Course contents

• Anatomy of the phlebotomy sites from which the worker is authorized to access blood.
• Infection prevention and control:

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  elements of standard precautions relevant to venepuncture (hand hygiene, wearing non-sterile gloves);

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  use of antiseptics – skin disinfection;

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  cleaning and disinfection of materials used on more than one patient, including tourniquets, scissors and specimen carriers;

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  disposal of used equipment, especially sharps.

• Protection of the patient:

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  patient identification, including children and confused patients;

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  awareness of the institution's rule to halt and seek help after a defined number of unsuccessful draws;

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  informed consent and patient rights;

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  managing supplies for patients in isolation;

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  awareness of contraindications to blood draws including drawing on the same side as a mastectomy, through infected or scarred tissues, and through in-dwelling vascular devices (per institutional policy).

• Protection of the health worker:

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  immunization with hepatitis B;

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  awareness of high risk devices and practices;

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  ability to state who and when to contact for support in the event of exposure to blood and body fluids;

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  awareness of the benefits of PEP and the need to have source patients tested and HIV PEP started, preferably within hours;

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  avoidance of two-handed needle recapping, disassembly of devices, removal of needles prior to injecting blood into tube;

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  placement and use of sharps container within arm's reach;

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  appropriate use of personal protective equipment, including gloves.

• Types of equipment available for blood sampling, and procurement and use of equipment.
• Practice taking blood samples, including blood sampling and simulated blood sampling (capillary blood, arterial blood, venous blood from adults and children according to responsibilities.
• Practice on artificial arms and clinical skills development.
• Special techniques:

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  capillary puncture

  • heel and finger-pricks
  • lancets
  • capillary tubes (filter paper, capillary blood tubes, rapid test strips, etc.)

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  venous blood

  • large volume (blood letting – aware that this must be done under direct physician order and management)
  • winged needles
  • evacuated tubes
  • blood cultures.

• Adverse events and management.
• Occupational exposure and management:

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  the country's relevant occupational health regulations, including PEP for prevention of HIV and hepatitis B;

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  the procedure for, and benefits of, reporting occupational exposure to blood;

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  first aid after exposure (see management);

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  PEP (importance of timely response);

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  surveillance and use of data for prevention of occupational exposure.

• Waste management, including disposal of waste and sharps, and procedures for spillage and breakage.
• Laboratory practices, including type of samples, forms, labelling and transportation.
• Standards of practice.
• Sustainability of training programme.
• Career path.
• Skill-based incentives.