Chapter 2 of 522% of exam

Safety and Compliance

The rules that keep you, the patient, and the specimen out of trouble: the federal bloodborne pathogens standard, personal protective equipment, sharps and exposure response, isolation precautions, and the privacy and quality regulations every lab operates under.

The OSHA Bloodborne Pathogens Standard

The federal rule at 29 CFR 1910.1030 is the backbone of phlebotomy safety and is the single most cited regulation on the exam. It requires the employer to build a written exposure control plan, provide engineering and work practice controls, supply protective equipment at no cost, and offer hepatitis B vaccination. Its governing philosophy is standard precautions: treat every patient's blood and body fluid as if it were infectious, regardless of diagnosis.

Exposure control plan reviewed annually

Every employer with at-risk staff must maintain a written exposure control plan, review and update it at least once a year, and document consideration of safer sharps devices.

OSHA 29 CFR 1910.1030

Hepatitis B vaccine offered free

The employer must offer the hepatitis B vaccine series at no charge within 10 working days of the employee's assignment to duties with exposure risk. An employee who declines signs a written declination and may accept later at any time.

OSHA 29 CFR 1910.1030

Standard precautions apply to everyone

All blood and all body fluids except sweat are handled as potentially infectious, so precautions do not vary by the patient's known or suspected diagnosis.

CDC Guideline for Isolation Precautions (2007)

Controls come before equipment

The hierarchy is engineering controls first (self-sheathing needles, sharps containers), then work practice controls (no recapping, no eating in the work area), and only then personal protective equipment as the last barrier.

OSHA 29 CFR 1910.1030

Biohazard labeling and containers

Containers of regulated waste, refrigerators holding specimens, and transport containers carry the fluorescent orange or orange-red biohazard symbol, or use red bags or containers.

OSHA 29 CFR 1910.1030

Free training at hire and yearly

Bloodborne pathogens training is provided at no cost during working hours at initial assignment and at least annually thereafter, with records retained.

OSHA 29 CFR 1910.1030

Hand hygiene and personal protective equipment

Hand hygiene is the single most effective infection control measure, and the exam frequently asks when alcohol rub is enough and when only soap and water will do. Gloves are changed between every patient and never washed or reused. The donning and doffing sequences are memorized in opposite directions because the most contaminated item comes off first.

Alcohol rub versus soap and water

Alcohol-based hand rub is preferred for routinely decontaminating hands, but soap and water are required when hands are visibly soiled and after exposure to spore-forming organisms such as Clostridioides difficile, which alcohol does not kill.

CDC Hand Hygiene Guideline (2002)

Scrub time

Rub all hand surfaces with alcohol product until dry, roughly 20 to 30 seconds, or lather with soap and friction for at least 20 seconds before rinsing with fingertips pointed downward.

WHO Guidelines on Hand Hygiene in Health Care (2009)

Donning order

Put on gown first, then mask or respirator, then goggles or face shield, and gloves last so the glove cuff covers the gown sleeve.

CDC Guideline for Isolation Precautions (2007)

Doffing order

Remove gloves first, then goggles or face shield, then gown, and mask or respirator last, performing hand hygiene after removal and again after leaving the room.

CDC Guideline for Isolation Precautions (2007)

Gloves are single patient, single use

Change gloves between patients and whenever torn or contaminated, and perform hand hygiene after removal; gloves are never washed, disinfected, or reused, and they do not replace hand hygiene.

Latex alternatives

Nitrile or vinyl gloves are provided for staff and patients with latex sensitivity, and latex-free tourniquets and bandages must be available at the drawing station.

Sharps handling and the needlestick exposure protocol

Most occupational exposures in phlebotomy come from a needle that was handled after it left the vein rather than during the puncture itself. Safety features are activated at the point of use, one-handed, before the needle travels anywhere. When an exposure does happen, the sequence of response is fixed and time sensitive.

Never recap

Recapping, bending, breaking, or shearing a used needle is prohibited. If a procedure absolutely requires recapping, use a one-handed scoop technique or a mechanical device, never two hands.

OSHA 29 CFR 1910.1030

Activate immediately, dispose at point of use

Engage the safety shield or retraction the instant the needle leaves the skin, then drop the whole assembly into a puncture-resistant, leakproof, closable sharps container located as close as practical to the work area.

Replace sharps containers before they overflow

Sharps containers are closed and replaced when they reach the manufacturer's fill line, generally about two-thirds to three-quarters full, and are never forced down or reached into.

