PRINCIPLES OF MEDICAL LABORATORY
SCIENCE LAB 2
PHLEBOTOMY: DEFINITION
PHLEBOTOMY or venesection came from two Greek words, phlebos
which means vein; and temnein which means to cut. It is the act of opening a vein
by using incision or puncture methods to draw blood for analysis or as part of
therapeutic or diagnostic measures under the physician’s request
PHLEBOTOMY: EVOLUTION (A BRIEF HISTORY)
The practice of Phlebotomy can be tracked back to the time of the
Stone Age when men used crude tools to cut vessels and drain blood from the
body. The ancient Egyptians also practiced this as a form of “Bloodletting” as early
as 1400 B.C.
However, Phlebotomy became widely accepted during the time of
Hippocrates (460-377 B.C.) when health was believed to be dependent on the
balance of humors:
 Earth – Blood & Brain
 Air – Phlegm & Lungs
 Fire – Black Bile & Spleen
 Water – Yellow Bile & Gall Bladder
To keep balance, excess humor is removed by bloodletting
PHLEBOTOMY: INTRODUCTION
Laboratory testing of blood specimen is vital to the correct diagnosis,
treatment, and monitoring of a patient’s condition. Laboratory results constitute
70% of the objective information used by health-care providers to manage
patient care and resolve patient health problems. The quality of a test result is
only as good as the quality of the specimen analyzed. Therefore, reports from a
suboptimal specimen can result in treatment that can be potentially harmful to
the patient by overmedicating or under-medicating the patient with death being
the worse patient outcome
Although the primary concern or personnel collecting blood specimens
is understandably to obtain the specimen, failure to adhere to the collection
procedure can compromise the integrity of a successful collected specimen.
Approximately 56% of laboratory error occurs during the pre-analytical phase
(process that occurs before testing of the sample) of laboratory testing
Influencing factors are the responsibilities of the blood collector and
include:
 Monitoring of specimen ordering
 Correct patient identification
 Patient communication and safety
 Patient preparation
 Timing of collections
 Phlebotomy equipment
 Collection techniques
 Specimen labeling
 Specimen transportation to the laboratory
 Specimen processing
PHLEBOTOMIST: ROLE IN HEALTHCARE
The Phlebotomist’s primary role is to collect blood for accurate and
reliable test results as quickly as possible and with the least discomfort to the
patient. The job description can vary greatly from one health care environment to
another
A Phlebotomist is usually cross-trained in venipuncture, capillary
collection, patient care, laboratory receptionist duties, sample processing, and
computer work
Phlebotomists have become key players on the health care team. They
represent the laboratory and the health care center, they are in direct contact
with the patient, and they perform tasks that are critical to the patient’s
diagnosis and care
PHLEBOTOMIST: PROFESSIONAL ATTITUDE
Central to the job of drawing blood is the patient, who is often
apprehensive about the procedure we perform. It is important not only to obtain
a good sample, but to do so with minimal trauma to the patient. Bear in mind that
the patient must be treated like anyone would like to be treated. Everyone must
follow a professional code of conduct in the treatment of patients.
The Phlebotomist’s own professional attitude toward the job and
duties determines how the patient is treated. If the Phlebotomist attempts to
draw a patient and does not feel confident about obtaining the sample, a “miss”
of the patient will most likely result. Even when you try to hide it, a negative
attitude will resurrect its ugly head and destroy rapport with patients, coworkers,
and supervisors. It is not the events of the day that shape the Phlebotomist, it is
how the Phlebotomist deals with those events.
PHLEBOTOMIST: PROFESSIONAL GROOMING
Just as the professional attitude of the Phlebotomist can determine
how well a Phlebotomist is perceived by the patient, so can the grooming of the
Phlebotomist affect this perception. The average patient a Phlebotomist will be
working with is an older individual for whom often only conservative grooming and
dress is acceptable. Most health care organizations restrict what the
Phlebotomist is permitted to wear
The following are the common dress code for most hospital-employed
Phlebotomists:
 No visible tattoos
 No body piercing other than a minimum of two in the ears (one for
each ear)
 No fingernails longer than one-fourth inch
 No blue jeans or casual attire
 No open-toed shoes
 No t-shirt or sweatshirts
Often the Phlebotomist will be most comfortable and acceptable wearing
scrub outfit. In some health care organizations, the scrub outfit is furnished
WHAT IS PHLEBOTOMY?
