Standard Infection Control Precautions PERSONAL PROTECTIVE EQUIPMENT

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Personal Protective Equipment

Standard Infection Control PrecautionsPERSONAL PROTECTIVE EQUIPMENT



PROTECT patients

PROTECT yourself



Introduction

The aim of this session is to give you an understanding of the correct and appropriate use of PPE

Key topics to be covered– awareness of the potential risks associated with blood/body fluids

infectious patients/clients pose to you

– your responsibilities in reducing the risk of transmission of infection between patients/clients

– how risk assessment can help you to select and to use the appropriate personal protective equipment

– how to safely put on, remove and discard personal protective equipment



Knowing what to wear

To protect patients/clients and yourself,understand the risk associated with each

activity you undertake within your job

• Personal protective equipment (PPE) is based upon – an assessment of the risk of transmission of micro-organisms to the

patient/client, and the risk of contamination of staff clothing and skin by blood, body fluids, secretions or excretions

• Risk assessment provides a set of logical questions to help with sometimes confusing decisions



Personal Protective Equipment (PPE)

PPE is specialised clothing or equipment worn as protection against infectious materials

• Gloves• Aprons and gowns• Face protection

– goggles, visors, face-shields, masks

• Other protective clothing– respiratory protective equipment, footwear



GLOVES



Use of GLOVES

Gloves are the most common type of PPE used within healthcare settings

• Gloves protect your hands from– contamination with organic matter and micro-organisms

– chemicals that could adversely affect your skin

• Gloves reduce the risk of cross-infection by preventing the transfer of organisms from you to patients/clients, and from patients/clients to you



Selection of GLOVES

Glove selection can only be made after a full and informed risk assessment

• Understand potential hazards before making glove choice• Be aware of the possibility of NRL allergy, and document cases• NRL (or an acceptable alternative) must be worn for actual or

potential contact with blood, or blood-stained body fluids• Make sure gloves fit correctly• Always use non-powdered gloves• Never use polythene (plastic) gloves for clinical tasks



Discarding GLOVES

Gloves are single-use items, you should treat them as healthcare (clinical) waste or domestic waste

in some settings

• Put on gloves immediately before an episode of patient/client contact or treatment, and remove gloves as soon as the activity is completed

• Never wash gloved hands• Dispose of decontaminated gloves immediately• Decontaminate hands after removing gloves

The re-use of gloves has legal implications



Do GLOVES leak?

Do not take the integrity of gloves for granted – always decontaminate hands after glove use

• Evidence suggests gloves can leak when they appear undamaged• Revised standards require gloves to perform to the same standard• Hands are not necessarily clean because gloves have been worn• Verify glove barrier properties with manufacturers• Hands may also become contaminated during glove removal

Double gloving should be considered for exposure prone procedures, or for procedures where there is a risk of glove puncture



APRONS and GOWNS



APRONS versus GOWNS

No studies support the routine use of gowns in general or specialist clinical settings

• Plastic aprons are recommended for general use• Gowns should be fluid repellent and used where there is potential for

extensive splashing of blood, body fluids, secretions or excretions



Use of APRONS

Single-use fluid-repellent aprons protect clothing from contamination with blood, body fluids or micro-organisms

• Aprons are routine wear for many clinical and care activities when– there is potential direct contact with blood or body fluids

– there is direct contact with an infectious patient/client and their environment

– clothing is likely to become wet or soiled

• Long-sleeved impermeable aprons are available for episodes when there is a risk of extensive contamination where clothing is likely to become wet or soiled



Discarding APRONS

Use an apron for the task or episode intended, and then discard it immediately

• Plastic aprons are single-use• Use for one procedure or episode of patient/client care• Discard apron after use• Dispose of as healthcare (clinical) or domestic waste



Use of GOWNS

Full-body fluid-repellent gowns must be worn when there is an extensive risk of splashing

• Sterile gowns that are impermeable to fluid protect staff from infectious materials and the patient/client from HAI

• Wear sterile gowns for– performing aseptic invasive procedures

– during surgery



Laundry of GOWNS

Poly cotton reusable gowns have been the usual wear within the theatre environment

• Laundering of gowns can increase– bacterial penetration through gowns to patient/client

– fluid penetration through gowns to staff

• Bacterial penetration is notably reduced in single-use gowns• Surgical gowns are ‘medical devices’ (and must carry a CE mark)



Standard Infection Control Precautions

PERSONAL PROTECTIVE EQUIPMENT

group activity



FACE protection



Types of EYE protection

Predominantly worn to protect eyes from contamination by blood and body fluids

or chemicals

• Goggles• Visors• Face-shields

– single-use surgical face mask with integrated eye-shield



Use of EYE protection

Goggles, visors and face-shields protect eyes from splash/spray from blood/body fluids, from chemicals, and

during aerosol-prone procedures

• Protect the mucous membrane of your eyes• Use goggles for potential splashes• Use visors or face-shields for

