PMLS 2: Principles of Medical Laboratory Science 2

College of Allied Health Sciences

Bachelor of Science in Medical Laboratory Science
Second Semester, A.Y. 2022-2023

[[TRANS] INFECTION CONTROL AND SAFETY

OUTLINE

I Infection
A. Components of the Chain of Infection
i. Infectious Agent
ii. Reservoir
iii. Portal of Exit
iv. Means of Transmission
v. Portal of Entry
vi. Susceptible Host
B. Breaking the Chain of Infection
II Infection Control Programs
A. Employee Screening and Immunization
B. Evaluation and Treatment
C. Surveillance
III Infection Control Methods
A. Hand Hygiene
B. Personal Protective Equipment INFECTIOUS AGENT
● Also called the causative agent, is the pathogenic microbe
responsible for causing an infection.
o Bacteria, fungus, protozoon, rickettsia, virus
INFECTION
● Infection is a condition that results when a RESERVOIR
microorganism/microbe is able to invade the body, ● Source of an infectious agent; a place where the microbe
multiply, and cause injury or disease. can survive and grow or multiply.
o Microbes include bacteria, fungi, protozoa, and o Reservoirs include humans, animals, food, water,
viruses. Types include: soil, and contaminated articles or equipment.
▪ Pathogenic - causing or productive of ▪ Reservoir host - individual or animal infected
disease. with a pathogenic microbe.
▪ Nonpathogenic - do not cause disease o Human reservoirs can be patients, personnel, or
visitors and include those with an active disease,
under normal conditions. But can become those incubating a disease, and chronic carriers
pathogens if they enter and multiply in areas of a disease.
of the body where they do not exist normally. o Another reservoir for potentially infectious
o Infections caused by pathogens can be:
microbes is a person’s own normal flora
▪ Local - restricted to a small area of the body. (microorganisms that normally live on the skin
and other areas of the human body).
▪ Systemic - entire body is affected.
● Types of Infection: EXIT PATHWAY
o Communicable Infection - able to spread from ● A way an infectious agent is able to leave a reservoir host.
person to person. o Secretions from the eyes, nose, or mouth;
o Healthcare-associated infection (infections exudates from wounds; tissue specimens; blood
associated with healthcare delivery in any from venipuncture and skin puncture sites; and
healthcare setting) / Nosocomial infection excretions from feces and urine.
(infections acquired in hospitals).
MEANS OF TRANSMISSION
THE CHAIN OF INFECTION ● Method an infectious agent uses to travel from a reservoir
● If the process of infection is stopped at any component or to a susceptible individual. Same microbe can be
link in the chain, an infection is prevented. If a pathogen transmitted by more than one route.
successfully enters a susceptible host, the chain is o Airborne Transmission - involves dispersal of
completed, the host becomes a new source of infectious infectious agents that can remain infectious for
microorganisms, and the process of infection continues. long periods of time in particles.

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▪ These particles can be generated by

