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Uploaded by fernando.almaguer
Dr. Almaguer
Phlebotomy Course: Government Agencies
Joint Commission, Centers for Disease Control and Prevention (CDC), Clinical and Laboratory Standards
Institute (CLSI) and Health Insurance Portability and Accountability Act (HIPAA)
The importance of providing operational standards for the clinical laboratory and phlebotomy practice has ensured
that laboratory practices are carried out in a responsible and accountable manner for the general public. There are
different agencies that certify and provide development standards to assist the delivery laboratory practices with an
integral part of the health system. The Joint Commission
The Joint Commission is a non-profit and nongovernmental institution that develops standards for improving
quality and patient safety in the health care, including laboratory practices
. As described on its website, “we
help organizations across the continuum of care lead the way to zero harm” (The Joint Commission, 2019). This
independent agency certifies and accredits hospitals and develops programs to assist facilities maintain good
operational standards. According to The Joint Commission (2020), the 2020 National Patient Safety Goals (NPSG’s)
Safety Goals for Laboratory Services Effective January 1, 2020 states that the purpose of NPSG’s is to improve
patient safety. The goal focuses on problems in health care safety and how to solve them. For example, there are three goals: 1. Identify patients correctly: use at least two ways to identify patients. For
example, use the patient’s name and date of birth
. This is done to ensure that each patient receives the correct
medication and treatment. 2. Improve staff communication: delivery important test results on time to the right staff
person. 3. Prevent infection: use the hand cleaning guidelines of the Center for Disease Control and Prevention or
the World Health Organization.
Centers for Disease Control and Prevention (CDC)
The CDC is a United States agency that protects citizens by increasing health security against threats to health and
safety. According to CDC (2019), they conduct critical science and provide health information that protects the
nation against health threats and responds when they arise. That is, CDC identifies any threat or diseases and
work harder to find a solution to solve it
. In the laboratory area, the CDC develops guidelines and provides
recommendations for standard precautions to avoid any exposure to body fluids. Some of the guidelines and recommendations from the CDC can be seen in the following writing:
Anticipate injury risks and prepare the patient and work area with prevention in mind. Use a sharps device
with safety features whenever it is available.(obtained directly form the CDC website: Sharps Safety for
Healthcare Settings https://www.cdc.gov/sharpssafety/tools.html
)
The use of gloves when in contact with any body fluid.
Wash hands with soap and water before and after phlebotomy or contact with the patient.
Wear appropriate personal protective equipment (PPE)
Act immediately after a needle stick, such as first washing the area with soap and water, notify
supervisor immediately, seek medical assistance and follow medical advice promptly. Clinical and Laboratory Standards Institute (CLSI)
CLSI also assists prevent any injuries during phlebotomy practice. This agency provides guidelines and work in
collaboration with the health industry and professionals to provide the most up-to-date information in the
health framework.
One of the most common guidelines in the laboratory area is the use of “order of draw”
in
which it is recommend to first collect blood cultures tubes or vials. Moreover, it mandates that needles or lancets be
Dr. Almaguer
Phlebotomy Course: Government Agencies
used once. Therefore, CLSI develops global standards through a Consensus Process that can be adopted by the
health industry, clinicians, or regulatory agencies (CLSI, 2019). Health Insurance Portability and Accountability Act (HIPAA)
HIPAA was passed by Congress in 1996 as a need to provide patients with the right to privacy on their personal
information. The patient has the right of protected health information (PHI) and should not be disclosed to
unauthorized third parties in the electronic, verbal or written sense. It is a federal law that must be complied with at
all levels of the health hierarchy. According to Department of Health Care Services (DHCS) (2019): HIPAA does the following:
Provides the ability to transfer and continue health insurance coverage for millions of American workers and their families when they change or lose their jobs;
Reduces health care fraud and abuse;
Mandates industry-wide standards for health care information on electronic billing and other processes; and
Requires the protection and confidential handling of protected health information
2
Infection Control Infection control is a gigantic topic in any medical profession. Professional exams in the medial area cover an
important section to assess professional health knowledge about infection control. There are multiple reasons to
enumerate the importance of infection control, but the most common are to reduce mortality of inpatient clients and
the aim to reduced nosocomial infection costs. Therefore, infection control
is the practice to prevent nosocomial
infection or healthcare associated infection (HAI) that can be easily transmission form health care personnel to
clients in the medical seating. One of the easy ways to prevent infection spread is to perform an adequately hand
washing technique. Infection results when a microorganism is able to multiply (reproduce) in the body and attack the human
body by causing a disease or injury.
