1.1 Infection Control & Personal Protective Equipment (PPE)
Key Takeaways
Standard precautions apply to ALL patients regardless of diagnosis or perceived risk — treat every specimen as potentially infectious
The single most effective method to prevent the spread of infection in healthcare is proper hand hygiene
Hand hygiene must be performed before and after every patient contact, after removing gloves, and after touching potentially contaminated surfaces
Alcohol-based hand rub (ABHR) is preferred for routine hand hygiene; use soap and water when hands are visibly soiled, before eating, after using the restroom, and during C. difficile or norovirus outbreaks
Gloves must be changed between every patient — never reuse or wash disposable gloves
The chain of infection has six links: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host
Sharps must be disposed of immediately in a puncture-resistant, leak-proof, labeled sharps container at the point of use
Biohazard waste includes blood-soaked materials, used lancets, contaminated PPE, and any items saturated with blood or body fluids
Infection Control & Personal Protective Equipment
Infection control is the cornerstone of phlebotomy practice. As a phlebotomist, you handle blood and body fluids daily, placing you at direct risk for exposure to bloodborne pathogens. Strict adherence to infection control protocols protects both you and your patients.
Standard Precautions
Standard precautions (formerly called universal precautions) are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status. The core principle: treat ALL blood and body fluids as potentially infectious.
Standard precautions include:
- Hand hygiene before and after every patient contact
- PPE use (gloves, gowns, masks, face shields) based on anticipated exposure
- Safe injection and sharps practices — never recap needles, dispose at point of use
- Respiratory hygiene / cough etiquette — masks for patients with respiratory symptoms
- Environmental cleaning — disinfect work surfaces between patients
- Safe handling of contaminated equipment and linens
Hand Hygiene
Hand hygiene is the single most effective measure to prevent healthcare-associated infections. The CDC and WHO recommend hand hygiene in the following situations (the "5 Moments"):
| Moment | When | Method |
|---|---|---|
| Before patient contact | Before touching the patient | ABHR or soap & water |
| Before aseptic procedure | Before venipuncture or capillary puncture | ABHR or soap & water |
| After body fluid exposure | After handling blood specimens, removing gloves | ABHR, or soap and water if hands are visibly soiled |
| After patient contact | After touching the patient or their surroundings | ABHR or soap & water |
| After touching patient surroundings | After touching bed rails, IV poles, etc. | ABHR or soap & water |
Alcohol-Based Hand Rub (ABHR) vs. Soap and Water
| Method | When to Use | Duration |
|---|---|---|
| ABHR (60-95% alcohol) | Routine hand hygiene; hands NOT visibly soiled | 20-30 seconds; rub until dry |
| Soap and Water | Hands visibly soiled, before eating, after using the restroom, and caring for patients during C. difficile or norovirus outbreaks | 40-60 seconds minimum; friction is key |
Personal Protective Equipment (PPE)
PPE creates a barrier between the healthcare worker and infectious materials. Selection depends on the anticipated exposure:
| PPE Item | When Required | Key Points |
|---|---|---|
| Gloves | ALL blood collection procedures | Change between patients; inspect for tears; non-sterile exam gloves are acceptable for routine phlebotomy |
| Gowns | When splashing or spraying of blood is possible | Fluid-resistant; cover arms and torso; remove after procedure |
| Masks | When within 6 feet of a patient with respiratory symptoms; during procedures that may generate splashes | Standard surgical mask for droplet precautions |
| Face shields / Goggles | When splashing of blood to the face is anticipated | Protect eyes, nose, and mouth from splash exposure |
| N95 Respirator | When entering the room of a patient on airborne precautions (TB, measles, varicella) | Must be fit-tested annually; provides higher filtration than surgical masks |
PPE Donning (Putting On) Order
- Gown first
- Mask or respirator
- Eye protection (goggles or face shield)
- Gloves last (over gown cuffs)
PPE Doffing (Removing) Order
- Gloves first (most contaminated)
- Eye protection
- Gown
- Mask or respirator last
- Perform hand hygiene immediately
The Chain of Infection
Understanding the chain of infection helps phlebotomists identify where to break the cycle:
| Link | Description | Phlebotomy Example |
|---|---|---|
| Infectious Agent | The pathogen (bacteria, virus, fungus) | Hepatitis B, Hepatitis C, HIV |
| Reservoir | Where the pathogen lives and multiplies | Infected patient's blood |
| Portal of Exit | How the pathogen leaves the reservoir | Through the venipuncture site, blood specimen |
| Mode of Transmission | How the pathogen travels to a new host | Needlestick injury, splash to mucous membranes |
| Portal of Entry | How the pathogen enters a new host | Through a break in the phlebotomist's skin |
| Susceptible Host | A person at risk for infection | An unvaccinated or immunocompromised healthcare worker |
Breaking the chain: Standard precautions, PPE, hand hygiene, and sharps safety target the mode of transmission and portal of entry links to prevent infection.