sneezing, coughing, talking and activities
that produce aerosols, which can remain
suspended in the air or in dust particles.
o Contact Transmission - most common means.
▪ Direct Contact transmission - physical
transfer of an infectious agent to a
susceptible host through close or intimate
contact such as touching or kissing. Ex:
Kissing Disease - caused by Epstein-Barr
Virus
▪ Indirect Contact transmission - when a
susceptible host touches contaminated
objects such as patient bed linens, clothing,
dressings, and eating utensils.
BREAKING THE CHAIN OF INFECTION
o Droplet Transmission - transfer of an infectious ● Involves stopping infections at the source, preventing
contact with substances from exit pathways, eliminating
agent to the mucous membranes of the mouth,
means of transmission, blocking exposure to entry
nose, or conjunctiva of the eyes via infectious
pathways, and reducing or eliminating susceptibility of
droplets generated by coughing, sneezing, or
potential hosts.
talking or through procedures such as suctioning
● Ways to Break the Chain:
or throat swab collection.
o Effective hand hygiene procedures
o Vector Transmission - carried by an insect,
o Good nutrition, adequate rest, and reduction of
arthropod, or animal. Examples include:
stress
▪ transmission of West Nile Virus by o Immunization against common pathogens
mosquitoes o Insect and rodent control
o Isolation procedures
▪ bubonic plague (Yersinia pestis) by rodent
o Proper decontamination of surfaces and
fleas instruments
▪ malaria is caused by plasmodium falciparum o Proper disposal of sharps and infectious waste
carried by female anopheles mosquitoes o Use of gloves, gowns, masks, respirators, and
other personal protective equipment (PPE) when
▪ Dengue virus - aedes aegypti indicated
o Vehicle Transmission - transmission through o Use of needle safety devices during blood
contaminated food, water, or drugs. Ex: collection
Salmonella Infection from handling contaminated
chicken and Shigella Infection from drinking INFECTION CONTROL PROGRAMS
contaminated water. ● Infection Control - the procedures that aim to control and
monitor infections in health-care facilities.
ENTRY PATHWAY EMPLOYEE SCREENING AND IMMUNIZATION
● Way an infectious agent is able to enter a susceptible ● Screening for infectious diseases typically takes place
host. prior or upon employment and on a regular basis
o Body orifices; mucous membranes of the eyes, throughout employment.
nose, or mouth; and breaks in the skin. ● Vaccine-preventable diseases:
(hookworms - skin penetration) o Diphtheria - can release a toxin that can block the
airway leading to death. Causative agent is
SUSCEPTIBLE HOST corynebacterium diphtheriae.
o Tetanus - causative agent is clostridium tetani
● Someone with a decreased ability to resist infection.
o Pertussis (whooping cough) - bordetella pertussis
Factors that affect susceptibility include age, health, and
immune status. o Poliomyelitis (polio) - polio virus
o Newborns (immune system still forming), elderly o Mumps - mumps virus
(immune system weakens with age), disease, o Rubella - rubella virus
antibiotic treatment, immunosuppressive drugs, o Haemophilus influenzae type b infections -
and procedures such as surgery, anesthesia, and haemophilus influenzae
insertion of catheters. o Hepatitis B - hepatitis B virus
o Influenza - influenza virus

EVALUATION AND TREATMENT

● Evaluation and treatment of employees who are exposed
to infections on the job. This includes OSHA (Occupational
Safety and Health Administration)-mandated confidential

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medical evaluation, treatment, counseling, and follow-up o Gloves - worn when collecting or handling blood
as a result of exposure to blood-borne pathogens. and other body fluids, handling contaminated
items, and touching non intact skin or mucous
SURVEILLANCE membrane.
● Involves monitoring patients and employees at risk of o Gowns - nonsterile, fluid-resistant gowns to
acquiring infections as well as collecting and evaluating protect the skin and prevent soiling of clothing
data on infections contracted by patients and employees. during patient-care activities in which splashes or
● Infection control measures are updated and new policies sprays blood or body fluids are possible or when
instituted based on this information. entering isolation rooms.
o Masks - to protect against droplets generated by
INFECTION CONTROL METHODS coughing or sneezing.
o Face shields and goggles - to protect the eyes,
HAND HYGIENE nose, and mouth from splashes or sprays of body
● One of the most important means of preventing the spread fluids.
of infection provided that it is achieved properly when o Respirators - required when entering rooms of
required. patients with pulmonary tb and other diseases
o Use of Alcohol-Based Antiseptic Hand with airborne transmission.
Cleaners ● Provides a barrier against infection.
▪ CDC (Centers for Disease Control and
DONNING AND DOFFING OF PPE (CDC)
Prevention) / HICPAC (Healthcare Infection
● Donning means putting on; Doffing means
Control Practices Advisory Committee)
removing/removal.
guidelines recommend this.
● Donning:
▪ Gels, foams, and rinses 1. Gown
2. Mask or Respirator
▪ As long as the hands are not visibly soiled. 3. Goggles or Face Shield
o Hand Washing 4. Gloves
● Doffing:
▪ Routine Hand washing - uses plain soap and 1. Gloves
water to remove soil and transient bacteria. 2. Goggles or Face Shield
▪ Hand antisepsis - use of antimicrobial soap 3. Gown
4. Mask or Respirator
to remove, kill, or inhibit transient
microorganisms.
▪ 2-minute surgical hand scrub - uses an
antimicrobial soap or equivalent to remove or
destroy transient microorganisms and
reduce levels of normal flora prior to surgical
procedures.

