncture standard;
  • Completely new script, narrator, and organization of the material;
  • Filmed in high-definition;
  • 12-minutes longer than the 2nd edition;
  • Closed captioned by the National Captioning Institute.

"Basic Venipuncture is the gold standard for venipuncture training," says Dennis J. Ernst MT(ASCP), NCPT(NCCT) who wrote, produced and directed the video. "Because of the precise nature of performing a venipuncture and the risks to the patient when it isn't performed according to CLSI standards, this video took 18 months to develop and film, and 15 rounds of editorial revisions before I deemed it impeccably accurate and what our customers deserve from the Center for Phlebotomy Education. It's one of the most polished productions I've ever released."

A preview clip is available on the Center's web site.

 


From the Editor's Desk

DE_grayscale_411wFriends,

By the time you read this, I'll be in the middle of a real moving experience. 

After thriving in Indiana since it's birth in 1998, the Center for Phlebotomy Education is relocating to Michigan. As you know, my wife and I moved to the Wolverine State 18 months ago, but kept the office in Indiana open and under the capable supervision of our office manager extraordinaire, Anita Schultz. Because of the power of the InterWeb, I can develop educational materials, write newsletters, produce videos, maintain business relationships and conduct the myriad activities a Director is supposed to do from anywhere. Filling orders and taking care of customers' needs, however, requires access to inventory. Because Anita wrote the book on customer service, it would have been pure foolishness to replace her with a Michigan equivalent. Besides, one does not exist. 

This will be the company's 5th move since opening it in a spare bedroom of our Indiana home in 1998. After 9 years, it had grown to occupy the entire first floor and employ three full-time employees, so we kicked it out. It fit nicely into 1800 square feet of leased office space in Corydon, Indiana. We expanded into an adjacent office in 2009 and opened up our School of Phlebotomy to serve the local healthcare employers with qualified phlebotomy applicants. For five years, we turned those without a job skill into a highly marketable commodity coveted by healthcare employers in the Louisville, Kentucky area. It's among the most satisfying contributions we've made as a company. With the addition of still more employees, we needed additional room and again expanded, moving our inventory and shipping equipment into another adjacent space.

AnitaTrophy_500wSince closing the school at the end of 2013, we've moved the company three times for various reasons. In July, the Center for Phlebotomy Education will call Mio, Michigan its new home as we move it into 2000 square feet of leased space in a town we've grown quite fond of.

What we're not so fond of is having to function without Anita. 

AS
Anita Schultz

Many of you have come to know her as a kind and helpful customer-care professional. We came to know her as "high-powered talent." In fact, I created a one-page document listing what high-powered talent looks like and distributed copies to my staff. While others filed it away, never to be seen again or circled what they thought were typos and kept it on their desk for me to notice (true story), Anita framed her copy and hung it near her desk to serve as a constant reminder of attributes she should never stop trying to possess. The funny thing is, she already epitomizes every bullet point on the list, especially the one that read "doesn't think of him/herself as high-powered talent, but is always striving to be."

Anita joined us in January of 2007 when the company still operated in our home and has been with us ever since, setting the tone for a highly professional office environment for what would soon expand int a team of nine employees. Among the many gifts she shared include mentoring team members on turning disgruntled customers into satisfied patrons and happy customers into happier ones.

In her 12 years with the company, she's turned a fair share of bad customer experiences into not only positive encounters, but life-loyal customers. She can probably count the number of unsatisfied customer encounters on the fingers of both hands, and has turned 90% of them around with her charm, southern (Indiana) hospitality, and treat-others-as-you-would-like-to-be-treated approach. That's a testimony to Anita's talent. If there exists a customer whose negative experience she did not convert, I dare say it was not possible. 

Many of you have interacted with Anita. Trust me when I say she counts you as one of the grandest blessings of her work. You know who you are, Mary L., Adriana N., Gladys P., Kim F., Joe M., Debby B., Amie B., and many others. She will miss you dearly, as I know you will miss her. I will, as well.
     But one does not let someone like Anita just go away. She's become family to us, as has her husband and children. Our friendship will continue. There's a saying that "people come into your life for either a reason, a season, or a lifetime." With Anita, it's a lifetime. Neither of us would have it any other way.

So as I'm having my moving experience, rest assured the transition should seem pretty seamless to you. It's not like I'm going live with Epic or anything; just an address change. I'll be sending out a general announcement by email in the next week or two just to make sure all our customers know to change our mailing address in their systems. Nothing else will change.... except that Anita will be applying her high-powered talent to some other company. They have no idea how fortunate they are about to become. 

Respectfully,

Dennis J. Ernst, editor
phlebotomy@phlebotomy.com
 

 


AUMT Announces CE Day Date, Location, Topics

IMG_20141112_144126857AUMT Institute and the Center for Phlebotomy Education have just announced the date, location, and agenda for the 6th annual Phlebotomy CE Day. The event will be conducted in San Diego, California on Saturday, September 21, 2019. 

All topics will be presented by the Center's Director, Dennis J. Ernst MT(ASCP), NCPT(NCCT) and will include:

  • The Ten Commandments of Phlebotomy
  • What's New in Phlebotomy (and What Isn't!)
  • Ending Hemolysis in the ED... and Everywhere Else
  • What Would You Do? (Case studies)

"Speaking to my phlebotomy friends in California at CE Day has become one of my favorite annual events," says Ernst. "I'm particularly looking forward to collaborating with AUMT again, one of the finest phlebotomy programs in the country."

