Special Feature: Randolph World Ministries Update
What began in 2000 as a partnership with one Haitian clinic laboratory to improve laboratory services, Randolph World Ministries, Inc. (RWM) continues to expand its mission and outreach through medical missions, disaster relief, education, small business start-ups and evangelism to meet the spiritual and physical needs of the people of Haiti and beyond. Teaching Haitians how to draw blood properly and safely is a very important part of the ministry, but only a small part of their efforts to improve the quality of care Haitians receive.
In the wake of last year’s devastating earthquake, RWM experienced an unprecedented outpouring of support for the people of Haiti. Thanks to its partners including two laboratory suppliers, Infolab, Inc., and Greiner Bio-One, RWM shipped donated goods to Haiti almost every week for months following the quake.
In addition to its ongoing disaster relief efforts, RWM is bolstering the local economies of some communities through small business startups, such as The Lab Supply Company of Haiti, with other businesses under development. RWM is also conducting sickle cell research in Haiti, with the ultimate goal of transforming sickle cell disease in Haiti from a fatal disease that currently claims the lives of 90 percent of its victims before age five.
Earlier this year, RWM announced new projects including “Love a Rwandan Child” child sponsorship program that will provide assistance to over 800 orphans in coordination with local ministry efforts in Rwanda. RWM is also working with individuals in Africa to develop a new ministry called “African Genocide Reconciliation” with the goal of bringing together adversarial African tribes through Christian education. Plans are also underway to reopen the vision correction ministry, which fitted over 750 Haitians with glasses during RWM’s 2009 summer mission trip.
RWM has also partnered with the Saint Louis University Medical School and its Coe Service Program. Interested SLU medical students may apply to RWM to work in one of three areas: research, mobile clinics, and the free mass screening program. Selected students will log service hours in the U.S. to develop their respective program and then participate on two RWM teams to implement what they helped plan.
Currently, Randolph World Ministries has a list of urgent requests posted on its website, including prayer support, various medical and laboratory supplies, basic medicines and toiletries, and non-perishable food. The most important needs that the phlebotomy community can fill (in order of priority) are below:
To learn more about this ministry and how you can help, visit www.randolphworldministries.org.
CDC Reports on Contaminated Alcohol Prep Pads
Last month, the Centers for Disease Control and Prevention reported on the investigation by a Colorado children’s hospital into two cases of pediatric sepsis involving Bacillus cereus. As part of the investigation, alcohol prep pads used in the treatment of both patients were obtained from various locations within the hospital and cultured. Forty of the 60 pads representing eight different manufacturing lots, grew B. cereus or Bacillus spp.
All of the alcohol prep pads tested were supplied by a single manufacturer and were not labeled as either sterile or non-sterile on the outside of the individual package or on the box in which the prep pads were contained. Alcohol prep pads are commercially available as sterile and non-sterile products. Sterile products are labeled as such and should not be interchanged with non-sterile products.
B. cereus group and Bacillus species are resistant to killing by alcohol and have been previously linked to healthcare-associated outbreaks and product contamination. Healthcare facilities and users of alcohol prep pads should know if the pads they stock are sterile or non-sterile, and assess the risk for iatrogenic infection among their patients if non-sterile alcohol prep pads are used.
Ernst Interviewed by ADVANCE for MLP
Executive Director Dennis J. Ernst, MT(ASCP) shares personal insights regarding his career path and passion for phlebotomy education in his recent interview with ADVANCE for Medical Laboratory Professionals.
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.
Q: I drew blood from an elderly woman using a 22g needle and a tube holder. I needed two gold tops and one purple top. The first gold top filled fine, but when I switched tubes, a hematoma was forming and I had to take the needle out. Why do hematomas form during a blood draw? Would it have helped to use a butterfly instead of a 22-gauge needle? Is it possible that during the switching of tubes in the holder that I moved the needle out of position causing the hematoma? What can I do to prevent this from happening in the future?
A: The hematoma was likely a result of two things: the age of the patient and needle movement during tube exchange. Elderly patients are more prone to hematoma formation than younger patients. That's because when you puncture a vein of a younger patient, the vein is more elastic and constricts around the needle when it is inserted. In older patients, the elasticity is gone and the blood readily oozes from the vein where the needle passes through its upper wall. Should the needle be disrupted during tube exchange, as is likely in your case, the space around the needle increases and the hematoma forms.
