Personal protective equipment:Looking back to move forward

The OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION considers personal protective equipment (PPE) to be specialized clothing or equipment worn by an employee for protection against a hazard, such as patient blood and other body fluids.

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The OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION considers personal protective equipment (PPE) to be specialized clothing or equipment worn by an employee for protection against a hazard, such as patient blood and other body fluids. General work clothes (e.g., uniforms, pants, shirts, or blouses) not intended to function as protection against a hazard are not acceptable forms of PPE.

There is a hierarchy of safety and health controls. The most effective are training and administration controls, followed by engineering, and then work practice controls. Training and administration, engineering, and work practice controls eliminate or minimize employee exposure. Where occupational exposure remains after application of these controls, one can use PPE to improve employee safety and health.

The common PPE used by dental personnel include gloves, masks, protective eyewear, face shields, and clinic gowns. Each year, new products and materials enter the marketplace. PPE, such as gloves and masks, are now widely available in pharmacies and discount stores. Sometimes, a combination of PPE with a disinfectant and an antiseptic comprise a prevention kit for home use.

Guidance concerning the selection and use of PPE is valuable. The Centers for Disease Control and Prevention has prepared a useful PowerPoint presentation. It is available at www.cdc.gov/ncidod/dhqp/pdf/ppe/PPEslides6-29-04.ppt.

The presentation reviews the applicable OSHA position on PPE. Employers must provide appropriate PPE for employees, and ensure that the PPE is disposable – or if reusable – it is properly cleaned, laundered, repaired, and stored for use. OSHA also specifies circumstances that require PPE use and recommends when, what, and how to use PPE.

A number of factors affect the selection of PPE. The first decision involves the nature of the exposure anticipated – infectious, heat, or chemicals. Is the PPE reasonable, necessary, and appropriate for the hazard? Fit is also important when it comes to PPE since comfort improves compliance. Other decision points include biocompatibility, longevity, style, fashion, and cost.

Gloves are used for patient care, instrument handling, and environmental infection control. They come in a variety of materials including latex, nitrile, rubber, and vinyl. They are single use or reusable. Gloves are available in sterile or nonsterile forms as singles or pairs.

Glove type must match the hazard present. Utility gloves are for transporting and cleaning soiled instruments. Heat-resistant gloves are for removing hot instruments from sterilizers. Gloves used clinically for exams, and sterile surgical types are single-use, disposable items. Like other types of PPE, gloves are not considered to be regulated medical waste. Thus, they do not require special storage, handling, or disposal.

Masks are also single-use, disposable items. In order to protect the nose and mouth, masks must fit properly (tight seal). The goal of the mask is to protect against spatter, and to filter incoming air at a 95 percent efficiency level. Avoid touching a mask with gloved, or worse yet, ungloved hands. Never move the mask to the top of your head or pull the mask under your chin, and then put it back into place. This action spreads microorganisms and defeats the purpose of the mask. Change masks between patients, and if they become moist.

Protective eyewear, such as spectacles with side shields and goggles, must also fit tightly around the eyes and should have adequate projectile resistance. Face shields should cover the forehead, extend below the chin, and wrap around the sides of the face. Reusable PPE, such as protective eyewear and face shields, require routine cleaning with soap and water. Once visibly soiled, they should be disinfected between patients. This should be done according to the manufacturer’s directions.

Appropriate clinic gowns do not permit blood or other potentially infectious materials to reach an employee’s work clothes, street clothes, undergarments, or skin. They are to be the outermost clothing worn. Clinic gowns may be single use, disposable, or reusable. Employers must not only provide clinic gowns but must clean, launder, and dispose of them at no cost to an employee.

Employers also must repair or replace clinic gowns, as needed, to maintain its effectiveness at no cost to the employee. If blood or other potentially infectious materials penetrate a garment, the garment must be removed as quickly as possible. Removal of gowns also must occur prior to leaving a work area. The selection of gowns can pose a problem. Many of these concerns involve comfort. Employee input is required to better assure success.

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Dr. Charles John Palenik is the director of Infection Control Research and Services at the Indiana University School of Dentistry. He is the co-author of the popular “Infection Control and Management of Hazardous Materials for the Dental Team.” In 2003, he was chairman of the Executive Board of OSAP. Infection control questions may be directed to cpalenik@iupui.edu.

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