1

INFECTION CONTROL
Infection control is a system of techniques and practices that is used to prevent and reduce the
transmission of infectious diseases. Infection control protects patients and health care works.
Infection control is one of the most important responsibilities of phlebotomy technicians.
Our environment is full of microscopic organisms referred to as microbes. Microbes include bacteria,
fungi, protozoa, and viruses. The majority of microbes are nonpathogenic, meaning they do not
cause disease under normal conditions.
 Bacteria: Bacteria are common microscopic organisms (not visible to the eye) that are
everywhere. Bacteria are in the air, the soil, the water, and there are countless bacteria in the
human body. There are more bacteria in and on the human body than there are normal tissue
cells. Most of the bacteria in the body are found in the gastrointestinal tract, the lungs, and on the
skin. These bacteria are called the normal flora (flora means organisms commonly found in a
particular environment) of the body, and they perform many vital functions. Bacterium is the
correct term for a single organism, and bacteria are the plural form. The term bacteria
commonly is used and accepted for both.
 Viruses: Viruses are common microscopic organisms, as well, but they are much smaller than
bacteria. Most viruses are about 1/100th the size of the average bacteria. Viruses are
everywhere in the environment and are commonly found in the human body. Unlike bacteria,
viruses cannot reproduce by themselves; they can reproduce only by entering living cells.
Many of the bacteria and viruses that are commonly found in the body are usually
harmless and some bacteria are even essential for maintaining body processes such
as digestion. Bacteria and viruses are basically parasitic; they must live inside or on
a host to survive.
 Pathogens: Microbes that is capable of causing disease.
 An infection can be defined as "the presence of a disease-producing agent”. An infection
happens when either a foreign microorganism enters the body, or a bacteria or a virus that is
normally found in the body is particularly powerful or multiplies rapidly and there are large
amounts of them. When that happens, a disease, e.g., influenza or pneumonia can occur.
Remember: An infection is the presence of a disease-causing agent, but an
infection does not necessarily mean that a disease is present or that a disease will
happen. The human body has many strong defense mechanisms that actively
prevent infections from occurring and stop the progression of infections before they
can cause harm. An infection can occur, and the body's immune system will destroy
the micro-organisms before they cause harm.
 Local Infection: Infection restricted to a small area of the body.
 Systemic Infection: Infection in which the entire body is affected.
 Communicable Infections: Infection caused by microorganisms that can be spread from
person to person.
 Communicable diseases: The diseases that result of communicable infections.
 Nosocomial infections: (healthcare-associated infections (HAIs) Infections that contracting
after admission to a health care facility. Nosocomial infections can result from contact with
infected personnel, other patients, visitors, or equipment.
Approximately 5% of patients in the United States contract some nosocomial infections.
The most common nosocomial infection in the United States is urinary tract infection (UTI).
Other types of nosocomial infections. (HAIs)
Ventilator-associated pneumonia (VAP)
Surgical site infection (SSI)

2
 Bloodstream infection (BSI)
In addition, infections caused by Clostridium difficile are rapidly becoming common in
hospitals

1 mm = 1000 µm.

1 µm = 1000 nm.

Blood-borne Pathogens: Blood-borne pathogen is a term applied to any infectious

microorganism present in blood and other body fluids and tissues. The term most commonly refers
to hepatitis B virus (HBV) and human immunodeficiency virus (HIV). (Found in blood, semen,
urine, cerebrospinal fluid (CSF), vaginal fluids, breast milk, saliva, tears, amniotic fluid, and blood
product.)
Other blood-borne pathogens include:
 HCV (Hepatitis C): Isolated in blood.
 HTLV (Human T linfotropic virus): Cause an acute leukemia, usually fatal within a year.
Found in blood, sexual contact and breast milk.
 The microorganism that cause syphilis, malaria, relapsing fever and others.

Chain of Infection
This consists of links, each of which is necessary for the infectious disease to spread. Infection
control is based on the fact that the transmission of infectious diseases will be prevented or stopped
when any level in the chain is broken or interrupted

(SOURCE)

Agents- are infectious microorganisms that can be classified into groups namely: viruses,
bacteria, fungi, and parasites. When infectious diseases are identified according to the specific