Sharps Safety
Sharps injuries (needlesticks and cuts from contaminated sharps) are one of the most significant occupational hazards for phlebotomists.
Key Sharps Safety Rules
- NEVER recap needles — recapping is a leading cause of needlestick injuries
- Use safety-engineered devices — needles with retractable or shielding mechanisms (required by the Needlestick Safety and Prevention Act)
- Dispose of sharps immediately at the point of use into a puncture-resistant, leak-proof, color-coded (red) or labeled sharps container
- Never overfill sharps containers — replace when 2/3 to 3/4 full
- Never reach into a sharps container to retrieve or push down contents
- Report all needlestick injuries immediately — even minor ones require documentation and follow-up
Biohazard Waste Disposal
Proper disposal of biohazardous waste protects healthcare workers, patients, and the environment:
Categories of Biohazard Waste
| Category | Examples | Disposal Method |
|---|---|---|
| Sharps waste | Needles, lancets, broken glass contaminated with blood | Puncture-resistant sharps container (red or labeled) |
| Regulated medical waste | Blood-soaked gauze, contaminated PPE, blood tubes | Red biohazard bag |
| Liquid waste | Blood specimens, body fluid samples | Pour down laboratory drain with running water (per facility policy) or autoclave |
| Pathological waste | Tissue specimens, organs | Special incineration or treatment |
Biohazard Symbol Requirements
- The universal biohazard symbol (three-lobed design) must be displayed on:
- Sharps containers
- Biohazard waste bags and containers
- Refrigerators and freezers storing blood or infectious materials
- Doors to laboratories and specimen storage areas
- Transport containers for specimens
Spill Cleanup Protocol
- Notify others in the area of the spill
- Don PPE — gloves, gown, eye protection if splashing risk
- Contain the spill with absorbent material (paper towels, spill pads)
- Disinfect with an EPA-registered tuberculocidal disinfectant or 10% bleach solution (1:10 dilution)
- Allow contact time — most disinfectants require 10-30 minutes of wet contact
- Clean up the absorbent material and dispose in a biohazard bag
- Remove PPE and perform hand hygiene
- Document the incident per facility policy
Transmission-Based Precautions
In addition to standard precautions, some patients require transmission-based precautions based on the route of pathogen spread:
| Type | Route | Examples | PPE Required |
|---|---|---|---|
| Contact precautions | Direct or indirect contact | MRSA, VRE, C. difficile, scabies | Gloves + gown for all contact |
| Droplet precautions | Large respiratory droplets (>5 microns) | Influenza, pertussis, meningococcal disease | Surgical mask within 6 feet |
| Airborne precautions | Small particles that remain airborne (<5 microns) | Tuberculosis (TB), measles, varicella (chickenpox) | N95 respirator (fit-tested) + negative pressure room |
Phlebotomy in Isolation Rooms
- Check isolation signage before entering the room
- Don appropriate PPE before entry (as specified by the precaution type)
- Bring only the supplies you need — leave extra supplies outside
- Do NOT bring the phlebotomy cart into an isolation room
- Remove PPE properly before leaving (doffing order)
- Perform hand hygiene immediately after removing PPE
What is the single most effective measure to prevent the spread of infection in healthcare settings?
Wearing gloves
Proper hand hygiene
Using N95 respirators
Disposing of sharps correctly
When should alcohol-based hand rub (ABHR) NOT be used for hand hygiene?
Before venipuncture
After removing gloves
When hands are visibly soiled with blood
Between patient encounters
Arrange the correct order for REMOVING (doffing) PPE after a phlebotomy procedure:
Arrange the items in the correct order
Remove eye protection
Perform hand hygiene
Remove mask or respirator
Remove gown
Remove gloves
Which of the following are components of standard precautions? (Select all that apply)
Select all that apply
Hand hygiene before and after patient contact
Using PPE based on anticipated exposure
Only applying precautions to patients with known infections
Safe sharps disposal at the point of use
Respiratory hygiene and cough etiquette
Recapping needles before disposal
A sharps container should be replaced when it reaches what fill level?
1/2 full
2/3 to 3/4 full
Completely full
Only when the container is overflowing
The minimum recommended duration for hand washing with soap and water is ___ seconds.
Type your answer below
Match each link in the chain of infection to its phlebotomy example:
Match each item on the left with the correct item on the right
Infectious Agent
Reservoir
Mode of Transmission
Susceptible Host
Which of the following PPE items should be donned (put on) LAST?
Gown
Mask
Eye protection
Gloves
A patient in the hospital has a sign on their door that says "Airborne Precautions." What PPE must the phlebotomist wear?
Gloves and gown only
Surgical mask only
N95 respirator (fit-tested) plus standard PPE
Face shield and gown only
How often must bloodborne pathogens training be provided to phlebotomists?
Once at the time of hire only
Every 6 months
At the time of hire and annually thereafter
Every 2 years
Sections you finish are checked off in the contents.