Healthcare-Associated Infections: Personal Protective Equipment
Personal protective equipment (PPE) is specialized clothing or equipment used to prevent exposure to communicable diseases. Use of PPE is an integral part of the infection control and prevention measures that protect workers from exposure to blood, body fluids, and other potentially infectious materials.
PPE, such as gowns, gloves, masks, and goggles, provides a physical barrier that prevents the hands, skin, clothing, eyes, nose, and mouth from coming in contact with infectious agents. PPE is used to reduce transmission of communicable diseases when other measures, such as engineering controls and work practices, cannot completely eliminate exposure.
Employers are required by OSHA standard 29 CFR Part 1910.132 to assess the workplace for hazards that necessitate the use of PPE and document that such an assessment has been done. They must also provide appropriate PPE in the workplace, store and maintain PPE in good working order, train employees on proper use of PPE, and ensure that employees use PPE appropriately.
For additional information on PPE, visit the DHS Personal Protective Equipment webpage.
The following PPE affords protection of mucous membranes, skin, and clothing from infectious agents. In health care settings these items must be readily available at all times for use by employees with exposure to communicable diseases. Items such as uniforms, pants, blouses, and eyewear not intended to protect against communicable diseases, are not considered PPE.
Clean, disposable gloves are worn during direct contact with:
- Blood and body fluids
- Mucous membranes
- Non-intact skin
- Any other potentially infectious material
They are also worn as a part of contact precautions (for persons infected with pathogens transmitted by the contact route, such as MRSA, VRE, and RSV) while directly touching the patient or when in the immediate patient environment. Note: This does not apply to gloves worn for purposes of chemotherapy or reprocessing of reusable medical equipment.
Disposable gloves are available in latex, vinyl, and nitrile materials.
- Since many individuals are allergic to latex, vinyl or nitrile gloves are recommended alternatives.
- Vinyl gloves can be used for brief patient contact, but nitrile gloves provide greater barrier protection for extended patient care activities or those requiring more manual dexterity.
Discard gloves at point of use and wash hands immediately after removing gloves.
Isolation gowns are used as part of standard and contact precautions to protect clothing and arms of health care workers. When used for standard precautions, gowns are worn only if contact with blood and/or body fluids is expected. Fluid resistant gowns should be used when splashes or sprays of blood or body fluids are expected. For contact precautions, gowns are worn during all patient contact and when in the patient's environment.
Gowns are always worn in combination with gloves, and with other PPE when indicated. Remove at point of use, and discard disposable gowns or place cloth gowns in laundry container. Practice correct hand hygiene immediately after removing all PPE.
Surgical masks are used to protect the mouth and nose from splashes or sprays of blood and/or body fluids, or respiratory secretions, and to place on coughing patients to reduce dissemination of respiratory secretions. They may have either ear loops or ties, and can be either pleated or made of molded material. Surgical masks are cleared by the FDA as having fluid-resistant properties.
Procedure or isolation masks may also be used to protect the mouth and nose, but are not cleared by the FDA for fluid-resistant properties. There is no evidence to show that surgical masks are more protective than procedure masks, but there may be more variation in quality and performance among procedure masks. Many procedure masks have built-in eye protection, and are available in pleated or molded styles.
Goggles or face shields are used to protect eyes from splashes or sprays of blood and/or body fluids. Personal eye glasses or contact lenses are not considered adequate eye protection. Goggles and face shields should wrap around the sides of the face to protect against splashes from all angles.
Note: If PPE is being worn to protect against the spraying or splashing of a bloodborne pathogen, then all mucous membranes must be covered with a face shield or a mask and goggles.
Respirators protect the user in two basic ways, either by filtering contaminated ambient air or by providing a clean source of air. Respirators that remove contaminants from the air are called air-purifying respirators and include particulate respirators that filter out airborne particles and “gas masks” that remove gases and vapors from ambient air.