3
disease-causing microorganism, the disease may be prevented with the use of anti-infective drugs or
infection control practices.
Viability: Is the ability of the organism to survive on the source.
Virulence: Or degree to which an organism is capable of causing disease.
Example: The virus that causes H.B (hepatitis B) is much more virulent or capable of causing
disease from a small amount of infective material than the virus that causes AIDS. It is also more
viable, meaning it is capable of surviving on surfaces longer than the AIDS virus.
Portal of exit the method by which an infectious agent leaves its reservoir. Standard Precautions
and Transmission-Based Precautions are control measures aimed at preventing the spread of the
disease as infectious agents exit the reservoir.
Mode of transmission -specific ways in which microorganisms travel from the reservoir to the
susceptible host. There are five main types of mode of transmission:
1- Contact: direct and indirect
2- Droplet
3- Airborne
4- Common vehicle
5- Vectorbome.
1-Contact:
Direct contact: Involves direct, physical transfer of a pathogenic microbe to a susceptible host
through close intimate contact such as touching or kissing.
Indirect contact: Involves personal contact with a contaminated inanimate object, such as bed
lines, eating utensils, and clothing.
Fomites: Are objects or substances that are capable of adhering to infectious materials and
transmitting infection .Fomites in laboratory including telephones, computer terminals, and
countertops.
2-Droplet: Droplet contact involves the transfer of the infective microbe to the nose, mouth or
conjunctiva (mucous membrane of the eye) of a susceptible individual through sneezing, coughing,
or talking by an infected person.
3-Airborne transmission: Airborne transmission involves droplet nuclei. Droplet nuclei are the
residue of evaporated droplets generated by sneezing, coughing, or talking. Droplet nuclei can
remain viable even though suspended in the air for a long time. Droplet nuclei can be inhaled by or
deposited on a susceptible host.
4- Common Vehicle. Vehicle transmission involves the transmission of the infective microbe
through contaminated food, water, or drugs. Examples of vehicle transmission are salmonella
infection from handling contaminated chicken, and shigella infection from drinking contaminated
water. The transmission of hepatitis and AIDS through blood transfusion is also considered vehicle
transmission.
5- Vectorborne: Vector transmission involves the transfer of the microbe by an insect, arthropod,
or animal. An example of vector transmission is the transmission of malaria by mosquito or the
plague by rodent fleas.

Typical Vector-Borne Disease Cycle (St.

Louis encephalitis virus)
4
Portal of entry - allows the infectious agent access to the susceptible host. Common entry sites
are broken skin, mucous membranes, and body systems exposed to the external environment such
as the respiratory, gastrointestinal, and reproductive. Methods such as sterile wound care,
transmission-based precautions, and aseptic technique limit the transmission of the infectious
agents.

Susceptible host - The infectious agent enters a person who is not resistant or immune. Control
at this level is directed towards the identification of the patients at risk, treat their underlying condition
for susceptibility, or isolate them from the reservoir.
A susceptible host can be anyone. Susceptibility is affected by age, health, and the immune status of
the individual. For example, newborns whose immune systems are not yet developed and old people
whose immune systems are no longer functioning properly are more susceptible to infections.

Susceptibility of potential hosts can be reduced through:

 proper nutrition
 reduction of stress,
 immunization against common agents
The goal of infection control in phlebotomy is to prevent micro-organisms from entering the body.
Doing so is a challenge because one of the most important defense mechanisms is intact skin.
Intact skin acts as a physical barrier to micro-organisms. But when the phlebotomy technician
punctures a patient's skin with a needle, that barrier is broken, micro- organisms have an entry point,
and an infection - and possibly a disease - can result. An infection and a disease can be caused by
a patient's normal flora, but infection and disease also can be transmitted from person to person.
The potential for the spread of micro- organisms from patient to patient - with the phlebotomy
technician acting as a “carrier” - is tremendous.

Breaking the chain of infection:

Breaking the chain of infection means stopping infections at the source, eliminating means
of transmission, and reducing or eliminating susceptibility of potential hosts.

The basic principles of infection control are:

 Handwashing: Handwashing is the easiest and most effective way to prevent
the transmission of disease. There are different handwashing techniques. The one
you chose will depend on the situation. However, the most important point to
remember is that you must always wash your hands before and after any contact with
a patient or after contact with any blood, body fluids, or body secretions.
Your workplace will have a hand-washing protocol. The handwashing procedure
explained here can differ for that protocol but if you use this procedure, you will be
in compliance with basic infection control requirements. Remove rings and other
jewelry. use lukewarm water, wet your hands, and apply soap. Rub your hands
together, making sure all parts are scrubbed. Wash for at least 20 seconds. Rinse off
the soap, use a paper towel to turn off the water, and gently dry your hands. You
can also use an alcohol-based hand sanitizer. Apply the hand sanitizer and rub it in
and over your hands until your hands are dry. Do not use an alcohol-based hand
sanitizer if your hands are visibly dirty. A routine hand wash procedure uses plain
soap to remove soil and transient bacteria. Hand antisepsis requires the use of
antimicrobial soap to remove, kill or inhibit transient microorganisms .

