PERSONAL PROTECTIVE EQUIPMENT (PPE)
Personal protective equipment (PPE) refers to a variety of barriers, used alone or in combination, to protect mucous membranes, airways, skin and clothing from contact with infectious agents. The goal of using personal protective equipment (PPE) for infection control is to improve personnel safety in the healthcare environment through appropriate use of PPE. Selection of protective equipment must be based on assessment of the risk of transmission of infectious agents to the patient and the risk of contamination of the clothing or skin of healthcare workers or other staff by patients’ blood, body substances, secretions or excretions.
Personal Protective Equipment (PPE) is specialized clothing or equipment worn by an employee for protection against infectious materials (Occupational Safety and Health Act).
PPE prevents contact with an infectious agent or body fluid that may contain an infectious agent, by creating a barrier between the potential infectious material and the healthcare worker.
Factors Influencing PPE Selection
· Type of exposure anticipated
· Splash/spray versus touch
· Category of isolation precautions
· Durability and appropriateness for the task
· Fit: PPE must fit the individual user
Types of the PPE used in health care
· Gloves – protect hands
· Gowns/aprons – protect skin and/or clothing
· Masks and respirators – protect mouth/nose
· Respirators – protect respiratory tract from airborne infectious agents
· Goggles – protect eyes
· Face shields – protect face, mouth, nose, and eyes
· Purpose patient care, environmental services, other
· Glove material – vinyl, latex, nitrile, other
· Sterile or non-sterile
· One or two pair
· Single use or reusable
Do’s and Don’ts of Glove Use
Work from “clean to dirty”
Limit opportunities for “touch contamination”
protect yourself, others, and the environment
Masks: Should fully cover nose and mouth and prevent fluid penetration.
Goggles – protect eyes
· Should fit snuggly over and around eyes
· Personal glasses not a substitute for goggles
· Antifog feature improves clarity
· prescriptive lenses do not provide adequate eye protection
· Goggles should be warn as part of Standard Precautions
· Don’t touch your face or adjust PPE with contaminated gloves
· Don’t touch environmental surfaces except as necessary during patient care
· When visibly soiled, torn or punctured.
· During use if torn and when heavily soiled (even during use on the same patient)
· After use on each patient
· Discard in appropriate receptacle
· Never wash or reuse disposable gloves
· Wash hands upon removing gloves. Gloves do not replace the need for excellent hand washing!
Face shields – protect face, nose, mouth, and eyes
· Should cover forehead, extend below chin and wrap around side of face.
· Wear a face shield when facial skin protection is needed in addition to eye, nose and mouth protection.
GOWNS OR APRONS
· Gowns help protect you from the contamination of clothing with potentially infectious material.
· Wear a gown when contamination of clothing with potentially infectious material is possible.
· Your gown should fully cover the torso, fit close to the body and cover the arms to the wrists.
Choose a gown appropriate to the situation:
· Disposable vs re-useable (requires laundering).
· Fluid-resistant vs non fluid-resistant
· Sterile vs clean.
· Purpose protect from inhalation of infectious aerosols (e.g., Mycobacterium tuberculosis)
· PPE types for respiratory protection
· Particulate respirators For example, N95 particulate respirators might be worn by personnel entering the room of a patient with infectious tuberculosis.
· Self-Contained Breathing Apparatus (SCBA) Respirators
· Powered air purifying respirators (PAPR)
SHOE AND HEAD COVERS
· Shoe and head covers provide a barrier against possible exposure within a contaminated.
· Wear shoe covers to provide a barrier against possible exposure to air borne organisms or contact with a contamination environment.
· Use shoe covers for patients with hemorrhagic disease.
· Shoe covers should be worn as part of full barrier precautions.
Head covers (bonnets)
Wear head covers to protect the hair and scalp from possible contamination when sprays or airborne exposure is anticipated.
3. Handling and disposing of sharps
The use of sharp devices exposes healthcare workers to the risk of injury and potential exposure to blood borne infectious agents, including hepatitis B virus, hepatitis C virus and human immunodeficiency virus (HIV).
Sharps injuries can occur in any healthcare setting, including non-hospital settings such as in office based practices, home health care and long-term care facilities. Injuries most often occur
· during use of a sharp device on a patient (41 0/0);
· after use and before disposal of a sharp device (40%); and
· during or after appropriate or inappropriate disposal of sharp devices (15%).
Examples of sharps associated with sharps injuries in healthcare settings
Examples of hollowbore sharps
Examples of non hollowbore sharps
• Disposable needles/ syringes
• Glass vials
• Steel-winged (butterfly) needles
• Dental probes
• Intravenous catheter stylets
• Scalpel blades
• Multi-sample blood collection needles
• Suture needles
• Arterial blood collection syringe needles
• Aspiration needles
• Skin or bone hooks
• Injector pen needles
• Sharp electrosurgical tips
Handling of sharps
All healthcare workers should take precautions to prevent injuries caused by needles, scalpels and other sharp instruments or devices: during procedures; when cleaning used instruments; during disposal of used needles; and when handling sharp instruments after procedures.
