Lesson Plan

Phlebotomy Essentials (6e)

Lesson Plan

Chapter 3 — Infection Control, Safety, First Aid, and Personal Wellness

Goals of the Lesson:

Cognitive : Students will understand how patients and healthcare workers acquire healthcare-associated infections (HAIs) and be able to identify the steps necessary to prevent them. Students will be able to identify warning labels. They will be able to list and explain isolation and other procedures used to minimize the spread of infection. They will be able to identify safety principles and how to maintain a safe environment for patients and healthcare workers. Students will be able to identify key components of personal wellness and explain how to maintain their own personal wellness.

Motor : Students will be able to properly don and remove protective attire and perform hand washing procedures. They will be able to demonstrate proper handling of an exposure incident and clean-up of spills of biohazardous materials. They will have a working knowledge of laboratory first aid procedures, CPR, and AHA’s chain of survival.

Affective: Students will understand the inherent risk involved when working with all patients in the healthcare environment and will take action to protect themselves, patients, and other individuals from excessive risk for infection and biohazard exposure.

Learning Objectives. The lesson plan for each objective starts on the page shown below:

Objective 3-1: Demonstrate knowledge of terminology and practices related to Infection Control and identify agencies associated with infection control precautions, procedures, and programs.. .....................................................3-3

Objective 3-2: Identify key elements of the Blood-Borne Pathogen Standard and the Needlestick Safety and Prevention Act, and identify associated organizations.............................................................................................................3-12

Objective 3-3: Identify hazards, warning symbols, and safety rules related to the laboratory, patient areas, and biological, electrical, fire, radiation, and chemical safety, and discuss actions to take if incidents occur.. .....................3-16

Objective 3-4: Recognize symptoms needing first aid and list the main points of the American Heart Association CPR and ECC guidelines.. .....................................................................................................................................................3-19

Objective 3-5: Describe the role of personal wellness as it relates to nutrition, rest, exercise, stress management, and back protection.. .....................................................................................................................................................3-20

You Will Need:

Suggested list of classroom materials and teaching aids for Chapter 3:

3-3 Blood agar plate; incubator; fluorescent lotion; UVA light

3-3, 3-4 True Confessions of a Filthy, Rotten, Germ . (Healthcare Professionals Version) Brevis Corp, Salt Lake City, UT. www.brevis.com.

Page 3-1

© 2016 Wolters Kluwer. All rights reserved.

Key Terms

asepsis

BBP

Biohazard

CDC chain of infection engineering controls

EPA fire tetrahedron fomites

HAI

HBV

HCS

HCV

HICPAC

HIV immune infectious/causative agent isolation procedures microbe neutropenic

NHSN

NIOSH nosocomial infection

OSHA parenteral pathogenic pathogens percutaneous permucosal pictogram

PPE reservoir reverse isolation

SDS standard precautions susceptible host transmission-based precautions vector transmission vehicle transmission work practice controls

Phlebotomy Essentials (6e)

Chapter 3 — Infection Control, Safety, First Aid, and Personal Wellness

3-3, 3-4 CLSI (2005). Preventing Bloodborne Pathogen Infection: Improved Practice Means Protection. [CLSI Document M29-A2-

DVD].Wayne, PA.

Fake blood, gloves for each student, EPA-approved cleanup kit, biohazard container

3-5

3-5

3-5

Lab safety equipment

CLSI (2012). Clinical Laboratory Safety. Approved Guideline –3rd Edition [CLSI Document GP17-A3]. Wayne, PA.

CLSI (2014). Protection of Laboratory Workers from Occupationally Acquired Infections. Approved Guideline-4 th Edition [CLSI

Document M29-A4]. Wayne, PA.

Page 3-2

© 2016 Wolters Kluwer Health. All rights reserved.



Objective 3-1a: Demonstrate knowledge of terminology and practices related to Infection Control and identify agencies associated with infection control precautions, procedures, and programs

Lecture Outline

— Objective 3-1a

Content

Key Terms listed on p. 59

Text PPt

60-64

Figures, Tables, and

Features

All tables and figures are available in the Image

Bank on the IRC.

Resources and

In-Class Activities

Outside Assignments/

Evaluation


IRC

Critical Thinking Question

Outside Assignments

SRC

Audio Glossary of key terms

Flashcards of key terms

Evaluation

WB

Matching 3-1: Key Terms and Descriptions

Knowledge Drill 3-2:

Scrambled Words

Skills Drill 3-2: Word

Building

Instructor’s Notes

Legend : PPt: PowerPoint; IRC: Instructor Resource Center (found at http://thepoint.lww.com/McCall6e); SRC: Student Resource Center (found at http://thepoint.lww.com/McCall6e); WB: Workbook.

