the training manuals, worn all the right personal protec- tive equipment . . . but your patient jerks his arm right at the end of the phlebotomy procedure, and you are punctured by a contaminated needle. Now what? The Bloodborne Pathogens Standard carefully spells out what type of follow-up care employers must offer to their employees (free of charge) if there is an accidental expo- sure to blood or other potentially infectious materials in the workplace. Remember, an exposure can be percuta-
neous (through the skin) as in the scenario above, but it
may also be a mucous membrane exposure through a splash in the eyes or in the mouth. Here are the steps to follow if there is an accidental exposure:
1. Wash the site thoroughly with soap and water. If it is
a mucous membrane exposure, thoroughly flush the exposed area with water.
2. The incident must be reported immediately to the ap-
propriate manager or other contact person within your health-care facility. Many of the antiviral medications used for treatment after an exposure should be started within a few hours, so an immediate report is critical.
3. Fill out an incident report form. The route of expo-
sure and the circumstances surrounding the incident are very important and are required by law.
4. Identification of the source individual needs to be
determined as soon as possible. Consent should be obtained for the source individual to be tested for HBV, HCV, and HIV, unless his or her status is already known for these diseases. If the individual refuses to consent for the test, the employer must document that a refusal was made. If allowed by local law, the test will be performed regardless, so that the employee can be treated effectively. The results of these tests will be made available to the exposed employee. A blood sample will also need to be obtained from the exposed employee to test for a baseline level for HBV, HCV, and HIV.
5. The exposed employee will have the opportunity to
seek medical attention as soon as possible after the initial report has been completed. Postexposure pro-
phylaxis is most effective if initiated rapidly after the
exposure. This means that preventive medication (such as antiviral medicine) should be administered within hours of exposure. The health-care profes- sional providing the follow-up care will be provided with information about how the accident happened, any laboratory testing results that might be available,
Test Your Knowledge 3-27
What are two characteristics that hepatitis B and HIV
and all medical records for the employee that might be relevant (such as vaccination records). The health- care professional also must be provided a copy of the Bloodborne Pathogens Standard.
6. The health-care professional performing the follow-up
care will determine whether postexposure prophylaxis is necessary for HBV, HCV, or HIV, depending on the risk evaluation. The route and amount of exposure, the vaccination status of the employee, and the circum- stances of the exposure will be taken into consideration. The treatment for the employee often consists of a combination of drugs for an extended period of time.
7. Follow-up blood tests are generally performed on the
exposed employee, at a minimum interval of 6 weeks, 12 weeks, and 6 months. It is possible that this series may be extended up to 12 months.
8. The exposed employee also must be offered counsel-
ing and reminded that confidentiality must be retained in reference to the source individual. All medical follow-up for the employee is also retained confidentially.
from chemicals in the workplace, and the Blood- borne Pathogens Standard educates health-care employees about the risks they face from blood- borne pathogens as they perform their duties. Med- ical assistants must be familiar with the details contained in these documents to use safety materials in their workplace and to be prepared for accidents when they happen.
TIME TO REVIEW
1. A bacteria that is aerobic needs Outcome 3-1
_____________ to survive and replicate:
a. Nitrogen b. Oxygen
c. Carbon dioxide d. Water
2. True or False: A substance that Outcome 3-1
produces or causes cancer is carcinogenic.
3. The types of microorganisms listed Outcome 3-2
in this chapter that may be human pathogens include:
a. Protons, neutrons, and electrons b. Bacteria, viruses, and parasites
c. Bacteria, viruses, fungi, and parasites d. None of the above
4. True or False: Most of the types of Outcome 3-3
bacteria present in our environment are pathogenic.
5. True or False: The presence of Outcome 3-3
bacteria anywhere in our bodies is always an infection.
6. A round-shaped bacteria that appears Outcome 3-4
in pairs when viewed under the microscope is known as a:
a. Cocci b. Spirilla
c. Bacilli d. Diplococci
7. Which type of infection is best treated Outcome 3-5
by antibiotic use?
a. Viral b. Bacterial
c. Viral and bacterial d. None of the above
Chapter 3 Laboratory Safety and Preventing the Spread of Disease 59
SUMMARY
The world we live in is a complex place, with new health hazards constantly emerging. As health- care workers, we must protect ourselves from poten- tial pathogens in our environment, our patients, and our workplace. There are several government regula- tions that have been designed to protect employees in a health-care or laboratory environment. Educa- tion concerning these regulations, and careful adher- ence to their principles, are essential steps to working safely in this unique environment. Standard Precau- tions have been developed to assist with infection control efforts. The Hazard Communications Stan- dard establishes guidelines to protect employees
Test Your Knowledge 3-28
What should happen immediately if an employee splashes blood in her eyes? (Outcome 3-21)
Test Your Knowledge 3-29
True or False: All employees who are victims of a blood- borne pathogen exposure will be sent to see a health- care provider for follow-up care. (Outcome 3-21)
8. True or False: In a medically aseptic Outcome 3-6
environment, bacteria may still be present on surfaces.
9. How does the “chain of infection” Outcome 3-7
have to be broken to keep a pathogen from causing disease?
a. It must be broken at multiple points to keep the
pathogen from causing disease
b. Only vaccinations will break the chain of
infection
c. The chain of infection must only be broken at
one point to discontinue the spread of infection
d. The pathogen must be killed before the chain
will be broken
10. What are the elements addressed in Outcome 3-8
CDC Standard Precautions document?
a. Appropriate use of personal protective equipment b. Equipment disinfection procedures
c. Respiratory hygiene d. Sharps use
e. All of the above
11. True or False: Hand washing is Outcome 3-9
designed to remove the normal (resident) flora from our skin.
