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2017 OSAP Annual Conference

FAQ - Personal Protective Equipment (PPE) - 2016
 FAQ - Personal Protective Equipment (PPE) - 2016

 

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Are staff allowed to move with the blue gown ( single use) from the clinical area to sterilisation area or in-lab for transporting impression, devices or dirty instruments. Do we have to change the blue gown after each patient even if it is not soiled? Can we go with a blue gown to waiting area to call a patient and bring him to operating room? Thank you 

The 2003 CDC guidelines for infection control in dentistry states as follows:

Protective Clothing

Protective clothing and equipment (e.g., gowns, lab coats, gloves, masks, and protective eyewear or face shield) should be worn to prevent contamination of street clothing and to protect the skin of DHCP from exposures to blood and body substances (2,7,10,11,13,137). OSHA bloodborne pathogens standard requires sleeves to be long enough to protect the forearms when the gown is worn as PPE (i.e., when spatter and spray of blood, saliva, or OPIM to the forearms is anticipated) (13,14). DHCP should change protective clothing when it becomes visibly soiled and as soon as feasible if penetrated by blood or other potentially infectious fluids (2,13,14,137). All protective clothing should be removed before leaving the work area (13). 1

And,

B. Protective Clothing

1. Wear protective clothing (e.g., reusable or disposable gown, laboratory coat, or uniform) that covers personal clothing and skin (e.g., forearms) likely to be soiled with blood, saliva, or OPIM (IB, IC) (7,8,11,13,137).

2. Change protective clothing if visibly soiled (134); change immediately or as soon as feasible if penetrated by blood or other potentially infectious fluids (IB, IC) (13).

3. Remove barrier protection, including gloves, mask, eyewear, and gown before departing work area (e.g., dental patient care, instrument processing, or laboratory areas) (IC) (13) 1

Infection Control and Management of Hazardous Materials for the Dental Team states the following regarding protective clothing:

Protective Clothing

Appropriate protective clothing such as gowns, aprons, lab coats, clinic jackets, or similar outer garments are to be worn in occupational exposure situations. The employer must evaluate the task to determine the appropriate nature of the protective clothing to be used. Examples of different levels of exposure given by OSHA are “soiled” (low level, requiring laboratory coats), “splashed, splattered, or sprayed” (medium level, requiring fluid-resistant garments), “soaked” (high level, requiring fluid-proof garments).

Protective clothing must not permit blood or saliva to pass through or reach the employees’ work clothes, street cloths, undergarments, or skin. If an item of clothing is intended to protect the employees’ person or work clothes or street clothes against contact with blood or saliva, then it would be considered as personal protective clothing. If a uniform is used to protect the employee from exposure, the uniform is considered personal protective equipment. If a lab coat or protective gown is placed over the uniform, the uniform is not protective clothing: the lab coat or protective gown is. Thus the outer covering is the protective clothing that the employer must provide.

The employer is also required to maintain, clean, launder, and dispose of all personal protective equipment, including protective clothing, at no cost to the employee. Furthermore, employees cannot launder the protective clothing at home. Thus employers must provide disposable protective clothing or reusable protective clothing that is laundered in the office or cleaned by a laundry service. OSHA reasons that, with these options, the employer has control over the protective clothing to ensure proper disposal or cleaning. 2

And,

A convenient approach to the management of protective clothing involves use of disposable gowns with long sleeves and a high neck to cover to cover regular work clothes…For routine dental procedures, one may change these clothes at least once a day (e.g., over the lunch hour) or more frequently if they become visibly soiled. Another approach is use of reusable protective clothing such as uniforms, lab coats, or other attire that may be put on at the beginning of the day, but it must be changed for lunch, changed when it becomes visibly soiled, and removed before one leaves the office. Use of protective clothing that is pulled on and removed over the head is not wise because removal may contaminate the face and head with the outside of the clothing. 2

The CDC also states in an FAQ section on its Website:

When should protective clothing be worn?

Various types of protective clothing (e.g., gowns, jackets) are worn to prevent contamination of street clothing and to protect the skin of personnel from exposure to blood and body fluids. When the gown is worn as personal protective equipment (i.e., when spatter and spray of blood, saliva, or other potentially infectious material is anticipated), the sleeves should be long enough to protect the forearms. Protective clothing should be changed daily or sooner if visibly soiled. Personnel should remove protective clothing before leaving the work area.  3
http://www.cdc.gov/OralHealth/infectioncontrol/faq/protective_equipment.htm 

In summary, as stated above, it is the employer’s responsibility to evaluate the task and determine the appropriate protective clothing to be used. Requirements when using disposable and reusable protective clothing have been outlined above. As the CDC states above:

Remove barrier protection, including gloves, mask, eyewear, and gown before departing work area (e.g., dental patient care, instrument processing, or laboratory areas) 1

Resources

1)     Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM, Centers for Disease Control and Prevention (CDC). Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep 2003;52(RR-17):1-61. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm    Accessed on January 27, 2016.

2)     Miller CH. Infection Control and Management of Hazardous Materials for the Dental Team, 5th edition. Elsevier/Mosby Publishers. Pages 83 & 117.

3)     US Centers for Disease Control and Prevention. Infection Control in Dental Settings - Infection Control Frequently Asked Questions - Personal Protective Equipment (Masks, Protective Eyewear, Protective Apparel, Gloves. http://www.cdc.gov/OralHealth/infectioncontrol/faq/protective_equipment.htm   Accessed on January 27, 2016.

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