5
  Barrier Protection (PPE's or personal protective equipment): Always wear
disposable gloves when you come in contact with a patient; when you are handling blood or
body fluids/secretions; or, when you can come in contact with blood or body fluids/secretions.
You also should wear a lab coat or some sort of covering that protects your skin in case of
splash contact with blood or body fluids. Other barrier protection equipment such as face
shields or face masks are not needed when you are performing a routine venipuncture. If
special barrier equipment is needed, you will be notified by the nurse or other health care
personnel.
Putting it on: the sequence.
1. Put on the gown. Fully cover torso from neck to knees, arms to end of wrists, and wrap
around the back.
2. Put on the mask, respirator. Secure ties or elastic bands at middle of head and neck
3. Put on the goggles or face shield. Place over face and eyes and adjust to fit.
4. Put on the gloves. Extend to cover wrist of gown.
Taking it off: the sequence
Removal of personal protective equipment can be one of the most risky areas in
infection control if it is not done properly
1. Removing the gloves. : Grasp outside of glove with opposite hand; peel off. Hold removed
glove in gloved hand. Slide fingers of ungloved hand under remaining glove at wrist. Peel glove
off over first glove. Discard gloves in waste container.
2. Goggles or face shield: Handle by headband or ear pieces. Place in designated receptacle
for reprocessing or in waste container.
3. Gown: Unfasten ties. Pull away from neck and shoulders, touching inside of gown only. Turn
gown inside out. Fold or roll into a bundle and discard.
4. Mask or respirator: Grasp bottom, then top ties or elastics and remove. Discard in waste
container.
Perform hand hygiene again after removing all PPE.

 Handling body fluids/secretions: All blood and all body fluids and body secretions
should be considered contaminated. Always wear gloves when you are -or can be - handling
body fluids or secretions.
 Equipment use and disposal: Any phlebotomy equipment that breaks the
surface of the skin must be sterile. Other equipment that touches the surface of the skin
should be clean but does not have to be sterile. Sterile equipment used for venipuncture is
disposable and must never be reused, even if the equipment would be used for the same patient.
All one-time use equipment that breaks the surface of the skin or any equipment that comes in
contact with blood or body fluids/secretions should be considered contaminated and must be
disposed of in a hazardous waste container. Gloves should be discarded after use, but if they
have not been contaminated, they do not need to be put in a hazardous waste container. Never
use the same pair of gloves when caring for two patients.
Hazardous waste containers are typically brightly colored (often red), made of a
hard plastic, and clearly marked. It is important to use these containers to discard
contaminated equipment. Putting contaminated equipment in an ordinary trash
container poses a risk to anyone who must dispose of this trash.

6
 Others ways to prevent transmission of infectious organisms are:
 Isolation procedures
 Insect and rodent control
 The decontamination of surfaces and instruments (sterile technique)

Respirator Face Shields gloves Mask Goggles gowns

Personal protective equipment

Isolation Procedures
Isolation separate patients with certain transmissible infections or diseases from contact with other
patients as well as limit their contact with hospital personnel and visitors. The type of isolation is
generally posted on the patient’s door in the form of the color -coded card or sign. The diagnostic of,
or the suspicion of, a transmissible disease is necessary before implementation of either system.

Types of isolation: Category-specific system

Disease specific system

A-Category-specific system
1- Strict isolation (complete isolation): For patient with highly contagious diseases, such as
diphtheria. Strict isolation requires the wearing of gowns, gloves, and mask by all personal
entering the room.
2- Contact Isolation: For patient with highly transmissible disease that are spread by direct
contact. Contact isolation requirements include gloves and gown.
3- Respiratory Isolation: Respiratory isolation is used for patients with infections can be ,spread
via droplets or through the air, such as whooping cough (pertussis ), haemophilus influenza,
meningococcal meningitis. Masks must be worn by those coming in close contact with the
patient.
4- Acid-fast bacillus (AFB) isolation. AFB isolation is used for patients with active
tuberculosis. Masks or particulate respirators, gowns, and gloves are indicated. The room will
generally have a special ventilation system.
5- Drainage secretion: Drainage/secretion isolation is often used for patients with skin
infections, open wounds, or burns. it is sometimes used following surgery. Masks, gowns and
gloves are indicated for procedures where splashing or soiling may occur.
6- Enteric isolation. Enteric isolation is used for patients with intestinal infections that can be
transmitted by ingestion. Enteric infections include those caused by Salmonellas, Shigella,
Campylobacter, or other organisms causing diarrhea or dysentery. Masks and gloves are
indicated for procedures where soiling or splashing may occur.

