The personal protective equipment (PPE) that is required will differ depending upon the situation.1 For example, where there is a chance of blood splashing, eye goggles should be worn. Where there is a copious amount of blood present, a full gown, hat, eyewear, shoe covers and gloves should be worn. Each piece of protective clothing offers a different level of protection.2 Examples of appropriate protective equipment include:

• Gloves.
• Goggles.
• Gowns.
• Shoe covers.
• Face shields.

Care should be taken when removing protective gear that has become contaminated with blood or body fluids. For instance, if you wear gloves to protect yourself but then get blood on your hands when removing your gloves, the protection was ineffective.

Removing gloves

After use, gloves should be removed as follows:

1. Grab the outside of one glove (as shown in the picture), peel it down off your hand, and keep it in the gloved hand.
2. Using your clean hand, grip the inside of the other glove and peel it off.
3. The result is that one glove ends up inside the other without ever touching the outside of either glove with a clean hand.
4. The gloves should then be disposed of in an appropriate biohazard container.

Glove Removing Practices

CDC/Kimberly Smith, Christine Ford acquired from Public Health Image Library (Website) https://www.freestockphotos.biz/stockphoto/15279

Hand-washing after removing gloves

Hand washing is the single most effective tool in preventing the transmission of all diseases. If done properly it is your first and best defense against disease transmission. Handwashing areas should be provided for all employees. They should be located away from areas of food and food preparation. It is not acceptable to wash hands in the same sink that is used to prepare food. Even if hands are immediately washed using antiseptic hand cleaner, they should be washed with soap and water at the first available opportunity.

Sharps handling safety

Gowns

Gowns are worn when there is the potential for a large exposure to bodily fluids such as during patient care in an intensive care unit. They should be disposable, easy to put on and take off and should be removed immediately following exposure. The gown should be removed by pulling it into an “inside out” position and disposed of in a biohazard bag.

Goggles and eye shields

Goggles and eye shields should be worn anytime there is a risk of blood or body fluids splashing towards the face. This would include healthcare, tattoo, and body piercing facilities. The mucous membranes around the eyes make them a potential source for infection. They should also be worn at any time a worker is cleaning a biohazard spill.

Prevention utilizing vaccination

There is a vaccine available for hepatitis B.⁴ If there is a chance you might come in contact with blood or body fluids on your job, then your employer should offer you the vaccination free of charge.

Eating and drinking in the workplace

If you work in an area where there are blood or blood products, you must not eat, drink or smoke in that area as germs can enter your body through your mouth. Make sure to wash your hands well before eating, drinking or smoking.

Recognizing risk

• Waste containers that may contain contaminated materials.
• Laundry bags that contain contaminated clothing or linen.
• Containers used to transport, ship, or store blood and/or body fluids (Example: coolers used to transport organs for transplant or blood tubes from the doctor’s office to the laboratory).
• Contaminated equipment storage areas. This would include dirty utility rooms in healthcare facilities, or areas where dirty equipment is stored, i.e. at a tattoo parlor, until the equipment is cleaned. This is necessary because some facilities “batch” equipment for sterilization.
• Freezers or refrigerators used to store blood or infectious materials.
• Entrances to facilities containing potentially infectious materials.

Things you should never do in the presence of biohazards

Some everyday activities may seem natural but can be very dangerous when done in the presence of bloodborne pathogens. For example, a tattoo artist uses a pencil to sketch a tattoo for a potential client. The pencil is then set down on the counter next to the tattoo chair where the equipment from the previous contaminated client was placed during the last tattoo session. The artist, while making changes to the design, by force of habit places the pencil in their mouth while they erase an area on the drawing. They have just potentially exposed themselves to the infectious material present on the counter from the previous client. The following common actions should be avoided in a potentially infectious environment.

• Using a sink that is used for food to clean equipment or wash hands
• Eating or drinking in an area of potential contamination
• Placing pencils, pens or other objects that have been in a high-risk environment in your mouth
• Storing food or beverages in refrigerators or freezers used to store potentially infectious materials
• Handling your contact lenses
• Smoking
• Putting on lip balm, hand lotion or makeup

When exposure happens

Protective equipment and barrier devices have limitations. Gloves can have holes or tear; goggles do not cover the entire eye area, etcetera. The practitioner must always be vigilant against potential and real exposure and act accordingly. Any area of potential exposure due to inadequate or ill-fitting personal protective gear should be identified and taken to the employer to be rectified as soon as it is detected. Protective equipment cannot take the place of educated and prepared practitioners.

Despite wearing protective gear, if you have been exposed, such as being splashed with blood or you noticed a hole in the gloves that you were using, your best initial help comes from soap and water. You should:

1. Remove the source of contamination from your body. For instance, if your gloves have blood on them, take them off; if your clothing has blood on it, remove it.
2. Wash the area well with soap. Use copious amounts of water to get rid of the blood or body fluids.
3. If you have been splashed in your nose, eyes or inside your mouth, rinse with large amounts of water.
4. Your employer will send you to a healthcare professional for a post-exposure evaluation. Be sure to comply with the instructions of the caregiver. The medical follow-up required will depend upon the type of exposure, the agent involved and the medical status of the person who had the exposure. This will differ from person to person and exposure to exposure based upon best practices as determined by the responsible physician.

The first step is to recognize that an exposure has occurred. Exposures that need to be dealt with immediately include:

• Any needle or sharps stick with an object that has been exposed to blood or body fluids of another individual. This includes needlesticks, cuts from broken glass that have been exposed such as blood tubes, or any other injury that breaks the skin as a result of an item that has had blood or body fluid exposure.
• The splashing of blood or body fluid into an open wound or mucous membranes such as the eyes, nose, and mouth. For example, a dental patient who sneezes or coughs with blood in his mouth splashes the provider in the face or it lands on a cut that exists on the hand of the provider.

The policy regarding exposure will be unique to your employer. It should be described in your employer’s exposure control plan.5 Be sure that you are familiar with the policies that are unique to your company. E.g., they may require you to be seen by a healthcare professional following any exposure.

Following any workplace exposure, steps must be taken to prevent similar exposures in the future. If a needlestick has occurred, the incident must be reviewed and work practices put into place to prevent future sticks. For example, if a tattoo artist is stuck by a needle that was placed on the side table while changing colors, education must take place on how to safely store the needles between color changes. Perhaps the equipment that helps in this regard should be purchased.^7,8

Fortunately, the risk of exposure is extremely low. The CDC estimates the risk of infection from HIV exposure due to a needlestick to be only 0.32%. https://www.aidsmap.com/about-hiv/needlestick-injuries-discarded-needles-and-risk-hiv-transmission

Works cited

1. Beekman SE, Vlahow D, Koziol DE, et al. Temporal association between implementation of universal precautions and a sustained, progressive decrease in percutaneous exposures to blood. Clin Infect Dis. 1994;18:562-569.
2. Mathews R, Leiss JK, Lyden JT, et al. Provision and use of personal protective equipment and safety devices in the National Study to Prevent Blood Exposure in Paramedics. Am J Infect Control. 2008;36:743-749.
3. Centers for Disease Control. Recommendations for prevention of HIV transmission in healthcare settings. Morbid Mortal Weekly Rep. 1987;36:1-18.
4. Centers for Disease Control. Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination: recommendations of the Immunization Practices Advisory Committee (ACIP). Morbid Mortal Weekly Rep. 1991;40:1-25.
5. Occupational Safety & Health Administration. https://www.osha.gov/laws-regs
6. Becker C, et al. Occupational infection with human immunodeficiency virus (HIV). Risks and risk reduction. Ann Intern Med. 1989;110(8):653-6.
7. Leentvaar AK et al. Needlestick injuries, surgeons and HIV risks. Lancet. 1990;335: 546–547.
8. Gaughwin MD et al. Bloody needles: the volume of blood transferred in simulations of needlestick injuries. AIDS. 1991;5(8): 1025–1027.