Maintaining Safe Practices in Phlebotomy: Risks and Impact on Health Outcomes

This dissertation investigates the role of maintaining safe practices in reducing errors during phlebotomy and its impact on health outcomes. It explores the potential risks for lab technicians and patients, the effectiveness of safe practices, and ways to integrate and maintain safe sharp practices in the procedure.

Dissertation
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Executive Summary
Phlebotomy refers to the technique where a needle is inserted temporarily into a vein in
order to administer venous access for the blood sampling. Through this process, puncture is
made in a vein of arm with cannula with the aim of drawing blood. For the identification of
appropriate site for venous exercise, both tactile and visually evaluations are involved. This
study aims to perform an investigation on role of maintaining safe practices in minimising errors
during the process of phlebotomy along with its adverse impact on health outcomes. The report
explores the potential risks which arise during the process of phlebotomy for patients and lab
technician. These risks involve nerve damage, allergic reactions, back strain, physical injuries,
exposure to body fluids, infection, hemoconcentration, hematoma formation etc. All these are the
potential risks which could arise during the process of venipuncture.
Apart from this, using safe practices during the process will help in minimising risk and
enhancing the clinical outcomes. There are several ways through which safe sharp practices can
be maintained in the procedure of phlebotomy. The practices involve awareness raising,
provision of safety engineer devices, safe use and disposal of needles, elimination of unnecessary
needles, reporting and recording, education and training response and follow up etc. All these are
the appropriate ways through which safe practices can be maintained. In addition to this, it is
necessary for the lab technicians to use well-fitting gloves and take care of hand hygiene during,
after and before performing the process of phlebotomy. This study provides detail knowledge
and information on the topic and will help the scholars in carrying out further study on the
similar topic or the topic associated with it.
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Contents
Dissertation......................................................................................................................................1
Executive Summary.........................................................................................................................2
TITLE: “An Investigation into maintaining safe practices amongst lab technicians during
phlebotomy”.....................................................................................................................................4
1.0 Introduction and Background....................................................................................................4
2.0 Problem and Justification...........................................................................................................5
3.0 Objectives..................................................................................................................................6
4.0 Literature Review.......................................................................................................................7
4.1 Potential risks that could arise during phlebotomy for both lab technicians and patients7
4.2 Effectiveness of safe practices in reducing risks and improving clinical outcomes during
phlebotomy...........................................................................................................................10
4.3 Ways of integrating and maintaining safe sharp practices in phlebotomy procedure....13
5.0 Methodology............................................................................................................................17
6.0 Study Overview.......................................................................................................................23
6.1 Inclusion criteria......................................................................................................................24
6.2 Exclusion criteria.....................................................................................................................24
6.3 Timescales................................................................................................................................24
6.4 Ethical Considerations.............................................................................................................26
6.5 Outcomes.................................................................................................................................26
6.6 Intervention..............................................................................................................................26
6.7 Data Extract.............................................................................................................................27
7.0 Conclusion...............................................................................................................................28
REFERENCES..............................................................................................................................30
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TITLE: “An Investigation into maintaining safe practices amongst lab
technicians during phlebotomy”
1.0 Introduction and Background
Phlebotomy is referred as the process of making a puncture in vein, with the cannula in
order to draw blood. This procedure is known as venipuncture that is also utilised for intravenous
therapy. It has practiced from centuries and is still one of the common invasive procedure within
the health care settings. In the technique of phlebotomy, needle is inserted temporarily into a
vein in order to administer venous access for blood sampling. The veins have 3 layered wall
which is composed of intrinsic endothelium surrounded through thin layer of muscle fibres, that
in turn surrounded through connective tissue layer. Therapeutic phlebotomy is one among the
preferred treatment for blood related disorders where removal of serum iron or red blood cells is
an efficient method for managing the symptoms as well as complications in an effective way. If
the blood sample is collected poorly, then the outcome may be inaccurate as well as mislead to
the clinician and the person who give the sample may have to undergo inconvenience of repeat
testing. Maintaining safe practices among the lab technicians during phlebotomy is very
necessary in order to collect blood sample safely. The lab technicians are expected to maintain
high hygiene level to negate the vulnerability of patient as well as themselves towards potential
diseases and infection.
In modern health care settings, the safety of patient is considered as priority and it is very
necessary to take care of it during the nursing care. Avoiding the injury of patient and
administering them with best possible care is a constant struggle. The results of laboratory test
following phlebotomy constitute main cornerstone in diagnosis as well as treatment of patient.
The errors in phlebotomy might cause delay in diagnosis, sampling erroneous treatment. The
errors jeopardise the health and safety of patients. Lab safety is a critical and significant element
to the success of medical laboratory. The biosafety practices of professionals are influenced by
chemical, biological, electrical, radiological and fire hazards. The common threats to the safety
of laboratory involves improper utilisation of personal protective equipment, improper utilisation
of biological safety cabinets appropriate to work, potential technician exposure and failure in
following protocols for proper chemical hygiene plan.
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Ensuring a safe environment of laboratory is the key responsibility of laboratory personnel
management of healthcare institution. Laboratory safety is not purely voluntary function, but
needs mandatory safety rules as well as programs along with the ongoing commitment. Direct
responsibility for administration of laboratory safety program rests with safety director or
chemical hygiene officer. Laboratory instructors perform direct responsibility for the actions
taken by other people. They are responsible for promoting safety culture and inform them about
requisite knowledge and skills needed for handling the chemical safety. The main duties of lab
technician include receiving, processing as well as analysing the samples. Relying on the work
setting, samples may include tissue and blood, chemical product etc. Apart from this, performing
test; using, cleaning and maintaining different types of equipment; handling compressed gas
cylinders; handling chemicals as well as other materials; and administrative tasks like
documenting procedures, maintaining notebooks and preparing invoices and orders are all the
responsibilities of lab technician.
Research Question:
Research question is stated as a question which is set out in the research project to answer.
Selecting a question of research is crucial element of qualitative and quantitative research as
well. It requires data collection and analysis along with the methodology for this will vary
broadly. A good question of study seeks to enhance the knowledge on significant topic and is
usually specific and narrow. The research question in context of this study is “How safe practices
can be maintained amongst lab technicians during phlebotomy to reduce errors in health
outcomes?”
Hypothesis:
“Negligence of maintaining safe practices during phlebotomy result in laboratory errors and
delay in diagnosing diseases”.
2.0 Problem and Justification
This particular research study is based on the topic “An Investigation into maintaining safe
practices amongst lab technicians during phlebotomy” and it aims to carry out investigation on
role of maintaining safe practices in reducing errors during phlebotomy and its adverse impact on
health outcomes. The main reason of selecting this study is that phlebotomy is the procedure in
which the risk of infection is high for lab technicians. By performing this study, the ways to
maintain safe practices can be determining so that health outcomes will be improved. This study
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is significant as it assists researcher in exploring the potential risks which may arise at the time
of performing phlebotomy process. It also helps in determining the effectiveness of safe practices
in minimising risk and enhancing clinical outcomes during the process. Apart from this, study
analyses the way of integrating and maintaining safe practices in the phlebotomy procedure
which further help the lab technicians in preventing themselves as well as the patient from injury
from sharps and needles and infections associated with blood borne pathogens. This is study
provides deep insights on the topic to investigator and help in enhancing their knowledge. With
the help of this study, researcher get knowledge about other areas also which are associated to
the topic.
3.0 Objectives
Research Aim:
Research aim defines the aspiration or intention of study and summarises in single sentence
what the researcher hope to accomplish in the end of the research study. The aim of the study is
usually written in broad terms and is set out to show what the project hope to achieve in the end.
The aim associated with this particular study is “To carry out investigation on role of
maintaining safe practices in reducing errors during phlebotomy and its adverse impact on health
outcomes”.
Research Objectives:
Research objective is defined as the goal of a research that describes what the researcher
expect to accomplish through the project. They are linked to the hypothesis or utilized as
statement of purpose in the research which does not have hypothesis. The objectives are the
actions that will take to accomplish the aim of the study and provide direction to investigator to
perform the study systematically. The objectives associated with this particular study are as
follows:
1. To explore the potential risks that could arise during phlebotomy for both lab technicians
and patients.
2. To determine the effectiveness of safe practices in reducing risks and improving clinical
outcomes during phlebotomy.
3. To analyse the ways of integrating and maintaining safe sharp practices in phlebotomy
procedure.
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4.0 Literature Review
4.1 Potential risks that could arise during phlebotomy for both lab technicians and patients
As per the view point of Omiepirisa Yvonne Buowari, (2013), phlebotomy is the most
common procedure which is performed within health care settings. Whenever phlebotomy is
performed, early detection and effective communication between healthcare provider and patient
is very important in order to prevent serious complications. It is the act in which the vein is
puncturing for removal of blood or giving a drug. The process has been practiced from centuries
and is still a common invasive procedure. The process must be performed with proper care in
order to protect the patient as well as the health care provider. Before starting the procedure, it is
very necessary to determine the patient accurately (What Are Some of the Dangers of Being a
Phlebotomist? 2020). The key source of specimen for testing the medication and the site for
blood transfusion and intravenous infusion are the veins of patient as there are limited number of
veins which are easily accessible in patient. It is significant that everything will be done to
preserve their good condition as well as availability. there are many potential risks which could
