by Noel Kelsch, RDHAP
My great-niece Sydney came for a visit and was playing with my Barbie Dentist set. She said to me, “This could not be a good dentist; she has no lab coat.” My niece gets it. She is only 7 years old but she knows what you need to wear to practice safely in a dental setting.
Personal protective clothing (PPC) is a vital component of personal protective equipment (PPE). It is designed to cover your uniform, street clothing, and skin, and prevent cross-contamination from blood and other potentially infectious materials (OPIM).1 It is a barrier between potential diseases that dental health care personnel (DHCP) are exposed to every day. When used properly, personal clothing is very effective at limiting exposure to the pathogens that may be contained in blood and other body fluids. It is a safety feature that allows you to work in this environment and not bring home disease to your family on your clothing.
The Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard requires the PPC (e.g., gowns, jackets) to have sleeves long enough to protect the forearms, have a high neck, and be knee length.
Here are tips for wearing PPC:
- DHCP should change protective clothing daily or when it becomes visibly soiled and as soon as possible when penetrated by blood or other potentially infectious fluids.2
- All protective equipment should be removed before leaving the work area. The only acceptable places for this equipment are in patient care, instrument processing, and laboratory areas. This equipment is not to be worn in the restroom, front office, dentist’s personal office, or break room.1 It should never be worn outside the office.
- The employer can supply simple disposable gowns or reusable gowns and jackets that he or she is responsible for maintaining and laundering.
- Standard uniforms and street clothing are not intended for use as personal protective clothing and do not qualify to meet the standard.3
- When choosing PPC, look for clothing that is recyclable, stain- and fluid-resistant, simple to don and remove, breathable, and has antibacterial qualities in the material.
- When removing the garment, turn it inside out as you remove it so that the largest section of infectious material is on the inside, limiting exposure.
- Establish a specific area for hanging PPC when you are not wearing it. Do not hang patient items — jackets, purses, or street clothing — in that area, risking cross-contamination.
- An open back on garments such as disposable gowns gives good protection and allows ventilation for DHCP.
- In going green it is important to factor in transportation, electricity, laundry, safety, and other considerations when comparing disposable to reusable.
- Never store contaminated PPE in the pockets of personal protective clothing. Things such as contaminated masks can cross-contaminate your hands, pens, and other items stored in the gown. Eye protection must be disinfected before it is placed in the pocket.
Who has to clean the protective clothing if disposables are not used? Employees are not allowed to launder their contaminated personal protective clothing at home. This is the responsibility of the employer. This would include the gown, lab coat, or jacket that is worn for personal protection. The employee’s uniform, street clothes, or scrubs are usually not intended to be personal protective equipment and are worn under the lab coat or gown. They are not contaminated with blood or other potentially infectious materials and are the employee’s responsibility unless they become accidentally contaminated.
In the 2003 Guidelines for Environmental Infection Control in Health-Care Facilities, the CDC provides guidance for the handling, cleaning, and disinfection of contaminated laundry. The document can be found at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5210a1.htm. If employers want to have employees perform these duties at the office, they must establish an exposure-control program that covers all job classifications and tasks in which the employees have occupational exposure. If they choose to use an outside service, they must confirm that the service complies with OSHA guidelines.
The employer has to provide training to each employee who is required to use PPE. Each such employee has to be trained to know at least the following: When and what PPE is necessary; how to properly wear and adjust PPE; limitations of PPE; and the proper care, maintenance, and disposal of the PPE.
Each affected employee has to demonstrate an understanding of the training provided before being allowed to perform work that requires PPE.
When the employer has reason to believe that a trained employee does not have the understanding and skill required, the employer is responsible for retraining that employee. Circumstances where retraining is required include situations such as: changes in the workplace render previous training obsolete; changes in the types of PPE render previous training obsolete; or inadequacies in an affected employee’s knowledge or use of assigned PPE indicate that the employee has not retained the requisite understanding or skill.
The employer has to verify that each affected employee has received and understood the required training through a written certification that contains the name of each employee trained, the date(s) of training, and that identifies the subject of the certification.
My niece quickly adapted Barbie’s life by simply designing a line of protective gowns and jackets from paper towels. As health-care professionals, we need to make sure we are dressed in the proper clothing for our jobs and that we wear and handle it in a way that keeps both our families and us safe.
- Guidelines for Infection Control in Dental Health Care Settings, 2003.
- http://www.cdc.gov/Oralhealth/infectioncontrol/faq/protective_equipment.htm#4. Accessed 2/16/2010.
- From Policy to Practice: OSAP’s Guide to the Guidelines.
- http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table= STANDARDS&p_id=10051 Accessed 2/17/2010.
Noel Brandon Kelsch, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She is a member of the Organization for Safety and Asepsis Procedures and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamine and drug use. She is immediate past president of the California Dental Hygienists’ Association, and is on the board of directors for the Simi Valley Free Clinic.
What does OSHA have to say? OSHA regulations are specific about this clothing. Section 1910 of the bloodborne pathogen standard reminds us all:
1. Provision. When there is occupational exposure, the employer shall provide, at no cost to the employee, gowns and lab coats. Personal protective equipment will be considered “appropriate” only if it does not permit blood or other potentially infectious materials to pass through to or reach the employee’s work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used.
2. Use. The employer shall ensure that the employee uses appropriate personal protective equipment unless the employer shows that the employee temporarily and briefly declined to use personal protective equipment when, under rare and extraordinary circumstances, it was the employee’s professional judgment that in the specific instance its use would have prevented the delivery of health care or public safety services or would have posed an increased hazard to the safety of the worker or co-worker. When the employee makes this judgment, the circumstances shall be investigated and documented in order to determine whether changes can be instituted to prevent such occurrences in the future.
3. Accessibility. The employer shall ensure that appropriate personal protective equipment in the appropriate sizes is readily accessible at the worksite or is issued to employees.
4. Cleaning, laundering, and disposal. The employer shall clean, launder, and dispose of required personal protective equipment at no cost to the employee.
5. Repair and replacement. The employer shall repair or replace personal protective equipment as needed to maintain its effectiveness, at no cost to the employee. The employer must pay for replacement PPE, except when the employee has lost or intentionally damaged the PPE.
6. Removal. If a garment(s) is penetrated by blood or other potentially infectious materials, the garment(s) shall be removed immediately or as soon as feasible. All personal protective equipment shall be removed prior to leaving the work area. When personal protective equipment is removed, it shall be placed in an appropriately designated area or container for storage, washing, decontamination, or disposal.4