Page 3-3




Objective 3-1b: Identify the components of the chain of infection and give examples of each, describe infectioncontrol procedures used to break the chain, and identify four functions of infection-control programs.

Lecture Outline — Objective 3-1b

Content Text PPt


Features



Infection Control



Infection o

Communicable infections o

Nosocomial & healthcare-associated infections



The chain of infection



Six key components o

Infectious agent o Reservoir o Exit pathway o Means of transmission o

Entry pathway o Susceptible host



Infectious agent o Causative agent; microbe responsible for causing infection



Reservoir o Source of infectious agent



Humans



Animals



Food



Water



Soil



Contaminated items o Viability o Virulence

64–69 4–11 Figures

3-1: The chain of infection. p. 62

3-2: The N95 respirator. p. 63

Boxes

3-1: CDC List of

Infectious Diseases That

May Be Acquired in

Healthcare Facilities p. 61

3-2: Examples of Ways to

Break the Chain of

Infection p. 65

Resources and


NA


Evaluation


WB

Matching 3-2: Activity

Example and Means of

Transmission


Breaking the Chain of

Infection


Page 3-4





Content Text PPt


Features



Exit pathway o Eyes o Nose o Mouth o

Wounds o Tissue specimens o Blood o Feces, urine



Means of transmission o Airborne o

Contact



Direct



Indirect o Droplet o

Vector: insect; arthropod; animal o

Vehicle: food, water, drugs



Entry pathway o Body orifices o

Mucous membranes: eyes, nose, mouth o Breaks in skin



Susceptible host o Decreased ability to resist infection o Immune



Breaking the chain of infection



Stopping infections at the source



Preventing contact with substances from exit

Page 3-5


Resources and



Evaluation





Content Text PPt


Features

Resources and



Evaluation

Instructor’s Notes pathways



Eliminating means of transmission



Blocking exposure to entry pathways



Reducing host susceptibility



Infection control programs



Employee screening and immunization



Evaluation and treatment



Surveillance


Page 3-6




Objective 3-1c: Describe proper procedures for hand hygiene, putting on and removing protective clothing, and entering the nursery or neonatal ICU.

Lecture Outline

— Objective 3-1c

Content Text PPt


Features

Resources and



Evaluation




Infection Control Practices



Hand hygiene (Box 3-3)

— single most important means of preventing infection spread o Antiseptic hand cleaners o Washing



Personal protective equipment (PPE) o Gloves o Gowns



Properly worn with sleeves to wrist, belt tied, and gown overlapped and securely fastened



Removed from the inside by sliding arms out of sleeves o Lab coats o Masks, face shields, goggles o Respirators



Correct order to put on and remove protective clothing should be followed o

Gown first, mask next, then gloves o

Removal: Gloves,

65-72 12–16 Figures

3-3: Stop sign reminder to wash hands with soap and water.

p. 66

3-4: Glove removal. p. 69

Boxes

3-5: Protective clothing. A.

Phlebotomist slips arms into a protective gown. B.

A mask is applied by slipping the elastic band over the ears. C. Gloves are put on last and pulled over the gown cuffs. p. 71

3-3: Situations That

Require Hand Hygiene

Procedures p. 66

Procedure

3-1: Hand-Washing

Technique

Resources

True Confessions of a

Filthy, Rotten, Germ .

(Healthcare Professionals

Version) Brevis Corp, Salt

Lake City, UT. www.brevis.com


Discussion

Practice proper handwashing procedures.

Touch your hand to a blood agar plate after touching various surfaces or before and after hand washing. Incubate the plates overnight and observe growth of microorganisms.

Simulate hand contamination with fluorescent lotion and view hands under UVA light before and after washing.

Practice the proper way to put on and remove gloves.


WB


Situations That Require

Hand Hygiene

Skills Drill 3-3: Hand-

Washing Technique

Page 3-7




Lecture Outline — Objective 3-1c

Content Text PPt


Features gown, mask



Nursery and Neonatal

Intensive Care Unit

(ICU) Infection-Control

Technique o

Wash hands thoroughly o

Put on clean gloves, gown, and mask o

Bring only necessary items into nursery o

Remove gloves, wash hands, and put on new gloves after finishing with one patient and before going to next pp. 67-78

Resources and


IRC

Video: “Donning and

Removal of Protective

Equipment”

Video: “Hand Washing /

Hand Antisepsis”

Materials blood agar plate incubator fluorescent lotion

UVA light


Evaluation



Page 3-8




Objective 3-1d: Describe standard and transmission-based precautions and identify the organizations that developed them.

