Scenario # 1: The Medical Assistant is preparing to perform a venipuncture on a patient who has come into the office for their annual physical exam. To prevent exposure to blood you must wear personal protective equipment (PPE). When a medical assistant is performing or assisting with a venipuncture, the expected PPE to be used is gloves.
According to Delmar’s Clinical Medical Assisting, “Gloves will be worn when drawing blood and/or handling biomedical specimens.” Blood drawing is common sense, but biomedical specimens consist of urinalysis as well as fecal analysis. That means throughout the venipuncture and collection process you must wear gloves to protect yourself from any blood borne pathogen or contamination.
Gloves should be worn from the point prior to venipuncture until the blood tube is placed in the biohazard transport container. You want to wash your hands before and after every procedure and make sure that nothing is going to put you at risk for the barrier (the gloves) being broken, and if you think there is a risk to this, you want to double your gloves (long nails, wedding rings and things of that nature can put you at risk)
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PPE is to be utilized at all times in situations that involve potential exposure to blood or other body fluids. Your skin can have microscopic cuts and abrasions that can provide an avenue for transmission if exposed to blood or other infectious body fluid which is why it is of such an importance to wear gloves when coming in contact with any blood borne pathogen or bodily fluid such as saliva and semen.
Gloves are typically effective for protection from splashes but do not protect from penetrating injuries caused by needles or other sharp objects. If any such injury is to occur, you are to report it to your supervisor immediately so prompt action is taken to prevent further consequences such as a patient contracting HIV/AIDS or even worst, yourself.
Scenario # 2: Patient Sonny Jones is here for symptoms that include fever, sweating, lots of nasal congestion, and a cough that is productive in nature. This patient has been in contact with family members who just tested positive for the flu.
During a flu outbreak, governmental agencies such as the Center for Disease Controls, Health and Human Services and the Occupational Safety Health Administration may recommend that you protect yourself from infection by using a face mask, N95 respirator, or other type of equipment.
For this sort of outbreak, according to Delmar’s Clinical Medical Assisting and the Florida Department of Health and Human Services, employees who work in the medical field and are in constant contact with patients and those who handle the clinical aspect of medical assisting and healthcare as well as collect or transport clinical specimens should consistently adhere to recommended infection control precautions to minimize their exposure.
The Center for Disease Controls states that potentially infectious specimens should be placed in leak-proof specimen bags for transport, labeled or color coded for transport and handled by personnel who are familiar with safe handling practices, have been trained in the area of infection control as well as spill cleanup procedures. They also state that workers who collect specimens from pandemic-influenza infected patients should wear PPE as described for employees in the manual that is located on-site at the work environment while performing direct patient care.
PPE in this scenario would consist of gloves made of latex(if the patient has no latex allergy), vinyl, nitrile, or other synthetic materials as appropriate, when there is contact with blood and other bodily fluids, including respiratory secretions.
Common sense would be to wash your hands before and after seeing every patient, do not double glove unless your needed to for a specific reason, do not re-use the gloves previously used, properly dispose and discard the gloves after usage, and proper usage of hand hygiene should also be adhered to as well to prevent chance of infection.
Gowns may also be needed with the chance of heavily soiled clothing due to performing an intubation or where constant secretions might occur, but it is not required by OSHA or the CDC.
Goggles or Face Shields are not needed in this case, however, if sprays or splatters of infectious material are likely, it states that goggles or a face shield should be worn as recommended for standard precautions. If you are around a patient who is consistently coughing or hacking, you would want to ensure the patient has a face shield to prevent the spread of infection, and you would also want to protect yourself from getting that as well.
Scenario # 3: The Medical Assistant is assisting Dr. Jacobs with a cyst removal (a surgical procedure) in the office setting.
For removal of a cyst on a patient, the medical assistant would assist the doctor with whatever he needed. The book did not really go too much into detail so I decided to watch a few YouTube videos of the incision, draining and removal of a cyst to see what actually occurs during this. After watching these few videos on YouTube, because you’re dealing with bodily fluids like blood and pus, you would want to wear Gloves.
First you would want to wash your hands before placing the gloves on. Of course because this is surgery you would want to ensure your sterile field is maintained. To maintain a sterile field, you would want to open your sterile dressing kit and set it up on a tray. You want to make sure the tray is above waist height because anything below the waist is considered to be contaminated or not sterile. You would then want to open the sterile kit making sure you do not touch anything inside as you do not have your gloves on yet, and everything is sterile.
You would then want to put on your first set of PPE for the removal of the cyst, which would be your mask. You would want to wear a mask because this is a sterile procedure, and your mouth has germs. This way you’re not breathing on or around, talking, coughing or sneezing around the sterile field. You would then hand the doctor his or her mask, and any other assistants theirs.
