3 Personal Protective Equipment and Transmission-Based Precautions

Select PPE for the task

Personal protective equipment (PPE) creates a barrier between a healthcare worker and potentially infectious material. It is effective only when selected for the anticipated exposure, put on correctly, worn appropriately, and removed without contaminating skin, clothing, or the environment. PPE supplements, but does not replace, hand hygiene and other infection-control practices. Follow facility procedures and training.

Assess exposure and choose PPE

Standard Precautions apply to every patient in every care setting. Assess the task and likelihood of contact with blood, body fluids, secretions, excretions, mucous membranes, nonintact skin, or contaminated equipment, then select PPE accordingly.

• Gloves: Use when hand contact with potentially infectious material, mucous membranes, nonintact skin, or contaminated items is reasonably anticipated. Change them if torn or heavily contaminated, and between tasks when moving from a contaminated body site to a clean one. Gloves are not a substitute for hand hygiene.

• Gown or other protective clothing: Wear it when clothing or skin may contact infectious material or become soiled. Choose coverage appropriate to the task and anticipated exposure.

• Mask and eye protection, or a face shield: Use them when splashes or sprays may reach the nose, mouth, or eyes. A face shield may protect the full face, but it does not automatically replace a respirator when one is required.

• Respirator: Use one when the task or isolation requirements call for respiratory protection. For airborne precautions, healthcare personnel generally need a fit-tested, NIOSH-approved N95 or higher-level respirator, in accordance with the respiratory-protection program.

Put on and remove PPE safely

A common donning sequence is gown, mask or respirator, eye protection, then gloves. Perform hand hygiene first. Secure the gown, position the mask or respirator correctly, and put on eye protection. If using a respirator, perform the required user seal check each time it is donned. Put gloves on last, covering the gown cuffs. Keep hands away from the face and avoid touching unnecessary surfaces.

A common removal sequence is gloves, gown, eye protection, then mask or respirator. Facility procedures may instead use a combined gown-and-glove removal method. Remove gloves and gown without touching their contaminated outer surfaces. Handle eye protection and masks by their straps or ties rather than their fronts. For airborne precautions, leave the room and close the door before removing the respirator, unless facility procedures specify an anteroom or another safe location. Perform hand hygiene immediately after removing all PPE, and between steps if hands become contaminated.

Dispose of or reprocess PPE

Discard single-use PPE in the appropriate waste container. Place reusable eye protection in the designated receptacle for cleaning and disinfection. Handle soiled reusable garments and laundry according to facility procedures, and do not shake them. Replace damaged PPE; never wash or disinfect disposable gloves for reuse.

Apply Transmission-Based Precautions

Transmission-Based Precautions are added to Standard Precautions when an infection may spread by contact, droplets, or airborne particles. Some conditions require more than one category. Check the patient-care sign and facility guidance before entering.

• Contact: Used when infection spreads through direct contact with the patient or their immediate environment. Wear a gown and gloves for interactions that may involve contact with the patient or nearby environment; these are commonly put on when entering and removed before leaving. Use dedicated equipment when possible, or clean and disinfect shared equipment between patients.

• Droplet: Used when infection spreads through respiratory droplets at close range. Wear a mask upon entering the patient’s room or care space. Place the patient in a single room when possible. If transport is necessary, have the patient wear a mask if tolerated and follow respiratory hygiene practices.

• Airborne: Used when infection spreads through airborne particles. Place the patient in an airborne infection isolation room (AIIR) when available. Wear a fit-tested, NIOSH-approved N95 or higher-level respirator before entering the room. Mask the patient during necessary transport if possible.

Limit patient movement outside the room to medically necessary purposes. Before transport, follow the relevant precaution-specific instructions, including source control for the patient. Clean and disinfect equipment and the patient environment as required by facility policy.

Follow workplace requirements

In the United States, OSHA’s Bloodborne Pathogens Standard requires employers to provide appropriate PPE at no cost when occupational exposure is anticipated, ensure it is used, and provide for its cleaning, laundering, repair, replacement, or disposal. PPE must be removed before leaving the work area and placed in a designated container or area. If a garment is penetrated by blood or other potentially infectious material, remove it as soon as feasible.

Use the employer’s exposure-control plan and procedures for regulated waste and contaminated laundry. These requirements do not mean that all used PPE belongs in the same waste stream. If an exposure occurs, follow the facility’s immediate exposure-response and reporting procedures. PPE reduces risk but cannot eliminate every exposure hazard.