Lecture Outline

— Objective 3-1d

Content Text PPt


Features

Resources and



Evaluation



Isolation Procedures: doctor’s order; usually private room



Protective or reverse isolation o Highly susceptible patients



Traditional isolation systems o Category-specific o Disease-specific



Universal precautions o Prevent patient-topersonnel transmission



Body substance isolation o Requires that gloves must be worn when contacting any moist body substance



Revised guideline for isolation precautions in hospitals o Standard precautions

(Fig. 3-6) o Transmission-based precautions — to minimize the risk of infection transmission from both recognized and unrecognized sources

72–75 17–19 Figures

3-6: Standard precautions sign. p. 73

37: Respiratory hygiene/cough etiquette p. 74

3–8: Airborne precautions sign. p. 77

3–9: Droplet precautions sign. p. 78

3–10: Contact precautions sign. p. 79

Tables

3–1: Clinical Conditions

Warranting Transmission-

Based Precautions Pending

Confirmation of Diagnosis p. 75

Resources

True Confessions of a

Filthy, Rotten, Germ.

(Healthcare Professionals

Version) Brevis Corp, Salt

Lake City, UT. www.brevis.com

In-Class Activity

IRC

Critical Thinking Question

Evaluation

WB

Case Study 3-1: Airborne

Precautions

Case Study 3-2: Work

Restrictions (textbook

Appendix D)


Page 3-9




Lecture Outline — Objective 3-1d

Content Text PPt


Features



Airborne (Fig. 3-8)



Droplet (Fig. 3-9)



Contact (Fig. 3-10)

3–2: Transmission-Based

Precautions for Common

Diseases and Conditions p. 76

Resources and



Evaluation



Page 3-10




Objective 3-1e: State safety rules to follow when working in the laboratory and in patient areas.

Lecture Outline

— Objective 3-1e

Content Text PPt


Features

Resources and



Evaluation



Safety



Biosafety o

Biohazard o Biohazard exposure routes



Airborne



Ingestion



Nonintact Skin



Percutaneous



Permucosal



General Lab Safety

(Box 3-4)



Patient Area Safety

(Box 3-5)

75–80 20- Figures

3–11: The biohazard symbol. p. 79

Boxes

3-4: General Laboratory

Safety Rules p. 76

3-5: Safety Rules When in

Patient Rooms and Other

Patient Areas p. 80

Resources

CLSI. (2004). Clinical

Laboratory Safety.

Approved Guideline

[CLSI GP17-A2]. Wayne,

PA.


Discussion

Examine safety equipment such as face shields, goggles, and splash guards.

Materials

Lab safety equipment

Outside Evaluation

WB


Safety Rules When in

Patient Rooms and Other

Patient Areas



Page 3-11




Objective 3-2a: Identify key elements of the Blood-Borne Pathogen Standard and the Needlestick Safety and

Prevention Act, and identify associated organizations

Lecture Outline


Content Text PPt


Features

Resources and



Evaluation



Blood-Borne Pathogens



Infectious microorganisms



HBV and Hepatitis D

Virus o Vaccination is best defense o HBV exposure hazards — transmitted through:



Needlesticks



Contact with contaminated equipment, objects, and surfaces



Contact with infectious material through aerosols, spills, and splashing



Sexual contact



Sharing of dirty needles o Symptoms of HBV infection



Resemble flu symptoms, but generally last longer



Fatigue



Loss of appetite



Mild fever



Muscle, joint, and abdominal pain

80-81 21–23 NA Resources

CLSI (2005). Preventing

Bloodborne Pathogen

Infection: Improved

Practice Means Protection.

CLSI M29-A2-V or DVD.

Wayne. PA http://www.osha.gov


Discussion

Write an exposure control plan for the student laboratory.


WB


Pathogen Transmission and Precautions


Page 3-12




Lecture Outline — Objective 3-2a

Content Text PPt


Features



Nausea



Vomiting



HCV: Hepatitis C o HCV exposure hazards



Can enter the body in same manner as

HBV, only usually after large or multiple exposures o Symptoms of HCV infection



Similar to HBV, although only 25% to 30% of infections



HIV display symptoms o Virus that causes AIDS o HIV exposure hazards o Symptoms of infection



Mild to severe flu symptoms

Resources and



Evaluation



Page 3-13




Objective 3-2b: Discuss the major points of the blood-borne pathogens (BBP) standard, including changes required by the Needlestick Safety and Prevention Act, and identify key elements of a BBP exposure control plan.

