Use of PPE

Personal Protective Equipment (PPE) represents the final barrier in the “Hierarchy of Controls” designed to protect laboratory personnel from injury and infection. In Blood Bank, where the handling of human blood and blood products is the primary activity, PPE is essential for preventing exposure to Bloodborne Pathogens (HIV, Hepatitis B, Hepatitis C). Adherence to PPE guidelines is not merely a “best practice”; it is a federal requirement enforced by the Occupational Safety and Health Administration (OSHA) under the Bloodborne Pathogens Standard (29 CFR 1910.1030). The employer is responsible for providing appropriate PPE at no cost, maintaining it, and ensuring its use, while the employee is legally obligated to wear it

Hand Protection (Gloves)

Gloves are the most frequently used form of PPE in the Immunohematology laboratory. They serve as a barrier against direct contact with blood, plasma, reagents containing human source material, and contaminated surfaces

• Material Selection: While latex gloves offer high tactile sensitivity, many institutions have shifted to Nitrile or vinyl gloves to avoid latex allergic reactions (Type I and Type IV hypersensitivity) in both workers and patients. Nitrile offers superior chemical resistance and puncture resistance compared to latex
• When to Wear: Gloves must be worn during phlebotomy, when handling any blood specimen (e.g., performing a crossmatch), when handling reagents derived from human blood, and when touching non-intact skin or mucous membranes
• Proper Usage Rules
  • Single Use: Disposable gloves must never be washed or decontaminated for reuse, as this degrades the barrier integrity
  • Immediate Replacement: Gloves must be changed immediately if they become torn, punctured, or their ability to function as a barrier is compromised
  • Cross-Contamination: Gloves must be removed before touching “clean” areas such as telephones, door handles, computer keyboards (unless washable/designated dirty), or elevator buttons
  • Hand Hygiene: Hands must be washed with soap and water immediately after glove removal. The warm, moist environment inside a glove promotes bacterial proliferation

Body Protection (Laboratory Coats & Gowns)

Laboratory coats or protective gowns prevent contamination of street clothes and skin. In Blood Bank, where large volumes of blood (units) are processed, the risk of spills is significant

• Fluid Resistance: Coats used in Blood Bank must be fluid-resistant (impervious to liquids) rather than simple absorbent cotton, which creates a “wicking” effect that holds contaminants against the skin
• Design Features
  • Cuffed Sleeves: Knit cuffs are preferred to prevent loose sleeves from dragging across the workbench or dipping into biohazardous waste/specimens
  • Closed Front: Coats must be buttoned or snapped closed at all times while in the laboratory
  • Length: Must be long enough to cover the lap when seated to protect against spills
• Laundering and Disposal
  • Prohibition on Home Laundering: OSHA strictly prohibits employees from taking soiled lab coats home to wash. The employer must utilize a professional laundry service or provide disposable coats
  • Removal: Lab coats must be removed before leaving the testing area (e.g., going to the cafeteria, break room, or administrative offices) to prevent the spread of contaminants to public areas

Face & Eye Protection

The mucous membranes of the eyes, nose, and mouth are rapid portals of entry for bloodborne viruses. Protection is mandatory whenever there is a risk of splashes, spray, spatter, or droplets

• High-Risk Procedures in Blood Bank
  • Segment Opening: Cutting donor tubing segments for crossmatching is the highest-risk activity for facial splashes. The pressure inside the segment can spray blood several feet. This requires a chin-length face shield or a safety splash shield (acrylic barrier)
  • Uncapping Tubes: The “pop” of removing a rubber stopper can aerosolize blood
  • Centrifuge Accidents: Opening a centrifuge with a broken tube can release aerosols
• Types of Protection
  • Face Shields: Chin-length face shields offer the best protection as they cover the eyes, nose, and mouth simultaneously. They are often required when handling bulk blood components
  • Goggles + Mask: If a face shield is not used, safety goggles (with side shields) must be worn in conjunction with a mask
  • Prescription Glasses: Standard prescription eyeglasses are not considered PPE. They lack side protection and are not impact/fluid rated. Persons with glasses must wear goggles over them or prescription safety eyewear with side shields

Donning & Doffing Sequence

The sequence of putting on (donning) and taking off (doffing) PPE is critical to prevent self-contamination. Most exposures occur during the removal of contaminated equipment

• Donning (Putting On)
  1. Gown/Coat: Fasten fully
  2. Mask/Respirator: Secure ties and fit to nose
  3. Goggles/Face Shield: Place over face and eyes
  4. Gloves: Put on last, extending the cuff over the wrist of the gown
• Doffing (Taking Off)
  1. Gloves: Removed first, as they are the most contaminated. Peel from the outside, turning inside out
  2. Goggles/Face Shield: Handle by the head band or ear pieces (cleanest part)
  3. Gown: Unfasten ties, peel away from neck and shoulders, touching only the inside
  4. Mask: Remove last, handling only the ties
  5. Wash Hands: Immediately after completion

Limitations of PPE

It is important for the laboratory scientist to understand what PPE cannot do. Reliance solely on PPE without proper engineering controls is dangerous

• Needlesticks: Standard gloves do not prevent needlestick injuries. They provide no resistance to sharp steel. Engineering controls (safety needles) and work practice controls (no recapping) are the primary defense against sharps
• Integrity: PPE is only effective if intact. Micro-punctures in gloves or worn-out fluid resistance on lab coats render them useless
• False Security: Wearing PPE does not eliminate the need for careful technique. “Safety” is not achieved simply by putting on the gear; it requires constant vigilance regarding what the gloved hands are touching