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PPE in Healthcare: How to Prevent Exposure and Contamination

Jan 22, 2020

When people think about personal protective equipment (PPE), they may think of hard hats,Female surgeon putting on surgical gloves before operation steel-toe boots and protective eyewear. In the healthcare industry, however, PPE takes on a different meaning and purpose. In many work settings, PPE is used to protect workers from potential injuries. In healthcare, the primary purpose of PPE is to protect doctors, nurses and others from illness as they work with patients. 

More than 18 million Americans work in the healthcare industry and without the proper PPE, these workers are putting their own safety, health and well-being and that of the public at risk.

“PPE is very much an active control, where the employee has to recognize the need for it, find, get it, put it on and ensure that it is effective,” says Cory Worden, CSP, safety advisor for the City of Houston Department of Health.

In most cases, safety professionals are told to start at the top of the hierarchy of controls as they address workplace hazards. In healthcare, however, PPE may be the best, and in some cases, only option for protecting doctors, nurses and others from illness. 

“We can’t eliminate the hazard because it’s a patient and we can’t choose our patients,” says Worden. “We can’t substitute our patients or isolate doctors and nurses from the patient with engineering controls, so the only thing that even possible to do to keep all of those bodily fluids off of a nurse or doctor is PPE.”

These three concepts can help protect the health and safety of doctors, nurses, staff and the public. 

1.     Develop Situational Awareness

A hospital may have hundreds of patients at any one time, many with unique ailments. This makes situational awareness critical to protecting the health of doctors, nurses, patients and the public. 

A big part of this equation is doctors and nursing staff familiarizing themselves with the conditions of every patient,” says Worden. “It’s important for them to be diligent about staying up on all the patients that they’re dealing with and communicate that to everyone affected so they know what kind of PPE needs to be worn before they even set foot in a patient’s room.” 

Situational awareness helps hospital staff and visitors know what PPE they need to wear around each patient, such as a gown, gloves, a face shield or a respirator. Worden notes that each patient who comes through the door is unique situation, so medical staff must assess that patient by asking several key questions:

1.     Does the patient present any specific hazards, other than the fact that they’re seeking healthcare?

2.     What is the severity of those hazards? 

3.     What can be done to address those hazards?

For example, an ill patient may enter a healthcare facility after returning from overseas travel. In such a case, the staff must take precautions to protect the public. The patient may be given a surgical mask to prevent droplet contamination from coughing or sneezing. 

It’s also important to remember that each patient's condition is constantly changing, making communication and situational awareness throughout their stay at the healthcare facility all the more critical.

2.     Learn How to Don and Doff Equipment Correctly

To properly protect yourself and others in healthcare environments, you have to understand how to properly put on and take off PPE. To prevent potential exposure or contamination, staff must follow specific protocols for donning and doffing PPE before and after entering a patient’s room.

 “Donning and doffing is very much a diligence-based process that everyone needs to be intensely familiar with,” says Worden. “If we’re not extremely diligent in making sure everything is done properly, there will be an exposure.” 

CDC offers guidance on the sequence for donning and doffing specific pieces of PPE in healthcare settings. Both actions are step-by-step processes where employees must put on and take off equipment in a specific order.

When putting on equipment, users must ensure that PPE is the proper fit, that it is taped appropriately and that there are no gaps that would allow it to be infiltrated. After the patient has been treated and medical staff move from the “hot area” or hazardous area and into the “warm area” or transition area, they should remove equipment one piece at a time.

3.     Properly Dispose of Equipment

Once equipment is removed, it must be appropriately discarded to prevent potential bloodborne pathogen exposure or other contamination. 

“With any type of contaminated waste, there is always the possibility of cross-contamination, so any medical waste has to be properly discarded and properly disposed of,” says Worden. 

The waste is placed into containers that must be emptied when they are three-quarters full. State regulations dictate how disposal of medical waste is handled. The EPA encourages healthcare facilities to speak with their state EPA or state health agency for information regarding medical waste disposal. 

Worden notes that in addition to PPE “sharps” such as syringes and other such medical devices are subject to specific OSHA recordkeeping requirements. He adds that hospital staff must ensure that any medical waste is safely and securely disposed of, not only for employees to avoid injuries and illnesses, but also for patients and the general public. Having used medical equipment lying around or in a location that is easily accessible endangers the health and safety of everyone in the facility. 

To help medical professionals, safety professionals and healthcare facility staff, Worden developed a hazard control tracking chart, PPE assessment matrix and a frequency and severity model to help identify hazard groups, the PPE needs for each of those groups and  probability and severity of specific hazards. 

Related Links 

Safety Culture in Healthcare: The $13 Billion Case

Patient Safety: Hospital Technicians & Information Overload

Hazardous Drugs: Controlling the Risk in Healthcare Facilities  

Exposure to Bloodborne Pathogens in the Hospital

Behavior-Based Safety: Improvement Opportunities in Hospital Safety

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