Lecture Outline

— Objective 3-2b

Content Text PPt


Features

Resources and



Evaluation




OSHA Blood-Borne

Pathogens Standard



Engineering and work practice controls



PPE



Needlestick Safety and

Prevention Act of 2000



Exposure Control Plan o Determination o Implementation and compliance o Hepatitis B vaccine and postexposure follow-up o Employee hazard communication o Record keeping



BBP Exposure Routes o The skin is pierced by a contaminated needle or sharp object o Blood or other body fluid splashes into the eyes, nose, or mouth o

Blood or other body fluid comes in contact with a cut, scratch, or abrasion o A human bite breaks the skin



Exposure Incident

81-84 24–28 Figures

3-12: Eyewash basin. p. 82

Boxes

3-6: Key Elements of an

Exposure Control Plan p. 83

3-7: Key Elements of a

Postexposure Medical

Evaluation p. 83

Procedure

3-2: Cleanup Procedures for Blood and Other Body

Fluid Spills p. 84

Resources

CLSI (2005). Preventing

Bloodborne Pathogen

Infection: Improved

Practice Means Protection.

M29-A2-V or DVD. http://www.osha.gov

In-Class Activity

Discussion


WB

Matching 3-4: Type of

Spill and Cleanup

Procedure

Labeling Exercise 3-2:

Engineering Controls and

Work Practice Controls

Bring in some fake

“blood” and spill it on the floor. Demonstrate proper precautions and steps to take in cleaning up the spill. Then have students practice cleaning up their spills.

Materials

Fake blood, gloves for each student, EPAapproved cleanup kit, biohazard container

Page 3-14





Content Text PPt


Features

Procedure o Needlesticks o Mucous membrane o Incident reports



Surface

Decontamination o With a 1:10 bleach solution or other EPAapproved disinfectant



Cleanup of body fluid spills o Special EPA-approved chemical solutions available for cleanup of blood and other body fluid spills and for disinfecting surfaces



Biohazard Waste

Disposal o All discarded items contaminated with blood or other body fluids are considered biohazardous waste and must be disposed of in special containers or bags marked with a biohazard symbol

Resources and



Evaluation



Page 3-15




Objective 3-3a: Identify hazards, warning symbols, and safety rules related to the laboratory, patient areas, and biological, electrical, fire, radiation, and chemical safety, and discuss actions to take if incidents occur

Lecture Outline


Content Text PPt


Features

Resources and



Evaluation




Electrical safety (Box 3-8)



Actions to take if electrical shock occurs o

Shut off the source of electricity o

If the source cannot be shut off, use a nonconducting material to remove the source of electricity from a victim o

Call for medical assistance o

Start cardiopulmonary resuscitation if indicated o Keep the victim warm



Fire Safety (Box 3-9)



Components of Fire

(Fig. 3-14)



Classes of Fire o A: ordinary combustibles; waterbased extinguishers o B: flammable liquids and vapors; blocking oxygen or smothering required o

C: electrical; nonconducting agent required to extinguish

84- 92 29–42 Figures

3-13: Fire blanket storage box. p. 8

3-14: Fire tetrahedron. p. 86

3-15: Classes of fire extinguishers. p. 87

3-16: The radiation hazard symbol. p. 88

3-18: Example of DOT hazardous materials labels. p. 92

3-19: National Fire

Protection Association 704 marking system. p. 93

3-20: Combination safety shower and eye wash.

Resources Evaluation

CLSI. (2005). Protection of Laboratory Workers from Occupationally

Acquired Infections.

Approved Guideline

[CLSI M29-A2]. Wayne,

PA.

CLSI. (2004). Clinical

Laboratory Safety.

Approved Guideline [CLSI

GP17-A2]. Wayne, PA.


WB

Matching 3-3: Class of

Fire, Type of Material, and

Method Required to

Extinguish

Labeling Exercise 3-1:

NPFA 704 Marking

System

IRC

Critical Thinking

Questions

Page 3-16





Content Text PPt


Features o

D: combustible or reactive metals; frequently lead to explosions; dry powder or sand required to extinguish



Fire Extinguishers: (Fig.

3-15) A, B, C, K, and

ABC (multipurpose);

None for Class D



Radiation Safety: distance; shielding; time



Chemical Safety (Box 3-10)



OSHA Hazardous

Communication

Standard o HazCom Labeling

Requirements o

Material Safety Data

Sheets



Department of

Transportation Labeling

System (Fig. 3-18)



National Fire Protection

Association Labeling

System (Fig. 3-19)



Safety Showers and

Eyewash Stations (Fig.