WHO 5 MOMENTS APPROACH FOR HAND HYGIENE

● Before touching a patient,
● Before clean/aseptic procedures
● After body fluid exposure risk,
● After touching a patient, and
● After touching patient surroundings

SITUATIONS THAT REQUIRE HAND HYGIENE

PROCEDURES (PHLEB ESSENTIALS)
● Before and after each patient contact
● Between unrelated procedures on a patient such as
wound care and drawing blood
● Before putting on gloves and after taking them off
● Before leaving the laboratory
● Before going to lunch or on break
● Before and after going to the restroom
● Whenever hands become visibly or knowingly
contaminated

PERSONAL PROTECTIVE EQUIPMENT

● Protective clothing and other items worn by an individual
to protect mucous membranes, airways, skin and clothing
from contact with infectious substances.

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 PMLS 2: Principles of Medical Laboratory
College of Allied Health Sciences
Bachelor of Science in Medical Laboratory Science
First Semester, A.Y. 2022-2023

[TRANS] PMLS 2: HAZARDS IN THE HEALTHCARE SETTING

▪ Wear heavy-duty utility gloves when cleaning

OUTLINE
broken glass
I Biological Hazards ▪ Never handle broken glass with bare hands
A Biohazard exposure Routes • Permucosal
B Standard Precautions o Infection through mucous membranes of the mouth
C Biological Waste Disposal and nose and the conjunctiva of the eyes.
II Shard Hazards ▪ Observe proper handling to avoid aerosols and
III Chemical Hazards
splashes
A Chemical Hygiene Plan (CHP)
B Material Safety Data Sheets (MSDS) ▪ Avoid rubbing and touching the eyes, nose,
IV Radioactive Hazard and mouth
V Electrical Hazards
VI Fire or Explosive Hazards STANDARD PRECAUTIONS
VII Chemical Hazards • In 1987, CDC instituted Universal Precautions (UP).
A Characteristics of Fire o All patients are considered to be possible carriers of
B Types of Extinguisher blood-borne pathogens.
VIII Physical Hazards
• Body Substance Isolation (BSI) guidelines are not limited
to blood-borne pathogens; they consider all body fluids
BIOLOGICAL HAZARDS and moist body substances to be potentially infectious.
• In 1996, CDC and HICPAC combined the major features
• Also known as biohazard, which refers to any material that of UP and BSI guidelines and called the new guidelines
could be harmful to one’s health. Standard Precautions.
o Biosafety is used to prevent and protect clinical o Standard Precautions are as follows:
laboratories from harmful incidents caused by ▪ Hand hygiene
laboratory specimen that are potential biohazards ▪ Gloves
▪ Mask, eye protection, and face shield
▪ Gown
▪ Patient care equipment
• equipment used by the patients
▪ Environmental control
• disinfecting the surroundings
▪ Linen
• e.g., bed sheets, hospital gown
Figure 1. Biohazard Symbol ▪ Occupational health and blood-borne
symbolizes the continuous link of pathogens
the source and the host • e.g., (occupational health) avoid
mouth pipetting to prevent ingestion
BIOHAZARD EXPOSURE ROUTES of samples
• In A health worker could be exposed to a biohazard in ▪ Patient placement
various ways. These ways are called the biohazard
exposure routes. BIOLOGICAL WASTE DISPOSAL
• Airborne • All biological waste, except urine, must be placed in
o From splashes and aerosols during centrifuge and appropriate containers labelled with the biohazard symbol.
aliquot; patients with airborne diseases. o The waste is then decontaminated following
▪ Observe proper handling practices institutional policy:
▪ Wear PPE properly ▪ Incineration
▪ Use safety shield and guards • Refers to the process of burning wastes
• Ingestion ▪ Autoclaving
o Hands are not sanitized before handling food. • The use of steam sterilization to render
▪ Wash hands frequently waste harmless; an efficient wet thermal
▪ Avoid hand-to-mouth activities disinfection process.
▪ Avoid placing items in the mouth • 121 °C with a pressure of 15 psi for 15 to
• Non-intact skin 30 mins.
o Contamination through breaks or cuts in the skin. ▪ Pickup by a certified hazardous waste
▪ Cover skin breaks or cuts with non-permeable company
bandages • Urine is discarded by pouring it into a laboratory sink.
• Percutaneous o Disinfection of the sink using a 1:5 or 1:10 dilution of
o Exposure through the skin due to injuries from sodium hypochlorite should be performed daily.
needlesticks and other sharp objects
▪ Use needle safety devices