arise during the process of phlebotomy for the patients as well as lab technicians. Some of the
complications are discussed below:
1. Hematoma formation: this is a common type of complication which is caused due to
leaking of blood into tissue at the time of performing phlebotomy or after phlebotomy. A
common symptom of this complication is swelling at or near the site of venepuncture. It
can occur as minor complication of phlebotomy. Adjacent to the site of puncture, the
haematoma forms under the skin and when it occurs, it releases the tourniquet
immediately, withdraw needle as well as apply firm pressure. It occurs when the area
surrounding puncture site initiates to swell, this indicates that blood is leaking into tissue
which will out come in a bruise because of partial insertion into vein. If hematoma starts
to form when blood is being withdrawn, it is necessary for lab technician to remove the
middle immediately as well as pressure maintained over the site. The main causes of
hematoma formation after phlebotomy are excessive probing for finding vein, fragile
veins, removing needle prior to release tourniquet, too large needle, applying pressure to
gauze the needle before it is removed, needle entering partially into the vein allowing
leakage and needle going all way through the vein.
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2. Haemoconcentration: it can occur from prolonged tourniquet application, squeezing,
massaging or probing a site, sclerosis or occluded veins, intravenous fluid therapy for
long term, dehydration and some diseases. It may cause false rise in potassium ion,
ammonia, total protein and phosphorus. The intravenous line complications may
outcomes in morbidity and rising costs of health care from hospitalization for longer
duration, extended utilisation of intravenous antibiotics therapy as well as surgical
intervention.
3. Nerve damage: hematoma formation following phlebotomy can potentially cause
damage to nerve and can be painful. Among the complications related to venepuncture,
nerve damage is relatively rare however, is potentially serious as well as results in
malpractice lawsuits. If a nerve is hit, patient may feel electric tingling which is sharp. In
this condition, it is necessary for the lab technician that to discontinue the venepuncture
immediately and patient may require physical therapy. Excessive probing or
inappropriate sites may lead to damage to nerve. This cause severe pain to the patient
which requires to stop the procedure immediately.
4. Infection: the procedure of phlebotomy may be giving rise to thrombophlebitis or leading
to septicaemia. An infection might be systemic or localised however, the infections
associated with peripheral intravenous cannula are common related to localised then
systemic infection. Poor technique or inadequate cleansing can lead to infection. It can
cause formation of thrombus and phlebitis. The phlebitis is acute inflammation of intima
of veins and caused due to chemical and mechanical irritation or through microscopic
particles which may contaminate the infusion fluids. This is the risks for both
phlebotomist and patients. Exposure to bodily fluids increases the chances of infection
for lab technicians. The needle sticks may expose lab technicians to human
immunodeficiency virus, hepatitis b and c, parasites like malaria, bacteria like syphilis
etc. In some facilities, the lab technicians also handle sample specimen other than blood
like urine, stool and sputum. If these handle carelessly, then it can also carry disease
which infects phlebotomists.
5. Extravasations: it happens when cannula pulls out of vein or it becomes partially
occluded through venous construction which cause back flow of infusate by the site of
puncture into surrounding tissue. If burning, tightness and discomfort occurs around the
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intravenous site, then patient may complain and there may be blanching and swelling of
tissue. In extravagation, instead of the vein, the cannula enters into tissue. Flushing will
be difficult in this case and if swelling may be noted, then the cannula must be removed
by lab technician immediately.
6. Allergic reactions: As per the view point of Sharon Perkins, 2020, phlebotomists have
repeated, frequent exposure to latex which is a kind of rubber material which may cause
severe allergic reactions. In the process of venipuncture, the health care workers need to
wear latex gloves as well as handle other products made up of latex like syringes. This
increases the chances of allergic reactions for them. The symptoms associated with latex
allergic reactions can involve respiratory issues like shortness of breath, wheezing and
rashes to skin. In rare cases, this allergy can cause shock, anaphylaxis, collapse and death
(Complications of venepuncture, 2013).
7. Syncope and fainting: while undergoing the process of venipuncture, patients may feel
dizziness and faint at the sight of blood. This happens due to rapid decline in blood
pressure as well as it is a reaction to an autonomic nervous system which is usually based
on the fear of drawing blood or infusing medications.
8. Physical injuries: it is not necessary in all the cases that the person wants the blood
drawn to be done properly. In some cases, combative adults and children can throw kick
or punches and injure the lab technician. Not only the phlebotomists could sustain
injuries from a patient lashing out with arms or feet, but they are also much more
possibly to get stuck with the contaminated syringe if the patient is not cooperating.
9. Back strain: at the time of drawing blood, most of the lab technicians stand up. Standing
for long time period can cause neck strain or back strain and fatigue, especially if they
have to bend slightly in order to reach to the arm of client. This may increase the issue of
back strain for phlebotomists.
10. Edema: it is the abnormal collection of fluids in intercellular spaces of body of an
individual and it can be diffused or localised. in this condition, the collection of blood
must be avoided from the sites as this will contaminate the specimen sample with tissue
fluid.
Apart from this, as stated in a study by World Health Organisation, (2010), phlebotomy
has potential to expose the patience as well as health care workers to blood from other
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individuals, which put them at risk from blood borne pathogens. The three major issues
outcomes from errors in collection of blood are haemolysis, inaccurate labelling and
contamination. The factors which maximize the risk of haemolysis involves:
1. Mixing tube to vigorously.
2. Utilisation of needle of too large a gauge or too small a gauge for vessel.
3. Drawing blood sample from central line or intravenous line.
4. Reusing tubes which have been refilled through hands with inappropriate
anticoagulant amount.
5. Pressing the plunger of syringe to force blood into a tube, therefore rising the shear
force on red blood cells.
6. Failing to let disinfectant or alcohol dry.
7. Under filling tube so that the anticoagulant ratio to blood is higher than 1:9.
8. Utilising too great vacuum. For instance: utilising too large syringe or too large a tube
for paediatric patient.
The serious adverse events associated with phlebotomy are rare, however may involve
consciousness loss with toxic clonic seizures. Anxiety, fainting and pain at the site of
phlebotomy are included in less severe events (Issues in phlebotomy, 2010). The most
documented events are at the time of transfusion of blood services where the poor
phlebotomy practice or anatomical abnormality has outcome haematoma, injury to
anatomical structures and bruising in vicinity of needle entry. The injuries from sharps occur
between utilisation as well as disposal of needle. Reporting of accidental exposure to body
fluids and blood is frequent from well-developed health care systems, yet it is thought that
events of such exposures is high in systems which are not so well equipped.
4.2 Effectiveness of safe practices in reducing risks and improving clinical outcomes during
phlebotomy
As per the view point of Rami A. Ballout and et. al., (2016), the lab technicians and
healthcare workers all over the world face serious health hazards at workplace of sharp injuries,
known as needle stick injuries. There are around 2 million healthcare exposures to blood borne
pathogens or viruses per year from total 35 million healthcare workers. The phlebotomy
procedure alone responsible for 13% to 62% of injuries reported. The blood involving
procedures have high risk of contamination and transferring of blood borne infections
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comparison to other procedures. Because of their potential of transmission of blood borne
pathogens, needle stick injuries are hazardous, specifically hepatitis C virus, human
immunodeficiency virus and hepatitis B virus. The safety needle devices possess inbuilt safety
controls which declines and potentially prevent needle stick injuries. These enable needle safe IV
insertion, delivery, intra dermal, intra muscular, blood collection and subcutaneous injection.
As per the opinions presented by Heba Abdel Mowla Ahmed and Lobna Mohamed Gamal
Ali, (2016), Phlebotomy has practiced from many years and is one of the common invasive
procedures. Each step of process affect quality of specimen and therefore significant for
preventing the errors in laboratory, patient injury and death. There are high chances of injuries
from sharps and the way to reduce blood exposure and accidental injury is to replace the old
devices with safety engineered devices. Replacing the devices with safety engineered devices is
highly effective way to reduce the chances of occurring accidental injury. These devices
significantly impact on the exposures happening after use. The subsequent introduction of safety
needle devices with concomitant training outcomes in significant decline number of needle stick
and sharp injuries. In order to reduce the risk for patient, the lab technicians who are
undertaking phlebotomy need to be trained in the procedures particular to types of specimen
which they collect. Such procedures may involve blood culture collection, capillary sampling,
arterial sampling and venous blood draws. The lab technicians who collect blood sample from
infants and children will require special training for the procedures associated with phlebotomy.
Providing proper training and education is very effective in reducing the risks of exposure to
body fluids and blood. It is very effective and play significant role in decreasing needle stick and
sharp injuries when the safety engineered devices are not available. Wearing well fitted, non-
sterile gloves during the procedure and carry on hand hygiene are also the effective safe practices
that help in reducing the risk as well as improving the clinical outcomes during the process of
phlebotomy. Best practices in venipuncture protect the lab technicians and patients. The use of
retractable lancets, plastic laboratory tubes, retractable needles and syringe with needle are the
safety devices which help in reducing accidental injury and exposure of blood among lab
technicians.
The practice of discarding the syringe and needle in sharps container and popularity of all
the materials and working in suitable environment us effective for the lab technician in
preventing injuries. Adapting the practical skills to the situation and patient by harmonizing
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parallel aspects of it like physical support, performance and verbal interaction which means
being attentive to the needs of patient helps in preventing errors. Apart from this, developing a
respectful, accepting environment and considering the feeling of patient and their reactions to the
instrumental steps is also an effective practice which help lab technicians during performing the
process of phlebotomy and preventing them from errors. In performing the process of
phlebotomy, prevention of complications is a crucial goal. Proper monitoring and reporting of
adverse events is the general way to eliminate the errors. the correct practice of phlebotomy
reduces the pain and anxiety for patients and provide them with reliable test results. In addition
to this, the practice of labelling of test tubes help in reducing the labelling errors. Test tube must
always be labelled prior to the collection of blood as this assist in reducing the labelling errors
and providing accurate outcomes of test. Apart from this, increasing awareness among the lab
technicians about risks from process of phlebotomy is proved to be effective in ensuring that
understand the reason of strict adherence and adopting the behaviour that includes safe
procedures of utilising as well as disposing sharps. Safer use and disposal of needles are effective
in preventing infections that may occur from blood borne pathogens and viruses. By the
elimination of unnecessary use of sharps to executing changes in the practices and using devices
incorporating safety engineer protection mechanism is an effective approach that leads to safe
practices and help in preventing lab technicians along with the patients to prevent from injuries
and infections.
Applying best practices in the process of phlebotomy helps in protecting the lab
technicians and patients as well. There are some guidelines provided by World Health
Organisation which outlines the responsibility of lab technicians involving provisions of gloves,
single use needles, lancing devices and syringes in sufficient amount to make sure that each
patient has collection device and sterile needle for each blood sampling. it is also effective to
provide sufficient laboratory sample tubes in order to prevent the reuse as well as manual
