Shoe covers can protect your shoes and feet from spills of biohazardous materials or chemicals. Shoes that are not protected by shoe covers and that cannot be appropriately disinfected may need to be dis- posed of after a spill.
Putting on and Removing Personal Protective Equipment
The order in which you don and remove your PPE is chosen to ensure that you do not contaminate your skin or clothing with infectious agents. Proce- dures for putting on and removing PPE are illus- trated in Procedures 4-2 and 4-3.
Standard Precautions
Standard Precautions refer to infection control measures that use barrier protection and work prac- tice controls to prevent contact between skin or mucous membranes and blood, other body fluids, and tissues from all people. Standard Precautions are based on the difficulty of identifying all indi- viduals who are infected or harboring infectious agents with whom the health care worker may come in contact. Standard Precautions should be the minimum level of precautions applied when coming in contact with all patients. Guidelines for Standard Precautions were published by the Centers for Dis- ease Control and Prevention (CDC) in 1996 and include the following:
• Hand hygiene. Disinfect hands whether or not gloves are worn. Use an alcohol-based hand agent unless hands are visibly contaminated, in which case, use soap and water.
• Gloves. Wear gloves when collecting or handling blood, body fluids, tissue samples, secretions, excretions, and items contaminated with blood or body fluids. Remove gloves promptly after use and disinfect your hands.
• Gowns. Wear fluid-resistant gowns when there is a likelihood of contamination of your clothing or skin with blood or body fluids.
• Face protection. Wear appropriate protection (mask and goggles or chin-length face shield)
when there is a danger of spray, spatter, or aero- sol formation.
• Sharps disposal. Dispose of all needles and other sharps in a puncture-proof container after engag- ing the safety device. Do not recap the needle.
• Respiratory hygiene and cough etiquette. This component of Standard Precautions was added in 2003 in response to the severe acute respiratory syndrome (SARS) outbreak. These infection con- trol measures are aimed at preventing transmis- sion of respiratory infections. These measures apply to patients, their families and friends, and any person with signs of a cold and respiratory infection. The precautions include posting signs to instruct people who are coughing to cover mouth and nose with tissues, dispose of used tis- sues in the trash, and perform hand hygiene after contact with respiratory secretions. There should also be a supply of tissues and alcohol-based hand agents available for these patients, and people who are coughing should be asked to wear a surgical mask and separate themselves from other patients in the waiting room if possible.
OCCUPATIONAL SAFETY AND
PROCEDURE 4-2
Putting on Personal Protective Equipment
Perform hand hygiene before donning PPE.
1. Put on the gown.
Tie the gown behind your back.
2. Put on the mask, respirator, and goggles or face shield.
Secure the mask straps. Crimp the metal band down across the bridge of your nose. If you are donning a respirator, secure the elastic band at the middle of your head and neck.
Crimp the metal band down across the bridge of your nose. Perform a fit check. Don gog- gles or a face shield. Adjust the face shield headband for a firm, comfortable fit.
3. Put on the gloves.
Pull the gloves on tightly, and stretch the ends of the gloves over the cuffs of the gown. The gloves should fit snugly over the cuffs.
PROCEDURE 4-3
Removing Personal Protective Equipment*
The order of removal is important to prevent contami- nation of your skin and clothing. Except for the res- pirator, your PPE should be removed at the doorway, before leaving the patient’s room, or in the ante- room. Remove the respirator outside the room, after the door has been closed, to avoid airborne transmission.
1. Remove the gown and gloves.
These are likely to be the most heavily contaminated items, so they are removed first. If the gown has ties, be sure to untie before removal. Begin removing it by peeling it off over your arms, turning the sleeves inside out as you go. Before you complete removal of the gown, you will begin removing your gloves. Grasp the cuff of one glove with the opposite hand. Peel it off your hand, turning it inside out as you go. Repeat for the other glove, grasping it not with your bare hand but with the fabric of the gown. (In this way, your hands do not touch the contaminated outside surfaces of either the glove or the gown.) Complete removal by rolling the gloves and gown together and disposing of them according to hospital policy.
be treated as if they are infectious and must im- plement work practice and engineering controls to minimize or prevent occupational exposure.
• Employers must provide immunization against HBV to employees free of charge. If the em- ployee declines the vaccine, the employer must document that the vaccine was offered by having the employee sign a declination statement, which must be kept in the employee’s personnel file.
• Employers must provide free medical follow-ups to employees in the event of accidental exposure.
• Employers must provide education and safety
training for employees at the time of hire and annually thereafter.
• Employers must provide additional training, ed- ucation, and containment policies for human immunodeficiency virus (HIV) and HBV re- search laboratories.
• All biohazardous materials must be appropriately identified with a biohazard label (Figure 4-4) or a color-coded system and contained to prevent leak- age. Regulated medical waste must be disposed of into appropriate containers (e.g., sharps and needles into puncture-resistant, leak-proof containers).
PROCEDURE 4-3—cont’d
Removing Personal Protective Equipment
2. Perform hand hygiene.
3. Remove the goggles or face shield.
The outside of the goggles or face shield is contami- nated. To remove, handle by the clean headband or earpieces. Follow hospital infection control policy for proper disposal.
4. Remove the mask or respirator.
The front of the mask or respirator is contaminated.
Grasp the bottom ties or elastics and then the top ones, and remove. Follow hospital infection control policy for proper disposal.
5. Perform hand hygiene again after removing all PPE.
*These steps follow the World Health Organization guidelines. Each facility has its own procedures that may differ slightly; check with your facility for its procedure.
• Employers must provide a written schedule for cleaning, including a procedure for how to clean blood and other potentially infectious materials and the type of disinfectant to use. Employees must carry out daily and as-needed disinfection protocols on countertops and workspaces (e.g., bleach disinfection).
• Employers must maintain records on occupa- tional exposure and employee training sessions.
Following these mandated standards signifi- cantly reduces the likelihood of infection.
All specimens should be handled as if they con- tain bloodborne pathogens. This is the best way to ensure your safety and that of others in the work- place. All tubes should be placed in a biohazard bag after filling, and the bag should be sealed before transport.