Any bodily fluid has the potential to be infectious and needs to be treated as such. It’s up to every health care worker to take universal precautions to prevent the spread of infectious diseases. As a health care worker, it is done by wearing personal, protective equipment (PPE). Wearing proper PPE will protect you from coming into contact with bodily fluids as you perform patient care tasks, it will also help stop the transmission of pathogens from person to person.
The Center for Disease Control (CDC) first published an infectious disease manual back in 1970 that depicted isolation techniques for community hospitals as well as teaching hospitals. By the mid-70s, most of the hospitals in the US were using the included guidelines for PPE. Then again in the 80s during the AIDS epidemic, the increased use of gloves, gowns, and masks really set the standards for patient care as we know it.
PPE Main Components
PPE most often includes the use of gloves, masks, gowns, and face shields. Most commonly, they are single-use items meant to be worn once and then disposed of, not to be worn more than once. Having single-use items reduces the risk of transmitting infectious diseases from patient to patient. Also, donning and doffing PPE in a methodical way will ensure that microorganisms will be left on the PPE and not transferred to the wearer. Removing your PPE must be done in a way that will not expose others to the infectious agents.
Knowing what PPE to use, and when to use it, may be confusing to some as facilities can have different guidelines. Double-check with your institution’s policies regarding PPE or ask your supervisor if you are unsure. In general, if you think there is a possibility of coming in contact with bodily fluids, it’s smart to don PPE.
The first step in wearing gloves correctly is proper handwashing. Wash with warm water and a disinfectant soap for 20 seconds. Dry with a single-use towel. Make sure you have the correct size of gloves for your hands, and that rings are either off or don’t have high sharp edges that can puncture through them. The ends should sit just above your wrist bone.
To remove gloves safely, pinch the outside of the glove without touching your bare skin and pull off the glove and hold the dirty glove in the gloved hand. With your bare finger, insert it at the wrist of the gloved hand and turn the gloves inside out. The CDC has an excellent easy chart for reference.
Make sure your nose and mouth are properly covered under your disposable mask. Most commonly used are the elastic earloop style face covering. Tie strings are also used in health care settings so you may see those as well.
To remove, simply place a clean finger behind your ear and remove the mask on each side by only holding the earloops. Place the mask in the receptacle and wash your hands. While wearing a mask to perform a procedure, make sure not to contaminate the outside of your mask by touching it with gloved hands. The same goes for eye protection if it is being used.
Gowns are not used as often in daily patient care, but they are used in situations where splashing of bodily fluids may occur. They are generally a one-size-fits-all type of gown, with ties in the back. Again remember to put them on with clean ungloved hands. When removing the gown, release the ties and pull from one shoulder to the other and roll the exposed part of the gown into a ball off of your body and discard.
Other forms of PPE
Other PPE can involve the use of glasses or goggles to prevent droplets from going into your eyes. Just make sure they fit with a proper seal around and clean them in between uses.
Face shields are thin, clear plastic sheets that can be worn to cover a person’s entire face from splashes and droplets. Many physicians and nurses were using them while intubating patients during the recent COVID-19 pandemic.
The ways in which a facility uses PPE won’t vary too far on the spectrum. However, the facility needs to have documented procedures in place so that everyone is aware of what is expected, and infection control is the anticipated outcome. The CDC and the Joint Commission are great resources and continue to set the standard for the expected uses of PPE professionally and now in our daily interactions since COVID-19.
When onboarded by a facility, the expectations for PPE usage should be reviewed with every health care worker so that that compliance is expected. As a nurse, you can expect disciplinary action for not following PPE requirements, and your facility could face fines if employees are caught by the Joint Commission. It’s important that every facility has a system of checks and balances to keep patients and their employees safe.