ICT introduces a new, regular column in which members of industry suggest strategies for the evaluation and purchasing of infection prevention and control products. This month we take a look at personal protective equipment (PPE).
Participants are:
Pam Werner, RN, BSN, CNOR, MBA, clinical consultant for Ansell Healthcare Inc.
Judson Boothe, marketing director of medical supplies for Kimberly-Clark Healthcare
Milt Hinsch, MS, technical services director for Mölnlycke Health Care U.S., LLC
What are the most critical infection prevention-related aspects of PPE that clinicians must bear in mind to keep themselves and their patients safe from pathogenic organisms?
Werner: Informed use of PPE is a critical component of a hospital’s infection prevention program. Where there is a likelihood of contact with bodily fluids or potential hazardous chemicals, appropriate PPE includes gloves, gowns, face shield, mask, eye protection and ventilation devices. Aside from having the right product for the task at hand, the healthcare provider has to use the PPE according to the product directions for use and according to the hospital’s protocol. Hospital protocols usually include other conventions surrounding PPE use. For example: washing hands first, donning PPE according to directions, removing the PPE in a fashion that does not contaminate the healthcare provider, properly disposing of the PPE, and following up with adequate hand hygiene.
Boothe: Even the most scrupulously maintained healthcare facility can be teeming with germs that can cause healthcare-associated infections in patients, staff, and visitors. Outside contaminants that are brought into the environment on a daily basis and contaminant from the patients themselves are a constant hazard. Something as seemingly innocent as a visitor’s hug, or even a clinician’s healing touch, can leave behind dangerous germs. The first line of defense to protecting staff and patients from cross-contamination of such germs is through the proper use of PPE. According to the 2007 isolation guideline published by the Centers for Disease Control and Prevention (CDC), the need for and type of isolation gown selected should be based on:
1.The nature of the patient interaction
2. The anticipated degree of contact with infectious material
3. Potential for blood and body fluid penetration of the barrier apparel
Clinicians must be aware of their environment as well as what they touch before coming into contact with each patient. Organisms such as methicillin-resistant Staphylococcus aureus (MRSA) can survive as long as several months on virtually any surface with patient or healthcare worker contact, such as stethoscopes, pagers, pens, blood pressure cuffs, otoscopes, bed rails, bed tables, doorknobs, patient charts, etc., proper use of personal protective equipment is crucial in preventing the contact transfer of infection—to patients, visitors and to fellow HCWs. Clinicians should also note that not all PPE provides the same level of protection. It is important for both the HCW and purchasing manager to determine what level of protection is needed based on the tasks being routinely performed. For example, clinicians attending to patients in a burn unit who are at very high risk of developing an infection due to their compromised immune systems would need to don PPE that offers the highest level of isolation protection. However, one would not need to use the same gowns, gloves and masks when performing a standard examination or drawing blood.
Overall, consistency is key. Providing PPE and hand hygiene dispensers throughout the facility offers visual reminders to HCWs as they perform their tasks each day.
Hinsch: PPE must be easy to use, effective and used to keep themselves and their patients safe. To help prevent needlestick injuries, retracting needles, blunt needles (surgery), improved sharps containers and education have helped reduce chances of needlestick injuries during the past decade because they are easy to use, effective and are being used more often. In addition, more double gloving is taking place in surgery as OR personnel realize that, despite all of the new needlestick safety products and initiatives, barrier failures, needlestick injuries and sharps injuries still occur. Newer latex and non-latex surgical glove indication systems provide greater protection from injury and reduce possible exposure to bloodborne pathogens by providing greater glove thickness and indicating an outer glove failure when fluids are present. Double-gloving reduces chances of needlestick injuries and wipes more of the blood off of solid needles should they penetrate. The indication enables wearers to change their gloves to help avoid potential bloodborne pathogen contamination of the wearer and/or patient. Indicator gloves are easy to use and are effective. More operating room personnel are double gloving and are making indication gloves part of their PPE armamentarium.