washing. For best practice in the prevention and control of infection, quality assurance is crucial
part. It is effective in minimising the chances of mishappenings. The main components
associated with quality assurance includes education and training, correct identification of
patient, standard operating procedures, condition of sample, safe transportation and an incident
reporting system. For all the members who perform phlebotomy process, training in education is
very necessary. This needs to include awareness of risks from the exposure of blood,
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understanding of anatomy along with the consequences of poor prevention and control of
infection.
Apart from this, the standard operating procedures are needed for each step of the process
and they must be in written form and readily available for the lab technicians. Along with this,
correct identification of patient is very necessary by matching to the laboratory request form. For
the donation of blood, identify the donor must be accurately match to the screening test result.
And in case of sampling of blood, after the specimen have been taken from patient, an
identification and tracking system is very important to make sure that the sample is matched
correctly with the patient and the result. It is necessary for the lab technicians to ensure that the
condition of sample must be such that the quality of outcomes is satisfactory. In addition to this,
making safe transportation of the blood products is the part of best practices in the process of
phlebotomy. This is effective in improving the quality of outcomes from laboratory testing. For
reporting all the adverse event, an appropriate system is required.
So, within the laboratory settings, binning logbook and register with accurate details of
incident, possible cause as well as their proper management is necessary. This is an effective
way to prevent the adverse incidences and protect the lab technicians and patients from needle
stick and sharp injuries and prevention from blood borne infections. There are many factors that
enhance the safety standard as well as care quality for patient and laboratory workers. The use of
safety devices helps in reducing the exposure to injuries and blood. All the discussed practices
and highly effective in reducing the risks associated with the process of phlebotomy including
risk of haematoma formation, nerve damage, infection, hemoconcentration, extravasations,
allergic reactions, back strain, edema, physical injuries and syncope and fainting. Apart from
this, the safe practices improve the clinical outcomes not only for the lab technicians but for the
patients also during the process of venipuncture.
4.3 Ways of integrating and maintaining safe sharp practices in phlebotomy procedure
As per the view point of Gabriella De Carli, Dominique Abiteboul, Vincenzo Puro, (2014),
The lab technicians are at risk of sharp injuries as well as subsequent infection from over 40
blood borne pathogens. The human immunodeficiency virus, hepatitis b virus and hepatitis c
virus collectively account for majority of cases. The directive 2010 prevention from sharp
injuries in healthcare sector issued in order to protect the care workers from the risk associated
with the process of phlebotomy. This needs an integrated approach for prevention involving
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education, training, awareness rising, safe procedures for use of sharps and disposal, elimination
of unnecessary needles, use of personal protective equipment, banning of recapping, appropriate
surveillance, monitoring, provision of safety engineer devices and response and follow up. These
all are the ways of integrating as well as maintaining safe sharp practices in venipuncture
procedure. Some of these ways are discussed below:
1. Awareness rising: increasing awareness among Health Care workers regarding the risks
that possibly driving from their routine activity is the initial steps to make sure that they
understand the cause for strict adherence along with preventive behaviours that include
safe procedures for utilising and disposing sharps. Apart from this, it is very necessary to
ban recapping of sharps. In the health care settings, laboratory is the area which is in high
risk for biological hazards existing in research and clinical laboratories. Over around
5000 cases of laboratory related infections, acquired by different routes including
inhalation, inoculation, mucous membranes, contamination of skin and ingestion have
been reported in a study over last hundred years with approximately 4% mortality rate.
The initial reports related to occupational infection from hepatitis emerged in 1940s and
this involves laboratory workers, blood bank workers and pathologists. It alerted
researches to risk associated with occupational blood exposures. At the time of
performing the process of phlebotomy, the lab technicians and patients, both are at risk.
So, it is very necessary to increase awareness of these professionals regarding the risk
associated with phlebotomy as it is the best way to prevent lab technicians and patients
from issues associated with blood borne diseases.
2. Safe use of needles and their safe disposal: by considering the distinct steps of needle
manipulation, the 6% phlebotomy related exposures reported while recapping, 5 percent
when disassembling the used device through hand and 22% after utilization, but before
disposal. To sum up, 33% of the exposures could have been prevented through adopting
right behaviour in manipulation as well as disposal of the used devices. It has been found
from the study that the incorrect behaviour among phlebotomists accounting for high
injury rate among lab technicians. So, it is very necessary that the used needles must be
disposed off immediately, following the completion of process. By disposing the sharps
or used devices in container, the risk associated with the process of phlebotomy can be
reduced. Apart from this, eliminating the unnecessary use of sharps through executing
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changes in the practice and using medical devices that incorporating safety engineered
protection mechanism are the ways which help in reducing the exposure of healthcare
workers to blood borne pathogens (The importance of implementing safe sharps practices
in the laboratory setting, 2014).
3. Provision of safety engineered devices: in the process of phlebotomy, the choice of
device is very important for the safety of both patient as well as lab technician. Example:
use of small gauge needles and catheters may outcomes in hemolytic specimen which
may lead to incorrect outcome. Provision of such medical devices which incorporate
safety engineer protection mechanism will significantly influence on the exposure
happening after use. During phlebotomy procedure, use of safety engineer devices lower
down the risk of sharp injuries. It has been found from this study that around 25% of
needle stick and sharps injuries occurred between and end of the venipuncture procedure
and disposal of device, owing to failure of user to activate the safety feature. In addition
to this, one third of the needle stick and sharp injuries took place at the time of activation
of feature of safety, outcomes from incorrect activation of safety mechanism by user
instead of from failure of device. it may be because of inadequate training and
information of lab technicians. If the safety devices introduced within the laboratories,
significant decrease in the injury rates can be observe. Thus, providing safety engineered
devices is an effective way of integrating and maintaining safe sharp practices during the
procedure of phlebotomy.
4. Elimination of unnecessary needles: it is an another effective way of integrating as well
as maintaining safe sharp practices during phlebotomy procedure. The transfer of blood
from syringe into tubes not only depicts an example of unnecessary utilization of needle
in numerous requests through inexperienced doctors, but also detects geographic
differences that can only be explained through distinct culture of organisation.
Developing a good relationship among laboratorians and clinicians what outcomes in
more appropriate request for the test of blood, maximizing their diagnostic power as well
as avoiding unnecessary repetitions. In standardization of preanalytical process, the
relationship of laboratorians with clinicians is one among the factor that must be
considered as it could assist in maintaining safe phlebotomy procedure. Indeed, set of
processes includes in preanalytical phase which are difficult to define as they occur in
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different places as well as in different times. While the systems of quality control
developed to make sure the quality of analytical phase are designed and utilize in most of
the clinical laboratories, it is not the case associated with pre analytical phase. Regarding
the venipuncture, the ISO 15189 standard depicts that particular instructions for
extracting as well as handling samples must be documented and executed through
laboratory management and available readily to sampling supervisors. The elimination of
unnecessary blood test can have significant influence on decreasing the sharp injuries and
preventing lab technicians and patients to any kind of blood borne pathogens.
5. Education and training: it is the another way which is very helpful in reducing the risk
associated with mucocutaneous and percutaneous exposure to body fluids and blood
during the process of phlebotomy. Education and training play a significant role in
declining needle stick and sharp injuries rate as it declines recapping, improper disposal
of used devices and unnecessary needle manipulation. If the proper educational and
training programs will have executed along with safety engineer devices, low rate of
sharp injuries will be seen. Among the laboratory technicians, periodic renewal of
training associated with biosafety is very necessary in order to reinforce the safety
expectations within the laboratory and administering an opportunity to review safety
measures like adoption of devices that incorporate protection mechanism and reminding
about the old measures of safety like wearing gloves and other personal protective
equipment which are appropriate for the process to be performed. Apart from this, access
to training for older workers is necessary to encourage and ensure as this help in
increasing the adherence with infection control precautions - involving consistent
utilisation of personal protective equipment. Thus, providing education and training to
the laboratory technicians on continuous basis is very important and is one among the
way of integrating as well as maintaining safe sharp practices during the procedure of
phlebotomy.
6. Reporting and recording: though adopting all the preventive interventions, accidents still
may happen. A surveillance of exposures at workplace must be activated in every
laboratory setting in order to monitor the injuries and contamination as well as to
determine the requirement for corrective interventions. Developing a no blame culture
within workplace help in encouraging the reporting. The incident reporting procedures
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must emphasize on systemic factors instead of individual mistakes. As per the directives,
the mechanism of reporting must involve national, local and another system. In United
Kingdom, systems involved trusts. These systems can be adopted for the reporting
system. Monitoring is the responsibility of lab technician and facilitating and encouraging
their participation in educational courses as well as administering safety devices and
personal protective equipment will help in complying with the preventive requirements.
This will assist in preventing lab technicians and patients from needle stick and sharp
injuries.
7. Response and follow up: monitoring indicates the requirement and duty of lab owner to
completely record each accident and administer a follow-up of injured lab technician
after exposure, for which immediate steps for care, response procedures for post exposure
management and availability of post exposure prophylaxis should be in place as well as
well-known by lab technician. In exposure case, it is necessary to perform a risk
assessment by other appropriate health professional in order to decide if particular
exposure has happened and if there are forces maximizing the risk of transmission
associated with blood borne viruses infection. The risk assessment considers the
likelihood of HBV, HCV and HIV transmission, however in case the sources infected
with another agent, this need to be taken into consideration in post exposure evaluation as
well as follow up. Blood is the fluid of body that much frequently included in
occupational infection cases, but the other fluids containing agents can also represent a
risk. In comparison to mucous contamination, percutaneous exposures carry high risk
however, conjunctiva is a frequent entry portal for pathogens. In any case, the
psychological influence of exposure can be important, regardless of related risk. The
emotional distress for exposed lab technician and patients’ needs to be addressed in post
exposure management and the further consequences can be prevented with appropriate
support and counselling. Thus, proper response and follow up to exposure is very
necessary in order to prevent the lab technicians and patients as well from the needle
stick and sharp injuries and transmission of blood borne infection.
5.0 Methodology
Research methodology is defined as the basic piece of an examination which contribute
toward giving data with respect to a few procedures and techniques that are utilized to perform
18

