Infection Control in Phlebotomy

Hand Hygiene — The Single Most Important Infection Control Measure

Proper hand hygiene is the most effective way to prevent the spread of infections in healthcare settings. You must perform hand hygiene before and after every patient contact, before donning gloves, and immediately after removing gloves.

Alcohol-based hand sanitizer is the preferred method when hands are not visibly soiled. Rub hands together covering all surfaces until hands feel dry (around 20 seconds). Soap and water is required when hands are visibly dirty, after using the restroom, and when dealing with Clostridioides difficile (C. diff) or norovirus, as alcohol does not kill spores.

Personal Protective Equipment (PPE)

PPE creates a barrier between healthcare workers and infectious materials. For routine phlebotomy, gloves are always required. Additional PPE depends on the anticipated exposure:

• Gloves: Must be worn for all blood collection procedures. Change gloves between patients and anytime they become contaminated. Never wash or reuse gloves.
• Gown/Lab Coat: Required when clothing might become contaminated with blood or body fluids (e.g., drawing from a patient with active bleeding).
• Face Protection (mask and eye protection or face shield): Required when there is risk of blood or body fluid splashing into your face (e.g., arterial puncture, difficult draws with potential for spurting).

Proper PPE Donning and Doffing Order

The sequence in which you put on and remove PPE is critical to prevent self-contamination:

Site Preparation

• Clean with 70% isopropyl alcohol: Apply in a circular motion from center outward. Allow to air dry completely (30-60 seconds). Never blow on or fan the site to speed drying.
• Do not touch the cleaned site: If you re-palpate after cleaning, you must re-clean. This is a common source of contamination and a frequently tested exam point.
• Blood cultures require extra preparation: Use chlorhexidine gluconate or povidone-iodine (Betadine) in addition to alcohol. Allow iodine to dry for 1-2 minutes for full bactericidal effect. Clean the bottle tops with alcohol as well.

Environmental Cleaning

Maintain a clean work environment to prevent cross-contamination between patients. Wipe down phlebotomy trays, tourniquets, and collection areas between patients using EPA-registered disinfectants. The tourniquet is one of the most frequently contaminated items in phlebotomy — some facilities use disposable tourniquets for isolation patients. Clean up blood spills immediately using an approved germicide, following your facility's exposure control plan.

Hepatitis B Vaccination

Employers must offer the Hepatitis B vaccination series to all employees with occupational exposure, free of charge, within 10 working days of initial assignment. The vaccine is highly effective at preventing HBV infection. You have the right to decline vaccination, but you must sign a declination form.

Exposure Incident Procedure

An exposure incident is a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral (needlestick) contact with blood or other potentially infectious materials. If you experience an exposure incident:

1. 1.Immediately wash the affected area with soap and water (needlestick wound) or flush mucous membranes with water or saline.
2. 2.Report the incident to your supervisor immediately.
3. 3.Complete an incident report documenting the route of exposure, circumstances, and source patient (if known).
4. 4.Seek medical evaluation right away. If HIV post-exposure prophylaxis (PEP) is recommended, it should start as soon as possible and no later than 72 hours after the exposure; every hour counts.
5. 5.Follow-up testing will be arranged per OSHA requirements.

Sharps Safety

Needlestick injuries are the most common route of bloodborne pathogen transmission to healthcare workers. OSHA requires the use of safety-engineered devices (needles with safety features that shield or retract after use) whenever feasible.

Critical sharps safety rules:

• Never recap needles using the two-handed technique
• If recapping is absolutely necessary, use the one-handed scoop technique
• Activate safety features immediately after use
• Dispose of sharps immediately in a puncture-resistant, leak-proof sharps container
• Sharps containers must be easily accessible and located as close as feasible to where sharps are used
• Never overfill sharps containers (fill to the marked line only)

1. Infectious Agent

The pathogen (bacteria, virus, fungus, parasite) that causes disease.

2. Reservoir

Where the pathogen lives and multiplies (humans, animals, environment, contaminated equipment).

3. Portal of Exit

How the pathogen leaves the reservoir (blood, respiratory secretions, urine, feces, open wounds).

4. Mode of Transmission

How the pathogen travels from reservoir to host (direct contact, indirect contact via contaminated objects, droplet, airborne, vector-borne).

5. Portal of Entry

How the pathogen enters a new host (mucous membranes, non-intact skin, respiratory tract, GI tract, parenteral route via needlestick).

6. Susceptible Host

A person who lacks immunity or has compromised defenses (immunocompromised, elderly, very young, chronic illness, unvaccinated).

Scenario-Based Questions

Expect questions that describe a clinical situation and ask you to identify the correct infection control action. For example: "A phlebotomist is about to draw blood from a patient in contact isolation. Which PPE is required?" or "After removing gloves, what should the phlebotomist do next?"

Common Exam Topics

• Order of PPE donning and doffing
• When to perform hand hygiene (before and after gloves)
• Sharps disposal and needlestick prevention
• Difference between Standard and Transmission-Based Precautions
• Which PPE is required for each type of isolation
• Steps to take after a needlestick injury
• Chain of infection and how to break it