By Julie E. Williamson
Personal protective equipment (PPE) is a critical aspect of standard precautions for all health care workers because its proper use helps protect skin and mucous membranes from blood, bodily fluid and chemical exposure. The importance of PPE for infection prevention, which for the sterile processing (SP) environment includes fluid-resistant protective attire (gowns or jumpsuits) with sleeves, utility gloves, eye protection, fluid-resistant surgical masks and fluid-resistant shoe covers, has always been known, but many employees still aren’t properly trained on its correct use.
The International Association of Healthcare Central Service Materiel Management’s education department routinely fields calls and emails from SP professionals inquiring about attire requirements and what is necessary in the different areas of the sterile processing department. Here are the basics on attire/PPE:
- All attire should be clean, provided by the facility and not worn outside the facility. Technicians should change out of their street clothing (clothes worn at home) and shoes, and into scrubs and shoes kept at the facility. Scrubs should be left behind at the facility’s laundry to protect employees from infecting anyone at home or elsewhere outside the facility. Note: Jewelry of all kinds (including necklaces, watches and rings can harbor microorganisms and should not be worn in the department. Also, lanyards – if worn – should remain at the facility and be cleaned on a regular basis.).
- Basic attire should be word in every area of the department and by everyone working in the department. This includes scrub attire consisting of at least clean pants and a top (some facilities provide long-sleeve jackets). If T-shirts are worn, they should be completely covered by the scrub top, with no parts of the T-shirt visible outside the scrub attire. Scrub attire should always be put on just prior to starting work and then removed before leaving work. If attire becomes soiled during work (e.g. fluid strikethrough in decontam), it should be changed.
- A disposable, bouffant-type head covering should be worn in all areas of the department, and should cover all head hair, except eyelashes and eyebrows. If reusable head covers are allowed in the facility, they should be covered with a bouffant cover. Skull-type caps are not recommended because they do not always cover all head hair. Beards and mustaches should be covered with an approved facial cover.
- Sturdy shoes with non-skid soles should be worn in all areas of the department. Again, to prevent contamination, it is good practice to have shoes dedicated to the area and not worn outside the facility.
- Depending on facility policy, a cover gown/lab coat may be used to protect scrub attire when leaving the department for another area in the same facility.
For the decontamination area, all aforementioned basic attire/PPE should be worn to ensure compliance with Occupational Safety and Health Administration requirements and facility policy, and additional PPE is also required. Decontamination PPE includes the following:
Gloves approved for the decontamination area (these are thicker to protect the hands and also have longer cuffs, so they can be placed over the gown cuff to keep fluids from flowing into the glove or up the gown sleeve).
Mask that fits around the ear or ties on the head to protect the nose and mouth
Fluid-resistant gown or jumpsuit to protect clothing and skin.
Goggles or face shield to protect the face, including eyes, nose and mouth. Note: Wearing a face shield does not replace the need to also wear a face mask.
Shoe covers protect the shoes from contamination. These should be worn even if the shoes are dedicated to department use only.
Donning and doffing PPE requires some specific steps for employee safety. Donning steps are as follows:
- Prior to beginning the shift, employees should don surgical scrubs, a head cover and appropriate shoes.
- Don an impervious gown or jumpsuit. Tie, snap or zip completely.
- Don face mask, using care to ensure a proper fit (securing ties, fitting flexible band to bridge of nose, and ensure snug fit to face and below chin).
- Don goggles or face shield and adjust for a proper fit (goggles should wrap around the side of the face).
- Don shoe covers and ensure shoes are fully covered.
- Don gloves and ensure they are placed over the gown cuff.
All PPE should be removed in the following order as recommended by the Centers for Disease Control and Prevention (CDC). Note: All PPE will be contaminated, so care must be taken to minimize risks of touching/spreading potentially infectious materials:
- Shoe covers
- Gloves (Using a gloved hand, grasp the palm area of the other gloved hand and peel off first glove. Hold removed glove in gloved hand. Slide fingers of ungloved hand under remaining glove at the wrist and peel off second glove over the first one. Discard. If hands become contamination during glove removal, immediately wash hands or use an alcohol-based hand sanitizer.)
- Goggles or face shield (remove from the back by lifting head band and without touching the front of the goggles or face shield. If hands become contaminated during removal, immediately wash hands or use an alcohol-based hand sanitizer.).
- Gown (gown front and sleeves will be most contaminated. If hands become contaminated during gown removal, immediately wash hands or use an alcohol-based hand sanitizer. Unfasten gown ties, using care to ensure sleeves don’t contact the body when reaching for ties. Pull gown away from neck and shoulders, touching only the inside of the gown. Turn gown inside out and then fold or roll into a bundle and discard in a waste receptable.)
- Mask (grasp bottom ties or elastic, followed by the ones at the top and then remove without touching the front of the mask)
- Head cover
- Wash hands or use an alcohol-based sanitizer immediately after PPE removal.
Employees should be educated on the purpose and proper use of PPE upon hire and annually thereafter. Training documents (competencies) should be kept on file.
For a downloadable/printable reference on proper PPE use, including donning and doffing diagrams, visit: https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf . These image-based instructions can help take the guesswork out of the process.
Julie E. Williamson is IAHCSMM’s director of communications and senior editor.
1. IAHCSMM. Central Service Technical Manual, Eighth Ed. 2016.
2. American National Standards Institute/Association for the Advancement of Medical Instrumentation. ANSI/AAMI ST79:2017 Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities.
3. Centers for Disease Control and Prevention. Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings. https://www.cdc.gov/hai/pdfs/ppe/PPEslides6-29-04.pdf and Sequence of Putting on (and Safely Removing) Personal Protective Equipment. https://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf
4. Occupational Health and Safety Administration. 1910.1030 Bloodborne Pathogens. 1910.1030 – Bloodborne pathogens. | Occupational Safety and Health Administration (osha.gov).