2.1 Infection Control & Standard Precautions

Safety and Compliance is the largest domain on the NHA Certified Phlebotomy Technician (CPT) exam at 26% (about 26 of the 100 scored items). Infection control is the part that protects you, your patients, and the integrity of every specimen. Expect scenario questions that ask you to break the chain of infection or pick the correct precaution for a given exposure.

The Chain of Infection

Infection spreads only when six links connect in sequence. Phlebotomists prevent infection by deliberately breaking the easiest link to interrupt — most often the mode of transmission through hand hygiene and personal protective equipment (PPE).

Standard Precautions

Standard Precautions are the minimum infection-prevention practices applied to every patient, every time, regardless of suspected or confirmed infection status. The core principle: treat all blood, body fluids, secretions, excretions (except sweat), non-intact skin, and mucous membranes as if they are infectious.

Key components include hand hygiene, PPE based on anticipated exposure, safe injection and sharps practices, and respiratory hygiene. Standard Precautions replaced the older "Universal Precautions" by extending coverage to body fluids beyond blood.

Transmission-Based Precautions

When a patient has a known or suspected highly transmissible infection, Transmission-Based Precautions are layered on top of Standard Precautions.

• Contact — gown and gloves; used for organisms spread by touch (e.g., multidrug-resistant organisms, C. difficile).
• Droplet — surgical mask within about 3–6 feet; used for influenza, pertussis.
• Airborne — a fit-tested N95 respirator and an airborne infection isolation room (negative-pressure); used for tuberculosis, measles, varicella.

A common exam trap: a routine surgical mask is not adequate for an airborne precaution patient — an N95 respirator is required.

Hand Hygiene

The CDC identifies hand hygiene as the single most effective measure to prevent the spread of healthcare-associated infections. Phlebotomists perform hand hygiene before patient contact, before a clean/aseptic task, after exposure risk, after patient contact, and after touching patient surroundings.

• Alcohol-based hand rub (60–95% alcohol) is preferred for routinely decontaminating hands when they are not visibly soiled — it is faster and more effective against most pathogens.
• Soap and water must be used when hands are visibly soiled with blood or body fluids, and after caring for a patient with a spore-forming organism such as C. difficile (alcohol does not kill spores).
• Remove gloves and perform hand hygiene between every patient; gloves are not a substitute for handwashing.

PPE Selection, Donning, and Doffing

PPE is selected based on the anticipated exposure. For routine venipuncture, gloves are the minimum; a gown, mask, and eye protection are added when splashes or sprays are likely (e.g., an uncooperative patient or arterial procedures).

Sequence matters because doffing is where most self-contamination occurs.

The memory rule: don clean-to-dirty, doff dirty-to-clean. Gloves are dirtiest, so they come off first; the mask protects your airway, so it stays on until you have left the contaminated area, then perform hand hygiene.

OSHA Bloodborne Pathogens Standard

The Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard is codified at 29 CFR 1910.1030. It is the federal regulation that governs occupational exposure to blood and other potentially infectious materials (OPIM). The three primary bloodborne pathogens of concern are HBV, hepatitis C virus (HCV), and HIV.

Core employer requirements:

• Maintain a written Exposure Control Plan and review/update it at least annually and whenever tasks change.
• Offer the hepatitis B vaccine series at no cost to employees with occupational exposure, within 10 working days of initial assignment. An employee may decline by signing a declination form but can request the vaccine later.
• Provide PPE, engineering controls, and work-practice controls at no cost to the employee.
• Provide free post-exposure evaluation and follow-up after an exposure incident.
• Use labeling and signage (the biohazard symbol) on contaminated waste, refrigerators, and containers.
• Provide annual bloodborne pathogens training, and maintain training and medical records.

What Counts as OPIM

OPIM includes semen, vaginal secretions, cerebrospinal/synovial/pleural/peritoneal/pericardial/amniotic fluid, and any body fluid visibly contaminated with blood. Under OSHA, intact skin contact with sweat, tears, saliva (without blood), urine, or feces is generally not considered an exposure incident unless visibly bloody.

The Exposure Control Plan

The Exposure Control Plan is the written program that documents how an employer eliminates or minimizes exposure. It must include the exposure determination (which job classes have exposure), the schedule and method for implementing controls, the procedure for evaluating exposure incidents, and an annual review that documents consideration of safer sharps devices.