examination inside flow research study. This give the technique picked out of accessible one to
accumulate, assess and decipher the data and simultaneously give legitimate explanation with
respect to picking it. The combination of methods chose help a lot in affecting the result of
examination. Other than this it additionally helps the perusers in getting a thought regarding the
dependability and legitimacy of information. Research methodology technique is known as one
of the main piece of each exploration study as this explain the methodology and strategy in
which exploration will be completed. It helps in examination all set targets and backing in get a
dependable result. In a word, it very well may be summed up as the system of accumulate data
which is fundamental to draw results of study. Examination technique mirror all strategies,
techniques and procedures which specialist use to do examination. It is fundamental for
investigator to know about the primary reason behind complete examination as this assistance in
select right tools and approach for the examination and offer more in adequacy of examination.
The different methods which are utilize in relation to this particular study are as follows:
Research philosophy: Research philosophy is a set of belief regarding way in which
information is gathered regarding the particular phenomena and the same information will be
analysed and used. There are 4 main types of research philosophies including positivism,
realism, interpretivism and pragmatist. The positivism research philosophy claims that social
world can be understand in objective way and the scientist in this philosophy is an objective
analyst and dissociate themselves from personal values as well as works independently. On the
other hand, in the interpretivism philosophy, the researcher on the basis of principles states that it
is not easy to understand the social world. It can be interpreted in subjective way. The pragmatist
philosophy deals with facts and claims that choice of philosophy is an ascertain through issue of
research. The realism philosophy is based on the principles of interpretivist and positivist
research philosophy. In this particular study, researcher make use of interpretivism philosophy as
this prefers humanistic qualitative methods and involves investigators to interpret the elements of
study appropriately.
Research approach: This part of research methodology includes major steps, everything
being equal, techniques for information assortment and information investigation. This
straightforwardly relies upon the idea of examination issue which specialist needs to settle.
Further, this help in create questions that needed to be response to reach last inference.
Henceforth, it is essentially relied upon the idea of examination issue which is being involves
19

