Standard Precautions during Phleontomy: Do Healthcare Workers Pay Heed?

Abstract

In healthcare settings contaminated fomites are potential vectors for cross-transmission of nosocomial pathogens when equipment is shared between patients. The primary mechanism of transmission from one patient to another is via healthcare workers' (HCWs) hands. The risk of transmission of nosocomial infections can be kept low through standard precautions such as good hand hygiene and proper glove utilization. The aim of this study was to assess standard precautions during phlebotomy in a tertiary care hospital in Sri Lanka. Observations of HCWs during venepuncture for routine blood investigations were made on 96 occasions in 24 general wards of the Colombo South Teaching Hospital, Kalubowila. Four observations were made at random in each ward. The HCWs were unaware of the audit and observations were made during collection ot1specimens for another part of this study. Only 7 of96 (7.3%) HCWs washed hands before wearing gloves or performing phlebotomy without gloves. More than two thirds of HCWs (68.8%) did not use gloves for phlebotomy. None of the HCWs who wore gloves changed gloves in between patients. Only 19 of 96 (19.8%) HCWs washed their hands after removing gloves or performing phlebotomy without gloves. Only one of the HCWs washed hands both before and after handling the patient. Jewellery was worn on bands by 19 of 96 (19.8%) HCWs and none of them removed these before the procedure. Most of the time tourniquets were improperly stored and were seen tied to the trolley. No attempt was taken by HCWs to clean the tourniquets in between patients. HCWs pay poor attention to standard precautions during routine phlebotomy procedures. Precautions for personal safety are disregarded by most as they do not use gloves. HCWs need to be educated that the spread of nosocomial pathogens to patients, instruments and environment is primarily through hands of workers and that it is important to follow standard precautions at all times.