By Angela Lewellyn on July 2021
A Sterile Processing (SP) topic critical to our daily working practices is Personal Protective Equipment (PPE). Usually, the discussion about PPE is verbalized as too hot and uncomfortable. Technicians wonder if the department’s availability of PPE meets the AAMI requirements, or if some are being worn correctly. As sterile processing technicians, we assume that if worn correctly during tasks the PPE protects us from the possible pathogenic microorganisms found on contaminated instruments, especially during the decontamination process. This article will provide findings from a new study conducted by Cori L. Ofstead, widely respected president and CEO of Ofstead & Associates, and discuss how best we can protect ourselves.The guidelines and standards for ppe use have been laid out for us. SP has requirements from multiple reputable sources that we follow.We are all familiar with OSHA’s Bloodborne Pathogens Standard (29 CFR 1910.1030). In ANSI/AAMI ST79: 2017 Comprehensive guide to steam sterilization and sterility assurance in health care facilities, there is clear guidance provided for the use of PPEs, and they are defined as “Specialized clothing or equipment… worn for protection against hazardous materials, blood-borne pathogens, or other potentially infectious materials.”It is human nature to get comfortable and sometimes lax with information or practices performed often. Due to the new study, we may want to familiarize ourselves with a back-to-the-basics approach of when, where, and how to use PPE. The study demonstrated that if the requirements were not followed, they may not offer the protection we felt assured of.Study Findings The Association for Professionals in Infection Control and Epidemiology (APIC) journal published a study in their latest headline that “determined that PPE barriers did not protect Sterile Processing professionals in the decontamination area from blood and body fluids.” This may be alarming news to some, but many working in the decontamination area may have suspected this for some time.“This pilot documented substantial splashing and droplet dispersal during manual cleaning of medical instruments, and personnel got wet even though they were wearing all the recommended PPE,” said Cori L. Ofstead.”During the study, “Highly trained processing personnel then simulated the performance of routine reprocessing tasks, including filling a sink, brushing a ureteroscope, and using a power sprayer when rinsing the sink basin. Following completion of the tasks, researchers detected splashes and droplet dispersal of at least three, and in some instances up to five feet from the sink.”PPE Worn CorrectlyAs we all know, PPE consists of a scrub uniform laundered by the hospital, a hat, eye goggles, a face mask, gloves, shoe covers, and an impervious gown. The sterile processing industry has pushed and educated all to wear PPE properly for many reasons, one of the most important being self-protection from possible exposure to contaminants.To reacquaint technicians with best practice use of PPE, ANSI/AAMI ST79: 2017 section for Decontamination area/room states, “… personnel working in the decontamination area/room should wear PPE including utility gloves that are fitted at the wrist, prevent contact of the wearer’s skin with contaminated water, and have cuffs that extend beyond the cuff of the gown, a liquid-resistant covering with sleeves (e.g., a backless protective gown, jumpsuit, or surgical gown), liquid-resistant shoe covers if there is potential for shoes becoming contaminated and/or soaked with blood or other bodily fluids, a fluid-resistant face mask and eye protection if there is anticipated risk of splash or splatter, and eye protection, which may include goggles, full-length face shields, or other devices that prevent exposure to splash from all angles.” I would add to wearing face masks over the nose to help assure protection of mucous membranes.Tasks Correctly PerformedAAMI provided guidance to reduce aerosolization or to minimize water spray or droplets during the manual cleaning process, which states, “clean immersible devices underwater to minimize aerosolization”. To help assure no water is sprayed or splashed into mucous membranes it helps to reduce spray by extending the spray arm in a manual sink to as close to the surface of a filled sink as possible. When doffing PPE, to perform the tasks of removal by ensuring contaminates do not come in contact with skin. Always remember to wash hands upon removal or when the integrity of the PPE/gloves are compromised.AAMI also states and provides rationales if PPE in use improperly fits or becomes damaged. “Wearing heavy-duty gloves while handling contaminated items decreases the potential for punctures, limits the microbial burden on hands, and decreases the risk of cross-contamination. Gloves do not offer absolute protection, however, because they can develop small leaks because of the stresses of the cleaning process; hand hygiene can help prevent any further contamination of the worker or environment. When the integrity of reusable gloves, aprons, or protective eyewear is compromised, they cease to function as a protective barrier. “Remedies and RecommendationsMs. Ofstead tells us that “a combination of engineering solutions such as physical barriers and automated cleaning systems, better protective gear, and splash/exposure-reducing practices is needed to reduce environmental contamination and personnel exposure in sterile processing and endoscopy departments.”Each of the following organizations and associations provides clear guidance for proper PPE and decontamination processes. ANSI/AAMI guidelines, AORN, CDC, and SGNA provide standards of care and practical application and rationales. Advantage Support Services and SP departments have provided education and demonstrations for proper use, processes, orienting, and re-educating seasoned technicians and leaders.
“The results from this important real-world evaluation establish the need for additional research by auditors, regulators, and other decision makers to reassess the guidelines for personnel exposure and environmental contamination due to splashes generated in instrument processing areas,” said Ann Marie Pettis, BSN, RN, CIC, FAPIC, and APIC 2021 president. “Until then, controls such as splash-reduction training, correct donning and doffing of PPE, maintaining dirty-to-clean workflow, and cleaning and disinfecting workspaces between activities represent the best approach to reduce cross-contamination and protect sterile processing personnel from exposure to infectious pathogens.”In ClosingSterile Processing technicians have an arduous responsibility, and some would say that the decontamination process is one of the most challenging tasks when reprocessing instrumentation. We want to show recognition and appreciation to Ofstead and Associates for bringing to light the scientific study and findings for these real-world challenges. We can better serve and protect our SP community of hard-working technicians and, ultimately, our patients with these results.
Association For the Advancement of Medical Instrumentation. Sterilization Standards Committee, Association for The Advancement of Medical Instrumentation, & American National Standards Institute. (2017). Comprehensive guide to steam sterilization and sterility assurance in health care facilities. Association For the Advancement Of Medical Instrumentation.
New research suggests medical instrument processing personnel may be exposed to tissue, blood, and patient fluids despite the use of personal protective equipment. APIC. (n.d.). Retrieved January 21, 2022, from https://apic.org/news/new-research-suggests-medical-instrument-processing-personnel-may-be-exposed-to-tissue-blood-and-patient-fluids-despite-the-use-of-personal-protective-equipment/
Written by: Angela Llewelyn LPN CRCST CHL
Director of Development & Research
Advantage Support Services, Inc.
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