through many exploration procedures. The function of research approach serves to specialist to
planned and assess generally speaking discoveries based on examination results. As it likewise
expounds the measure through which they can build up their issues and targets to improve the
entire examination. This is the technique of study which permits the correct assessment alongside
arising questions that having information that assembled in the point of view of respondent's
setting and examine what's more, invigorate their information that would change structure
explicit to general based subject. As for present exploration, deductive methodology will be
applied on subjective information for tending to referenced points and destinations, in given time
imperative.
Research choice: The research choice is basically referring to the method which is adopted
for collecting the information about particular area of investigation. This is one of the crucial part
of methodologies over which the success of whole investigation depends and on the bases of
research strategy adopted further methods are adopted by the investigator that are interrelated
with it. The most commonly used strategies within investigation are qualitative, quantitative or
mixed method. Among them all the qualitative strategy will be adopted as it helps in providing
the detail understanding regarding the area of study. This is so because it makes use of
theoretical framework which presents detailed theory and concept about area of study which
further help in developing in depth understanding regarding the phenomenon to be discussed
within study.
Research strategy: It is defined as the overall plan for performing a particular research
study. It guides the researcher in planning, implementing and monitoring the study and offers
high level of guidance. The different strategies of research include case study research,
quantitative survey, action oriented research, qualitative survey, experimental research,
systematic literature review etc. Among all these research strategies, this study makes use of
quantitative survey research strategy in which a survey is performed through using questionnaire.
The main reason of using this strategy is that it has the potential to gather huge amount of
information from the pool of respondents quickly in less time as compared to other method.
Data Collection Methods: Data collection is generally acknowledged as the effective way
through which researcher emphasizes on gathering information on the proposed topic. This is
effectively done by simply making use of two most popular methods such as primary and
secondary methods. For carrying out present research in most effective manner, the respective
20

