L3_Diploma_in_Peri_Operative_Support_Assist_in_Receiving,_Handling_and_Dispatching_Clinical_Specimens

[pic][pic] |Unit |Assist in receiving, handling and dispatching clinical specimens. | |456 | | |PSC0100 |Learners Name: James Sullivan | | | | | |Date Completed………………………… | City & Guilds – Level 3 Diploma in Perioperative Support work book Outcome 1 Understand how health and safety measures are implemented when receiving, handling and dispatching clinical specimens. Outcome 1.1 Explain how the standard precautions for infection control apply when receiving, handling and dispatching specimens. Collecting, handling and labelling specimens As well as the standard precautions, North Tees & Hartlepool NHS Foundation Trust has a written policy (IC14 Version 4) for Clinical Specimen (Infection Prevention and Control Precautions) regarding the collection and transportation of laboratory specimens. Standard precautions for collecting, handling and labelling specimens state you should: • Be trained to handle specimens safely • Collect samples (wearing protective clothing) in an appropriate sterile and properly sealed container • Complete form using patient labels (where available) and check that all relevant information is included • Take care not to contaminate the outside of the container and the request forms • Ensure that specimens are transported in accordance with the Safe Transport of Dangerous Goods Act 1999 • Make sure specimens are sent to the laboratory as soon as possible. Under no circumstances should specimens be left on window sills or placed in staff pockets • Once results are available check and enter into the patient’s records. Any results outside normal • Limits should be highlighted to the patient’s clinician. Act on any infection control issues immediately. If you feel you need further training in any of the above, speak to your infection control team who will be able to provide you with advice and training. Some of the general principles of infection prevention and control (standard precautions) also apply when collecting, handling and labelling specimens. • Achieving optimum hand hygiene: Hand hygiene is widely acknowledged to be the single most important activity for reducing the spread of disease. Hands should be decontaminated before direct contact with patients and after any activity or contact that contaminates the hands, including following the removal of gloves. While alcohol hand gels and rubs are a practical alternative to soap and water, alcohol is not a cleaning agent. Hands that are visibly dirty or potentially grossly contaminated must be washed with soap and water and dried thoroughly. Hand preparation increases the effectiveness of decontamination. • Using personal protective equipment: Personal protective equipment (PPE) is used to protect both yourself and your patient from the risks of cross-infection. It may also be required for contact with hazardous chemicals and some pharmaceuticals. PPE includes items like gloves, aprons, masks, goggles or visors. In certain situations such as theatre, it may also include hats and footwear. • Training/education. All health care professionals who have a clinical responsibility for patients must include infection prevention and control as part of their every day practice. All North Tees & Hartlepool NHS Foundation Trust health care staff receives mandatory infection control training as part of their induction and on an ongoing annual basis. It is particularly important that knowledge and skills are continually updated. The training should cover all the general principles of infection prevention and control to emphasise the key role that health care professionals play in minimising the spread of infection; to highlight what can happen as a result of bad practice and underline the importance of good communication. Training includes: • practical hand washing sessions/use of alcohol hand gel • aseptic technique • the importance of environmental/equipment cleaning and whose responsibility • who to go to for advice/ more information • trust infection and prevention policies (IC14, IC2 & IC17) • What you can do to help yourself, your colleagues and your patients (uniform, hair, general hygiene). • Surgical site infections (theatre specific) Outcome 1.2 and 1.3 Describe how to avoid compromising the sterile field and also the actions you would take when there is a breakdown in the sterile field. Sterile Field: An area immediately around a patient that has been prepared for a surgical procedure with the use of sterile drapes or towels. The sterile field includes the scrubbed team members, who are properly attired, and all furniture and fixtures in the area. Drapes can be placed around the site of the procedure and/or on a trolley or stand. Only sterile items should be taken and placed into the sterile field. In an operating theatre, there are two areas: the sterile operating field, and the non-sterile area. During the surgery, the goal is to keep the operating field totally sterile for patient safety. Circulating nurses & Theatre Support Workers (TSW) monitor the sterile field, informing the scrub nurse when something might compromise the sterility. This might be a circulating nurse or TSW have accidently touched the sterile area or a piece of non-sterile equipment has touched the sterile area. A circulating nurse or TSW must inform the scrub nurse immediately if there is a compromise in sterility. The scrub nurse will then asses the situation and decides how to deal with the compromise in sterility. They may cover the now; unsterile area with sterile tape or they might need a new set of drapes and instruments, this will be decided by the scrub nurse. Again it is imperative that anyone in theatre who (or suspects they may have) compromised the sterile field inform the scrub nurse so action can be taken. A