7
 B-Disease specific Isolation The disease-specific system recommends specific
isolation procedures based on mode of transmission for the most common diseases in the United
States.
Protective or Reverse Isolation: A special kind of isolation called protective or reverse
isolation is used for patients who are highly susceptible to infections. Examples of patients
requiring protective isolation include patients with suppressed immune systems such as transplant
patients, patients with AIDS, some chemotherapy patients, and patients with extensive burns.

Body Substance Isolation

 Because in some cases, transmission of infection can occur before a diagnosis is made, both
the category-specific and the disease-specific systems are subject to error. Body Substance
Isolation is following for every patient without the need for suspicion or diagnosis of a
transmissible disease .Special “stop sign” alert health care worker when additional precaution
are needed.

Universal Precautions
1.) OSHA Standards
2.) Needlestick and Safety Prevention Act
3.) PPE.
Needlestick and Safety Prevention Act
The standard outline necessary engineering and work practice controls that OSHA believes will help
minimize or eliminate exposure to employees. The employer must establish and maintain a sharp
injury log for percutaneous injury from contaminated sharps and it must be done in such a manner to
protect the confidentiality of the injured employee.

The sharps injury log must contain, at a minimum:

A. The type and brand of device involved in the incident.
B. The department or work area where the exposure incident occurred.
C. An explanation of how the incident occurred.
The CDC issued a revised guidelines consisting of two tiers or levels of precautions:
Standard Precautions and Transmission-Based Precautions.

8
Standard Precautions
This is an infection control method designed to prevent direct contact with blood and other body
fluids and tissues by using barrier protection and work control practices. One of the basic principles
of standard precautions is that all blood and all body fluids/ secretions are considered potentially
contaminated and potentially dangerous.
Under the standard precautions, all patients are presumed to be infective for
blood-borne pathogens.
These replace universal precautions and body substance isolation: Standard Precautions are
composed of Universal precautions and body substance isolation.

They are used when there is a possibility of contact with any of the following:
 Blood
 All body fluids, secretions, and excretions (except sweat), regardless of whether or not they
contain visible blood
 Nonintact skin
 Mucous membranes
 Recognized and unrecognized sources of infections.

The standard precautions are:

 Wear gloves when collecting and handling blood, body fluids, or tissue specimen.
 Wear face shields when there is a danger for splashing on mucous membranes.
 Dispose of all needles and sharp objects in puncture-proof containers without recapping.

Transmission- Based Precautions the second tier of precautions and are to be used when
the patient is known or suspected of being infected with contagious disease. They are to be used in
addition to standard precautions. All types of isolation are condensed into three categories:

1-Contact precautions: are designed to reduce the risk of transmission of

microorganisms by direct or indirect contact. Direct-contact transmission involves skin-to-skin
contact and physical transfer of microorganisms to a susceptible host from an infected or colonized
person. Indirect-contact transmission involves contact with a contaminated intermediate object in the
patient's environment. Ex:
 Hepatitis A
 Scabies
 Lice
 Impetigo
The patient must be placed in private room.
The health care worker should wear gloves, protective gown.

2-Airborne precautions: are designed to reduce the risk of airborne transmission of

infectious agents. Microorganisms carried in this manner can be dispersed widely by air currents and
may become inhaled by or deposited on a susceptible host within the same room or over a longer
distance from the source patient. Special air handling and ventilation are required to prevent airborne
transmission. Ex:
 Varicella
 Tuberculosis
3-Droplet precautions: are designed to reduce the risk of droplet transmission of
infectious agents. Droplet transmission involves contact with the conjunctivae or the mucous
membranes of the nose or mouth of a susceptible person with large-particle droplets generated from

9
the source person primarily during coughing, sneezing, or talking. Because droplets generally travel
only short distances, usually three feet or less, and do not remain suspended in the air, special air
handling and ventilation are not required. Health care workers will need to wear mask within 3 feet
of the patients. Ex:
 Meningococcal meningitis
 Influenza
 Mumps
 German measles(rubella)

Medical Asepsis
Best defined as "the destruction of pathogenic microorganisms after they leave the body." It also
involves environmental hygiene measures such as equipment cleaning and disinfection procedures.
Methods of medical asepsis are Standard Precautions and Transmission-Based Precautions.