investigator has made use of both primary as well as secondary method in order to access
maximum information within the available period of time. In secondary method, data is gathered
from sources like books, journals, articles, blog and other webpages using online sources as it
provides the most updated and edited information. The main reason behind using this method is
that it allows investigator in attaining maximum information in limited period of time. Also, it
helps investigator in looking the topic with different point of views which ultimately contributes
in attaining its outcome in the quicker manner. The primary data is gathered through using
questionnaire. By making use of the questionnaire tool, researcher enable to collect fresh data
which assist in improving the accuracy of outcomes of research. Apart from this, collecting
primary data will help in ensuring the reliability and validity study. The main reason behind
performing both the primary and secondary research in this particular study is that with the help
of using both methods, ample amount of information associated with the topic is collected which
help the research in drawing valid and reliable outcomes of research. The questionnaire
associated with this study is provided below:
Questionnaire: It is a research instrument which includes some questions which aims to
collect information from the respondents. It provides a quick, cheap and effective way of
acquiring huge amount of information from large number of people. By using questionnaire,
researcher can be able to collect the data relatively quickly as they would not require to present
when the questionnaire was filled out. Apart from this, this tool is useful for larger population
when it is not possible to conduct interview. It is effective means of measuring attitude,
preferences, behaviour, intentions and opinions of relatively use number of subjects in most
quicker manner in comparison to other method. The questionnaire is provided below:
Questionnaire
Name –
Age –
Profession –
Contact No. –
E- Mail Id –
Q 1. Are you acknowledging with the procedure of phlebotomy?
a) Yes
21