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SHARP HAZARDS o Physical and chemical characteristics

• Caused by sharp objects in the laboratory (e.g., needles, o Fire and explosion potential
lancets, and broken glassware) o Reactivity potential
• Sharps must be disposed in puncture-resistant containers o Health hazards and emergency first aid procedures
(color coding of the container: red) o Methods for safe handling and disposal
o Primary routes of entry
o Exposure limits and carcinogenic potential

CHEMICAL LABELING
• National Fire Protection Association (NFPA)
o Symbol on doors, cabinets, containers

Figure 2. Sharp Hazard Symbol

CHEMICAL HAZARDS
• Chemicals are used as cleaning agents, in adding
preservatives in urine container (24-hour), or in delivering
specimens to the laboratory.
• As a general rule, the phlebotomist should always wear
PPE when working with chemicals.
• Chemical clean-up materials should be properly used in
case of chemical spill
• For Chemical Spills,
o Flush the area with large amounts of water for at
least 15 minutes and then seek medical attention
o Proper use of emergency showers and eye wash
stations
• For Chemical Handling,
o Acid should always be added to water
o Wear goggles and prepare reagents under a fume Figure 4. Hazardous
hood Materials Classification
• The following practices should NEVER be done
o Storing chemicals above eye level RADIOACTIVE HAZARD
o Adding water to acid • Radiation exposure depends on time, distance, and
o Mixing chemicals indiscriminately protection, or shielding.
o Storing chemicals in unlabeled containers o The length of time of the exposure and the distance
o Pouring chemicals into used or dirty containers of the individual from the source of radiation matter
o Using chemicals in ways other than their intended because the effect is cumulative.
uses o The protection worn at the time also has a bearing
effect on the intensity of exposure
• Radiation hazards can be encountered by phlebotomists
when collecting specimens from the following:
o From the patients who have been injected with
radioactive dyes
o From the nuclear medicine department
o When delivering specimens to the
radioimmunoassay sections of the laboratory
o Procedures using radioisotopes
Figure 3. Chemical Hazard Symbol • Persons working in a radioactive environment are
required to wear measuring devices to determine the
CHEMICAL HYGIENE PLAN (CHP) amount of radiation they are accumulating.
• The purpose of the plan is to detail the following:
o Appropriate work practices
o Standard operating procedures
o Personal Protective Equipment (PPE)
o Engineering controls
o Employee training requirements
o Medical consultation guidelines

MATERIAL SAFETY DATA SHEETS (MSDS)

• OSHA Federal Hazard Communication Standard Figure 5. Radioactive Hazard Symbol
• Information included in an MSDS are as follows:

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ELECTRICAL HAZARDS o Aim at the base of the fire.

• Laboratory personnel should continually observe for any o Squeeze handles.
dangerous conditions such as frayed cords and o Sweep nozzle side to side.
overloaded circuits
• All electrical equipment must be grounded with three-
pronged plugs

