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BIO 316 Module 3 Discussion Question One
BIO 316 Module 3 Discussion Question One
In an emergency situation, what do you think are your responsibilities and limitations? Compare these to the responsibilities of the other responder.
These guidelines were produced to improve the quality of blood specimens and the safety of
phlebotomy for health workers and patients, by promoting best practices in phlebotomy.
In April 2008, the WHO Injection Safety programme – part of the Department of Essential
Health Technologies (EHT) at WHO Headquarters in Geneva – convened a consultation on best
practices for phlebotomy and blood collection. The consultation included special categories, such
as arterial blood sampling, capillary blood sampling and paediatric blood collection. A working
group of international experts and colleagues from WHO departments identified the need for
phlebotomy guidelines, and this document was produced in response.
This document provides guidance on the steps recommended for safe phlebotomy, and reiterates
the accepted principles for drawing and collecting blood. The guidelines are based on a literature
review that focused on identifying systematic literature reviews and evidence relating specifically
to phlebotomy practices in developing countries. Draft guidelines and evidence were reviewed by
an expert panel, who reached consensus on the recommendations.
xiv WHO guidelines on drawing blood: best practices in phlebotomy.
To reduce the risk of adverse effects for patients, health workers undertaking phlebotomy need
to be trained in procedures specific to the types of specimen they collect. Such procedures may
include arterial sampling, capillary sampling, blood culture collection and venous blood draws.
Health workers who collect specimens from children and infants will need special training and
practice for these procedures. Phlebotomists working in settings with more technology may be
trained in techniques for plasma and red cell exchange, photophoresis, stem cell collection and
cord blood collection. Health workers may need to collect specimens from in-dwelling central
lines or arterial lines. Training should include techniques that ensure that the specimen collected
will be adequate, and measures that reduce the risk of contamination, clerical error, infection
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When taking blood, health workers should wear well-fitting, non-sterile gloves, and should also
carry out hand hygiene before and after each patient procedure, before putting on gloves and
after removing them. The blood should be taken in a dedicated location that ensures patient
comfort and privacy. To remove the risk of environmental contamination with pathogens,
counter and work surfaces, and chair arms should be cleaned with disinfectant at the start
of each shift and when visibly dirty. To prevent infections and other adverse events, health
workers should follow the guidelines on patient identification, hand hygiene, use of gloves, skin
disinfection, use of appropriate blood-sampling devices and safe transportation of laboratory
Patient consent and cooperation are important components of respecting patient rights. A
patient information leaflet or poster that explains the procedure in simple terms is helpful.
Protecting health workers
Best practices in phlebotomy protect health workers as well as patients. One way to reduce
accidental injury and blood exposure among health workers is to use safety (i.e. engineered)
devices such as retractable lancets, syringes with needle covers or retractable needles and, when
appropriate, plastic laboratory tubes. Another approach is to eliminate two-handed needle
recapping and manual device disassembly, and instead dispose of the sharps into a punctureresistant sharps container (i.e. a safety container) immediately after use. The best practice is
to discard the needle and syringe, or needle and tube holder, as a single unit, into a sharps
container that is clearly visible and within arm’s reach. The size of the container should permit
disposal of the entire device rather than just the needle.
Institutions should conduct surveillance on sharps injuries and accidental exposure to blood, so
that preventable factors can be identified. Support services should also be available for health
workers accidentally exposed to blood.
These should include immunization with hepatitis B
before assuming duties that include potential exposure to blood and body fluids, and post-exposure prophylaxis for HIV and hepatitis B. All health-care facilities should display clear
instructions for procedures to follow in case of accidental exposure to blood and body fluids.
These guidelines also outline the responsibilities of managerial staff, including provision of:
• gloves in multiple sizes, single-use disposable needles, and syringes or lancing devices in
sufficient numbers to ensure that each patient has a sterile needle and collection device or
equivalent for each blood sampling;
• sufficient laboratory sample tubes to prevent reuse and manual washing
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