The next thing you would want to do is put on your sterile gloves. Because this is a surgery procedure, putting on sterile gloves is important because you do not want to cause the patient to be at risk of any sort of infectious diseases. Our skin carries and comes in contact with several billion bacteria during each hour of the day, and you would not want to be the cause of a patient catching MRSA or VRE or a super bug because they got sick and then developed a resistance and could not be treated, so it is important you follow each step about putting on sterile gloves. How you would do this is by opening the glove wrapper with the palm facing up.
You then would want to pick up the first glove by the cuff making sure you are only touching the inside portion of the cuff. While you’re holding the cuff with one of your hands, you want to slide your other hand into the glove this way your sterile hand is the first to go into the sterile gloves. While you are doing this you want to be careful that you are not touching anything, as everything else is again considered to be contaminated. The second glove is the hardest part of placing sterile gloves but the most important step to maintain sterility in the sterile field and environment. You want to slide your gloved hand under the cuff of the second glove and slide your hand inside the glove until you’re able to adjust both gloves to fit comfortably.
The next step would be to proceed to assist the doctor with the removal of the cyst by applying sterile dressings from the sterile field, as well as making sure he does not need your help with anything. Before the doctor enters the room you would want to make sure the tray for the removal of the cyst is ready in the sterile field, this way the doctor does not need to leave the room for any reason at all and the sterile field is maintained until the removal of the cyst is completed.
The doctor might also ask the medical assistant to assist by giving an injection to numb the area of the cyst removal on the patient. The medical assistant would be responsible for explaining the procedure, and then giving the injection at the site of the cyst removal. Because you might come into close contact with bloods, pus and other bodily fluids, I would recommend wearing a gown. Gowns are worn to protect against bodily fluids from soiling clothing, and depending on the location of the cyst and how large it is, you might want to wear this.
Scenario # 4: The Medical Assistant is assisting Mrs. Johnson to the exam table in the patient room. Mrs. Johnson has Stage 2 lung cancer and is undergoing chemotherapy and radiation treatments – she tells the Medical Assistant that the oncologist called and told her that her WBC count is 2.1 and that she cannot be around anyone who is ill, etc.
The first thing to note with this patient is that she does have stage two lung cancer. I as the medical assistant would first verify in the patients chart that she has this condition and check what her white blood cell count is. If confirmed that she indeed does have this low of a WBC, than I would immediately prepare for isolation of the patient so she is not around any possible contamination to where she would get ill. She would be moved from the exam table into an isolation unit exam room. I would then make sure the patient is in a comfortable position for examination and proceed with the check up and assisting the doctor.
As with any other procedure or PPE usage, you will want to begin with first washing your hands. The next thing you will want to do is put on a special gown called an isolation gown which is either cloth or paper. You want to make sure you tie your isolation gown at both points which is usually behind the neck and at the waist. You do this so that when you’re treating a patient in the isolation unit, in this case Mrs. Johnson, you do not contaminate your uniform or the patient for that matter.
The next thing you will want to do is apply your face mask or shield. Usually these have a clear protective eye shield. You again want to ensure that the mask and shield are on your face properly and fit this way you do not risk contamination to the extremely ill patient by breathing on them, and you do not risk contamination to yourself either.
The next item of PPE you will want to apply is your examination gloves. It is important that you pull the cuff over the sleeve of the gown this way you are not exposing your skin to the ill patient or any toxins that could make you ill as well. You want to avoid exposure of your skin in the isolation room.
After you are done with the examination of the patient in the isolation unit, you want to be sure that the door to the unit is closed securely so no pathogens can come into the room, and then you want to remove your PPE the same way you put it on. Be sure to wash your hands after any visit with a patient.
Scenario # 5: The Medical Assistant is assisting her co-worker in cleaning up a blood spill in the office laboratory.
Blood spills or other human body fluids that occur inside or in the outside environment need to be decontaminated to prevent the potential transmission of communicable disease.
The circumstances associated with blood spills can obviously vary greatly depending on the volume and type of contact surface. A small amount of blood, if splashed, can cover a large surface area. A large volume, if undisturbed on a flat surface, can pool in a relatively small area. A good example of blood or bodily fluids is a pregnant woman’s water breaking.
Prior to beginning the cleanup, you would want to notify your supervisor of the spill and ask where the spill cleanup kit was located.
Per OSHA and CDC Standards, a typical spill kit consists of the following: 10% bleach solution (or Lysol, virex or other EPA reg. Tuberculocidal), gloves, clear plastic bags, biohazard labels (available from OSEH HazMat), leak-proof sharps containers, brush & dustpan, or tongs or forceps for picking up sharps and disinfectant wipes.
