PPE, Sharps & Exposure Prevention

Personal Protective Equipment (PPE)

Personal Protective Equipment provides a physical barrier between the healthcare worker and infectious biohazards. Selection of PPE is dictated by the nature of the clinical interaction and the anticipated degree of blood or body fluid exposure.

CDC Donning Sequence (Putting On PPE)

PPE must be donned prior to entering the patient environment or initiating contaminated tasks in the following precise sequence:

1. Isolation Gown: Fully cover the torso from neck to knees, arms to the end of wrists, and wrap around the back; securely fasten ties at the neck and waist.
2. Mask or Respirator: Secure ties or elastic straps at the crown of the head and the nape of the neck; mold the flexible band snugly across the bridge of the nose; pull beneath the chin; perform an N95 positive/negative pressure seal check.
3. Goggles or Face Shield: Place over face and eyes; adjust headband for a comfortable, snug fit.
4. Gloves: Extend the glove cuffs over the wrists of the isolation gown so no bare skin is exposed.

CDC Doffing Sequence (Removing PPE)

The exterior surfaces of used PPE are heavily contaminated. Doffing must proceed in a deliberate manner that prevents self-contamination:

Standard Doffing Sequence:
1. Gloves (Most contaminated) ➔ 2. Goggles/Face Shield ➔ 3. Isolation Gown ➔ 4. Mask/Respirator ➔ 5. Hand Hygiene

• Step 1: Gloves: Grasp the outside of the glove near the wrist with the opposite gloved hand; peel downward turning it inside out; hold the balled-up glove in the remaining gloved hand; slide bare fingers under the remaining glove at the wrist; peel downward into a second inside-out ball; discard into biohazard waste.
• Step 2: Goggles or Face Shield: Handle only by the clean headband or ear pieces from behind; lift forward away from the face; discard or place in a designated reprocessing container.
• Step 3: Isolation Gown: Unfasten ties; peel gown forward away from neck and shoulders, touching only the clean inside of the gown; turn inside out, roll into a compact bundle, and discard.
• Step 4: Mask or Respirator: Grasp the bottom elastic strap or ties first, then the top strap; lift forward and off without touching the front filter surface.
• Step 5: Immediate Hand Hygiene: Wash hands with soap and water or apply alcohol hand rub immediately following PPE removal.

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Safe Sharps Handling & OSHA Bloodborne Pathogens Standard

The Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard (29 CFR 1910.1030) mandates legal requirements designed to eliminate occupational exposure to Hepatitis B, Hepatitis C, and HIV.

Universal Sharps Rules

• Safety-Engineered Devices: Clinical facilities must provide IV catheters with active or passive needle-retraction or blunting mechanisms. Safety mechanisms must be deployed immediately upon withdrawal from the vein.
• Prohibition of Two-Handed Recapping: Standard two-handed needle recapping is strictly prohibited under federal law. Recapping needles with two hands is the leading cause of accidental percutaneous puncture wounds among healthcare personnel.
• One-Handed Scoop Exception: Only when the employer demonstrates that no alternative is feasible or a specific medical/dental procedure requires recapping, personnel must use a mechanical recapping device or the one-handed scoop technique (using the needle tip to scoop up the cap resting on a flat surface without the second hand approaching the needle).
• Sharps Disposal Containers: Must be rigid, puncture-resistant, leakproof on sides and bottom, color-coded red or clearly marked with the biohazard symbol, and located within immediate arm's reach of the procedure site. Containers must be sealed and replaced when contents reach the manufacturer fill line (do not assume one universal fraction); containers must never be overfilled or forced shut.

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Clinical Scenario & Exam Traps

Clinical Scenario: An Imaging Assistant is preparing a 68-year-old outpatient with an indwelling Foley catheter for an MR examination. After positioning the patient on the table, the assistant empties the urinary drainage bag, removes their gloves, and reaches into their pocket for an alcohol hand rub before starting an IV line on the next patient.

Exam Trap Breakdown:

• Trap 1: Believing gloves eliminate the need for hand hygiene. Gloves contain microscopic pinholes and hands become contaminated during removal. Hand hygiene is mandatory after every glove doffing.
• Trap 2: Relying on alcohol rub after body fluid contact. While alcohol rub is acceptable for uncontaminated urine contact if no spores are suspected, any visible soiling on hands requires soap and water.
• Trap 3: Needle management. Never bend, shear, or manually disassemble needles from syringes prior to container disposal.