 Does not generally talk about venesection only
 Includes arteries and capillaries
 VENESECTION – Ancient Times
 PHLEBOTOMY – Now
 Comes from the Greek words Phlebos which means “veins” and
Temnein which means “to cut”
 The act of opening the vein by using incision or puncture for
therapeutic or diagnostic measures
WHY IS IT IMPORTANT?
 Correct and accurate diagnosis and treatment
 Monitoring of condition
 Follow proper procedure in blood collection and other
medications
 Every step has a reason
 Good test result = Good quality specimen
 Failure to adhere to the collection procedure = Compromise integrity
of a successfully collected specimen
 Approximately 56% of the laboratory errors occur in the preanalytical phase or process that occur before testing the sample of
laboratory testing
 Most critical phase in the laboratory
 Includes phlebotomy or blood collection
RESPONSIBILITIES OF A PHLEBOTOMIST
 Monitoring of specimen
 Correct patient identification
 Very critical; Has patient interaction
 Patient communication and Safety
 Communications is a skill
 Patient preparation
 Give the patient proper instructions before blood collection
 Timing of collections
 Phlebotomy equipment
 Collection techniques
 Specimen labeling
 As important as correct patient identification
 Specimen transportation
 Specimen processing
THE PHLEBOTOMIST
ROLE IN HEALTHCARE
 PRIMARY ROLE: To collect blood sample
 Represents the laboratory
 In direct contact with the patient
 Perform tasks critical to patient’s diagnosis and care
PROFESSIONAL ATTITUDE
 Self-Confidence – Ability to trust your own personal judgement
 Know what you are doing
 Integrity – Quality of being honest and having strong moral principles
 Compassion – Being sensitive to the needs of a person and offering
reassurance in a caring and humane way
 Show TLC (Tender Loving Care)
 Self-Motivation – Direct reflection of a person’s attitude towards life
 There is the initiative to do your work
 Dependability – If you are confident = Dependable
 Ethical Behavior – Making the right personal choices to help maintain
high respect for self and for profession
 Code of Ethics
PROFESSIONAL GROOMING
 DONT’S
 Visible tattoos
 Only tattoos that can be hidden
 Body piercing
 Only in the ears
 Fingernails longer than one-fourth inch
 For safety from hazardous waste; Use gloves
always



Jeans or casual attire
Open-toed shoes
T-shirts or sweatshirts – Casual attire is okay as long as
it is proper
 Never forget your lab gowns & scrub suits
 Always wash your lab gowns regularly
 Never re-use gloves and PPE (masks, hairnets,
etc.)
PATIENT-CLIENT INTERACTION
 Important because we are in direct contact with the patient
 Recognize Diversity
 Every patient has different beliefs and opinions
and we should respect that
 Professionalism
 Communication
 Patient’s Right
 Patient has the right to refuse and to request
 Confidentiality
ANATOMY OF A PHLEBOTOMIST
 Sharp mind
 Learn how to troubleshoot
 Be cheerful
 Have a calm tone of voice
 Be compassionate and kind
 Have high level of patience
 Communication skills
 Steady hands
 Strong feet
LABORATORY BIOSAFETY
 Regard all samples as potentially infectious (all types of fluids)
BIOSAFETY AND BIOSECURITY
BIOSAFETY
 Measures employed when handling biohazardous materials to avoid
infecting oneself, others, or the environment
 “Protecting people from bad bugs”
 The containment principles, technologies, and practices that are
implemented to prevent unintentional exposure to pathogens and
toxins or their accidental release (WHO, 2006)
 Contain the pathogens so as not to infect others
BIOSECURITY
 Measures employed to protect biohazardous materials, or critical