b) No
Q 2. Do you think proper training is required before practicing the phlebotomy?
a) Yes
b) No
Q 3. What are the practices need to take care while conducting phlebotomy?
a) Not harm the patient
b) Label sample properly
c) Take the sample of blood correctly
d) Don’t disturb any nursing care of patient
e) Deliver sample properly to lab
f) Store blood sample correctly
Q 4. What skills are required by phlebotomist for conducting safe practices of phlebotomy?
a) Always be kind and caring with patients
b) Willing to hands on with the patients
c) Follow proper instruction and procedures
d) Willing to work in team but use own initiatives
e) Ability to explain procedure and methodical to patients
Q 5. Is there any risk associated with procedure of phlebotomy?
a) Yes
b) No
Q 6. What are the issues faced by professionals due to negligence of safe practices in
phlebotomy?
a) Allergic reaction
b) Exposure of bodily fluids
c) Physical injuries
d) Back Strain
e) All of the above
Q 7. What are the potential risks of phlebotomy for patients?
a) Dehydration
b) Loss of vein patency
c) Low blood pressure
22

d) Nature of phlebotomist
e) All of the above
Q 8. What are the ways through which clinical outcome during phlebotomy can be
improved?
a) Proper training
b) Implementation of safe practices
c) All of the above
Q 9. What are the safe practices need to take for reducing risks and improving clinical
outcome while conducting phlebotomy process?
a) Train phlebotomist the different ways to take blood
b) Phlebotomist must know how to take blood sample from different patients
c) Lab technicians must ensure healthy and safety consideration
d) Conduct labelling of sample properly
e) All of the above
Q 10. What are the advantages of conducting phlebotomy procedure in effective manner?
a) Help patients in getting proper health information which could save their life
b) Developing effective relation with patient
c) Increasing goodwill and market image
d) All of the above
Q 11. What are the legal compliances established by NHS for developing safe practices in
phlebotomy?
a) Take care of patient protection
b) Ensure safety of health workers
c) Practitioner need to have proper academic degree
d) All of the above
Q 12. Any suggestions for the further modification- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Sampling: Sampling is the procedure in which pre determine number of observations taken
from large population. Sample is defined as group of individuals which are chosen from large
population for measurement. There are two types of sampling includes probability sampling and
23

non-probability sampling. Probability sampling is the method the sample is chosen randomly by
using the theory of probability. In non-probability sampling, the samples are selected based on
the subjective judgement by researcher. In this study, probability sampling method is used in
which random probability sampling is considered to select the sample size. In this method the
observers are selected randomly so that biasness can be avoided from the procedure and more
accurate outcomes can be drawn.
Data analysis: This is the procedure through which the assembled information is assessed to
change over it into important data with connection to investigate point and goals. This guarantees
that the reason behind directing the examination get satisfied with the investigations of
information which present ultimate result of the exercises performed by agent all through
investigation. The current investigation dissects information with the help of topical
investigations which present subject before a conversation to be occurred to give a fundamental
plan to the peruser about what will be talked about straightaway. This further contribute toward
growing better comprehension about the investigation performed.
Research reliability & validity: The reliability and validity of an examination implies that a
specific sources utilized inside the examination must reliably uphold the point talked about for
the qualification of report. The data introduced inside the current report is dependable as it is
gathered from better sources and data can be reused by some another researcher for advocating
their decision of theme. This data remains absolutely solid and not be changed to uphold the
examination objective. Other than this the legitimacy inside examination shows the degree to
which the sources utilized inside an examination are affirmed and utilize how much as often as
possible by the researchers. The data introduced inside report are utilized from confirmed
sources which are approved by a few of the researchers. Thus it tends to be said that information
introduced inside eth report are more dependable and substantial which thus guarantees that
genuine data are introduced and doesn't include any sort of changed information to make
research all the more intriguing.
6.0 Study Overview
This particular study is based on the topic “An Investigation into maintaining safe practices
amongst lab technicians during phlebotomy” and the study aims to perform an investigation on
role of maintaining safe practices in minimising errors during phlebotomy and its adverse impact
on health outcomes. Maintaining safe practices within the laboratory is very crucial as it helps in
24

minimising the errors and improving the accuracy of tests. Safe practices help in preventing not
only the patient, but lab technicians also from any kind of infection and infectious diseases. The
handling of blood, tissues and body fluids must be done carefully as it may contain infectious
agent. There are some health issues for lab technicians including working with electrical
instruments and equipment, lacerations and cut from broken glass, scalds and burns from hot
equipment, corrosive, toxic and flammable chemicals etc. So, using preventive measures is very
necessary for the lab technicians in order to perform a test safely within the laboratory settings.
6.1 Inclusion criteria
Inclusion criteria is referred as the key characteristics of target population which researcher
will utilise to answer the question of research. This research the includes the data of last 10 years
and view point of different authors are included in the study. Apart from this, for searching the
data, different search strategies are used in the study. The key words like phlebotomy,
venipuncture, needle stick, blood borne infection etc. are used. Apart from this, the Boolean
operators like AND, OR are used for the searching of topic. This study makes use of different
research methods which helped in performing it in systematic way and draw valid outcomes of
the study.
6.2 Exclusion criteria
The exclusion criteria are defined as those characteristics or features which disqualified
prospective subjects from inclusion in the research study. This research not includes the data
older than year 2010. The sources which are not authenticated and copyrighted are not used in
the investigation. Apart from this, all the methodologies which are used in the study are chosen
according to the nature of research, the methods are not used in it. Moreover, the topics other
than the research topic are also not included. The sample size limits to the 50 respondents only,
more than this was not involved in the study.
6.3 Timescales
The time scale in the research is important in mapping out a reasonable schedule for the
work so that the progress can be monitor and the project can be managed effectively. It is the
arrangement of events utilised to measure absolute or relative duration of period for a particular
activity. The timescale associated with each activity included in the study is provided below:
25

