09/23/2017
Standards Update: Trays and tourniquets
The newly revised venipuncture standard released by the Clinical and Laboratory Standards Institute in April, 2017 is the most comprehensive revision in the document's history. With over 140 new mandates, facilities have a lot of changes to implement. This series discusses one or more substantive changes each month.
Nearly 100,000 patients die every year in the U.S. from infections they acquire during hospitalization. Phlebotomists and other healthcare professionals who draw blood samples play a role in the chain of infection that must be minimized, if not eliminated. Two new provisions in the newly released CLSI venipuncture standard are designed to prevent those who draw blood samples from spreading infection.
Phlebotomy trays
While many facilities have moved away from phlebotomy trays in favor of wheeled carts, trays are still widely used. Unfortunately, too often they are carried into patients' rooms and set upon surfaces patients contact frequently. Since the bottoms of phlebotomy trays are among the most highly contaminated pieces of equipment used in patient rooms, the threat they pose to patients is significant.
Patients use bedside trays, tables and nightstands to set their glasses, hearing aids, dentures, and other personal items upon. Visitors and healthcare professionals sit in the chairs next to patient beds. That's why the committee that revised the recent venipuncture standard banned the practice of setting phlebotomy trays on surfaces patients and visitors frequently come in contact with. When such surfaces are used for phlebotomy trays, the standard requires a protective barrier, such as a disposable pad, between the tray and the surface.
The standard also requires phlebotomy trays to be cleaned on a "scheduled basis." Most OSHA consultants recommend inspecting trays for cleanliness daily and cleaned whenever there is visible contamination or exposure to blood or body fluids due to a spill. The standard doesn't mandate how frequently trays should be cleaned, but requires it to be at regular intervals of the facility's choosing.
When cleaning is required, a thorough cleaning would be to completely empty the tray of supplies and decontaminate the interior and exterior with a tuberculocidal spray, making sure all of the surfaces have been decontaminated. A consultation with an infection control officer would be helpful in establishing a good policy and effective procedure.
Tourniquets
One study found 78% of all reusable tourniquets at one facility had microorganisms. Twenty-five percent of the tourniquets harbored methicilin-resistant organisms. There is no regulation or standard mandating single-use tourniquets, but it is an effective means by which to reduce hospital-acquired infections. Some facilities mitigate this risk by assigning patients their own tourniquet to be used exclusively on them throughout their stay.
While the new venipuncture standard does not mandate single-use tourniquets, it recommends the practice, and also suggests facilities consider assigning tourniquets to be used on each inpatient exclusively.
Readers are urged to obtain their own copy of the standard as soon as possible and begin implementing all new provisions as soon as possible. The document, Collection of Diagnostic Venous Blood Specimens (GP41-A7), is the standard to which all facilities will be held if a patient is injured during the procedure or suffers from the consequences of an improperly performed venipuncture.