You would want to put on a pair of rubber, latex, PVC or similar type gloves. For small blood spills no other PPE should be required. For larger spills where there is a possibility of contaminating your face or other parts of your body, call HazMat to assist in the cleanup, and then put on a mask and face shield along with a gown.
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The next thing you will want to do is to cover the spill area with a paper towel and then pour a fresh mix of the bleach solution together. You will want to allow the solution to soak into the contaminated material to ensure that it is completely disinfected. You want to also treat this similar to treating a wound in the sense that you want to work from the outside in. Next you will wipe the area with paper towels. The last and final step is that you would want to dispose of the contamination into the biohazard waste bag and dispose in the proper bio hazardous area.
To complete the cleanup, you will want to finally remove your gloves and wash your hands to avoid the risk of contamination to yourself and other patients.
Scenario # 6: The Medical Assistant is working with the autoclave machine today in the office laboratory.
The autoclave that most medical offices use is the ones that are dry heat autoclaves. These get extremely hot so it is important that the medical assistant who is using these is able to understand the proper usage along with the PPE that he or she would need to prevent any potential injury.
Some personal protective equipment you would consider to use would be eye equipment, a button lab coat to prevent burns, closed toed shoes to again prevent possible burns and injuries in the case that something is dropped, and heat resistant gloves as you will be removing the items from the autoclave.
Potential hazards that could occur without the use of PPE are burns and pressure releases Hazards may be general or specific, depending on the design of the autoclave or pressure cooker. They can include Physical injury to persons in the vicinity from the rapid release of stored energy resulting from autoclave failure (e.g. failure of doors/lids) Physical injury from exploding vessels that have become pressurized during processing (e.g. glass containers) Scalding / burns from steam or the hot contents of items being processed Risk of infection from pathogenic micro-organisms due to inefficient deactivation of the waste Inadvertent release of genetically modified organisms to the environment Manual handling issues during loading/unloading heavier items, Electrocution (e.g. damaged/wet electrical components) and Fire hazard (e.g. human error – leaving manually operated autoclave equipment unattended).
It is utterly important that the medical assistant knows how to operate the autoclave from what the manufacturers manual says, as every autoclave is different. The reason for this is to prevent injury from occurring in the work place.
Sources:
http://extranet.fhcrc.org/EN/sections/ehs/hamm/chap3/section6.html
http://webcache.googleusercontent.com/search?q=cache:Uw7lf6KE1osJ:www.cardiff.ac.uk/osheu/resources/Autoclave%2520Guidelines%2520draft%2520document.doc+ppe+for+autoclaves&cd=10&hl=en&ct=clnk&gl=us
http://www.sterilizers.com/aboutsterilizers.asp
http://webcache.googleusercontent.com/search?q=cache:C8l9I41OLkYJ:roundtable.healthsafe.uab.edu/pages/resources/Autoclave%2520Training%2520Final.ppt+autoclave+and+ppe&cd=1&hl=en&ct=clnk&gl=us
http://docs.google.com/viewer?a=v&q=cache:uYDSE-dYDbQJ:www.oseh.umich.edu/pdf/sop/blood_spill_SOP.pdf+blood+spills+and+ppe&hl=en&gl=us&pid=bl&srcid=ADGEEShRsZJO5EZW5mXd4823i2EM5UzlmRZRHdzPyo-JH_KnURDhFeWzkeaUJMxTJUU0F38knieNnixNUzbWnd3Iy2XYFN9lq6f_FGFN4CU569u3ezegbDf_w0iu_D6aK-FEyJivIXIe&sig=AHIEtbRO4Jxq83SAZdUaqxqEyyhFdP4bbw
http://webcache.googleusercontent.com/search?q=cache:FkfgBq95zbEJ:www.nyc.gov/html/doh/downloads/ppt/bhpp/bhpp-train-don-PPE.ppt+ppe+for+isolation&cd=3&hl=en&ct=clnk&gl=us
http://www.youtube.com/watch?v=y53k3eQgb20
http://www.youtube.com/watch?v=kmWS5jGnKjE
http://www.osha.gov/SLTC/pandemicinfluenza/pandemic_health.html
http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/PersonalProtectiveEquipment/default.htm
http://www.doh.state.fl.us/disease_ctrl/std/prevent/MODULE_2_V2.1.pdf
http://www.cdc.gov/niosh/topics/bbp/
Delmars Clinical Medical Assisting, 4th Edition, Lindh, Dahl, Delmar Cingage Learning, Copyright 2010
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PPE consists of gloves, gowns, aprons, surgical face masks, protective eye wear, and face shield. PPE is a component of standard precautions and the implementation of these precautions is considered the most important strategy for preventing infections.
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