Infection Control: PPE + Safety Practices

PPE

is used every day by healthcare personnel (HCP) to protect themselves, patients, and others when providing care

PPE

helps protect HCP from potentially infectious patients and materials, toxic medications, and other potentially dangerous substances used in healthcare delivery. 

• Surgical Gloves

• Surgical Gowns

• Masks/Respirators

• Goggles/Face Shields

WHAT ARE THE PPE?

Hierarchy of Controls

Method of identifying and ranking safeguards to protect workers from hazards

•Elimination

•Substitution

•Engineering Controls

•Administrative Controls

•PPE

HIERCHY OF CONTROLS | Arranged from the most to least effective which includes:

Elements of PPE selection

•Type of anticipated exposure – low risk exposure or high-risk exposure

•Durability and appropriateness for the task – type of glove/gown that will be used

•Fit – appropriate size of gloves/gown

Protective gown

•Protects from splash, splatter, spray, aerosols of blood or other potentially infectious materials (OPIM)

•Long sleeves, covers the torso from neck to knees, wrapped around back

•Disposable or reusable

•Resistant to liquid and microbial penetration

•Changed between patients

Protective gown

•Disposable or reusable

•Resistant to liquid and microbial penetration

•Changed between patients

MASKS

•Must cover nose and mouth

•Protects from splash, spatter, spray and aerosols

•Fluid resistant, molded/unmolded, ties/earloops

•1 per patient; change if wet intraoperatively

•Surgical masks, particulate respirators

•Bacterial Filtration Efficiency (BFE) - % bacteria filtered by fabric

•Particulate Filtration Efficiency (PFE) - % particle filtered by fabric

•Breathability (PΔ) - Resistance to airflow (>resistance = >protection)

•Flammability - Rate of flame speed (min. burn rate = 3.5s)

Mask Tested for:

Bacterial Filtration Efficiency (BFE)

% bacteria filtered by fabric

Particulate Filtration Efficiency (PFE)`

% particle filtered by fabric

Breathability (PΔ)

Resistance to airflow (>resistance = >protection)

Flammability

Rate of flame speed (min. burn rate = 3.5s)

Flammability

Rate of flame speed (min. burn rate = 3.5s)

Particulate Respirator

•For aerosol precautions

•N95 (95%), N99 (99%), N100 (99.7%)

•Filters 0.1-1.0 um

•“fit-check”

•Goggles

•Prevents transmission of pathogens through conjunctival mucosa directly or by touching the eyes with contaminated hands

•Protects from splash, spatter, spray, aerosol

•Fits snuggly from corner of the eyes across the brow

•Effective eye protection but not the other parts of the face

•Anti-fog feature improves quality

•Face shields

•Protects face, nose, mouth and eyes

•High crowns and chin protection that wrap around the face to the point of the ears

•Worn with surgical masks

•Gloves

•Used for patient care, environmental services, etc.

•Made from Latex, nitrile, vinyl (higher failure rate)

•Single use; disposable

•‘wicking’ – penetration of liquid through undetectable holes in gloves (from washing)

Patient Examination Gloves

•Least expensive, non-sterile, disposable

•For examination and other non-surgical procedures

•Different sizes (xs, s, m, l)

•Latex, nitrile, vinyl

•Direct contact with patients who are infected with pathogens transmitted by the contact route

•Sterile Surgical Gloves

•Most expensive

•For oral surgical procedures

•Excellent tactility, comfort and dexterity

•Right-, left-handed fitted

•Latex, nitrile, vinyl

•Non-medical Gloves

•Utility gloves

•Neoprene or polynitrile gloves

•Thick and bulky

•Handling contaminated instruments and cleaning contaminated surfaces

•Washed or disinfected for REUSE

•Gloves

•May trigger sensitivity through inhalation of air-borne latex aero-antigens or absorption through damaged skin

•May develop Type IV or Delayed hypersensitivity (contact dermatitis, rhinitis, conjunctivitis)

•May develop Type I or Immediate hypersensitivity (asthma, urticaria, laryngeal edema, anaphylactic shock)

•Work from ‘clean to dirty’

•Change if torn or punctured

•Limit ‘touch contamination’

DO’S OF GLOVES USE

•Don’t touch the face or adjust PPE

•Don’t touch surfaces unless necessary

DON’TS OD GLOVE USE

•Don before contact with the patient, generally before entering the room

•Use carefully – don’t spread contamination

•Hand hygiene before and after PPE donning and doffing

ENUMERATE

Donning of PPE

GOWN

MASK/RESPIRATOR

GOGGLES/FACESHIELD

GLOVES

•Proper Sequence of Donning PPE

GLOVES

GOGGLES/FACESHIELD

GOWN

MASK/RESPIRATOR

•Proper Sequence of Doffing PPE

Safe Working Practices

Strategies designed as a guide on how to perform a task with minimum risk to people, equipment, environment and process

-written rules and proper operating procedures

-administrative guidelines to inform the workers of proper conduct in work

-trainings

-engineering controls that provides protection to the equipment as well to the user

-visual alerts or graphic presentation of safety practices

Safe Working Practices may be in form of:

Reduce the risk of exposing health workers and patient

In infection control, safe working practices are implemented to?

Standard Precaution

Safe working practices are part of?