26

6.4 Ethical Considerations
There are some ethical considerations that required to be considered in the study while
performing it by the researcher. One of the consideration includes taking consent of participants
prior to involve them in the study. The researcher requires to make sure that all the respondents
participate in the study fill the consent form and provide their consent of participation.
Researcher also need to aware the participants about they can take their consent back anytime.
Apart from this, maintaining anonymity and confidentiality of data is also one among the
consideration which needs to consider. It is necessary to make sure that all the information of the
participants will be kept confidential by making use of encrypted application or other ways.
Moreover, it is also required to protect the data from theft and not to share data to the third party.
By following the data protection Act 1998, the data can be kept confidential.
6.5 Outcomes
This study proves to be highly effective in achieving the overall aim of the research, i.e., the
role of maintaining safe practices in minimising errors during the process of phlebotomy and its
adverse influence on health outcomes. Along with this, the study also supports in determining the
effectiveness of safe practices in reducing the errors and risks and improving the outcomes of
health. In addition to this, it effectively analyses the ways which help in maintaining safe
practices within the laboratory settings and lab technicians and patients from infection and
injuries.
6.6 Intervention
As per the above discussion, it can be said that it is very important for lab technicians to
wear well-fitting and non-sterile gloves while carry out the process of phlebotomy. Apart from
this, they need to carry out hand hygiene during, before and after performing the procedure on
each patient and before putting on and after removing gloves. It is very important to ensure that
the blood must be taken in dedicated location that makes sure comfort and privacy of patient.
Apart from this, in order to eliminate the risk of contamination of environment with pathogens,
work surfaces, chair arms and counter must be cleaned with disinfectant. Moreover, to prevent
from the infections along with other adverse events, the lab technicians must follow the
guidelines on the identification of patient, uses of gloves, ensure hand hygiene, use of
appropriate devices for blood sampling, use of skin disinfection and safe transportation of the
27

samples of laboratory. In order to respect the rights of patient, their consent and cooperation are
significant components. In this, the information poster or leaflet which explains the procedures
are useful and helpful.
On the basis of above discussion and findings, it is recommended that the lab technicians
must use safety engineered devices during the process of phlebotomy as these will help in
preventing the risks of infections and needle stick injuries. Another recommendation is that the
factors which impacts the outcomes of laboratory results at the time of collection and
transportation of blood sample must be taken into consideration. These factors include
transportation conditions, knowledge of staff members involved in blood collection, anatomical
insertion site for phlebotomy, patient sample matching, use of recommended collection tubes,
interpretation of outcomes for clinical management etc. Apart from this, it is very necessary to
make sure that the indications for sampling of blood are clearly defined, whether it can be in the
documented instructions or it can be in written protocol. In addition to this, the lab technicians
must perform proper hand hygiene which means that they should wash their hands with soap and
water and make use of sanitizers before and after performing the process of phlebotomy. In order
to withdraw large quantity of blood, syringe and needle is a very common tool. So, lab
technicians must ensure that a sterile single use syringe and needle must be used for each patient
as well as must be placed into sharps container immediately after using it. The safety engineer
equipment provides better protection for the lab technicians, but must be appropriate for a
particular task. Some of the devices are developed to prevent reuse. These devices are not
appropriate for the process of phlebotomy. So, the laboratory technicians must ensure that the
capillary punctures must be performed utilising a sterile device with safety features which
automatically retract the lancet in order to assist prevent both reuse as well as sharp injuries.
6.7 Data Extract
While performing the study, it is planned to extract the data by using different sources. The
data extract in this particular study is as follows:
1. Details of the study including author, publication year, journal, period, publication status
etc.
2. Baseline characteristics of the participants including age, sex etc.
3. Setting and nation of study
4. Inclusion criteria and exclusion criteria
28

5. Number of participants in the study
6. Details and duration of follow up
7. Unit of analysis
8. Primary outcomes and secondary outcomes
9. Design / methodological quality data according to the risk of bias criteria
10. Description of control intervention
11. Unit of randomisation
12. Results and primary statistical analysis
13. Aspects of morbidity of blood recipients, like predictors of susceptibility to bacteraemia
14. Description of intervention
7.0 Conclusion
As per the above discussed report, it has been concluded that phlebotomy is a puncture of
vein or surgical opening to withdraw blood or introduce a fluid. It is a common invasive
procedure within the healthcare setting and has high potential to expose the lab technicians as
well as patients to the blood of other individual which put them into the risk from blood borne
pathogens. this involves hepatitis b virus, hepatitis c virus, human immunodeficiency virus and
other viruses which causes viral haemorrhagic fevers. There are many issues which are
associated with the process of phlebotomy involving haematoma formation, infection, allergic
reactions, syncope and fainting, edema, back strain, physical injuries, extravasations, nerve
damage, hemoconcentration etc. If the blood sample of the patient is collected poorly, then this
leads to inaccurate results and misleading the clinician and also the patient may lead to undergo
the inconvenience of repeating test.
The injuries associated with sharps occur between use and disposal of needle. In order to
minimise the risk of adverse effects for patients, it is very necessary to provide training to the
laboratory technicians about the procedures which are specific to the types of blood sample they
are collected. Apart from this, it is very necessary for the lab technician to wear non-sterile, well-
fitting gloves and perform hand hygiene at the time of performing the procedure of phlebotomy.
It is also necessary for the patient to be correctly prepared before the phlebotomy requisitioned
analysis. There are some ways which help in preventing lab technicians as well as the patients
from the needle stick and sharp injuries and from the infections caused due to blood borne
pathogens. Labelling of tube is one of the best practice and very common within the laboratory
29

settings. It is very necessary to label the test tube prior to the collection of blood as this will
assist in reducing the chances of errors. The phlebotomists have frequent exposure to latex which
may cause severe allergic reaction to them. The symptoms associated with allergic reaction
includes wheezing, rashes on skin and respiratory issues. In addition to this, it may also cause
some physical injuries as sometimes patient may not want willingly to provide the blood sample
and resulted to this they can throw kicks or punches. So, this creates a risk of injury for lab
technicians.
Some safe practices like using gloves, labelling the test tube, using safety engineered
devices etc. are the ways which help in reducing the injury risks for patients and lab technicians
and also improve clinical outcomes at the time of performing phlebotomy. In addition to this,
there are ways to integrate and maintain safe sharp practices in the procedure of phlebotomy.
These ways include increasing the awareness among the lab technicians about the risks which is
associated with their daily routine activity along with the initial steps which day need to take in
order to ensure that they are not exposed to any kind of risk. Moreover, safe use of needles and
their disposal is also very necessary in order to minimise the chances of errors of transmission of
infection. If the needles and other surgical equipment are use and dispose properly then it then
the risks of infections and blood borne diseases are reduced for phlebotomists and patients.
30

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