relevant information, against theft or diversion by those who tend to
pursue intentional misuse
 “Protecting bad bugs from bad people”
 The protection, control, and accountability for valuable biological
materials within laboratories in order to prevent unauthorized access,
loss, theft, misuse, diversion, or intentional release (WHO, 2006)
 Protect samples from the wrong people (may be used as a murder
weapon)
DIFFERENT ORGANIZATIONS IN THE FIELD OF BIOSAFETY
 Common goal: SAFETY
1. American Biological Safety Association (ABSA)
 Promotes biosafety as a scientific discipline
 Research and theories
2. Asia-Pacific Biosafety Association (A-PBA)

Members are required to contribute to the development
of the best biosafety practices
 Similar to PAMET (has contributions)
 Funds will be used for everyone
 Benchmark – recording
3. European Biological Safety Association (EBSA)
 Provide a forum for discussions and debates on issues of
concern
 Convention
 Other people get to address their concerns and create a
solution for it
4. Philippine Biosafety and Biosecurity Association (PhBBA)
 Assists the Department of Agriculture (DA) and
Department of Health (DOH) to create a national policy and
implement plan for biosafety and biosecurity
 No concrete policy for biosafety and biosecurity
5. Biological Risk Association Philippines (BRAP)
 Serve the emergent concerns of biological risk
management in various professional fields
CLASSIFICATION OF MICROORGANISMS ACCORDING TO RISK GROUPS
 Based on principal characteristics and relative hazards posed by
infectious toxins or agents
CLASSIFICATION OF LABORATORY BIOSAFETY ACCORDING TO LEVELS
 Based on composite of the design features, construction, containment
facilities, equipment, practices, and operational procedures required
for working with agents from various risk groups
PRINCIPAL CHARACTERISTICS – Biochemical Results
FUME HOOD
 Enclosure/ventilation which is connected to the exhaust fan
 So that the aerosol (fumes) like strong acids will be sucked and
released into the environment
BIOSAFETY CABINET
 Operator – Has filter (HEPA filter or High Efficiency Particulate Air
Filter)
 Filters air so the smallest pathogens or particles will be trapped and
filtered
 Sample is protected in a way that it is not contaminated
HEPA FILTERS
 To prevent discharge of aerosol (source of infection)
 At least 2 filters – Supply & Exhaust
AEROSOL
 Created by any activity that imparts energy into a liquid or semiliquid
material
 E.g. When shaking, pouring, centrifugation, pipetting, streaking (in
centrifugation – should be closed as well as the tube)
Classification
Biosafety Level
Application
Low to moderate risk
Class-I
1,2,3
biologic agents
Low to moderate risk
Class-II
1,2,3
biologic agents
Class-III
4
High risk biologic agents
Biosafety Cabinets
 Ebola – Biosafety Level 4
 Class 3 – Also known as glove boxes
Risk Group
Biosafety Level
Laboratory Type
1
1
Microorganism: Unlikely
Suitable for work involving Basic teaching, Research
to cause disease
viable microorganisms
Risk: Low
2
2
Microorganism: Unlikely
Deal with indigenous Primary health services;
to be a significant risk
moderate-risk,
Diagnostic services,
to; treatment and
appropriate for samples Research
preventive measure
when there is uncertain
are available
Risk: Moderate
presence of infectious
agent
3
Microorganism: Known
3
to cause serious
Works with indigenous or
disease; Treatment and
Special diagnostic
exotic agents with
preventive measure
services, Research
potential for respiratory
are available
transmission
Risk: High (individuals),
Moderate (Community)
4
Microorganism: Known
4
to produce lifeWork with dangerous and
threatening,
readily
exotic agents. Generally a
transmissible.