Sharps

medical term for devices with sharp points or edges that can puncture or cut skin

needles

scalpels

lancets

razor blade

scissors

metal wire

retractors

clamps

pins

staples

cutters

and glass items

example of sharps

anesthetic needles

suture needles

burs

scalpels

endodontic files

orthodontic wire and bands

broken instruments

metal matrix bands

broken anesthetic cartridges.

In dentistry, example of sharps includes

-During preparation - the moment where the sharps are first exposed

-While in use

-During the clean up

-During disposals or after using the sharps

There are 4 risk periods where sharps injury can happen:

1. during use(most injuries)

2.after use

3.before disposal(least injuries)

Studies show that the incidence of sharp or needlestick injuries occur most:

-Hepatitis B

-Hepatitis C

-HIV (Human Immunodeficiency Virus) which leads to AIDS (Acquired Immune Deficiency Syndrome)

Incidental punctures by contaminated needles exposes the health worker to number of possible infectious diseases especially blood-borne viruses such as:

Elimination- Physically remove the hazard

Substitution-Replace the Hazard

Engineering controls- Isolate the people from the hazard

Administrative controls- Change the way people work

PPE-Protect the worker with personal protective equipment

Hierarchy of Controls

Elimination and Substitution

most effective in reducing hazards however, the most difficult to implement

Engineering Control

-use of device that is designed to eliminate or reduce the risk of needlestick injuries and other percutaneous injuries

-reduce the exposure to blood-borne pathogens brought by sharps injury

Safety needle

Safety scalpel

Recapping devices

Safety syringe

Examples of device that is designed to eliminate or reduce the risk of needlestick injuries and other percutaneous injuries

1. DO NOT uncover or unwrap the sharp object until it is time to use it

2. Always be aware of where the sharp object is.

3.Ensure the needle is pointed away from the user, and maintain visual contact

with the sharp at all times

4.When working with sharps, avoid placing your hand or part of your body in the

"line-of-fire."

5.Never hand a sharp object to someone else or put it on a tray for another person

to pick up.

6.Tell the people you are working with when you plan to set the object down or pick

it up.

Administrative Controls (Work Practices) - Needles

7. Do not walk around the room with an uncapped needle.

8. Do not break or shear the needle shaft from the hub. This may aerosolize the

material.

9. Do not bend the needle.

10. Do not remove the needle from the disposable syringe.

11. Do not re-cap a needle.

12. If you absolutely must re-cap a needle, do not hold the cap while attempting to

reinsert the needle.

13. Use the one-handed "scoop" technique

Administrative Controls (Work Practices) - Needles

1. Use disposable safety scalpels with a fixed blade when possible so that the need

to remove and replace the blade is eliminated.

2. Do not use blades without a handle. The handle serves as a barrier between your

hand and the sharp

3. If working with a blade or razor, always cut away from yourself. Use forceps or a

tool to hold the specimen.

4. Do not manipulate the blade on a scalpel with your hands. Only perform this task

if you have received training on how to do it safely

Administrative Controls (Work Practices) - Blades and Scalpels

1. Never throw treated or untreated sharps containers or sharps directly into garbage cans or dumpsters.

2. Sharps can puncture regular waste bags and endanger waste handlers. If a needle is sticking out of the container, do not push it in with your hands.

3. Dispose of needles and syringes in puncture-resistant (hard-walled) containers.

Administrative Controls (Work Practices) - Safe Disposal of Sharps

"Biohazard"

For medical waste sharps, the sharps waste container needs to have the biohazard symbol and the word "__________." There is no requirement for the sharps container to be red.

should NOT have the biohazard symbol

For non-medical waste sharps (i.e. no human pathogenic potential), the container ____________ have the biohazard symbol or the word "Biohazard.

1. Prepare injections using aseptic technique in a clean area.

2. Disinfect the rubber septum on a

medication vial with alcohol before piercing.

3. Do not use needles or syringes* for more than one patient (this includes manufactured prefilled syringes and other devices such as insulin pens).

4. Medication containers (single and multidose vials, ampules, and bags) are entered with a new needle and new syringe, even when obtaining additional doses for the same patient.

5. Use single-dose vials for parenteral medications when possible.

6. Do not use single-dose (single-use) medication vials, ampules, and bags or bottles of intravenous solution for more than one patient.

Safe Injection Practices

(a) Dedicate multidose vials to a single patient whenever possible.

(b) If multidose vials will be used for more than one patient, they should be restricted to a centralized medication area and should not enter the immediate patient treatment area (e.g., dental operatory) to prevent inadvertent contamination.

(c) If a multidose vial enters the immediate patient treatment area, it should be dedicated for single-patient use and discarded immediately after use. (

d) Date multidose vials when first opened and discard within 28 days, unless the manufacturer specifies a shorter or longer date for that opened vial.

(e) Do not use fluid infusion or administration sets (e.g., IV bags, tubings, connections) for more than one patient

Safe Injection Practices

1. Do not combine the leftover contents of single-use vials for later use.

2. The following apply if multidose vials are used—

1. First Aid

2. Assess Incident

3. Assess source patient

Managing sharps injury

1. Gently encourage bleeding

2. Wash with soap and water

(Mucosal Exposure)- Wash copiously with water or saline

Don't scrub wound and Don't use antiseptic

Wash eyes before and after removing contact lenses

3. Cover with Impermeable dressing

Managing sharps injury First aid steps: