PersonalProtectiveEquipmentPolicy

Instructions: Copythis andthe followingpageas neededandhaveemployeessignto acknowledgeunderstandingyourfacility's PersonalProtectiveEquipment(PPE) Policy.

Gloves – allemployeeswearlatexglovesof the correct sizefor allprocedures whenit canbereasonablyanticipatedthat the employeemay havehandcontact withbloodor otherpotentiallyinfectiousmaterial,mucousmembranes,andnon- intact skin.

Disposable gloves arechangedafter eachpatient,or as soonas feasible,if torn, punctured,or theirabilityto functionas a barrieris compromised. Disposableglovesshallneverbewashedor decontaminatedfor re-useat this facility.

Utility gloves(thick rubber)aredecontaminatedfor reuseif the integrityof the gloveis not compromised.Utilityglovesarediscardedif they arecracked, peeling,torn, punctured,or exhibitothersignsof deterioration.Considerusing autoclavableutilityglovesmanufacturedby somecompanies(e.g., Hu-Friedy).

Fluid-resistant gownsareusedif fluidpenetrationis likely.

Masks,EyeProtection Glasseswithsolidsideshieldsandface shieldsareto bewornincombinationwheneversplashes,sprayor dropletsof bloodor other potentiallyinfectiousmaterialsmay begeneratedandeye, nose,or mouth contaminationcanbereasonablyanticipated.Prescriptionglasseswithsolid sideshieldsareappropriate.Anewmask is usedfor everypatientor willbe changedeveryhourto ensurebarriereffectiveness.

Eyeprotection shallbecleanedanddisinfectedas often as possibleandis not to bewornoutsidethe workarea.

Sequence for donning PPE:The anticipatedclinicalprocedurewilldetermine the combinationof PPE to beusedandconsequentlythe sequencefor donning that PPE.The gownshouldbedonnedfirst.The mask or respiratorshouldbe put onnext andadjustedto fit properly.The gogglesshouldthenbedonned, followedby the face shield.The glovesaredonnedlast.

1) Gown- 2) Mask or respirator- 3) Goggles- 4) Face shield- 5) Gloves

Sequence for removing PPE:The sequencefor removingPPE is designedto limitthe possibilityfor self-contamination.The glovesareconsideredthe most contaminatedandareremovedfirst.The gogglesandface shieldremovednext. The gownis thirdinthe sequence,followedby the mask or respirator.

1) Gloves- 2) Face shield- 3) Goggles- 4) Gown- 5) Mask or respirator

PersonalProtectiveEquipmentChart

SelectingProperPersonalProtective Equipment

It is importantfor the employerto makeaninformeddecisionbasedonthe routineswithinthis office andprovideappropriatePPE.PPE must bereadilyavailableinappropriatesizes. This form determinesappropriate PPE selection for the various tasksperformedin this office that could result in exposureto blood or other potentially infectious materials.It is understoodthat youcanalwaysexceedthis schedulefor minimumPPE if youdeemit necessary. If you, ouremployee,areawareof anyadditionalprocedures,whichmay leadto occupational exposureto bloodor otherpotentiallyinfectiousmaterial,weask youto bringthem to management’s attentionso wecanact uponthem.

MinimumPPE requirements:

Procedures / Gloves / Mask
Injections

Employeeacknowledgementof understandingthe PPE policyat: (FacilityName):

Employee Signature / Print Name / Job Title / Date