circulating nurse or TSW also connect the people in the sterile field with the non-sterile area. For example, a circulating nurse or TSW can open an autoclaved tray, sterile equipment or sterile implant so that someone in the sterile field can access that sterile item. Great care must be taken by a circulating nurse or TSW when preparing an item to be taken into the sterile field. The item must be checked it is double wrapped or in a sterile container and has no perforations or holes in its packaging. The item is then opened away from the person opening it and held in the non-sterile area till the scrub nurse reaches across to take the item. The item should not be passed to the scrub nurse or thrown onto the sterile trolley. Great care must also be taken that your clothing does not compromise the field when near the sterile filed. Exactly the same care must be taken when receiving items, (such as specimens) from the sterile field. Take care when approaching sterile trolleys that your clothing won’t compromise sterility and never lean across the sterile to receive an item, wait till it is pass out. Because the circulating nurse or TSW works in the non-sterile field, he/she does not need to be sterile. For patient safety, however, the circulating nurse, TSW and other staff in the theatre non-sterile area usually wear face masks, keep their hair contained under surgical caps, and take other measures to avoid compromising the clean conditions in the operating theatre. Outcome 2. Understand the reasons for different containers and transport media for different clinical specimens. Outcome 2.1 Identify different types and uses of containers and transport media used in the peri-operative environment. |Container |Usage |Transport media | |Universal clear container, white lid. |Urine, semen, cerebrospinal fluid, sputum |None. Sent with histology/cytology form | |Universal clear container, wide neck, |Urine, pus, faeces, fungal specimens, sputum |None. Sent with histology/cytology form | |sealed sterile, orange lid | | | |Sterilin Swab |Pus swab |Black charcoal media. Sent in | | | |microbiology sealed bag | |Small clear pot with yellow lid. |Histology specimens |10% formalin. Sent with | | | |histology/cytology form | |Medium clear pot with orange lid. |Histology specimens |10% formalin. Sent with | | | |histology/cytology form | |White pots & buckets of various sizes |Histology specimens, |10% formalin. Sent with | | | |histology/cytology form | |White or clear pots & containers |Breast, frozen sections |None dry, | |various sizes | | | |Blood – 7.5ml - red top - Group & Save, cross match | |Blood – 2.7ml – red FBC, Hb, WBC, RBC, Platelets | |Blood – 4.7ml – brown – Urea & electrolytes, cardiac enzymes, hormone assays (serum gel) | |Blood – 5.5ml – yellow glucose levels | |Blood – 3.0ml – green Clotting studies | |Blood – 9.0ml – white Immunology | |Blood – 2.0ml – orange – blood gases | Outcome 2.2 Explain the difference between the types of specimens and how these are received, handled and dispatched. |Specimen |Received/handled |Dispatched | |Frozen sections |Specimen must be sent dry |Phone the laboratory | |The frozen section procedure is a | |Specimen must be sent dry | |pathological laboratory procedure to perform | |Specimen must be taken to the laboratory | |rapid microscopic analysis of a specimen | |immediately | |while surgery is taking place | |Include phone number that report is to be | | | |telephoned to | |Foetus for cytogenetics |If < 14 weeks gestation place in 10% formalin|As per histology | |Checking chromosomes |as per routine Histology |Some foetuses are sent directly to Newcastle.| | |If > 14 weeks gestation send dry |If so a consent form from Northern Genetics | | |Or as per surgeons instructions |Service must be completed and is sent to | | | |Newcastle by taxi if specimen is dry. | |Histology is used to study the microscopic |From sterile field into chemical fixative The|Usually collected by the labs within 24hrs or| |anatomy of cells and tissues. It is performed|most common fixative is 10% neutral buffered |taken immediately to the labs if requested by| |by examining a thin slice (section) of tissue|formalin or can be in a dry sterile |the surgeon. | |under a light microscope or electron |container. | | |microscope. | | | |Cytology is used to study the cells in terms |From sterile field into chemical fixative The|Usually collected by the labs within 24hrs or| |of structure, function and chemistry |most common fixative is 10% neutral buffered |taken immediately to the labs if requested by| | |formalin or can be in a dry sterile |the surgeon. | | |container. | | |Microbiology requests will usually be sent to|Usually taken via a sterilin swab and sealed |Placed in a microbiology bag and dispatched | |check pathogenic microbes within a sample |in a tube in the sterile field then handed |using the tube system (sterilin swab) | | |out. A dry sterile universal container can |collected by the labs within 24hrs or taken | | |also be used |immediately to the labs if requested | Outcome 2.3 Explain the potential consequences of failing to follow the correct procedures when handling, labelling and dispatching clinical specimens. |Handling |Contamination of specimen | | |Injury or harm if not wearing correct PPE from spillages and | | |splashes | |Labelling |Lost specimen | | |Wrong results / wrong patient | | |Results to wrong consultant | | |Lack of treatment for patient | | |Not able to test (no patient details) | | |MAKE SURE THE RIGHT FORM IS WITH THE RIGHT SPECIMEN WITH THE CORRECT| | |PATIENT DETAILS | |Dispatching |Lost specimen | | |Lack of treatment for patient (specimen not delivered in time or | | |sent to wrong area) | | |Not able to test (sent to wrong area) | Candidate signature Date Assessor signature Date Quality Assurers signature Date (if sampled)