How to safely collect blood samples

by phlebotomy from patients suspected to be infected with Crimean-

Congo Haemorrhagic fever (CCHF) virus?
Interim Guidance
April 2018

Step 1: Before entering patient room, assemble all equipment

Step 1a: Assemble equipment for collecting blood
 Laboratory sample tubes for blood collection (sterile  Gauze pads
glass or plastic tubes with rubber caps, vacuum-
extraction blood tubes, or glass tubes with screw
 Adhesive bandage
caps). EDTA tubes are preferred

 Tray for assembling blood collection tools

 Blood sampling systems (Needle and syringe

system, vacuum extraction system with holder,
winged butterfly system (vacuum extraction) or
winged butterfly system (syringe))
 Rack for holding blood tubes

 Tourniquet (single-use)

 Skin antiseptic solution: 70% isopropyl alcohol

 Durable marker for writing on laboratory samples

Step 1b: Assemble equipment for preventing infections

For hand hygiene use
 Alcohol-based handrub OR
 Clean running water, soap and disposable (paper)
towel

Personal Protective Equipment (PPE)

 Several pairs of disposable gloves  Long-sleeved, cuffed gowns (if in
(non-sterile, ambidextrous, single layer) hospital) or disposable coverall suit
- One pair for blood collection (if in rural area)
- Additional pairs as a replacement if Note: For tasks where contact with blood or
they become damaged or body fluid could happen, an impermeable
gown or a plastic apron over the non
contaminated impermeable gown are recommended.

 Footwear: Rubber boots (wear socks in

order to remove easily) or shoes with
puncture-resistant soles with  Face protection: Face mask + [face shield OR
disposable overshoes secured around goggles]
the shoes to prevent direct contact with
ground and infected bodily fluid spills
+ OR
Waste management
 Leak-proof and puncture resistant sharps container
 Two leak-proof infectious waste bags
- one for disposable material (destruction)
- one for reusable materials (disinfection)

WHO/CCHF/Guidance/ Lab18.1 adapted from WHO/EVD/GUIDANCE/Lab/14.4

 Step 1: Before entering patient room, assemble all equipment
Step 1c: Fill out patient documentation
 Label blood collection tubes with date of collection,
patient name, and his/her identifier number.

 Do NOT forget to fill out necessary laboratory form

and epidemiological questionnaire.

 If several patients have to be sampled in the same place or during the same investigation,
create a line list. One patient per line. The list should include: patient name, identifier number, sex,
age (birthdate), clinical information: symptoms, date of onset, date specimen was collected, type of
sample taken.

Step 1d: Assemble materials for packaging of samples

 Plastic leak-proof packaging container
 Disposable (paper) towels
 Cooler or cold box, if sample requires refrigeration

For the shipment of samples to the National Central Laboratory follow Sample Shipment
packaging requirements (see document "How to safely ship Emerging and Dangerous Pathogen
samples”)

Primary Container

Secondary Container

Tertiary Container

Important: A designated Assistant wearing gloves should be available to help you.

This person should stand outside the patient room. He/She will help you prepare the
sample for transport. He/She will assist you with putting on the personal protective
equipment. He/She will provide any additional equipment you may need.

How to safely collect blood samples by phlebotomy from patients suspected to be infected with Crimean-Congo 2
Haemorrhagic Fever (CCHF) virus?
 Step 2: Put on all personal protective equipment (PPE)
DO NOT ENTER THE PATIENT AREA IF YOU DO NOT HAVE ALL PROTECTIVE GEAR ON

Step 2a: Perform hand hygiene. Duration of the entire procedure: 40-60 sec if handwashing with soap
and water; 20-30 sec if handrubbing with an alcohol-based solution.

Wet hands with water Rub hands, Right palm over left Palm to palm with
and enough soap to palm to palm dorsum with interlaced fingers interlaced
cover all hand surfaces fingers and vice versa

Back of fingers to Rotational rubbing of Rinse hands with Dry hands thoroughly
opposing palms with left thumb clasped in water with single use towel
fingers interlocked right palm and vice versa

Step 2b: Put on a gown Step 2c: Put on face protection

Put on a Put on eye protection

medical mask (face shield OR goggles)

OR

Step 2d: Put on gloves (over gown cuffs)

How to safely collect blood samples by phlebotomy from patients suspected to be infected with Crimean-Congo 3
Haemorrhagic Fever (CCHF) virus?
 Step 3: Collect blood sample from patient
Step 3a: Prepare room Step 3b: Identify and Step 3c: Select the site,
 Put infectious waste bags and prepare the patient preferably at the bend of the
leak-proof and puncture resistant  Introduce yourself to the patient elbow
sharps container into patient and explain what you will do with  Palpate the area; locate a vein of
room and make sure they are the blood sample and why good size that is visible, straight
ready for use
 Make sure that this is the correct and clear
 Place all blood collection patient from whom you wish to  The vein should be visible without
equipment in a place that is easy take the blood sample applying a tourniquet
to access

Destruction Disinfection

Step 3d: Apply a tourniquet Step 3e: Ask the patient to Step 3f: Disinfect the area
around the arm form a fist so that the veins where you will put the
 Tie approximately 4–5 finger are more prominent needle.
widths above the selected site  Use 70% isopropyl alcohol
 Wait 30 seconds for the alcohol to
dry
 DO NOT touch the site once
disinfected

