Adapted sample taking

Best infection control measures for

sampling venous
and capillary blood

WHO intermediate recommendations

February 2004

May 2007
Laboratory Training for FieldEEpidemiologists
P I D E M I C A L E R T A N D R E S P O N S E
 Best practices
• Ensure blood is sampled safely, no exposure to
bloodborne pathogens to patients, health care
workers, environment
• Scope of best practices restricted to infection control

• Do not address other routine practices:

• labelling
• selecting the right equipment for the right patient
• containers
• protecting the sample from contamination

Laboratory Training for FieldEEpidemiologists

P I D E M I C A L E R T A N D R E S P O N S E
 Steps of safe blood sampling

Step 1: select equipment, prepare area

Step 2: prepare patient, collect blood sample

Step 3: transfer blood sample

Step 4: waste management

Other practice issues: type of phlebotomy equipment

Laboratory Training for FieldEEpidemiologists

P I D E M I C A L E R T A N D R E S P O N S E
 Step 1
Select equipment, prepare area

• Provide an appropriate environment for blood

collection

Laboratory Training for FieldEEpidemiologists

P I D E M I C A L E R T A N D R E S P O N S E
 Step 1
Select equipment, prepare area
• Wash and/or disinfect your hands first

• Avoid collecting blood if local infection or other skin

condition (e.g., weeping dermatitis, skin lesions)
compromises the skin integrity of your hands.

• Cover any small cuts on your hands

(e.g., with a bandaid/plaster).

Laboratory Training for FieldEEpidemiologists

P I D E M I C A L E R T A N D R E S P O N S E
 Step 1
Select equipment, prepare area
• Prepare a clean,
designated and if
possible, dedicated area
for collecting blood
samples.

Laboratory Training for FieldEEpidemiologists

P I D E M I C A L E R T A N D R E S P O N S E
 Step 1
Select equipment, prepare area
• Wear a new pair of gloves for
each patient

• Use a sterile single-use lancet or

phlebotomy set for each patient

• Inspect packaging for breaches

in integrity

• Do not use equipment that may

not be sterile (punctured, torn or
damaged).

Laboratory Training for FieldEEpidemiologists

P I D E M I C A L E R T A N D R E S P O N S E
 Step 2:
Prepare patient, collect blood sample
• Wash visibly soiled/dirty skin

• Swab
• Antiseptic - clean,
single use swab and maintain
product-specific recommended
contact time.

• Do not use cotton balls stored wet

in a multi-use container.
• Unnecessary to swab clean skin before blood sampling

• Don’t touch the puncture site after skin disinfection or

before
Laboratory Training blood sampling.
for Field Epidemiologists
E P I D E M I C A L E R T A N D R E S P O N S E
 Step 2: Preparation of the patient
and collection of the blood sample
• Discard in an appropriate sharps disposal container
any needle or lancet that has touched a non-sterile
surface prior to sampling.

• When the use of a tourniquet is indicated, use a clean

device that has not been contaminated with blood or
body fluids.

Laboratory Training for FieldEEpidemiologists

P I D E M I C A L E R T A N D R E S P O N S E
 Step 2: Preparation of the patient
and collection of the blood sample
• Anticipate and take measures such as appropriate
patient restraint to prevent sudden patient movement
during and after blood sampling.

Laboratory Training for FieldEEpidemiologists

P I D E M I C A L E R T A N D R E S P O N S E
 Step 2: Prepare the patient and
collect the blood sample
• After sampling, minimize bleeding by applying gentle
pressure on the sampling site with a dry, clean cotton
ball or other similar material.

• Apply clean dressing to the wound after bleeding has

stopped.

Laboratory Training for FieldEEpidemiologists

P I D E M I C A L E R T A N D R E S P O N S E
 Step 3. Transfer blood sample

• When using a syringe and a needle to perform

phlebotomy,

• transfer the collected blood slowly and directly into the

collection tubes without removing the needle to prevent
spillage or splashing

• Cover the tubes

Laboratory Training for FieldEEpidemiologists

P I D E M I C A L E R T A N D R E S P O N S E
 Step 3. Transfer the blood sample

• Avoid recapping needles and other manipulations of

used needles.

• If recapping is necessary, use one hand only to avoid

puncturing the hand holding the cap.

Laboratory Training for FieldEEpidemiologists

P I D E M I C A L E R T A N D R E S P O N S E
 Step 3. Transfer the blood sample

• Collect used sharps at the point of use in puncture

resistant and leak-proof sharps containers.

Laboratory Training for FieldEEpidemiologists

P I D E M I C A L E R T A N D R E S P O N S E
 Step 3. Transfer the blood sample

• Prepare blood collection tubes for storage or

transport according to recommended national and/or
international packaging requirements.

Laboratory Training for FieldEEpidemiologists

P I D E M I C A L E R T A N D R E S P O N S E
 Step 3. Transfer of the blood sample

• Disinfect the sampling area

to eliminate the risk of
contamination of equipment
with blood or body fluids for
future use, particularly if
spillage or splashing of
blood occurred.

• Wash hands after removing

gloves.

Laboratory Training for FieldEEpidemiologists

P I D E M I C A L E R T A N D R E S P O N S E
 Step 4. Waste management

• Seal sharps containers before they are completely full

for transport to a secure area in preparation for
disposal.

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P I D E M I C A L E R T A N D R E S P O N S E
 Step 4. Waste management

• Manage waste in an efficient, safe and environment-

friendly way to protect people from voluntary and
accidental exposure to used equipment.

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P I D E M I C A L E R T A N D R E S P O N S E
 Type of phlebotomy equipment

• Single-use, vacuum-based phlebotomy equipment is

available to reduce the risk of environmental
contamination.

• Safer injection devices are increasingly available to

prevent reuse of injection equipment and needle-stick
injuries.

Laboratory Training for FieldEEpidemiologists

P I D E M I C A L E R T A N D R E S P O N S E
 Module 2: Adapted sample taking

Developed by the Department of Epidemic and

Pandemic Alert and Response of the World Health
Organization with assistance from:

European Program for Intervention Epidemiology

Training

Canadian Field Epidemiology Program

Thailand Ministry of Health

Institut Pasteur

Laboratory Training for FieldEEpidemiologists

P I D E M I C A L E R T A N D R E S P O N S E