– potential spraying/splattering of blood

– aerosolisation of other potentially infectious material

• In cases of accidental exposure, use eye wash• Protect eyes from chemicals when scrubbing instruments



Decontaminating EYE protection

Follow local policies for the cleaning and disinfection of multi-use eye protection

• Wash with detergent, rinse with hot water and dry thoroughly• If contaminated with blood or body fluids

– clean as above, then disinfect according to local policy

• Monitor multi-use items and replace when appropriate (for example, due to scratched lenses or loose elastic)



Use of MASKS

There is no evidence to suggest any clinical benefit from wearing surgical masks to protect patients/clients

during routine ward procedures

• Wear a visor for splash-prone non-operating theatre procedures– child deliveries, dentistry, invasive procedures

• Surgical face masks must be worn in the operating theatre– for procedures involving the splashing of blood and body fluids

– for procedures that pose a high risk of the patient/client acquiring a surgical site infection (SSI)



Maximising MASKS

The fit of the mask is very important to the efficiency of the mask

• Masks should fully cover the nose and the mouth• To maximise protection from a face mask, ensure it is

– close fitting

– changed between operations or patients/clients

– handled as little as possible

– changed if it becomes wet



Discarding MASKS

Once removed, never re-use a mask

• Discard immediately after removing• Treat as healthcare (clinical) waste



otherforms of protection



Respiratory protective equipment

Certain respiratory diseases require additional precautions

• Specialised respiratory protective equipment includes dust mist respirators or filtering masks for use with:

– multiple drug-resistant tuberculosis (MDRTB), drug-resistant tuberculosis (DRTB)



Footwear

The wearing of overshoes isunnecessary for routine or isolation nursing

• Overshoes are often hazardous• Dedicated shoes are better for theatre and sterile services

– always keep dedicated footwear clean

• Calf-length boots minimise the risk of exposure to blood-borne viruses





quiz



further study



Improving compliance

Information

accepted

understood

applied

saves lives



Health and Safety legislation

Health & Safety at Work Regulations (1999)

Approved Code of Practice and Guidance

Personal Protective Equipment at Work Regulations: Guidance on Regulations (1992)

Control of Substances Hazardous to Health

(COSHH) Regulations (2004)



Core references NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE (2003) Infection control: Prevention of healthcare-associated infection in primary and

community care. Clinical Guideline [on-line]. London: NICE. Available at: www.nice.org.uk/page.aspx?o=71774 [Accessed March 2005].

PELLOWE C M, PRATT R J, LOVEDAY HP, HARPER P, ROBINSON N, JONES S R L J, (2004) The epic project. Updating the evidence-base for national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England: a report with recommendations. British Journal of Infection Control, December 2004, vol. 5, no. 6, (pp 10-16)

GARNER J S (1996) The Hospital Infection Control Practices Advisory Committee: Guidelines for Isolation Precautions in Hospitals. Infection Control Hospital Epidemiology, 17 (1), 53-80

CLARK L, SMITH W, YOUNG L (2002) Protective Clothing; Principles and Guidance. Bathgate, UK: Infection Control Nurses Association.

BRITISH STANDARDS INSTITUTION (2000) Medical gloves for single use part 1: specification for freedom from holes. BS-EN 455-1, British Standards Institution, London

BRITISH STANDARDS INSTITUTION (2000) Medical gloves for single use part 2: specification for physical properties. BS-EN 455-2. British Standards Institution, London

BRITISH STANDARDS INSTITUTION (2000) Medical gloves for single use part 3: requirements and testing for biological evaluation. BS-EN 455-3, British Standards Institution, London

UK HEALTH DEPARTMENTS (1998) Guidance for Clinical Health Care Workers. Protection Against Infection with Blood-borne Viruses. Recommendations of the Expert Advisory Group on AIDs and the Advisory Group on Hepatitis. London: The Stationery Office

HEALTH AND SAFETY EXECUTIVE (1992) Personal Protective Equipment at Work Regulations. (EEC Directive). London: The Stationery Office

DEPARTMENT OF HEALTH (1996) The Interdepartmental Working Group on Tuberculosis. The Prevention of Tuberculosis in the UK. Recommendations for the Prevention and Control of TB at Local Level. Department of Health. London:Stationery Office

UK HEALTH DEPARTMENTS (1998) Guidance for Clinical Health Care Workers: Protection Against Infection with Blood-borne Viruses. Recommendations of the Expert Advisory Group on Aids and the Advisory Group on Hepatitis. London: The Stationery Office

Health & Safety at Work Regulations (1999) Approved Code of Practice and Guidance Personal Protective Equipment at Work Regulations: Guidance on Regulations (1992) Control of Substances Hazardous to Health (COSHH) Regulations (2002)



Further web sources

www.sehd.gov.uk

www.hse.gov.uk

www.hpa.org.uk

www.cdc.gov

www.hps.scot.nhs.uk

www.medical-devices.gov.uk

www.healthcareA2Z.org





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PROTECT patients

PROTECT yourself

Standard Infection Control Precautions PERSONAL PROTECTIVE EQUIPMENT

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