You can minimize the oozing of blood around the needle by keeping the needle as stationary as possible during the transfer. Keep the backs of your fingers holding the syringe or tube holder firmly on the patient's forearm and make sure you use the flared extensions of the device to push on and pull off the tubes.
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.
Last month, visitors to our website were asked when performing phlebotomy procedures if they ever feel pressured to draw from unorthodox sites. For those who do, we asked they identify the most common source of the pressure encountered, and if they have ever actually drawn from an unorthodox site.
When performing phlebotomy procedures, do you ever feel pressured to draw from unorthodox sites?
Those who affirmed feeling pressured identified the top three sources as the patient (30%), followed by nursing (26%) and the Emergency Department (22%). Attending physicians and parents of pediatric patients tied at nine percent, with the laboratory at four percent (see Figure 1).
When asked if they had ever drawn from an unorthodox site, almost two-thirds (64.4%) of survey participants responded that they had. Interestingly, over half of this group (52.6%) indicated that they did not feel pressured by outside sources to do so.
According to CLSI’s venipuncture standard (H3-A6), veins on the underside of the wrist must not be used due to the close proximity of nerves and tendons to the skin’s surface. In addition, alternative sites such as ankles or lower extremities must not be used without physician permission due to the risk of serious complications.
In difficult draw situations, the phlebotomist can escape liability if the physician provides permission, ideally in writing. Collectors should also keep in mind that obtaining the patient’s permission to draw from an orthodox site may not be sufficient to protect them from liability should an injury or complication occur, since the patient may not fully comprehend the risk.
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.]
One reader writes: “We are allowed to have one tourniquet when we go about our duties. Primarily, this is a safety measure to prevent a phlebotomist from leaving a tourniquet in the patient's room, or worse, on the patient. The difficulty is that we have to carry this same tourniquet from room to room. To get another, we have to call the lab for one to be sent. This is fine on the evening shift when the work slows and we can afford to wait for materials to reach the floor. However, on the day and night shifts, when a phlebotomist may draw from 30 or more patients in a three- or four-hour period and all samples have to be in the lab by a specific time, waiting for tourniquets to get to the floor is not an option.
How are we to help lower the rates of infection when the tools we use are contaminated and there isn't time to replace them? We have tried using gloves as tourniquets, but for patients that are larger and/or edematous, getting a glove that fits is sometimes a problem. Tying the glove tightly enough to constrict venous blood flow while ensuring that it will be easy to take off immediately after drawing the sample is also a concern. Any alternatives or solutions you are able to offer would be greatly appreciated.”
Our response: Although well intended from a patient safety perspective, the one-tourniquet limit you describe appears to have at least one unintended consequence, that of negatively impacting staff productivity, not to mention the potential to spread nosocomial infections. Clearly, continuing to use a soiled tourniquet is not acceptable. According to CLSI, tourniquets must be discarded immediately when contamination with blood or body fluids is obvious or suspected.(1) When a tourniquet is not available, one option is using a blood pressure cuff inflated to 40 mmHg to distend the patient’s veins.(1)
Regardless, it sounds like it’s time for you to communicate your concerns to your supervisor. If addressed as a patient safety, process improvement, and infection control issue, input from your facility’s risk manager and infection control personnel may be helpful. Because reusable tourniquets are a potential reservoir for bacterial pathogens, and have been known to spread MRSA, some institutions have implemented a single-use tourniquet policy.(2,3)
In terms of your current protocol, there are ways to account for tourniquets without compromising turn-around times and efficiency. For example, each phlebotomist could be issued two tourniquets per shift, with the second tourniquet held in reserve on the phlebotomist’s tray/cart in a zip-closure bag. Should the primary tourniquet become soiled, the phlebotomist could request a replacement from the lab, as is your facility’s current practice. The difference is the phlebotomist could then continue drawing patients in the interim using the second tourniquet. The tourniquet delivered by the lab would then serve as the phlebotomist’s new “reserve” tourniquet. This would ensure that the phlebotomist has only one tourniquet in use at any given time, but makes a replacement tourniquet readily available when needed.
Alternatively, your facility could combine strategies and issue a dedicated tourniquet to each patient upon admission, and designate it as the primary tourniquet. If it disappears, you would still have the one you have been personally allocated as a backup.
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