Disinfection. Process of removing infectious material from selected objects, but not
necessarily their spores this procedure used in medical asepsis using various chemicals that can be
used to destroy many pathogenic microorganisms.
The least expensive and most readily available disinfectant for surfaces such as countertops is a
1:10 solution of household bleach. Boiling water (temperature of 212 F) is considered a form of
disinfection, but use of it in today's medical setting is limited to items that:
1. Will not be used in invasive procedures;
2. Will not be inserted into body orifices nor be used in a sterile procedure.

Surgical Asepsis (sterile technique)

All microbial life, pathogens and nonpathogens, are destroyed before an invasive procedure is
performed. Surgical asepsis and sterile technique are often used interchangeably.
Four methods of sterilization
1. Gas sterilization: often used for wheelchairs and hospital beds. Useful in hospitals, but costly
for the office.
2. Dry heat sterilization: requires higher temperature than steam sterilization but longer
exposure times. Used for instruments that easily corrodes.
3. Chemical sterilization - uses the same chemical used for chemical disinfection, but the
exposure time is longer.
4. Steam sterilization (autoclave) - uses steam under pressure to obtain high temperature of
250-254F with exposure times of 20-40 minutes depending on the item being sterilized.

Contact with Blood or Body Fluids/Secretions - Prevention

For phlebotomy technicians, contact with blood is far more likely than contact with bodily fluids and
secretions.
Needle stick injuries are common. A recent article in the journal Academic Medicine noted that 59%
of surgical residents had suffered a needle stick, and that the annual incidence of needle stick
injuries in the U.S. has been estimated at more than 800,000.
Preventing contact with body fluids/secretions - other than blood - is relatively simple for phlebotomy
technicians. Preventing needle stick injuries is more difficult, but almost all needle stick injuries
suffered by health care workers are caused by poor technique.

In order to prevent needle stick injuries:

10
 Concentrate: If you are distracted when handling needles or sharps, you are more likely
to stick yourself.
 Don't re-cap: Unused sterile needles are covered with a plastic cap The cap is removed
in order to use the needle, but trying to place the cap back on is one of the most common, if not
the most common, causes of needle stick injuries.
 Hazardous waste containers: It already has been mentioned that all
contaminated equipment should be placed in hazardous waste containers. These containers
have a fill line. If the fill line has been reached, seal the container. If you put needles or sharps in
a hazardous waste container that is overflowing, you risk puncturing your skin.
 Risky situations: Small children or patients who are confused can become frightened
and uncooperative during a venipuncture. Sudden movement by the patient could dislodge the
needle and cause a needle stick injury. If you feel that you may not be able to perform a
venipuncture without a needle stick, notify your supervisor or the patient's nurse and get help.
 Patience: Rushing leads to carelessness and carelessness can cause needle sticks. When
you are handling needles and exposed to blood, slow down and take your time.

Needle Sticks and Contact with Body Fluids/Secretions -

What to Do if They Occur
If you come into contact with body fluids/secretions, act immediately. If there is skin contact, wash
the area with soap and water. If you are splashed in the eye, rinse your eye for 15 minutes with
lukewarm tap water and any other suitable solution. If you suspect that you could have inhaled a
body fluid/secretion, immediately leave the area and seek fresh air. The next step is to report the
exposure, and you should report the exposure as soon as possible. Do not wait to report the
exposure any longer than is absolutely necessary to perform first aid.
If you suffer a needle stick injury, act immediately. Wash the area with soap and water, cover the
wound with a sterile dressing, and report the needle stick as soon as possible.
Do not wait to report the needle stick any longer than is absolutely necessary to perform first aid.
There is real risk of disease transmission from needle sticks and exposure to body fluids/secretions.
Many people think that transmission of disease only happens if there is contact with blood or if the
surface of the skin is broken and there is contact with blood or body fluids/secretions. However,
bacteria and viruses can find an entry point through ocular exposures, by inhalation, and through
breaks in the skin (e.g., in and around the nail beds on the hands) that are not obvious.

If you suffer a needle stick or are exposed to a body fluid/secretion - or you

suspect you have - do not try to decide for yourself whether the needle stick or
exposure is or is not serious.
In these situations, there is a risk for the transmission of serious diseases such as hepatitis B,
hepatitis C, and HIV but that risk can be reduced by prompt treatment with medications. If you have
suffered a needle stick or if you have had any exposure to a bodily fluid/secretion, you must
contact a physician or an infectious disease specialist, and you must do this as soon as
possible. Remember the basics of standard precautions: All blood and body fluids/secretions are
considered to be potentially contaminated and dangerous.

11