Step 3g: When using Step 3h: Anchor the vein by Step 3i: Perform the blood
vacuum extraction system holding the patient’s arm and draw
with holder, insert the blood placing a thumb BELOW the  Enter the vein swiftly at a 30
collector tube into the place where you want to place angle
holder the needle
 Avoid pushing the collector tube  DO NOT touch the disinfected site
past the recessed line on the  DO NOT place a finger over the
needle holder or you may vein to guide the needle
release the vacuum

How to safely collect blood samples by phlebotomy from patients suspected to be infected with Crimean-Congo 4
Haemorrhagic Fever (CCHF) virus?
 Step 3: Collect blood sample from patient
Step 3j: When blood starts Step 3k: Once sufficient Step 3l: Withdraw the needle
to flow, ask patient to open blood has been collected gently
his/her hand (minimum 5ml), release the  Give the patient a clean gauze or
tourniquet BEFORE dry cotton wool ball to press
withdrawing the needle gently on the site
 Ask the patient NOT to bend the
arm

Step 3m: Remove blood Step 3n: Put needle into leak-proof and puncture resistant
collector tube from holder sharps container
and put in rack
If the sharps container DOES NOT
HAVE a needle remover:
 Put the needle and holder into a sharps
container
 Do not remove the needle from the holder
 Do not reuse the needle

If the sharps container DOES HAVE a

needle remover:
 Remove the needle following instructions
on the sharps container
 Put the holder into the infectious waste bag
for disinfection

Step 3o: Stop the bleeding Step 3p: Put items that drip Quick Tips
and clean the skin blood or have body fluids on
 Do not leave patient until them into the infectious  The blood holder tray and
bleeding has stopped waste bag for destruction rack will need to be
 Put an adhesive bandage on the disinfected after use
site, if necessary

 A minimum of 5ml of blood

should be collected for
each patient

How to safely collect blood samples by phlebotomy from patients suspected to be infected with Crimean-Congo 5
Haemorrhagic Fever (CCHF) virus?
 Step 4: Prepare blood sample for transport
Step 4a: Take the blood Step 4b: Place all items that Step 4c: Protect the sample
tube from the tray and wipe came into contact with from breaking or leaking
the blood tube with a blood into the infectious during transport by
disposable paper towel waste bag for destruction wrapping the tube of blood
in a paper towel

Step 4d: Ask the designated Step 4e: The person who Step 4f: Have the gloved
assistant to approach the has collected the blood assistant tightly close the
patient room, without sample should put the top of the plastic leak-proof
entering wrapped tube of blood into packaging container
 This person should have gloves the plastic leak-proof  Disinfectant the outer side of the
on packaging container plastic leak-proof packaging
 This person should come close container with a disinfectant
 Be careful not to touch outside of
to you holding the open plastic leak-proof packaging container
leak-proof packaging container. with gloves
 This person should not enter the
patient room

Step 4g: The assistant

removes gloves and
performs hand hygiene

Note: The sample is now ready for shipment to the National Central Laboratory. Follow
Sample Shipment packaging requirements for infectious substances.

 Store samples at room temperature for up to 24 hours. If you need to store the sample for
one week before shipping, store between 0-5° Celsius.

 If you need to store the sample for more than one week before shipping, store at -20 °
Celsius (or better at -70 ° Celsius if available). Avoid freeze-thaw cycles.

How to safely collect blood samples by phlebotomy from patients suspected to be infected with Crimean-Congo 6
Haemorrhagic Fever (CCHF) virus?
 Step 5: Remove Personal Protective Equipment (PPE)
Step 5a: Remove the gloves Step 5b: Remove the gown Step 5c: Perform hand
hygiene
1. Hold the outer edge 1. Untie the gown
of the first glove  Alcohol-based handrub solution
and peel it off (20-30 sec) OR
 Soap and water (40-60 sec)

2. Remove the
2. Hold the first glove gown from
in the gloved hand behind starting
and drag a bare at the neck and
finger under the shoulders
second glove

3. Remove second glove

from the inside, 3. Put the gown in the
creating a "bag“ for infectious waste
both gloves and put in bag for destruction
the infectious waste
bag for disposal

Step 5d: Take off face protection When wearing a face shield
 Remove face shield from behind
 If it is a reusable face shield, place it in an infectious waste bag
for disinfection
 If it is a disposable face shield, place it in an infectious waste
bag for destruction
 Remove the medical mask from behind, starting with the
bottom strap, and place it in a infectious waste bag for
destruction
When wearing goggles and mask
 Remove goggles from behind
 If reusable goggles, place it in an infectious waste bag for
disinfection
 If disposable goggles, place it in an infectious waste bag for
destruction
 Remove the medical mask from behind, starting with the
bottom strap, and place it in an infectious waste bag for
destruction

Step 5c: Perform hand Quick Tips

hygiene
 Place all reusable equipment into a separate infectious waste bag
 Alcohol-based handrub solution
for disinfection
(20-30 sec) OR
 Soap and water (40-60 sec). When collecting blood samples from multiple patients
 Change gloves between each patient
 Wash hands between each patient
 DO NOT WASH GLOVED HANDS
 DO NOT REUSE GLOVES

© World Health Organization 2014. All rights reserved. Reprinted in 2018 with changes.

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