PMLS 2

• Classification of Infectious Microorganisms by Risk Groups:
• Risk Group 1:

  • No or low individual or community risk
  • Unlikely to cause disease
• Risk Group 2:

  • Moderate individual risk
  • Low community risk
  • Treatments available
• Risk Group 3:

  • High individual risk
  • Low community risk
  • Effective and preventive treatments available
  • Can cause death
• Risk Group 4:

  • High individual and high community risk
  • Effective and preventive treatments not usually available
• Biosafety Levels, Practices, and Equipment:
• Risk Group 1 (BIOSAFETY LEVEL 1):

  • Lab type: basic teaching, research
  • Lab practices: Good Microbiological Techniques (GMT)
  • Safety equipment: None, Open Bench
  • Examples: Bacillus subtilis, Naegleria gruberi, infectious canine hepatitis virus
• Risk Group 2 (BIOSAFETY LEVEL 2):

  • Lab type: primary health services, diagnostic services, research
  • Lab practices: GMT, protective clothing, biohazard sign
  • Safety equipment: Open bench plus BSC for potential aerosols
  • Examples: Hepatitis B virus, HIV, salmonellae, Toxoplasma species
• Risk Group 3 (CONTAINMENT BIOSAFETY LEVEL 3):

  • Lab type: special diagnostic services, research
  • Lab practices: as level 2 plus special clothing (HAZMAT), controlled access, directional airflow
  • Safety equipment: BSC and other primary devices for all activities (NOT OPEN BENCH)
  • Examples: Mycobacterium Tuberculosis, St. Louis encephalitis virus, Coxiella
• Risk Group 4 (BIOSAFETY LEVEL 4, MAXIMUM CONTAINMENT):

  • Lab type: dangerous pathogen units
  • Lab practices: as level 3 plus airlock entry, shower exit, special waste disposal
  • Safety equipment: Class III BSC or positive pressure suits with Class II BSCs, double-ended autoclave (positive pressure)
  • Examples: Marburg, Crimean-Congo hemorrhagic fever, Ebola
• Chain of Infection:
• Infectious Agents

  • Reservoir
  • Portal of Exit
  • Mode of Transmission
  • Portal of Entry
  • Susceptible Host
• Laboratory Safety Measures:
• Standard Precautions:

  • Handwashing, PPE, Proper handling of blood and other body fluids
• Biohazard universal precautions:

  • Microbial control, sterilization, and disinfection
• Proper (Thorough) Handwashing

  • Personal Protection (BASIC)
  • DONNING (put on): Gown, Gloves, Mask, Headcap
  • DOFFING (take off): Headcap, Gown, Gloves, Mask
• Cytotechnologist:

  • Evaluate patients' cell samples to detect precancerous, malignant, and infectious conditions
  • Work closely with a pathologist
• Histotechnologist:

  • Work alongside pathologists in medical laboratories to prepare and analyze tissue samples
• Patient Rights:

  • Considerate and respectful care
  • Receive understandable information
  • Make decisions about plan of care and refuse treatment
  • Have an advance directive
  • Privacy
  • Confidentiality of medical records
  • Review records
  • Expect reasonable response to requests for care and services
  • Information regarding hospital business relationships impacting care
  • Consent or decline to participate in research studies
  • Expect continuity of care
  • Be informed of hospital policies and practices related to patient care, treatment, and responsibilities
• Bedside Labelling:

  • Immediately label the specimen after collection
• Patient Identification (MOST IMPORTANT):

  • Full name said by the PATIENT
• Materials for Phlebotomy (Venipuncture):

  • Personal Protective Equipment (PPE)
  • Cleaning Agent: Routine use (Alcohol pad, cotton)
  • Cotton
  • Gauze
  • Sharps Container: Discard needles, lancets, biohazard marking, puncture resistant, NEVER recap, bend, or break needles
  • Tourniquet: Slow venous blood flow, makes veins more prominent, NEVER leave for 1 min, AVOID rigorous fist clenching or hand pumping
  • Needle: NEVER reuse, NEVER use if shield is broken, drop immediately into sharps container after use, size indicated by Gauge
  • Tube Holder/Vacutainer Adapter: Threaded, flanges
• • Syringe: Graduated
  • Blood Collection Tubes: Contain a vacuum, stoppers universal color coded, have an expiration date
• Order of Draw for Blood Collection Tubes:

  • Yellow (blood culture)
  • Blue (citrate)
  • Red or gold (serum, separator)
  • Green (Heparin)
  • Lavender (EDTA)
  • Gray (Flouride)
• Safety Practices:

  • Handwashing: Primary means of preventing spread of infection, wash hands before and after each blood draw
  • PPE: Lab coat, gloves, mask
  • Standard Precautions at all times
• Venipuncture Procedure:

  • Review and Accession Test Request
  • Patient identification
  • Selecting the site: Antecubital area most often accessed
  • Clean and air-dry the site
  • Prepare the equipment based on the chosen venipuncture procedure
  • Anchor vein and insert needle
  • Establish blood flow and fill tube or syringe
  • Fill, remove, mix tubes or fill syringes
  • Remove the needle
  • Label the tube immediately (Bedside Labelling)
• Blood Function:

  • Supplies nutrients to tissue: O2, hormones, glucose
  • Removes end-products of metabolism: CO2, urea, creatinine
  • Provides defense mechanism: WBC, antibodies
  • Prevents blood loss: Platelets, coagulation proteins
• Blood Composition:

  • Formed Elements (~45%): RBC, WBC, Platelets
  • Fluid component (~55%): Water (~92%), Protein (~7%), Etc. (minerals)
• Coagulation:

  • In Vivo: Blood is fluid, clot is formed to protect injured vessel
  • In vitro: Spontaneous reaction, triggered by glass or poor drawing technique
• Anticoagulants:

  • Remove calcium
  • Neutralize thrombin
  • Whole Blood (not centrifuged yet): Plasma, Serum
  • Blood with Anticoagulant: Clotting is prevented and irreversible
  • Blood without Anticoagulant: Spontaneous clotting occurs and is irreversible
• Plasma/Serum Appearance:

  • Normal: clear and yellow
  • Abnormal: Hemolyzed (ruptured RBC), Icteric (bilirubin), Lipemic (cloudy - fat, triglycerides)
• Blood Collection Tubes:

  • Type and amount of specimen dependent upon test, amount of sample needed, multiple labs needing the same specimen at the same time
• Valid Test Results Require:

  • Trained personnel
  • Quality control
  • Quality assurance
  • Sophisticated instruments
• Safety Practices:

  • For infection to spread: Infectious substance (HBU, HCV, HIV), Mode of transmission, Susceptible host
  • Handwashing: Minimum 15 secs, soap, friction, wash hands before and after each blood draw
  • PPE: Lab coat, gloves, mask, Standard Precautions at all times
• Safety: Engineering Controls:

  • PPE
  • Sharps container
  • Safer medical devices
• Vacutainer Labeling:

  • Black indelible marker (waterproof), Required information: Patient name, Identification number, Date of draw, Time of draw, Phlebotomist signature
• Vacutainer or Syringe:

  • Vacutainer (Closed system): Most often used, most economical, quick, least risk of accidental needle stick
  • Syringe (Open system): More control, reposition easily, will see "flash" of blood in syringe hub when vein successfully entered
• Equipment:

  • PPE: gloves, lab coat, mask
  • Cleaning agents: Alcohol pads, Povidone iodine, Soap and water
  • Cotton balls, gauze
  • Bandage, tape
  • Sharps Container: Discard needles, lancets, biohazard marking, puncture resistant, NEVER recap, bend, break needles
• Plasma/Serum Appearance:

  • Normal: clear and yellow
  • Abnormal: Hemolyzed (ruptured RBC), Icteric (bilirubin), Lipemic (cloudy - fat, triglycerides
• Patient information required for blood draw includes: patient name, age, gender, identification number, date of draw, time of draw (in military time), and your initials