Attendees present at all sessions will earn six P.A.C.E. CE credits, which satisfy the biannual requirement for California phlebotomists. Discounted registration will be available for groups of four or more who register at the same time. All healthcare professionals throughout the U.S. and Canada are invited to attend this lively and informative event. As the event coordinator, AUMT will be managing the event, processing all registrations, communicating with all registered attendees, and providing P.A.C.E. certificates.

For more information and to register visit AUMT's CE Day web site or contact AUMT by phone at (424) 278-9442 or email at CEday@AUMT.org.

 


Advice From the OSHA Expert: When OSHA Comes to visit

Scungio_2018
Dan the Lab Safety Man

As a phlebotomist, you no doubt are familiar with how to handle inspectors when they come to your area. If you work in a hospital or a laboratory, you have been a part of a CAP or maybe a Joint Commission inspection. You know to be polite, to do your best to answer any questions, and to find a helpful resource when you may not know the answer to a question. But can you be involved when an OSHA inspector comes to your facility? Absolutely!

If someone comes to your area and identifies themselves as an OSHA inspector, the first thing you need to do is request to see his/her identification. Believe it or not, there have been people who have impersonated OSHA inspectors! Your next step is to escort the properly-identified inspector to your manager or to your facility's administration area. When OSHA is in the building, all facility executives need to be aware of it.

OSHA inspections are conducted by trained safety professionals, and they may come to your site for a variety of reasons with little or no notice. They may come to investigate a recent employee accident, or they may have been notified of a situation that causes imminent danger to employees. They may also be inspecting your site based on a complaint. OSHA also performs programmed, scheduled , or follow-up inspections of certain high-hazard facilities.

An OSHA inspection always begins with an opening conference detailing the scope and purpose of the inspection. You may not be involved in that conference, but you should receive communication from your facility about what to expect. The inspector will always be accompanied by a representative of your employer, and their next steps will be a walk-through of the inspected areas to look for safety hazards and to talk to employees. That's where you become involved. The inspector may ask to speak to you in private or in front of others. Either way, you are expected to always be completely honest with your answers to questions. If you don't know an answer, it is fine to say so.

An OSHA inspector can never suggest penalty amounts or collect money during their visit. They will conduct a closing conference with your employer to discuss their findings and let them know when to expect a written report.

Can you help your facility incur a fine? Can you help them reduce fines? Yes you can, and we will discuss that in more detail next month!

 

You can contact Dan Scungio, "Dan the Lab Safety Man" at samaritan@cox.net.

 


Test Talk: Procalcitonin

A column that features a different laboratory test each month, what it measures, why physicians order it, and any collection handling restrictions and requirements that must be met.

BloodTestTextGraphicVery few laboratory tests have garnered so much attention lately as a protein known as procalcitonin (PCT). That's because it's only recently been found to be extremely useful in managing antibiotic therapy in septic patients.

As a biomarker for the presence and severity of sepsis, it's been used in Europe for decades, and in the U.S. since 2008. Traditionally, PCT is used to differentiate between bacterial and viral infections. With bacterial infections, PCT is elevated whereas it remains normal or only slightly elevated with viral infections. However, more and more physicians are using PCT to assess the effectiveness of antibiotic therapy in the crucial hours after administration.

That's because PCT starts rising two to four hours after the toxins of a bacterial infection bring about sepsis, and peaks at 24 to 48 hours. If an effective antibiotic was chosen early in the diagnosis, PCT decreases rapidly as the infection weakens. If the antibiotic is not effective, PCT levels continue to increase. Since the test can be performed quickly, physicians who order a PCT level can assess the effectiveness of their chosen antibiotic far sooner than traditionally possible, and switch the patient to something more effective if necessary, significantly reducing mortality. 

PCTs are drawn without special patient requirements into serum tubes and centrifuged. Because patients can rapidly succumb to sepsis, PCT levels are often ordered stat and must be transported, processed and tested quickly. Delays in collecting and testing PCT levels can seriously compromise the physician's ability to prevent patient mortality.

Bibliography

  1. LabTestsOnline. American Association for Clinical Chemistry. AACC. Accessed 6/18/2019.
  2. Meisner M. Update on procalcitonin measurements. Ann Lab Med. 2014 Jul; 34(4): 263273.
  3. Jiun-Lih JL, Swee LY. Procalcitonin Medscape. http://emedicine.medscape.com/article/2096589-overview#a4. Accessed 6/18/2019. 

 


What's Wrong Here?

  RemovingStopperUnsafeWhat's wrong with this picture? We guarantee something isn't as it should be. The answer will be in next month's issue. (Click image to enlarge.) 

TwoFingerStretchLast month's image (right) depicted an anchoring technique referred to as the "two-finger stretch" or "C-hold." It's a method of anchoring in which the vein is secured both above and below the intended puncture site. However, it's easy to see how vulnerable the index finger is to a needlestick. All that has to happen to plunge the collector into six months of fear is for the patient to jump or the phlebotomist to be bumped from behind. The contaminated needle comes out and impales the index finger, positioned perfectly for the exposure. 

Whenever a finger is positioned in front of a needle, it's begging to be stuck. Instead of using the two-finger stretch, anchor the vein firmly from below the intended puncture site only. It's a sufficient compromise, and likely to be just as effective. You'll sleep better, too.

 


 

Tip of the Month: Fudging the Numbers

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