Sharps injury log and worker input

Employers must keep a sharps injury log recording the device type and brand, the department, and how the incident occurred, and must involve frontline staff in choosing safer devices.

Needlestick Safety and Prevention Act (2000)

First action after a stick

Wash the wound immediately with soap and running water; flush mucous membranes or eyes with water or saline for about 15 minutes. Do not squeeze the wound or apply caustic agents such as bleach.

CDC/USPHS post-exposure guidance

Report and evaluate without delay

Report to the supervisor and employee health at once so that source-patient testing, baseline testing of the exposed worker, and post-exposure prophylaxis can begin; HIV prophylaxis is most effective within hours and is not started beyond 72 hours.

CDC/USPHS post-exposure guidance

Isolation precautions and other workplace hazards

Transmission-based precautions are layered on top of standard precautions when an organism spreads by a specific route. The exam expects you to match the route to the barrier and to know which mask is which. Fire, chemical, and electrical safety appear as a smaller but predictable group of questions.

Contact precautions

For organisms spread by touch or contaminated surfaces, such as MRSA, VRE, and C. difficile, wear gown and gloves on room entry and use dedicated or disinfected equipment.

CDC Guideline for Isolation Precautions (2007)

Droplet precautions

For agents carried in large respiratory droplets, such as influenza, pertussis, and meningococcal disease, wear a surgical mask when working within about three to six feet of the patient.

CDC Guideline for Isolation Precautions (2007)

Airborne precautions

For tuberculosis, measles, and varicella, the patient is placed in a negative-pressure room and the collector wears a fit-tested N95 or higher respirator, not a surgical mask.

CDC Guideline for Isolation Precautions (2007)

Protective environment

Severely immunocompromised patients, such as stem cell transplant recipients, are protected by positive-pressure rooms; the precaution protects the patient from you rather than you from the patient.

Fire and chemical response

Use RACE for a fire (rescue, alarm, contain, extinguish or evacuate) and PASS for an extinguisher (pull, aim, squeeze, sweep). For chemical splashes, flush at an eyewash or shower for at least 15 minutes and consult the safety data sheet.

OSHA Hazard Communication Standard 29 CFR 1910.1200

Spill cleanup

Blood spills are covered with absorbent material, then decontaminated with an EPA-registered tuberculocidal disinfectant or a freshly prepared 1:10 dilution of household bleach, wearing gloves and other appropriate barriers.

OSHA 29 CFR 1910.1030

HIPAA, chain of custody, CLIA, and quality control

Compliance questions cover who may see a result, how a legally defensible specimen is documented, who is allowed to run a test, and how the lab proves its results are trustworthy. These four frameworks come from different agencies and are often mixed together in distractors, so anchor each one to its purpose.

HIPAA minimum necessary

Protected health information is disclosed only to those who need it for treatment, payment, or health care operations, and only the minimum amount needed. Discussing a patient in an elevator or leaving a requisition in view is a violation.

HIPAA Privacy Rule, 45 CFR Part 164

Patient rights under HIPAA

Patients may inspect and obtain a copy of their records, request corrections, receive an accounting of certain disclosures, and be given a notice of privacy practices; electronic records carry additional safeguards under the Security Rule.

HIPAA Privacy Rule, 45 CFR Part 164

Chain of custody

Forensic and legal specimens, including drug screens and blood alcohol for law enforcement, require an unbroken written record of every person who handled the specimen with date, time, and signature, plus a tamper-evident seal applied in the donor's presence.

SAMHSA Mandatory Guidelines for Federal Workplace Drug Testing Programs

Blood alcohol antiseptic

For a legal blood alcohol collection, clean the site with a nonalcoholic antiseptic such as aqueous benzalkonium chloride or soap and water, because an alcohol prep pad can be challenged in court and may affect the result.

CLIA governs testing complexity

The Clinical Laboratory Improvement Amendments classify tests as waived, moderate, or high complexity and set personnel, proficiency testing, and quality standards for every facility that tests human specimens.

CLIA 1988, 42 CFR Part 493

Quality control is documented daily

Point-of-care and analyzer controls are run and recorded on the required schedule, results are plotted and reviewed against acceptable limits before patient results are released, and refrigerator and centrifuge temperatures and equipment maintenance are logged.

CLIA 1988, 42 CFR 493.1256

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Last updated: July 2026