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Mabel Adams

proper use of PPE in the lab

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We are debating the proper use of PPE in the lab so we are looking for anyone who has a pretty granular policy or procedure for this that they would be willing to share.  The debates are around things like whether you should wear gloves to touch a keyboard or phone that someone wearing gloves has been using.  Then it progressed to refrigerator door handles.  If anyone has strict policies like this, then how do you deal with units of blood and paperwork?  If you touch papers wearing gloves or let them sit on workbench surfaces, can they then go to a clean section of the lab?  If you touch a unit of blood while wearing gloves then you send it to a patient's room is that a problem?  No I don't want to try that CDC recommendation from a few years back when they wanted us to disinfect the blood bags at issue.  The FDA said that wouldn't fly so it went nowhere.  Or is a policy that allows us to touch blood units sufficient for the rest of the lab and we should just be sensible and not lick our fingers when touching items in the lab like keyboards and door handles and papers?  Are there any evidence-based studies on what approach is required for adequate worker safety?  I appreciate your collective wisdom.

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WOW; a real can of worms!

Just for fun and off the top of my head here is my opinion. PPE is by definition to protect the techs. The lab lay out should allow a transition location to don lab coat. When entering lab proper; add gloves and safety glasses (ask anyone who has had their head in the eyewash for 15min). Gloves should be changed when visibly soiled and periodically as they loose their impermeability over time (I remember reading either vinyl or latex in ~20min). Wash hands when changing gloves. Put face shields in key locations. Small reagent/blood smudges on paperwork are taped over, if larger spill occurs put in plastic folder and photocopy. If this is followed the tech is protected and contamination throughout the lab minimized/contained. Gloves are prohibited but lab coats required in labeled "Clean" areas of the lab that are used for issuing blood products and manager/Sr. tech paperwork. Blood products worked on in the lab are handled with gloves but products are issued without gloves and placed in Ziploc bags so that if dropped leaks are contained. The RBC will be taken out of the bag and hung by an RN wearing gloves.

Yes I know that it is purely semantically that if working on a RBC I wear gloves but when issuing the same unit I do not. It does however provide a clear distinction as far as writing and interpreting policy.  

The last thought is that whatever you decide is your policy; it must be practical and enforceable or will not be followed by the techs and therefore only an academic exercise.

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Remember, you have to follow it to a "T" if stringent rules are written in a policy. You can be dinged for not following your policy. I would be a bit vague when writing the policy with a lot of wiggle room: wash hands after removing gloves or when leaving area, no lab coats outside of lab area, no eating or drinking or applying makeup, etc.

All of our area is considered dirty, including phones, community pens, benches, door knobs and refrigerator handles. We couldn't swing a clean area and a dirty area here since everything is in one room with phones and computers scattered around. All it takes is one person with gloves answering a "clean" phone on a busy day to mess up everything.  I agree with Ensis01, if it is too hard, your techs won't adhere to the policy and an inspector would notice.

PPE is available to protect the tech and is readily available for them. If someone wants to be absolutely safe they should wear gloves all day no matter what they are doing and consider everything dirty.

(I never thought of putting tape on paper with blood spots- good idea)

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On 10/23/2018 at 8:51 AM, DebbieL said:

(I never thought of putting tape on paper with blood spots- good idea)

Should the blood spot be taped on both sides of the paper routinely or be based on procedure criteria?:unsure:

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I have never taped on both sides as When we are talking small drops, which are blotted, the blood/reagent does not soak through so taping one side works OK. If the spill is big and paper is wet then it is better to put in clear folder and photocopy. 

For a policy: probably better not to say both sides as it would be irritating to always need to check and especially get dinged by an inspector for that. 

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I would read the actual OSHA regulations, there are a lot of statements in there about "reasonable expectation of exposure".  https://www.osha.gov/SLTC/bloodbornepathogens/bloodborne_quickref.html  Be sure to read the definitions and don't implement rules for a research lab or micro/viro lab that don't apply to blood bank.  This whole subject is one of my pet peeves, I would vote for common sense and don't lick anything in the lab!

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