Best Practices for PPE Use


September 2020 - Vol. 9 No. 8 - Page #2

The final level of protection from workplace harm, as illustrated in the CDC/NIOSH Hierarchy of Controls, is the use of personal protective equipment (PPE)(see FIGURE 1).1 By this definition, PPE is the least effective method of protecting employees from hazard exposure, but remains necessary because other protective mechanisms, such as engineering controls and administrative controls (eg, changes to specific work practices) do not remove all risk of exposure. Due to the radical impact of the SARS-CoV-2 pandemic on health care practices, changes to when, where, and how PPE should be used have been necessary, and in many cases, quite complicated.

In several clinical-practice locations, employees who collect routine inpatient and outpatient specimens are affected in a few ways by SARS-CoV-2. Under “normal” circumstances, phlebotomy staff are not required to wear PPE other than gloves for routine venipuncture procedures. Given the likelihood that phlebotomists would now encounter asymptomatic COVID-19-positive patients, those staff members have had to add new PPE to their arsenal. The current CDC guidelines recommend the use of isolation gowns, surgical masks or N95 respirators, and eye protection when performing patient-facing procedures. In some locations, phlebotomy staff members have been trained to collect COVID-19 swab specimens from patients for routine testing or screening purposes.

Training and Clear Communication Remain Key

Whenever staff members are introduced to new or different PPE, be sure that adequate training is provided. This training needs to include information about how to properly don and doff the PPE, and how to care for or disinfect PPE that may be reused. Remember, PPE will only be effective if it is used as intended, so make sure staff feel informed as to why it is necessary in addition to how it is properly used. Be sure to answer any questions your staff may have; as the last line of defense, exposure risk is certainly more substantial when there is a lack of thorough PPE training.

In the lab, PPE guidance has changed multiple times in the months since the pandemic began. Individual facilities have done their best to follow national and state guidance, and others have set policies that may go above and beyond that guidance. Some labs require the use of surgical masks, cloth masks, and even eye protection at all times while working in the department. Others have added a requirement of N95 respirators.

In some cases, these extra PPE mandates have created confusion. Some may wonder: if this PPE is not necessary for other pathogens handled in the department, why is it needed now? If only two people work in the department and they are not near each other, why is a mask necessary? To help mitigate this confusion, remain proactive about educating staff on all PPE updates and changes, and explain the rationale for the changes. Projection of a clear and common cause will go a long way toward ensuring PPE compliance, and be sure to practice what you preach. Although OSHA has temporarily suspended the requirement for annual N95 fit-testing, initial fit-testing is still required for any employee who may be new to wearing a protective respirator on the job. Make sure all staff are trained and prepared to utilize any new PPE they may encounter now and moving forward.

Handling Supply Shortages

The pandemic has created a world-wide shortage of many types of PPE including lab coats, isolation gowns, gloves, face shields, masks, and respirators. To resolve these issues, many facilities moved from disposable to reusable PPE products. Items such as gowns, lab coats, and goggles or face shields are available in reusable varieties.

However, making the change to reusable items is not always straightforward and easy. Purchasing specific goggles and face shields has not traditionally been difficult, but the pandemic has created a high demand for reusable lab coats and gowns and it can take several months to receive products once ordered. To extend the life of these products, laboratories that did not previously have access to laundry facilities will need to make arrangements when using washable coats, and they need to ensure that their biohazard garments are cleaned using the regulations handed down in OSHA’s Bloodborne Pathogens standard.2

Another option for extending the life of PPE includes reprocessing and disinfection. In many locations, hospitals have adopted methods to decontaminate and reuse masks, N95 respirators, and gowns. Some disinfection processes involve the use of ultraviolet light, whereas others use a hydrogen peroxide mist that inactivates virus particles. While these technologies are not new, using them for PPE disinfection is a recent innovative development.

When utilizing these disinfection methods, establish physical and biological checks of the PPE to ensure that the reprocessing is effective. Spot test disinfected N95 respirators by performing randomized fit-testing as batches are reprocessed. Use a biological indicator to ensure any virus particles have been eradicated. Of note, do not reprocess PPE used for protection against tuberculosis unless it is certain the disinfection process is known to effectively destroy TB bacteria.

Conclusion

In response to international shortages during the pandemic, the CDC has provided other options to optimize PPE, including protocols to extend the normal use of protective gear.3 The options provided on the CDC website address specific practices that can be put into place by health care facilities during different levels of patient surge capacities. Optimization strategies include the extended use of PPE beyond what is normally recommended, reducing potentially infectious encounters when possible, and utilizing alternative types or styles of PPE when available. None of these strategies should be used unless the facility falls into the “contingency” or “crisis” capacity situations, or unless the current PPE supply is dangerously low. Consult the CDC website for further information.


References

  1. US Centers for Disease Control and Prevention (US CDC). NIOSH Hierarchy of Controls. Accessed 8.20.20: cdc.gov/niosh/topics/hierarchy/
  2. US Department of Labor. Occupational Safety and Health Administration (OSHA). Bloodborne pathogens and needlestick prevention. 29CFR1910.1030. Accessed 8.20.20: osha.gov/SLTC/bloodbornepathogens/standards.html
  3. US CDC. Coronavirus Disease 2019 (COVID-19). Optimizing Supply of PPE and Other Equipment during Shortages. Accessed 8.20.20: cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html

Daniel J. Scungio, MT(ASCP)SLS, CQA(ASQ), has over 25 years of experience as a certified medical technologist. He worked as a laboratory generalist in hospitals ranging from 75 to 800 beds before becoming a laboratory manager, a position in which he served for 10 years. Dan is now the laboratory safety officer for Sentara Healthcare, a system of more than seven hospitals and over 20 laboratories and draw sites in the Tidewater area of Virginia. As “Dan the Lab Safety Man,” he also serves as a professional speaker, trainer, and lab safety consultant. Dan received his BS in medical technology from the State University of New York at Buffalo.


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