"A common mistake: people consider themselves safe because they are wearing gloves." Dr. Marcus Reska
Mission: Protection — How we keep healthcare professionals safe with PPE
Protecting oneself and the people in one's own work environment from infections or chemicals is a hallmark of professional work. In everyday professional work – under time pressure and during routine work – it is not easy to meet this requirement. The Molecular Biologist, Dr. Marcus Reska from the German Consulting Centre For Hospital Epidemiology and Infection Control (Deutsches Beratungszentrum für Hygiene, BZH GmbH), who previously worked in occupational medicine research and occupational safety and has now been working in hospital hygiene for years, explains errors in the handling of personal protective equipment (PPE). This interview reflects the German perspective of the topic.
Dr. Reska, you have an insight into various fields of work in the healthcare sector. What errors are often made when using PPE, especially protective gloves?
A common misunderstanding already concerns who should use the protective equipment. For whom is it actually? The protective equipment is not primarily a protection for patients. Rather, it is used by employees to protect themselves, for example, from contact with body fluids, liquid chemicals or puncture injuries.
When we talk about PPE, we are talking about occupational safety.
In contrast, patient safety is the focus of hospital hygiene. In practice, however, it is not always possible to separate the two specialist areas: what use is a disinfectant that works very well, but has employees queueing up after its use to see the occupational health physician because of skin problems?
In occupational safety, all protective measures derived from the risk assessment follow a hierarchical principle, the STOP principle.
S stands for substitution, that is, substitution or replacement of the hazard.
T stands for technical measures,
O for organisational.
P — the personal protective measures — come into play at the very last level when all protective measures in these areas have been exhausted
This makes sense, because all the personal protective measures that I have to expect of the employees are ultimately a hindrance to their workflow and susceptible to human error.
In particular, lack of time in combination with tasks that appear simple, such as putting on and taking off the PPE, harbours risks. Because the way in which the PPE is put on and taken off is critical if it is to provide protection.
Now to the gloves:
One aspect that is often not taken into consideration is the wearing time. After wearing for a long period, a moist environment forms under the glove, which causes the skin to swell and makes it more permeable to pathogens and hazardous substances. This means: protective gloves should not be worn for too long and the humid work should be kept as short as possible.
When I work with concentrated disinfectants, I cannot avoid using chemical-resistant gloves. Is that sufficient?
Whoever prepares ready-to-use solutions from a concentrate, should definitely wear chemical-resistant gloves, a liquid-tight protective gown and protective goggles. One could object that the safety glasses are unnecessary. If a person is careful, there shouldn't be any splashes.
Under time pressure or unfavourable working conditions, things can get messy.
Therefore: better work with protective goggles. Goggles and liquid-tight gowns are, however, not a general measure for cleaning the patient's room with a disinfectant at the working concentration. Sufficient for this are liquid-tight, mechanically stable protective gloves with a longer cuff, which are approved for the chemicals used. So-called medical disposable gloves are not recommended.
Let's stay with the patient rooms. How do I protect myself when I treat patients infected with contagious pathogens?
In principle, the characteristics of the route of transmission determine the choice of PPE. Regardless of the pathogen, the patient's specific situation – vomiting, coughing – and the type of intervention – such as suctioning – should also be taken into account. In cases where airborne transmission of pathogens is prevalent, I generally do not need protective gloves. In the case of a patient with overt pulmonary tuberculosis, for example, an appropriate respirator mask is mandatory. Gloves are only used for specific activities as the case with all other patients.
In contrast, in the case of a patient with a norovirus infection with contact/droplet transmission, gloves, protective gowns and, depending on the situation, respiratory protection should be worn.
What is often not considered: depending on the wall thickness and material, the medical disposable gloves can have microscopic holes in the glove surface. The penetration barrier for viruses or bacteria is then reduced and the skin under the gloves may be contaminated. Frequent and, above all, unnoticed contamination also occurs when the gloves are removed.
Therefore the essential rule is: After wearing the gloves, I take them off in the patient's room, dispose of them there and then disinfect my hands before I leave the room.