3.3 Personal Protective Equipment & Standard Precautions
Key Takeaways
- Standard Precautions assume every patient’s blood and body fluids may be infectious; PPE selection is based on anticipated exposure, not on a known diagnosis alone.
- Core phlebotomy PPE includes gloves for every draw, with goggles or face shield, gown, and mask added when splash, spray, or contamination of clothing is reasonably anticipated.
- Donning order typically follows gown → mask → eye protection → gloves; doffing removes the most contaminated items first, usually gloves → eye protection → gown → mask, followed by hand hygiene.
- Gloves must be changed between patients and when torn or heavily contaminated; never wash or reuse disposable gloves.
3.3 Personal Protective Equipment & Standard Precautions
Standard Precautions are the CDC baseline infection-control practices applied to all patients in all care settings. They treat blood, body fluids, secretions, excretions (except sweat), non-intact skin, and mucous membranes as potentially infectious—regardless of whether a diagnosis is known. For phlebotomy technicians, Standard Precautions drive hand hygiene, safe sharps handling, environmental cleaning, and correct use of personal protective equipment (PPE).
PPE is selected by anticipated exposure, not by convenience. Under-protecting risks occupational exposure; over-protecting without removing PPE correctly can spread contamination to clean areas.
Core PPE Items in Phlebotomy
| PPE Item | Primary Purpose | Typical Phlebotomy Use |
|---|---|---|
| Gloves | Barrier against blood/body-fluid contact with hands | Every venipuncture and capillary puncture |
| Goggles / face shield | Protect eyes and face from splash or spray | Arterial sticks, difficult draws with spray risk, splash-prone procedures |
| Gown / lab coat (impervious as needed) | Protect skin and clothing from contamination | Anticipated soiling, isolation rooms per policy, heavy splash risk |
| Mask (surgical/procedure) | Source control and droplet barrier | Respiratory symptoms, droplet precautions, splash near face |
Gloves — Non-Negotiable for Collection
Wear clean, well-fitting disposable gloves for every blood collection. Change gloves:
- Between patients
- If torn, punctured, or heavily contaminated during a procedure
- When moving from a dirty task to a clean task on the same patient (per facility policy)
Never wash disposable gloves for reuse. Perform hand hygiene before donning and immediately after doffing. Touching phones, door handles, or clean supply drawers with soiled gloves is a common compliance failure.
Face Protection — When Splash Risk Exists
Eyes, nose, and mouth need protection when splash or spray is reasonably anticipated. High-risk phlebotomy situations include:
- Arterial puncture / arterial blood gas collection (higher pressure, spray potential)
- Expelling blood from a syringe in an uncontrolled manner
- Patients who may cough, spit, or thrash during a difficult stick
- Known spray from tubing disconnection or tube overfill events
Goggles or a face shield (with mask as indicated) protect mucous membranes. Ordinary eyeglasses alone are usually insufficient side/top coverage unless they meet facility eye-protection standards.
Gowns and Masks
Wear a gown when clothing or exposed skin may be soiled. Wear a mask for droplet/source-control indications or when combined with eye protection for splash. Isolation rooms may require additional Transmission-Based Precautions (contact, droplet, airborne) layered on top of Standard Precautions—always follow the posted door sign and facility protocol.
Donning and Doffing Order
Incorrect removal is a leading cause of self-contamination. Use a consistent sequence and treat the outside of used PPE as contaminated.
Typical Donning (Put On) Order
- Perform hand hygiene.
- Gown — tie securely; cover torso from neck to knees and arms to wrists as designed.
- Mask / respirator — secure ties or loops; fit over nose and mouth.
- Goggles or face shield.
- Gloves — extend over gown cuffs so no skin is exposed at the wrist.
Typical Doffing (Take Off) Order
- Gloves first (most contaminated) — glove-in-glove / beak method to avoid bare-hand contact with the outer surface.
- Eye protection — remove by the clean headband or ear pieces.
- Gown — untie, pull away from neck/shoulders, turn inside out, discard.
- Mask — remove by ties/loops; avoid touching the front.
- Perform hand hygiene immediately.
Facility policies may refine this order (especially when a respirator is used). When in doubt, follow the posted PPE sequence for that unit and complete hand hygiene after every doffing step that risks hand contamination.
Standard Precautions Applied to Every Patient
Standard Precautions apply equally to outpatients who “look healthy” and critically ill inpatients. Diagnosis-based selective PPE is unsafe because many bloodborne infections are asymptomatic. Practical application includes:
- Hand hygiene at the Five Moments
- Gloves for blood collection and specimen handling
- Safe injection and sharps practices (engineered sharps injury protection, immediate activation, no recapping by two-handed method)
- Careful handling of contaminated equipment and laundry
- Respiratory etiquette and environmental cleaning of chair arms, tourniquets (per policy), and work surfaces
+-----------------------------------------------------------------------------------+
| PPE DECISION TREE FOR COMMON PHLEBOTOMY SCENARIOS |
+----------------------------------+------------------------------------------------+
| Scenario | Minimum PPE Expectation |
+----------------------------------+------------------------------------------------+
| Routine outpatient venipuncture | Gloves; hand hygiene before/after |
+----------------------------------+------------------------------------------------+
| Arterial stick / ABG | Gloves + face/eye protection; gown if splash |
+----------------------------------+------------------------------------------------+
| Patient on droplet precautions | Gloves + mask (and gown if contact also) |
+----------------------------------+------------------------------------------------+
| Visible bleeding / thrashing | Gloves + face protection ± gown |
+----------------------------------+------------------------------------------------+
| Between two consecutive patients | Remove gloves, hand hygiene, new gloves |
+----------------------------------+------------------------------------------------+
Glove Change Between Patients
Changing gloves between patients is mandatory. Carrying “one good pair” from room to room spreads organisms and violates Standard Precautions. If you need to leave the patient zone for additional supplies, remove gloves, perform hand hygiene, obtain supplies, then re-glove with clean PPE before returning to the procedure.
Exam Focus Points (Task 2.03)
- PPE is exposure-driven under Standard Precautions for all patients.
- Face protection is indicated for splash risk, including arterial sticks.
- Doffing order matters as much as donning; hand hygiene closes every PPE episode.
- Gloves never replace hand hygiene and are never shared between patients.
Mastering PPE judgment protects your career-long safety record and your patients’ infection-control outcomes.
Under Standard Precautions, when should a phlebotomy technician wear gloves for blood collection?
Which situation most clearly indicates the need for goggles or a face shield during phlebotomy?
After completing a draw, what is the safest immediate action regarding gloves before approaching the next patient?