At a magnification of 1000X, this trichrome-stained photomicrograph revealed the morphologic characteristics of a blue-stained Giardia intestinalis protozoan trophozoite (center). Photo courtesy of CDC/ DPDx - Melanie Moser. Personal protective equipment (PPE) is defined by OSHA as specialized clothing or equipment worn by an employee for protection against infectious materials. They are selected based upon:
As part of the Bloodborne Pathogen Standard, OSHA requires employers to provide appropriate PPE for employees. Employers must also ensure that PPE is disposed, or that reusable PPE is cleaned, laundered, repaired and stored after use. OSHA specifies the circumstances for which PPE is indicated; the CDC recommends when, what, and how to use PPE (CDC, 2007). Types of PPE
There are four key points to remember about PPE use:
Gloves Gloves are used in patient care situations as well as for environmental services. They are made of vinyl, latex, nitrile and other materials. They are available in both sterile and non-sterile forms; some are made for single use, others are reusable. Healthcare workers sometimes wear a single pair of gloves; sometimes double gloving is utilized (CDC, 2007).
Do's and Don'ts of Glove Use (CDC, 2007):
Gowns and Aprons Gowns and aprons can be made of natural materials or synthetic materials; they can be disposable or reusable; they vary in level of fluid resistance; they can be sterile or clean. Three factors influence the selection of a gown or apron. Firstly, the purpose of its use must be considered. Isolation gowns are generally the preferred PPE for clothing but aprons occasionally are used where limited contamination is anticipated. If contamination of the arms can be anticipated, a gown should be selected. Gowns should fully cover the torso, fit comfortably over the body, and have long sleeves that fit snuggly at the wrist. Second are the material properties of the gown. Isolation gowns are made either of cotton or a spun synthetic material that dictate whether they can be laundered and reused or must be disposed. Cotton and spun synthetic isolation gowns vary in their degree of fluid resistance, another factor that must be considered in the selection of this garb. If fluid penetration is likely, a fluid resistant gown should be used. The last factor concerns patient risks and whether a clean, rather than sterile gown, can be used. Clean gowns are generally used for isolation. Sterile gowns are only necessary for performing invasive procedures, such as inserting a central line. In this case, a sterile gown would serve to protect the patient and the healthcare provider.
Face Protection Masks protect the nose and mouth; they should fully cover the nose and mouth and prevent fluid penetration. They should fit snuggly over the nose and mouth, making masks with flexible nose pieces that are secured to the head with string ties or with elastic are preferable.
Goggles protect the eyes; personal prescription lenses do not provide optimal eye protection and are NOT a substitute for goggles. They should fit snuggly over and around the eyes; antifog feature improves clarity. Face shields protect the face, nose, eyes, mouth and eyes; they should cover the forehead, extend below the chin and wrap around side of face. When skin protection, in addition to mouth, nose, and eye protection, is needed or desired, for example, when irrigating a wound or suctioning copious secretions, a face shield can be used as a substitute to wearing a mask or goggles. The face shield should cover the forehead, extend below the chin, and wrap around the side of the face.
Respiratory Protection The purpose of respiratory protection is to protect workers from inhalation of infectious aerosols (e.g. Mycobaterium tuberculosis). Types of respiratory PPE include:
Safe Work Practices Key points about PPE:
Sequence for donning PPE: The order in which PPE is donned, is based on the combination of needed PPE, although the following recommendations are made, the specific situation will determine which sequence is practical.
Knowing the difference between "clean" and "contaminated" areas of PPE is key to effective protection. Contaminated areas include:
Clean areas include:
The order in which PPE is removed also is important in maintaining protection. The sequence is:
PPE is best removed at the doorway of the patient room. An anteroom is ideally used; hand hygiene facilities (sink or alcohol-based hand rub) are to be in this location, where they will be needed. Continue to Element V |