Infection control principles and practices for local health agencies
For communicable disease exposure, PPE is specialized clothing or equipment used to prevent contact with hazardous substances. Its use is an integral part of infection control and prevention measures that protect workers from exposure to blood, body fluids, and other potentially infectious materials. PPE such as gowns, gloves, masks, and goggles provide physical barriers that prevent the hands, skin, clothing, eyes, nose, and mouth from coming in contact with infectious agents. PPE is used to reduce transmission of communicable diseases when other measures such as engineering controls and work practices cannot completely eliminate exposure.
Employers are required by OSHA standard 29 CFR Part 1910.132 to assess the workplace for hazards that necessitate the use of PPE and document that such an assessment has been done. They must also provide appropriate PPE in the workplace, store and maintain PPE in good working order, train employees on proper use of PPE, and ensure that employees use PPE appropriately. The following PPE affords protection of mucous membranes, skin, and clothing from infectious agents. Local public health agencies must have these items readily available at all times for use by employees with exposure to communicable diseases. Items such as uniforms, pants, blouses, and eyewear not intended to protect against communicable diseases are not considered PPE.
Clean, disposable gloves are worn during direct contactwith blood/body fluids, mucous membranes, non-intact skin, or any other potentially infectious material. They are also worn as a part of contact precautions (for persons infected with pathogens transmitted by the contact route, such as MRSA, VRE, and RSV) while directly touching the patient or when in the immediate patient environment.
Disposable gloves are available in latex, vinyl, and nitrile materials. Since many individuals are allergic to latex, vinyl, or nitrile gloves are recommended alternatives. Vinyl gloves can be used for brief patient contact but nitrile gloves provide greater barrier protection for extended patient care activities or those requiring more manual dexterity. Local health agencies can select either vinyl or nitrile products for their clinical functions.
Discard gloves at point of use and wash hands immediately after removing gloves.
Isolation gowns are used as part of standard and contact precautions to protectclothing and arms of health care workers. When used for standard precautions, gowns are worn only if contact with blood/body fluids is expected. Fluid resistant gowns should be used when splashes or sprays of blood/body fluids are expected. For contact precautions, gowns are worn during all patient contact and when in the patients environment. Gowns are always worn in combination with gloves, and with other PPE when indicated. Remove at point of use and discard disposable gowns or place cloth gowns in laundry container. Wash hands immediately after removing all PPE.
Surgical masks are used to protect the mouth and nose from splashes or sprays of blood/body fluids, or respiratory secretions, and to place on coughing patients to reduce dissemination of respiratory secretions. They may have either ear loops or ties, and can be either pleated or made of molded material.
Surgical masks are cleared by the FDA as having fluid-resistant properties.
Procedure or isolation masks may also be used to protect the mouth and nose, but are not cleared by the FDA for fluid resistant properties. There is no evidence to show that surgical masks are more protective than procedure masks, but there may be more variation in quality and performance among procedure masks. Many procedure masks have built-in eye protection, and are available in pleated or molded styles.
Local health agencies may select either surgical or procedure masks, depending on employees preference.
Goggles or face shields are used to protect eyes from splashes or sprays of blood/body fluids. Personal eye glasses or contact lenses are not considered adequate eye protection. Goggles and face shields should wrap around the sides of the face to protect splashes from all angles.
PAPRs are battery operated respirators that filter the air before it enters a hood worn over the head. Loose fitting PAPRs do not require fit-testing but users must undergo a medical evaluation prior to wearing. Many users prefer PAPRs over an N-95 FFP as a more comfortable option for respiratory protection. Unlike N-95 FFPs, PAPRs require battery maintenance and cleaning procedures between uses.
Frequently Asked Questions
What PPE should be used to clean vomitus? How should it be discarded?
Wear gloves to protect hands, and a surgical mask to prevent ingestion of aerosolized particles that may have been generated in the contaminated area. Gowns are also recommended if clothing or skin will come in contact with potentially infectious material.
Disposable items used for clean-up and PPE saturated or dripping with infectious material should be discarded into red biohazard bags, otherwise items may be placed into the regular trash.
What PPE is needed when in contact with a known or suspected TB patient?
A NIOSH certified fit-tested N-95 filtering face piece (FFP) or a powered air-purifying respirator (PAPR) must be worn by staff sharing the same air space as a potentially infected person. Staff persons who have not been fit-tested or have not received a medical evaluation for the ability to wear a respirator must NOT have exposure to potentially infectious air.
What PPE is used if both airborne and contact precautions are needed, such as for SARS and Avian influenza?
Use a NIOSH certified fit-tested N-95 filtering face piece or PAPR, gown, and gloves. These diseases also require use of eye protection (goggles or face shield) during patient contact.
When PPE is needed during home visits, when should the PPE be put on?
PPE such as gowns, gloves, and surgical masks should be donned in an entrance of the home where a client is least likely to have contaminated the area. Clients should be notified in advance of the visit, if possible, to make sure they are not at the entrance when local health agency staff arrives.
If respiratory protection is needed, however, the N-95 filtering face piece or PAPR must be applied before entering the home and remains on until outside the home. Fit-check steps should be performed before entering the home when wearing an N-95 filtering face piece.
How often does the employer need to provide training for staff requiring PPE?
Initial training must be done prior to use of PPE, and thereafter when an employer has reason to believe that an employee does not have the understanding of use of PPE, or when there are changes in the workplace or types of PPE rendering previous training obsolete.
Who can provide training?
There are no specific requirements for the person assigned to provide training. However, it is best to select someone with knowledge in this area.
How should PPE be stored?
Generally PPE should be stored in a dry area at room temperature, protected from dust and moisture. Check with the manufacturer for more specific storage conditions. Some items may have expiration dates and will require rotation of stock to avoid outdating.
Gwen Borlaug, Infection Control Epidemiologist
Wisconsin Division of Public Health
Bureau of Communicable Diseases