The classification of air-purifying respirators can be further subdivided into three categories:
- Filtering facepiece respirators: These are sometimes referred to as disposable particulate respirators because the entire respirator is discarded when it becomes unsuitable for further use due to considerations of hygiene, excessive resistance, or physical damage. The most commonly used respirators in health care settings are the N95, N99, or N100 particulate respirators. The device has a sub-micron filter capable of excluding particles that are less than 5 microns in diameter.
- Elastomeric facepiece respirators: These are sometimes referred to as reusable respirators because the facepiece is cleaned and reused while the filter cartridges and canisters are discarded and replaced when they become unsuitable for further use.
- Powered air-purifying respirators: These are battery-powered respirators in which a blower moves the air through the filters to the user.
Like other PPE, the selection of a respirator type must consider the nature of the exposure and risk involved. For example, N95 particulate respirators might be worn by personnel entering the room of a patient with infectious tuberculosis. However, if a bronchoscopy is performed on the patient, the health care provider might wear a higher level of respiratory protection, such as a powered air-purifying respirator. Employees who share the same air space with suspected or known TB patients, avian influenza patients, or who will be in direct contact with pandemic influenza patients need to wear a National Institute for Occupational Safety and Health (NIOSH) approved, fit-tested N95 or a powered air-purifying respirator until they are no longer in the air space shared by the infectious person.
Before you use a respirator, your employer is required to have you medically evaluated to determine that it is safe for you to wear a respirator, to fit test you for the appropriate respirator size and type, and to train you on how and when to use a respirator. YOU are responsible for fit checking your respirator before use to make sure it has a proper seal.
Additional information can be found at the National Institute for Occupational Safety and Health Respirators webpage.
What PPE should be used to clean vomitus? How should it be discarded?
Wear gloves to protect hands, and a surgical mask to prevent ingestion of aerosolized particles that may have been generated in the contaminated area. Gowns are also recommended if clothing or skin will come in contact with potentially infectious material.
Disposable items used for clean-up and PPE saturated or dripping with infectious material should be discarded into red biohazard bags, otherwise items may be placed into the regular trash.
What PPE is needed when in contact with a known or suspected TB patient?
A NIOSH certified fit-tested N95 filtering face piece or a powered air-purifying respirator must be worn by staff sharing the same air space as a potentially infected person. Staff who have not been fit tested or have not received a medical evaluation for the ability to wear a respirator must NOT be exposed to potentially infectious air.
What PPE is used if both airborne and contact precautions are needed, such as for SARS and Avian influenza?
Use a NIOSH certified fit-tested N95 filtering face piece or a powered air-purifying respirator, gown, and gloves. These diseases also require use of eye protection (goggles or face shield) during patient contact.
When PPE is needed during home visits, when should PPE be put on?
PPE, such as gowns, gloves, and surgical masks, should be donned in an entrance of the home where a client is least likely to have contaminated the area. Clients should be notified in advance of the visit, if possible, to make sure they are not at the entrance when health care staff arrive.
If respiratory protection is needed, however, the N95 filtering face piece or a powered air-purifying respirator must be applied before entering the home and remain on until outside the home. Fit-check steps should be performed before entering the home when wearing an N95 filtering face piece.
How often does the employer need to provide training for staff requiring PPE?
Initial training must be done prior to use of PPE, and thereafter when an employer has reason to believe that an employee does not have appropriate understanding of the use of PPE, or when there are changes in the workplace or types of PPE rendering previous training obsolete. Per the Infection Control Assessment and Response assessments, PPE retraining and competency is recommended annually in all health care facilities.
Who can provide training?
There are no specific requirements for the person assigned to provide training. However, the trainer should have competency in this area.
How should PPE be stored?
Generally PPE should be stored in a dry area at room temperature, protected from dust, moisture, and other contamination. Check with the manufacturer for more specific storage conditions. Some items may have expiration dates and will require rotation of stock to avoid outdating.
The Sequence for Putting On and Removing PPE
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