Dangerous pathogen unit
separate building or
Treatment
and
completely isolated zone
preventive measures
with specialized ventilation
are not usually available
Risk: High
1: Unlikely to cause disease = Non-pathogenic
2: E.g. E.Coli; Staphylococcus aureus
 Control microbes/microorganisms
 Run it like a sample (to check presence)
4: E.g. Tuberculosis; St. Louis Encephalitis Virus (through respiratory transmission);
Coxiella
Ante-room – Room created before entering the actual site of infection
 Change clothes (No outside clothes allowed)
SPECIMEN PROCESSING AND HANDLING
 All specimens should be transported to the laboratory in sealed
containers/plastic bags
 Some has a biohazard symbol
 Place in transport container/vessel
 Contamination-leakage or improper collection technique
 Container must be screw-capped (slowly open it)
 Be careful when removing lids or caps – cover with gauze or
disposable tissue to prevent splatters or spray
HOW TO CLEAN SPILLED BLOOD
1. Get something that is absorbent (gauze, paper towel)
2. Let it absorb
3. Clean remnants using antiseptic (Best antiseptic: Bleach – 10% sodium
hypochlorate solution or NaClO)
HOW TO PREPARE 10% SODIUM HYPOCHLORATE
 9 parts water and 1 part bleach

Expired, spilt, and contaminated pharmaceutical products, drugs, and
vaccines
RADIOACTIVE WASTE
 Wastes that haven’t been in contact with communicable or infectious
agents
 Hazardous chemicals or radioactive substances
 Recyclable/Biodegradable/Non-recyclable/Non-biodegradable
PRACTICES OBSERVED IN A COLOR-CODING SYSTEM FOR HEALTH CARE WASTES
 Highly infectious waste must be disinfected at source
 Anatomical waste should be disposed through safe burial or cremation
 Pathological waste must be refrigerated if not collected or treated
within 24 hours
 Chemical and pharmaceutical waste shall be segregated and collected
separately
 Radioactive waste has to be decayed to background radiation levels
 All waste bins must be properly covered to prevent cross
contamination
 Aerosol containers can be collected with the general waste

Centrifugation-capped or covered trunnions to prevent aerosols. Tops
should be close when in operation and never stopped by hand
 CENTRIFUGAL FIELDS – 10-12 kilograms
 Has a calculated speed
 Paraffin – Wax paper used to cover the mouth of the
test tube
 NEVER PIPETTE BY MOUTH
 Check correct details of label and request name, age, sext, test,
requesting physician, patient number, official receipt number
 Should be complete name
WHAT’S IN THE TUBE
 Name
 Age
 Sex
 Date and time of collection
 Initials of physician/phlebotomist
HEALTH CARE WASTE MANAGEMENT
HEALTH CARE WASTE
 Solid or liquid wastes generated by any of the following:
 Diagnosis, treatment, and immunization of humans
 Research
 Production and testing of biological products
TYPES OF HEALTH CARE WASTE
INFECTIOUS WASTE
 Wastes suspected to contain pathogens or toxins in sufficient
concentration that may cause disease to a susceptible host
PATHOLOGICAL & ANATOMICAL WASTE
 Tissue section or organs from biopsy, autopsy, or surgery
SHARPS
 Items that can cause cuts, pricks, or puncture wounds
 MOST DANGEROUS HEALTH CARE WASTE
CHEMICAL WASTE
 Discarded chemicals during disintegration and sterilization
 May contain high content of heavy metals and derivatives
PHARMACEUTICAL WASTE
BENEFITS OF PROPER AND STRICT COMPLIANCE ON HEALTH CARE WASTE
MANAGEMENT
1. Protection of patients, health workers, and the general population
from adverse effects on health care waste
2. Contribution to the collaborative efforts of the world to protect the
environment
3. Increased compliance of health care institutions to laws, regulations,
and guidelines on health care waste
4. Prevention of long-term liabilities and loss of reputation
INTERNATIONAL AGREEMENTS ON HEALTH CARE WASTE MANAGEMENT
 Montreal Protocol on Substances that Deplete the Ozone Layer (1987)
 Basel Convention on the Control of the Transboundary Movements of
Hazardous Wastes and their Disposal (1989)
 UN Framework Convention on Climate Change (1992)
 ASEAN Framework Agreement on the Facilitation of Goods in Transmit
(1998)
 Stockholm Convention on Persistent Organic Pollutants (2001)
NATIONAL LAWS AND POLICIES ON HEALTH CARE WASTE MANAGEMENT
 DOH “Manual on Health Care Waste Management” in 2011
 DOH AO No. 2008-0021 “Gradual Phaseout of Mercury in all Philippines
Health Care Facilities and Institutions”
 R.A. 9275 “The Philippines Clean Water Act of 2004”
 R.A. 8749 “The Philippine Clean Air Act of 1999”
TREATMENT OF HEALTH CARE WASTE
 PYROLYSIS – Thermal decomposition
 AUTOCLAVE
 MICROWAVE
 CHEMICAL DISINFECTION
 BIOLOGICAL PROCESS – Used an enzyme to decontaminate
 ENCAPSULATION – Filling of containers then sealing
 INERTIZATION – Involves the mixing of waste with cement and other
substances; for pharmaceutical waste

LANDFILL – Engineered site designed to keep waste isolated from the
environment; must secure permit from DENR
HAND HYGIENE
 One of the methods of breaking the chain of infection is proper hand
hygiene
 The hand hygiene measures include hand washing and use of alcoholbased antiseptic hand cleaners
 Hand washing could be routine which uses plain soap and water.