Figure 7. Fire Hazard Symbol

Table 1. Characteristics of Fire

Figure 6. Electrical Hazard Symbol and Types of Extinguisher
EXTINGUISHING
ELECTRIC SHOCK TYPE EXTINGUISHER
MATERIAL
• Shock is a condition when there is not enough blood that
Class Ordinary combustibles Water or water-
circulates back to the heart, which results in inadequate
A (wood, paper, clothing / based solutions
supply of oxygen in the body.
garments, plastic)
• It may be cause by hemorrhage, heart attack, trauma, and
drug reactions Class Flammable organic Dry chemicals,
• The following actions should be taken if electric shock B chemicals / liquids carbon dioxide, or
occurs: (gasoline, paints, oil) foam
o Remove the source of electricity using a non- Class Electrical equipment Dry chemicals,
conductive object or simply turn off the source of C (machines, motor carbon dioxide, or
electricity. switches, plugs) halon
o Ask for medical assistance. (non-conducting
o Start cardiopulmonary resuscitation (CPR) if agents)
necessary.
Class Combustible / reactive Sand or dry
o Keep the victim warm.
D metals (Hg, Mg, Na, powder, Metal X, or
and Li) dry chemicals for
SYMPTOMS OF SHOCK
A, B, C
• Pale, cold, and clammy skin
Class Detonation or Arsenal Allowed to burn out
• Rapid and weak pulse
E fire and nearby
• Increased and Shallow breathing materials are
• Expressionless face with blank stare protected
FIRST-AID PROCEDURES Class High-temperature Potassium-based
K cooking oils, grease, alkaline liquid
• Keep the airway open
or fats (agents designed
• Call for medical assistance
to prevent
• Keep the patient lying down splashing, cooling,
• Control any bleeding or other cause of shock and smothering the
• Keep the patient warm fire)
FIRE/EXPLOSIVE HAZARDS
PHYSICAL HAZARDS
• Regular fire drills should be conducted so employees • Avoid running in rooms and hallways.
know what to do in case of fire. • Watch for wet floors.
o They should also be familiar with the location of
• Bend the knees when lifting heavy objects.
emergency exits and evacuation plans or routes.
o Sprain – injury to the tendons
o The location of fire extinguishers and heavy blankets
o Strain – injury to the ligaments
should be posted, and the staff should know how to
• Keep long hair pulled back.
use them.
• Avoid dangling jewelry.
• When a fire is discovered, all employees are expected to
• Maintain a clean, organized work area.
take the actions in the acronym RACE.
o Rescue: rescue anyone in immediate danger • Closed-toe shoes that provide maximum support are
o Alarm: activate the institutional fire alarm system essential for safety and comfort.
o Contain: close all doors to potentially affected areas
o Extinguish: extinguish the fire, if possible; evacuate
• The acronym PASS can be used to remember the steps
in the operation:
o Pull pin.

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• Proper posture
o It is important to maintain proper posture and to keep
one’s back safe from injury by using proper techniques
and equipment when lifting heavy objects.
• Time to relax
o One must achieve and maintain work-life balance by
finding time to relax and to relieve oneself of stress
from work.
Figure 8. Physical Hazard Symbol

Table 2. Summary of Safety Hazards

POSSIBLE
TYPE SOURCE
INJURY
Biologic Infectious Bacterial, fungal,
agents viral, or parasitic
infections
Sharps Needles, lancet, Cuts, punctures,
broken glass or blood-borne
Chemical Preservatives Exposure to
and reagents carcinogenic,
toxic, or caustic
agents
Radioactive Equipment and Radiation
radioisotopes exposure
Electrical Ungrounded or Burns or shock
wet equipment;
frayed cords
Fire/Explosive Open flames, Burns or
organic dismemberment
chemicals
Physical Wet floors, Falls, sprains or
heavy boxes, strains
patients

CARDIOPULMONARY RESCUCITATION (CPR)

• 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.
• 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.
• Lean forward (shoulders directly over the patient’s chest)
and press down on the chest for about two inches. Release
the pressure to allow the chest to come back up. Do not
leave your hands. Repeat. Give 30 compressions at a rate
of 100 compressions per minute.
• Tilt the patient’s head and lift the chin to open the airway
allowing the mouth to fall open slightly.
• Remove your mouth and watch the chest fall. Repeat steps
five and six once.
• 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.

COMPONENTS OF PERSONAL WELLNESS

• Personal Hygiene
o Personal wellness begins with personal hygiene.
• Proper nutrition
• Enough sleep
• Regular exercise

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