Personal Protective Equipment

Safety for Staff and Patients

Personal protective equipment (PPE) has been a topic of discussion in EndoNurse on more than one occasion. In the past, we have focused on new products and solutions for personal protection, but not always the reasons behind wearing these items. In this issue, EndoNurse explores good reasons to wear PPE and how to wear it properly, as well as new advances in technology to make healthcare workers safer than ever before. 

The Occupational Safety and Health Administration (OSHA) requires PPE to be provided for every healthcare worker, free of charge. According to OSHA’s Bloodborne Pathogens standard, in the section on PPE, the administration writes, “When there is occupational exposure, the employer shall provide, at no cost to the employee, appropriate personal protective equipment such as, but not limited to, gloves, gowns, laboratory coats, face shields or masks and eye protection, and mouthpieces, resuscitation bags, pocket masks, or other ventilation devices. Personal protective equipment will be considered ‘appropriate’ only if it does not permit blood or other potentially infectious materials to pass through to or reach the employee’s work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used.”¹ 

The question is, what is appropriate, and when? 

Gowns and Scrubs 

In many facilities, nurses, techs, and other healthcare workers will launder their own scrubs at home and wear them into work, rather than donning them at the hospital, or having the hospital launder the work clothing. Not only that, but non-scrub clothing, such as warm-up jackets, is also being worn into the healthcare setting. 

This is not necessarily “bad” — it depends on the healthcare setting and the policies and rules established by the facility. Restricted areas such as the operating room (OR) would necessitate more stringent rules about “street clothing” or home-laundered scrubs. But procedure rooms, which are not kept sterile like the OR is, leave more room for interpretation. 

Columnist Carol Peterson, RN, MAOM, CNOR, a perioperative nursing specialist from the AORN Center for Nursing Practice, commented, “AORN does not advocate people entering the restricted or semi-restricted area in street clothes or attire that is of questionable cleanliness ... Although there is controversy about home laundering scrub attire vs. facility-approve laundering, AORN recommends that all reusable surgical attire (i.e., scrubs, cloth hats, warm-up jackets) be laundered in a facility-approved and monitored laundry.” However, these comments were in relation to attire worn in the OR. 

Cover apparel is another issue; its use should be determined by each individual practice setting, the AORN standards say. “The value of cover apparel is unknown ... Controversy over cover apparel stems not from its effectiveness in reducing contamination, but from practical considerations of enforcement and cost.”² 

Many areas of healthcare require some kind of barrier product; OSHA suggests the following groups may be at high risk: medical technologists, OR staff, phlebotomists, intravenous therapy nurses, surgeons, pathologists, oncologists, dialysis unit staff, emergency room staff, nursing personnel, staff physicians, dental professionals, laboratory and blood bank technicians, emergency medical technicians.³ 

However, the suitability of scrubs at all may be questioned. Nathan L. Belkin, PhD, was selected by the guidelines committee of the Association for Professionals in Infection Control and Epidemiology (APIC) to author a “state-of-the-art report” (SOAR) on scrubs. A SOAR is developed to function similar to a guideline when there is little to no scientific evidence on which to base recommendations. (APIC guidelines are based on a body of scientific knowledge.) 

“There is no scientific evidence that the use of scrubs or other related apparel contributes to either the cause or the prevention of infections associated with healthcare facilities,” Belkin writes in his 1997 report. “However, because this type of apparel is now used so commonly as a replacement for the more traditional type of uniform, its original function as an ensemble worn by surgical personnel no longer prevails.⁴ 

“At a time when the entire healthcare community is being pressured to contain and reduce costs, continuing a practice for which there is no identifiable benefit may not be considered cost-effective or reflect a sense of fiscal responsibility,” he adds. “Therefore, if the costs associated with the use of scrubs are significant and outweigh any identified benefit, their use may need to be reevaluated.” 

This is not to say that scrubs should be eliminated from the workplace. An identifiable uniform is highly recommended so that patients can tell who is a “civilian” and who is a healthcare worker. But it is important to be aware of what protective benefits the clothing provides, and to know if more is necessary, such as a fluid-repelling gown to wear over the scrubs. 

Gloves 

Gloves are a more diverse breed of PPE. There are multiple gloves for multiple applications. Surgical and exam gloves are divided into latex or non-latex, powdered or powder-free, double gloves or gloves with a color indicator to reveal a breach in the glove’s outer layer. 

When choosing the right glove for the job, healthcare workers must consider the glove’s barrier properties, then comfort. Safety must always come first; this includes allergies of the staff member or patient to latex, for example. Staff members may develop latex allergy after repeated exposure; they may also develop allergies or sensitivities to the chemical used with the glove, including the powder. 

Gloves are available in latex or synthetic — which can be composed of nitrile, neoprene, polyisoprene, and others. A new option may soon be on the market — guayule, which is distantly related to the rubber plant, but does not contain the allergens that rubber latex does. 

But gloves are only good if they are cared for properly. “In order to maintain optimal barrier integrity prior to use, it is imperative to store gloves appropriately to prevent degradation and maintain glove reliability,” says Lori F. Jensen, RN, a clinical consultant at Ansell Healthcare. “Extreme temperatures adversely affect gloves. To obtain peak performance of any glove, most glove manufacturers recommend that gloves be stored in a cool, dry environment with a temperature ranging between 50°-72° F (10°-22° C). 

Gloves are so sensitive to heat that reports have been made of spontaneous combustion after chlorinated, powder-free, latex exam gloves were stored on pallets in warehouses, in high temperatures, Jensen says. “While it is not possible to identify a maximum safe storage temperature, research has confirmed that the greater the mass quantity of gloves, the cooler the temperature must be to avoid fires,” she adds. 

Radiation Protection 

Burlington Medical Supplies Inc. meets another PPE need — protection against radiation. Many endoscopy facilities provide imaging, often for “upper GIs” or barium swallows, and the healthcare workers providing this imaging need to be protected against exposure to radiation. “Everyone can be exposed to a certain amount of radiation in their lifetimes; however, a healthcare worker in an imaging suite could be exposed to a lifetime’s worth in a matter of days,” says Alan Leming, vice president of sales and service at Burlington. Burlington also provides outside coverings for the protective equipment that imaging workers use. The material can be made of vinyl or “pleather” and is washable, stain-resistant, and can be wiped down with a mild cleansing agent if exposed to fluid waste. They offer patient positioning sponges that can be cleaned and re-used, rather than disposed of. Some other protective equipment — “vests” and “kilts” may come with a back-saver type of design, Leming says — to transfer weight from the shoulders to the pelvic girdle region. They also can provide some lower back support. One-piece wraparound aprons are also available for both front and back protection. 

When selecting PPE, nurses and techs must choose the right items for each procedure, but also ensure that it is safe to use — that it has been stored properly and that it shows no signs of wear and tear. Only then can they assure the best possible outcomes for their patients and the safest environment for themselves. 

For references, visit www.endonurse.com 

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