12. When using an alcohol-based hand Outcome 3-10
rub to disinfect the hands, it is important to:
a. Put on gloves while hands are still damp b. Rub the solution thoroughly on all parts of the
hands and wrists
c. Use only a drop of the solution
d. Always wash the hands first before using 13. The OSHA Hazard Communications Outcome 3-11
Standard addresses:
a. The use of personal protective equipment b. The formal education required by everyone in
the laboratory before they can be hired to per- form certain tests
c. What type of fire extinguisher to use for various
types of fires
d. The brand of hand sanitizer endorsed by the fed-
eral government
14. Which of the following components Outcome 3-12
are required for any Material Safety Data Sheet?
a. Identification of the chemical b. Color of the chemical
c. Health hazards d. a and c
e. All of the above
15. True or False: Laboratory employees Outcome 3-14
may protect themselves from occupational back injuries by using appropriate bending techniques when lifting heavy objects.
16. Why was the OSHA Bloodborne Outcome 3-15
Pathogens Standard created?
a. To protect employers from lawsuits b. To create a revenue source for OSHA
c. To educate and protect employees from the
hazards of bloodborne pathogens
d. To protect patients from bloodborne pathogens 17. What is an example of parenteral Outcome 3-16
or percutaneous bloodborne pathogen exposure?
a. A respiratory infection contracted when working
with a patient with pneumonia
b. Touching a patient’s blood with a bare hand with
unbroken skin
c. An accidental needlestick with a needle contam-
inated with the blood of a patient
d. Splashing urine on the arm while pouring a
specimen
18. True or False: The OSHA Blood- Outcome 3-17
borne Pathogens Standard requires the development of an exposure control plan. Part of this plan requires that all employees who have occupational exposure to blood or other potentially infectious materials are offered an opportunity to receive a series of hepatitis C vaccinations at no charge.
19. True or False: When using a needle Outcome 3-18
to draw blood, it is okay to lay it down on the table next to the drawing chair right after the blood draw, and come back later to activate the safety device and dispose of it correctly.
20. Who must transport biohazardous Outcome 3-19
waste?
a. Employees of the laboratory that have been
appropriately trained
b. The local municipal garbage disposal company c. A certified, licensed biohazardous waste disposal
company
21. What do hepatitis A, hepatitis B, Outcome 3-20
hepatitis C, and HIV all have in common?
a. They are all caused by viruses b. They are all caused by bacteria
c. They all have vaccinations to prevent infection d. None of them have vaccinations to prevent
infection.
22. Are blood tests part of the follow-up Outcome 3-21
procedure for health-care workers who are are percutaneously exposed to blood in the workplace?
RESOURCES AND SUGGESTED READINGS
OSHA Hazard Communication Standard
OSHA regulation for chemical safety in the workplace http://www.osha.gov/SLTC/hazardcommunications/ standards.html
Small Business Handbook
General reference tool to verify that the OSHA Standards are in place properly at your worksite http://www.osha.gov/ Publications/smallbusiness/small-business.html#hazsub/ National Fire Protection Association
National Fire Protection Association website that includes information about fire, electrical, and building safety http://www.nfpa.org
Updated directives for OSHA Bloodborne Pathogens Standards, 1991
Additional information added to the OSHA Bloodborne Pathogens Standards in 1991 1910.1030- 29CFR http:// www.osha.gov/pls/oshaweb/owadisp.show_document?p_tab le=standards&p_id=10051
“Viral Hepatitis”
Excellent information about the different forms of viral hepati- tis presented by the Centers for Disease Control and Prevention http://www.cdc.gov/hepatitis/index.htm
Hepatitis B Foundation, “Meet Dr. Blumberg” Facts concerning the discovery of hepatitis B, and Dr. Blumberg who was awarded a Nobel Prize in 1976 for this discovery
http://www.hepb.org/about/blumberg.htm
Chapter 3 Laboratory Safety and Preventing the Spread of Disease 61
Case Study 3-1: Too tired to think
Jackie was really tired. She had been up all night with her 3-year-old daughter who had an ear infection. When she reported to her job at the GI clinic the next morning, she was relieved to find out that she would be working in the laboratory, as this meant that she would be on her feet a bit less than if she were working as the MA for one of the physicians. It was Friday, which was usually a slow day in the laboratory.
In the middle of the morning, Jackie had drawn three glass red-top blood tubes from Mr. Sifton. She was fighting back a yawn, and when she turned around to put the blood in the rack on the counter, she accidentally tapped one of the tubes against the edge of the counter with a great deal of force. The tube flew from her hand and broke against the refrigerator a few feet away.
Jackie was flustered. Mr. Sifton had already left, and she knew that she would have to call him and ask him to return for another blood draw. In addition, she had quite a mess to clean up, as the blood had splattered a great deal. She knew that the bloody mess had to take precedence, because other patients would be entering the laboratory at any time.
Jackie was already wearing her nitrile gloves, so she bent down and started to pick up the pieces of the tube that had broken. Suddenly she felt a sharp pain in her finger, and realized that she had punctured her glove and her finger with a slice of glass.
1. What are two things that could have been done to
avoid the parenteral exposure to the patient’s blood?
2. What is the first thing that Jackie should do now?
63