Which of the following is the first step a phlebotomist should take to prevent the spread of infection?
Wearing gloves for any patient contact
Washing hands with antimicrobial soap and water
Applying antiseptic to the puncture sites prior to venipuncture
Decontaminating the equipment before use
The Correct Answer is B
Choice A reason:
Wearing gloves is an important step in preventing the spread of infection, but it is not the first step. Gloves provide a barrier between the phlebotomist's hands and the patient, which can help prevent the transmission of pathogens. However, gloves can still become contaminated, and if hand hygiene is not performed before donning gloves, pathogens can be transmitted when gloves are changed or removed.
Choice B reason:
Hand hygiene is widely recognized as the single most important practice in preventing the spread of infections. It is the first line of defense against the transmission of infectious agents. Washing hands with antimicrobial soap and water mechanically removes pathogens, and the antimicrobial agents in the soap can kill or inhibit the growth of microorganisms. This step is crucial before any patient contact, especially before invasive procedures like venipuncture.
Choice C reason:
Applying antiseptic to the puncture sites prior to venipuncture is a critical step in the prevention of infection at the site of the blood draw. This practice is essential for eliminating skin flora that could potentially enter the bloodstream during venipuncture. However, this is not the first step, as effective hand hygiene should precede any patient contact or procedure.
Choice D reason:
Decontaminating equipment before use is a necessary step to ensure that no infectious agents are transmitted via medical instruments. This includes cleaning and sterilizing equipment that comes into direct contact with the patient. While this is a vital part of infection control, it follows hand hygiene in the sequence of steps a phlebotomist should take.
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Correct Answer is D
Explanation
Choice A reason:
While maintaining compliance with Clinical Laboratory Improvement Amendments (CLIA) standards is important, it is not the primary reason for explaining the venipuncture procedure to the patient. CLIA standards primarily deal with laboratory testing and do not specifically require the explanation of procedures to patients.
Choice B reason:
Evaluating the patient's understanding is a beneficial practice as it ensures that the patient is informed and can participate in their own care. However, it is not the primary legal or ethical requirement for explaining the procedure.
Choice C reason:
Maintaining compliance with Occupational Safety and Health Administration (OSHA) standards is crucial for ensuring the safety of both the healthcare provider and the patient. OSHA standards require that certain safety protocols be followed, but they do not specifically mandate that the procedure be explained to the patient for the purpose of obtaining consent.
Choice D reason:
Obtaining the patient's consent is the primary reason a phlebotomist should explain the procedure prior to venipuncture. Informed consent is a fundamental ethical and legal principle in healthcare. It involves informing the patient about the procedure, its risks, benefits, and alternatives, and ensuring that the patient understands this information before agreeing to proceed. This process respects the patient's autonomy and right to make decisions about their own healthcare.
Correct Answer is C
Explanation
Choice A reason:
An alcohol-based hand rub is generally used for hand hygiene when the hands are not visibly soiled. It is effective against many types of microbes but is not the best option for hands that are visibly dirty or contaminated with proteinaceous materials, such as blood or body fluids. The CDC recommends washing hands with soap and water in these situations.
Choice B reason:
Sterile water rinse alone is not sufficient for cleaning hands that are visibly soiled. While sterile water can be used to rinse off debris, it does not have the cleaning or antimicrobial properties necessary to properly decontaminate the hands.
Choice C reason:
Soap and water are the recommended decontamination agents when hands are visibly soiled with blood or body fluids. The physical action of handwashing, combined with the detergent properties of soap, effectively removes soil and transient microorganisms. The CDC guidelines specifically state that hands should be washed with soap and water when they are visibly dirty or contaminated with proteinaceous materia.
Choice D reason:
An alcohol rinse, similar to an alcohol-based hand rub, is not adequate for cleaning visibly soiled hands. Alcohol is a disinfectant that is effective against many germs when used on clean hands but does not remove visible dirt or organic material well.
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