Q What is the policy regarding wearing gloves during phlebotomy? I have a co-worker who often does not wear gloves despite the supervisor’s instructions to always wear gloves when drawing blood. Are gloves mandatory?
A On Dec. 6, 1990, the Occupational Safety and Health Administration (OSHA) published the Bloodborne Pathogen Standard that revolutionized the way we do business in the clinical laboratory. Some things were very straightforward, however, the use of gloves — when and by whom — still remains controversial. OSHA specifically states in the compliance document 2-2.69, which is used by its inspectors to determine if a violation exists, that “the exemption regarding the use of gloves during phlebotomy procedures in paragraph (d)(3)(ix)(D) only applies to employees of volunteer-donor blood-collection centers, and does not apply to phlebotomy conducted in other settings such as plasmapheresis centers or hospitals. Everyone dealing with blood and body fluids — including phlebotomists — must wear gloves at all times.” OSHA also requires that gloves must be provided by the employer in appropriate sizes, and no part of the glove must be removed (e.g., to palpate the vein) during the phlebotomy procedure.
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—Terry Jo Gile, MA Ed, MT(ASCP) The Safety Lady North Fort Myers, FL
A OSHA clearly mandates glove use for all venous-access procedures, including fingersticks and venipunctures. Employees caught not using them subject the facility to fines and citations. Therefore, your supervisor is protecting not only your co-worker from an exposure but also protecting the facility from the consequences of an OSHA violation.
Those who choose to violate the Bloodborne Pathogens Standard are at risk of acquiring any of the 20 diseases known to be transmitted by blood exposure. Therefore, your supervisor is trying to protect the tech from herself. Not only that, but the tech is risking passing along nosocomial infections to other patients. If the tech chooses to violate facility policy on this, she is asking for dismissal. Most hospitals are very strict about this.
Everyone on staff should be familiar with OSHA’s Bloodborne Pathogens Standard. Ask your co-worker to review the passage in Section 1910.1030(d)(3)(ix) at http://tiny.cc/wear_gloves.
—Dennis J. Ernst, MT(ASCP) DirectorCenter for Phlebotomy Education Corydon, IL
A OSHA requires all healthcare workers to wear gloves during phlebotomy. This is not an option! The intent is to wear two gloves, not just one, and to leave them intact. Popping off the fingertip to better feel the vein is not allowed. The regulations are as follows:
1910.1030(d)(3)(ix): Gloves shall be worn when it can be reasonably anticipated that the employee may have hand contact with blood, other potentially infectious materials, mucous membranes, and non-intact skin; when performing vascular access procedures except as specified in paragraph (d)(3)(ix)(D); and when handling or touching contaminated items or surfaces.
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1910.1030(d)(3)(ix)(A): Disposable (single-use) gloves, such as surgical or examination gloves, shall be replaced as soon as practical when contaminated or as soon as feasible if they are torn, punctured, or when their ability to function as a barrier is compromised.
There is one exception in OSHA’s Bloodborne Pathogen Standard [1910.1030(d)(3)(ix)(D)]:
If an employer in a volunteer blood-donation center judges that routine gloving for all phlebotomies is not necessary then the employer shall:
- periodically re-evaluate this policy;
- make gloves available to all employees who wish to use them for phlebotomy; and
- not discourage the use of gloves for phlebotomy.
The employer in this case shall require that gloves be used for phlebotomy in the following circumstances:
- when the employee has cuts, scratches, or other breaks in his skin;
- when the employee judges that hand contamination with blood may occur, for example, when performing phlebotomy on an uncooperative source individual; and
- when the employee is receiving training in phlebotomy.
—Ann Bachman, BS MT(ASCP), CLC(AMT) Tennessee Medical Laboratory Supervisor Partner and Compliance Department Director DoctorsManagement Knoxille, TN
Wearing gloves and defacing the product by tearing off the fingertip does not qualify as “wearing” personal protection.
A All laboratory accrediting agencies, such as College of American Pathologists and The Joint Commission, mandate wearing of gloves when performing venipunctures on patients. It is also likely that all state health departments require this as well (PA does).
So, there is absolutely no option here: gloves must be worn. This tech is putting himself at risk, and he is putting patients and the hospital at risk, as well. Wearing gloves during phlebotomy is for the protection of the healthcare worker from contamination from patients.
If you are friends with this tech, try to influence his behavior. Let him know that you worry about the potential for exposure when he fails to wear gloves. Explain that wearing gloves is not merely the supervisor’s rule but an accreditation regulation, so your facility can be cited for being in violation of The Joint Commission regulations, which puts everyone’s jobs at risk, not just his.
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If this tech refuses to become compliant with the glove-wearing policy, your supervisor should initiate disciplinary procedures.
Finding qualified techs can be difficult in many areas of the country, but everyone can be replaced. And no matter how bad things might be without this tech, it is worse to let him continue being non-compliant.
—Marti Bailey, MT(ASCP), CPC Work Unit Leader, Pathology Penn State Milton S. Hershey Medical Center Hershey, PA
Bottom line:
The Federal rules of the Bloodborne Pathogens Standard requires that gloves be worn at all times during a venipuncture or capillary stick procedure. Wearing gloves and defacing the product by tearing off the fingertip does not qualify as “wearing”personal protection.
The individual not wearing gloves during a procedure that requires gloves should immediately be counseled and have disciplinary actions taken against him — up to and including termination, depending on your facility’s policy. If your facility does not have such a policy, it should make one.
MLO’s “Management Q & A” provides practical, up-to-date solutions to readers’ management issues from a panel of laboratory management experts. Readers may send questions to Anne Pontius at [email protected]. Unless otherwise noted as “confi dential” by readers, all queries will be considered for publication without further notice to them. Names, institution, city, and state will be removed before publication.
Anne Pontius is a senior medical practice consultant with State Volunteer Mutual Insurance Co. in Brentwood, TN, and president of CLMA. Send questions to Ms. Pontius at [email protected].
Published: May, 2010
Source: https://t-tees.com
Category: WHEN