3-20)



Chemical Spill

Procedures (Fig. 3-21) o

Require cleanup using special kits p. 94

3-21: Spill cleanup kit. p. 93

Tables

3-3: United Nations

Hazard Classification

Numbers and Symbols p. 95

Boxes

3-8: Electrical Safety p. 85

3-9: Fire Safety Dos and

Don’ts p. 85

3-10: General Rules for

Chemical Safety p. 88

Resources and


Page 3-17



Evaluation





Content Text PPt


Features

Resources and



Evaluation



Page 3-18




Objective 3-4a: Recognize symptoms needing first aid and list the main points of the American Heart Association

CPR and ECC guidelines.

Lecture Outline


Content Text PPt


Features

Resources and



Evaluation




First Aid



External Hemorrhage o

Pressure o Elevation o Tourniquet — last resort



Shock o Common Symptoms of

Shock



Pale, cold, clammy skin



Rapid, weak pulse



Increased, shallow breathing



Expressionless face/ staring eyes o

First Aid for Shock



Maintain an open airway



Call for assistance



Keep victim lying down with head lower than rest of body



Attempt to control bleeding or other cause of shock if known



Keep victim warm

92-95 43–47 NA In-Class Activities

CPR Training

Arrange to have students participate in a basic CPR training course and become certified in CPR.

If possible, have a certified instructor come and provide the training in the class at a time all or most students can be there.

NA

Page 3-19





Content Text PPt


Features



Cardiopulmonary

Resuscitation and

Emergency

Cardiovascular Care o AHA CPR and ECC

Guidelines o AHA Chain of

Survival



Early access to care



Early CPR



Early defibrillation



Advanced care

Resources and



Evaluation



Page 3-20




Objective 3-5a

: Describe the role of personal wellness as it relates to nutrition, rest, exercise, stress management, and back protection.

Lecture Outline


Content Text PPt


Features

Resources and



Evaluation



Personal wellness



Personal hygiene — bathing, teeth, hair, fingernails, use of personal products



Proper nutrition (Fig. 3-

19)



Rest and exercise



Back protection (Fig 3-

24) — proper lifting technique, good posture



Stress management (Box

3-13) — important to overall health

95–97 48-50 Figures

3-22: Holistic food pyramid p. 95

3-24: Lifting techniques. p. 97

Boxes

3-13: Ways to Control

Stress p. 97


Discussion

Have students perform a personal wellness assessment.

IRC

Video: “Proper Lifting

Technique”

Video: “Good and Poor

Workplace Ergonomics in

Phlebotomy”

Outside Assignment

Study and Review

Questions text pp. 98-99

Case Studies text p. 99

Evaluation

IRC

Test Generator

SRC

Test your knowledge on the interactive exercises found in the SRC.

WB

Matching


Caution and Key Point

Recognition

Skills Drill 3-1:

Requisition Activity

Crossword

Chapter Review Questions

Unit 1 Crossword Exercise



Page 3-21


Lesson Plan - Wolters Kluwer Health

Phlebotomy Essentials (6e)

Chapter 3 — Infection Control, Safety, First Aid, and Personal Wellness

Goals of the Lesson:

Learning Objectives. The lesson plan for each objective starts on the page shown below:

You Will Need:

Key Terms

Objective 3-1a: Demonstrate knowledge of terminology and practices related to Infection Control and identify agencies associated with infection control precautions, procedures, and programs

Objective 3-1b: Identify the components of the chain of infection and give examples of each, describe infectioncontrol procedures used to break the chain, and identify four functions of infection-control programs.

Objective 3-1c: Describe proper procedures for hand hygiene, putting on and removing protective clothing, and entering the nursery or neonatal ICU.

Objective 3-1d: Describe standard and transmission-based precautions and identify the organizations that developed them.

Objective 3-1e: State safety rules to follow when working in the laboratory and in patient areas.

Objective 3-2a: Identify key elements of the Blood-Borne Pathogen Standard and the Needlestick Safety and

Prevention Act, and identify associated organizations

Objective 3-2b: Discuss the major points of the blood-borne pathogens (BBP) standard, including changes required by the Needlestick Safety and Prevention Act, and identify key elements of a BBP exposure control plan.

Objective 3-3a: Identify hazards, warning symbols, and safety rules related to the laboratory, patient areas, and biological, electrical, fire, radiation, and chemical safety, and discuss actions to take if incidents occur

Objective 3-4a: Recognize symptoms needing first aid and list the main points of the American Heart Association

CPR and ECC guidelines.

Objective 3-5a

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