Standard measures to avoid sharps injuries include handling sharp devices in a way that prevents injury to the user and to others who may encounter the device during or after a procedure. Examples include:
1) Using instruments to grasp needles, retract tissue, and load/unload needles and scalpels rather than fingers
2) Giving verbal announcements when passing sharps
3) Avoiding hand-to-hand passage of sharp instruments by using a basin or neutral zone
4) Using round-tipped scalpel blades instead of pointed sharp-tipped blades.
5) Needles must not be recapped, bent or broken after use.
Disposal of single-use sharps
· Any person who has used a disposable sharp instrument or equipment must be responsible for its safe management and immediate disposal after use.
· After they are used, single-use syringes and needles, scalpel blades and other sharp items should be placed in an appropriate container. These containers should be clearly labelled, puncture and leak proof.
· Sharps containers must be appropriately placed so that they are out of reach of children.
· They should also be placed in a secure position or mounted on the wall to prevent tipping.
Reducing risks if a sharp injury is sustained
· Seek care immediately if you sustain a sharps injury
· If skin is penetrated, wash the affected area immediately with soap and water. Alcohol-based hand rub can be used to clean the area if soap and water are not available.
· Do not squeeze the affected area.
· Report the incident immediately to your supervisor.
· Ask about follow-up care, including post-exposure prophylaxis, which is most effective if implemented soon after the incident.
· Complete an accident / incident report form, including the date and time of the exposure, how it happened, and name of the source individual (if known).
· If a sharps injury happens to you, you can be reassured that only a small proportion of accidental exposures result in infection. Taking immediate action will lower the risk even further.
4.) Routine management of the physical environment
Infectious agents can be widely found in healthcare settings and there is a body of clinical evidence, derived from case reports and outbreak investigations, suggesting an association between poor environmental hygiene and the transmission of infectious agents in healthcare settings. Transmission of infectious agents from the environment to patients may occur through direct contact with contaminated equipment, or indirectly, for example, in the acute-care setting, via hands those are in contact with contaminated equipment or the environment and then touch a patient.
Routine environmental cleaning
General surfaces can be divided into two groups – those with minimal hand contact (e.g. floors and ceilings) and those with frequent skin contact frequently touched’ or ‘high risk’ surfaces).
Minimal touch surfaces
A detergent solution (diluted as per manufacturer’s instructions) is adequate for cleaning general surfaces (e.g. floors, walls), as well as non-patient-care areas (e.g. administrative offices). Damp mopping is preferable to dry mopping for routine cleaning
Walls and blinds in patient-care areas should be cleaned with detergent solution when they are visibly dusty or soiled.
Frequently touched surfaces
Surfaces that are in close proximity to the patient and frequently touched surfaces in the patient care areas should be cleaned more frequently than minimal touch surfaces. Examples include doorknobs, bedrails, over-bed tables, light switches, tabletops and wall areas around the toilet in the patient’s room.
Management of blood and body substance spills
Prompt removal of spots and spills of blood and body substance followed by cleaning and disinfection of the area contaminated is a sound infection control practice and meets occupational health and safety requirements Process of spills management
Strategies for decontaminating spills of blood and other body substances (e.g. vomit, urine) differ based on the setting in which they occur and the volume of the spill:
· in patient-care areas, healthcare workers can manage small spills by cleaning with detergent solution
· for spills containing large amounts of blood or other body substances, workers should contain and confine the spill by:
· removing visible organic matter with absorbent material (e.g. disposable paper towels)
· removing any broken glass or sharp material with forceps
· soaking up excess liquid using an absorbent clumping agent (e.g. absorbent granules).
· Appropriate PPE should be worn at all times.
· If spillage has occurred on soft furnishings, a detergent solution can be used to clean the area thoroughly. Do not clean soft furnishings with a disinfectant such as sodium hypochlorite
· Soft furnishings can also be wet vacuumed. Following cleaning of soft furnishings, every effort must be made to air the room to allow drying of the furnishing before reuse.
· Alcohol solutions should not be used to clean spillages
A spill kit should be readily available in each clinical area and should include a scoop and scraper, single-use gloves, protective apron, surgical mask and eye protection, absorbent agent, clinical waste bags and ties, and detergent. All parts should be disposable to ensure that cross contamination does not occur.
5. Reprocessing of reusable instruments and equipment
Any infectious agents introduced into the body can establish infection. In all healthcare settings, reusable instruments and equipment should be handled in a manner that will prevent patient, healthcare worker and environmental contact with potentially infectious material.
Any instrument or piece of equipment that is to be reused requires reprocessing – cleaning, disinfection and/or sterilization. The minimum level of reprocessing required for reusable instruments and equipment depends on the individual situation (i.e. the body site and the nature by which the instrument will be used).