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Infection Control

 Phlebotomist training involves paying very close attention to what may appear to be minor details, but which can have a major impact on the health and safety of their patients and colleagues.

Infection control is a great area of concern in the NHS. Armstrong-Esther (1982) stated that ‘The prevention of infectious diseases is a much more sensible method of control than waiting until a disease or epidemic occurs and then attempting to deal with the consequences in a hurry.’ He also argued that the success of vaccines and antibiotics leads to increased pressure for their abandonment as mutating bacteria become resistance to the overprescribing of generic antibiotic drugs and thus weaken our efforts to control them.

While most medical problems are associated with infections, and are the result of immunological mediated hypersensitivity reactions to protein component common in the environment, a number of serious healthcare-associated infections continue to be a high priority. Although the H1N1 and SARS viruses continue to create newspaper headlines, the MRSA outbreaks with UK hospitals continues to claim lives. The Health Protection Agency 2010 reported a total of 1,898 cases of MRSA bacteraemia in 2009/10, which represents a reduction of 35% in reported cases from the previous year when 2,935 cases were recorded, and demonstrates the efforts made to reduce the risk as a result of extensive and collaborative research.

Phlebotomists are usually in close proximity with large numbers of patients and are especially vulnerable to cross infections. Particularly at risk are the very young, elderly and those receiving immunosuppressive treatments, where regular blood collection samples may be critical to the accurate diagnosis and monitoring of those treatments. As government budget cuts impact heavily upon NHS resources the problem is to develop a method of infection control that is safe, effective, and can be repeatedly delivered at low cost. The Royal College of Nursing (1995) states that correct hand washing is the single most effective measure in which a healthcare worker can control and prevent the spread of infections in hospitals.

The Integumentary system consists of the skin, hair, sweat and oil glands, teeth and nails, and has multiple functions including sensory reception, thermal regulation, insulation, absorption and excretion. However its primary role is that of protection from the millions of potentially harmful bacteria, viruses, fungi and parasites that aim to gain entry. The skin is the largest organ in the body and forms the outer surface of the entire body. It functions to keep internal tissues free from infection by forming a physically protective water proof layer.

It also has another defense mechanism by providing a home to millions of comensual, ‘friendly’ bacteria that create conditions unsuitable for potential pathogens to grow or establish themselves. Senior K 2011. Each and every individual has a different complement of comensual bacteria on their skin surface. As many as 180 different species can be growing there including benign species of Staphylococcus hominis, Arcanobacterium haemolyticum, Staphylococcus epidermidis, and Micrococcus luteus.

Removing all dirt and infectious contaminants from the skin is particularly important. Hands and other soiled areas of the body, clothing and equipment should be cleaned at least at the end of each working shift, prior to and after meal breaks, and after visiting the toilet. It is usual to wash the hands before any direct contact with a patient, after contact with blood or bodily fluids, after removing gloves, and before any aseptic techniques.

The correct method of hand cleaning is essential to reducing infections and developing a good hand washing technique will to ensure hands are cleaned thoroughly. Special attention should be paid to the backs of the hands, fingertips and the thumb areas as these are the most frequently missed. Avoid scrubbing the hands as this will remove many of the comensual bacteria offering protection to the skin. For heavily soiled hands most manufacturers recommended applying an appropriate specialist hand cleanser directly to the skin before wetting.

 

 

1. Rub palm to palm

 

2. Rub palm over back of hand, fingers interlaced

 

3. Palm to palm,
fingers interlaced

 

4. Fingers interlocked
into palms

 

5. Rotational rubbing of thumb
clasped into palm

 

6. Rotational rubbing of
clasped fingers into palm

 

To avoid the risk of drying out and chapping of the skin especially during cold weather the hands should always be properly dried. The use of barrier creams and emollients can also reduce damage to hands from the continued washing and drying. Clean towels should always be available as dirty, ‘communal’ towels would expose the skin to more dirt and lead to the risk of infection. If possible, Antibacterial paper or ‘single issue’ disposable towels should be used, and also the liberal use of alcohol based gels and sprays to further reduce contamination.

Regular hand washing will become an unconscious behaviour or ‘habit’ if practiced repeatedly for around twenty one days. It takes approximately three weeks for new neural pathways are to created and strengthened for any new learned behaviour or skill,  and hand washing is an extremely useful behaviour worth developing in the control of the spread of infection.

Phlebotomists are among a main group of healthcare sector workers considered most at risk from  transmission infections by what is more commonly referred to as a needlestick or ‘sharps’ injury. Needlestick injuries also occur in other fields of work such as the police, prison and probation services, social work, body art and piercing industry, customs and excise, and the funeral industry. Phlebotomists follow a standard safety procedure adopted in the UK for the prevention of needlesticks.

The major risk posed by needlestick injury to workers is exposure to blood-borne viruses (BBV).  The main viruses involved are:

Hepatitis B (HBV)

Hepatitis C (HCV)

Human immunodeficiency virus (HIV)

Phlebotomists may acquire a BBV infection if they are exposed to infected blood or body fluids. This could be either via the mucous membranes (eyes, inside of the mouth and nose), through broken skin or through an inoculation injury route, where the skin is punctured or scratched by a needle or ‘sharp’ that has been used in a medical procedure.

In the case of HBV an effective protective vaccine is available; however no such protection is available for other BBVs.  These other infections are difficult to treat, the prophylaxis or treatment is unpleasant, may cause significant side effects, and there is no guarantee that treatment will be successful. As the prevalence or carriage rates of BBVs in the general UK population is generally low, therefore the risk of infection from needlestick injuries remains minimal.

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