As defined by the World Health Organization, “infectious diseases are
caused by pathogenic microorganism, such as bacteria, viruses, parasites or fungi; the diseases can be spread,
directly or indirectly, for one person to another”. Moreover, infections can be fatal for immunocompromised or
vulnerable population, such as people infected with human immunodeficiency virus (HIV), hepatitis C virus (HCV),
during pregnancy, neonates, geriatric population, people who receive chemotherapy or some suppressive
medications that cause the immune system to become weak. That is why, health professionals are obliged to protect
clients for any pathogenic environment. Pathogens
are easily transmitted from one patient to another if the
phlebotomist does not wash his hands between patients.
Dr. Almaguer
Phlebotomy Course: Government Agencies
Box 1: CDC-healthcare acquired infection list that may be acquired in health facilities.
Hepatitis A, B, C viruses
Hepatitis A virus (HAV) is spread by the fecal-oral route (fecally incontinent or diarrhea). Hepatitis B virus (HBV) can be transmitted by blood or other body fluid. Hepatitis C virus can be transmitted primarily through contaminated needle, syringes, or other sharp instruments. Clostridium difficile (C. diff)
C. Diff is a germ that causes life-threatening diarrhea. It is usually a side-effect of taking antibiotics. In 2017, there were an estimated 223,900 cases in hospitalized patients and 12, 800 death in the United States. Carbapenem-resistant Enterobacteriaceae (CRE)
Includes bacteria that cause infections such as Escheria coli (E.coli) and Klebsiella pneumonia.
ESBL-producing Enterobacteriaceae (*extended-spectrum beta-lactamases)
This resistance means that there are fewer antibiotic options available to treat ESBL-producing Enterobacteriaceae infections. Includes bacteria that cause infections such as Eschericia coli (E.coli) and Klebsiella. In 2017, there were an estimated 197, 400 cases among hospitalized patient and 9,100 estimated deaths in the United States. MRSA (Methicillin-Resistant Staphylococcus aureus)
Most MRSA infections are skin infections that often appear as a bump, a boil, or area that is red, tender, and swollen, and is sometimes confused with a spider bite. VRSA (Vancomycin Resistant Staphylococcus aureus) and VISA (Vancomycin Intermediate Staphylococcus aureus)
Persons who develop this type of staph infection may have underlying health conditions (such as diabetes and kidney disease), tubes going into their bodies (such as catheters), previous infections with methicillin-resistant Staphylococcus aureus (MRSA),
and recent exposure to vancomycin and other antimicrobial agents.
Vancomycin-resistant Enterococci (VRE) in Healthcare Settings
Enterococci are bacteria (germs) that are normally present in the human intestines and in the female genital tract, and are often found in the environment, like in soil and water. These bacteria can cause infections. In 2017, VRE caused an estimated 54,500 infections among hospitalized patients and 5,400 estimated deaths in the United States Mycobacterium tuberculosis (TB)
Tuberculosis is a recognized risk to patients and healthcare personnel in healthcare settings. Transmission is most likely to occur from patients who have unrecognized pulmonary or larynx-related TB, are not on effective anti-TB therapy, and have not been placed in TB isolation. Transmission of M. tuberculosis
in healthcare settings has been associated with close contact with persons who have infectious TB, particularly during the performance of cough-
inducing procedures such as bronchoscopy and sputum induction. TB can spread through the air and can travel long distances
Others: Acinetobacter, Influenza, HIV/AIDS, Ebola, Mumps, Norovirus, Pneumonia, Healthcare-associated infections (HAI) are a threat to patient safety. CDC provides national leadership in surveillance, outbreak investigations, laboratory research, and prevention of healthcare-associated infections. CDC uses knowledge gained through these activities to detect infections and develop new strategies to prevent healthcare-associated infections. Public health action by CDC and other healthcare partners has led to improvements in clinical practice, medical procedures, and the ongoing development of evidence-based infection control guidance and prevention successes.
Source: Centers for Diseases Control and Prevention (CDC): Healthcare-associated Infections. Accessed on
December 27, 2019 from https://www.cdc.gov/hai/prevent/prevention.html
Written information adapted to and
word-excel box.
Therefore, the concept of communicable disease
adheres to the fact that it is a disease that can be easily transmitted
form one person to another, such as the influenza during winter season. For this, the health professional should be
aware and standard precautions should be taken when assessing to any client in the medical practice. Consequently, the importance of preventing the spread of infection consists to follow standard precaution protocols
and use the adequate personal protective equipment (PPE) to protect the health team and clients. Infection control
programs are one of the most important aspects in the phlebotomy training programs. Hospitals are spending a
tremendous amount of time educating and reinforcing training on how to prevent the nosocomial infection; thus, the
best weapon against it is to educate or re-educate the personnel since they have daily contact to their clients.
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