Meanwhile hand antiseptics uses antimicrobial soap to remove
transient microorganisms, which is also the kind of soap used when
washing the hands with the 2-minute surgical hand scrub prior to
performing surgical procedures
HAND WASHING
WE NEED TO FOLLOW PROPER PROCEDURES – If not = Deemed useless and hands
are still contaminated
PRINCIPLE
 The proper handwashing technique cleans the hands and wrists. This
procedure will also reduce the number of organisms present in the
said areas of the body. It will decrease the chances of transferring
organisms from a source to a susceptible host
MATERIALS
 Sink with running water, preferably with the following:
 Foot operated controls or
 Hand sensor automatic dispenser
 In the absence of foot-operated controls or automatic
sensors, the area should have a clean paper towel
 Disposal towels
 Soap from a foot-operated container or a pump container (bar soap
is discouraged)
 Disposable paper towel
 Nail stick and./or brush
HAND WASHING PROCEDURE
 Each step has a rationale
 Handwashing should be 40-60 seconds (whole procedure) while 20
seconds of it is for scrubbing-effective handwashing
1. Remove all rings, watches, and other jewelries or accessories
2. Stand a few inches from the sink
 Sink may be contaminated
 Body must not touch the sink
3. Turn on faucet with the foot pedal or with a disposable towel if not
foot-controlled
4. Wet hands under the running water. Be careful to not touch the sides
of the sink
 Warm water should be used
 The water should not be too hot or too cold and hand
should be wet before applying soap to minimize drying,
chopping, or cracking of hands from frequent hand
washing
 Not necessary to use tissue to open faucet before
handwashing
5. Apply soap, and lather well. The lather and scrubbing action will remove
dirty and dead skin
 Common mistake – There is not enough soap to make good
lather
6. Scrub for at least 15 seconds between fingers, knuckles, and around
fingernails. Use a nail stick and a brush during the first hand washing
of each day or when your hands become excessively soiled
 Necessary to dislodge microorganisms especially between
the fingers and around the knuckles
 Has proper step for scrubbing procedure – To cover all
surfaces of the hand
 Common Mistake – There is no force while scrubbing
7. Apply a little friction and rub hands together for at least 15 seconds
 Friction helps loosen dead skin, dirt, debris, and
microorganisms
8. Rinse hands with water flowing downward from wrist to fingertips
 Complete the washing process again if this is the first
hand washing of the day
 DOWNWARD MOTION
 Allows contaminants to be flushed from hands
and wrist and down to the sink rather than to
go back up to the hands, wrist, and to arms
 COMMON MISTAKE – Not all soap is rinsed off (usually
around the wrist parts and in between fingers)
9. Dry hands and wrists with the disposable clean paper towels
10. Turn off the water with the disposable towels if the sink is not footcontrolled

Tissue used for drying hands (if not fully soaked) – Can be
used to turn off the faucet
 Clean hands should not touch the contaminated faucet
handle (consider the whole sink as contaminated)
WHEN IS HANDWASHING REQUIRED?
