What are best practices for using personal protective equipment?

News of the coronavirus continues to capture the world’s imagination. Last week, as the virus spread in Italy and South Korea, the U.S. Centers for Disease Control and Prevention said that an outbreak in the United States was not a matter of if, but when.

Healthcare organizations are doing what they can to prepare for the coronavirus. One thing they can do is review communicable disease protocols. Another is to familiarize themselves with best practices for using personal protective equipment, which is a topic HBI members have been asking about. Below are examples of some questions we have been hearing from our members, and a summary of our research on PPE based on Occupational Safety and Health Administration recommendations and a review of organizational policies.

What are key considerations when selecting PPE for staff?

Hospitals need to keep PPE at staff members’ disposal in case of a mass casualty incident or disease outbreak, and selection of appropriate PPE is very important. OSHA’s Occupational Safety and Health Standard 1910.132 requires that organizations conduct an assessment to identify current or potential hazards in their work environment, and provide staff with adequate PPE to protect against these dangers. During the hazard assessment, hospitals need to perform a walkthrough to identify physical and health hazards. Data from the assessment can then be used to determine the specific types of PPE required by the facility.

While a hazard assessment is an essential starting point, OSHA recognizes that this approach cannot always predict what substances will be involved in a patient contamination incident and therefore what PPE will be needed. For that reason, OSHA published “Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances” to provide suggestions based on current regulations and literature. The guidelines in Table 3 – Minimum Personal Protective Equipment (click here) outline the basic level of protection needed for unidentified substances that healthcare personnel might encounter. From there, organizations are expected to add or modify PPE as needed to address any hazards unique to their facility.

In view of OSHA protection recommendations and peer organizations’ policies for decontamination, hospitals and health systems will likely need to make the following PPE available:

  • Protective full-body HAZMAT suits – including hood, boots, and elastic wrists – that are resistant to water, pathogens, solvents, and tears.
  • Double-layered protective gloves approved for handling a variety of solvents.
  • Powered air-purifying respirators that are hooded, offer an assigned protection factor of 1,000, and are approved by the National Institute for Occupational Safety and Health (NIOSH) for chemical, biological, radiological, and nuclear exposure.
  • High-efficiency particulate air (HEPA) cartridges for the powered air-purifying respirators. (Cartridges should be combination filters and approved by NIOSH.)

How do organizations’ PPE requirements vary for different decontamination zones?

Different decontamination zones – which include Hot, Warm, and Cold zones – require varied PPE to be donned by staff depending on the intensity of contact with patients and risk of exposure to hazardous substances. The contaminated area, the Hot zone, requires staff to don total encapsulated chemical-protective suits, often including butyl and Silver Shield laminate gloves, and self-contained breathing apparatuses. The Warm zone, where decontamination processes take place, may require workers to don a chemical liquid splash protective suit, or at a minimum gloves, disposable gowns, shoe and head covers, and masks. In the Cold zone, which is free of contamination, regular PPE used for infection control should be donned by staff.

How should staff be introduced to and educated regarding PPE?

Hospital staff need to receive a proper introduction and education on the necessity of using PPE during a mass casualty incident or disease outbreak. Hospitals should conduct training sessions on why PPE is necessary, when to use PPE, how to don PPE, and maintenance and disposal of PPE for designated employees who are expected to work in case of a hazard.

Obtaining employee buy-in regarding PPE is important to encourage staff to comply with protective measures. Employees should be given PPE to practice with on a trial basis, so that they get comfortable donning and disposing of PPE in the event of a contamination. Interactive teaching methods such as simulated patient scenarios and live PPE demonstrations should be conducted, which would help employees discover any issues with PPE and also make them comfortable with the equipment. During such demonstrations, the hospital should consider taking feedback from employees on the ease and adequacy of available PPE.