1. Before and after patient contact
 Each room of the patient has hand sanitizer
2. Between unrelated procedure from patient such as drawing of blood
3. Before putting on your gloves and after taking them off
4. Before leaving the laboratory
5. Before going to lunch or break
6. Before and after going to the restroom
7. Whenever the hands become knowingly and visibly contaminated
’
PERSONAL PROTECTIVE EQUIPMENT
Includes the gloves, masks, shoes, and laboratory gowns. It may also
include goggles and face shields. These PPE’s are used to protect the laboratory
scientist/medical technologist from infectious material
MASKS
 Prevent the transmission of infectious agents through the air. This
should always be worn by the medical technologists especially when
entering the respiratory isolation room. It should cover both the nose
and mouth, and worn only once then discarded in an appropriate
container. Masks are no longer effective once they become moist
from breathing
GLOVES
 Worn due to following reasons:
1. It prevents the medical technologists from transmitting
their own microdata to the patient
2. It prevents transmission of microorganisms from one
patient to another; and
3. It prevents the laboratory scientists or medical
technologists from being infected by organisms from the
patient
 Should be equivalent – Wearing should be as good as removing
 There is a proper order of putting on and removing PPE (form the
most contaminated o the least contaminated)
LABORATORY GOWNS
 Worn when soiling of clothes is possible while working in the laboratory
or extracting blood from patients. It should be fluid resistant to
prevent any blood or body fluids from soaking through and getting on
the medical technologist. Wearing of laboratory gowns prevents
transmission of microorganisms from the patient’s and environment
to the medical technologist. Ideally, it should be used only once then
disposed of in appropriate receptacle.
PROPER DONNING OF PPE’S
1. LAB SHOES
2. HEAD CAP
3. LAB GOWN
4. MASK OR RESPIRATOR
5. GOGGLES
6. GLOVES
 Should be over the sleeve of the lab gown
PRINCIPLE
 Proper donning and removing of PPE’s to prevent the transfer of
organisms from a source to a susceptible host
MATERIALS
 Biohazard waste container
 Disposable cap
 Disposable gloves (sterile or unsterile)
 Disposable mask
 Laboratory gown (preferably disposable)
 Laboratory shoes
PROCEDURE
1. Remove all accessories and put away all gadgets. Store them inside the
bag or locker
2. Remove street shoes and wear laboratory shoes
3. Wear the mask by placing the top of the mask over the bridge of the
nose and pinch the metal strip to fit the nose. If you are using a mask
with strings, tie the top strings of the mask so the strings are
positioned above the ears then the lower strings behind the neck
4. If necessary, apply the cap to cover hair and ears. Pull long hair up
under the cap
5. Place the gown in front of your body and place your arms through the
sleeves of the gown. If you are wearing a gown with strings, tie top
stings on the gown behind the neck then tie the lower strings of the
gown behind the back
6. Make sure to button the gown properly
7. Put on gloves
PROPER REMOVAL OF PPE’S

1.
2.
3.
4.
5.

PRINCIPLE

Opposite of donning
Gloves (most contaminated)
Goggles
Lab Gown
Mask
Head Cap
Before and after wearing PPE’s – Should do proper handwashing
Proper removal of PPE’s prevents the transfer of organisms from a
source to a susceptible host
MATERIALS
 Same as donning
PROCEDURE
1. Remove contaminated gloves properly and discard it into the biohazard
container
2. Wash hands properly
3. Remove the mask. If you are using a mask with strings, untie the top
tie first and then the bottom tie. Hold the mask by the ties and drop
it into biohazard waster container
4. Remove the laboratory gown. Slip the fingers of one hand inside the
cuff of the gown and pull the gown over the hand
5. Using the hand covered by the gown, pull the gown down over the
other hand
6. Pull the gown off your arms. Hold the gown away from you and roll it
into a ball with the contaminated side on the inside of the ball
7. Dispose the gown into the biohazard container or its appropriate
receptacle
8. Remove the cap
9. Remove the laboratory shoes
HOW TO REMOVE LAB GOWN
 Aim: To remove inside out
PROPER REMOVAL OF CONTAMINATED GLOVES
PRINCIPLE
 Gloves after usage should be removed properly to avoid contamination
of the laboratory scientist or medical technologist. This will also
decrease the transfer of organisms from a source to susceptible
host.
MATERIALS
 Biohazard waste container
 Gloves
PROCEDURES
1. Place hands with gloves in front and away from the body
2. Grasp the palm of the loves on the left hand, and pull it down to turn
it inside out. Do not touch the bare skin with the contaminated gloves
3. The right hand still having the gloves on should then hold the inverted
and removed glove
4. Contain the inverted glove completely in the gloved hand
5. Insert two fingers of the ungloved hand under the cuff of the glove
on the other hand
6. Pull down the glove to turn it inside out
7. Contain the other glove inside the inverted glove
8. Dispose the gloves into a biohazard container
9. Wash hands with running water