Protective Clothing in Healthcare

Background

Healthcare workers can be exposed to biological fluids that are capable of transmitting diseases.

Those diseases, which are caused by a variety of microorganisms such as, Hepatitis B virus, Hepatitis C virus, Ebola Virus, and Human Immunodeficiency Virus can pose significant risks to life and health.

Healthcare workers wear protective clothing (e.g., surgical gowns, isolation gowns, and coveralls) to protect both patients and them from the transfer of microorganisms by blood and body fluids. A common misunderstanding among many end users is that they are protected from blood, body fluids, and other potentially infectious materials when they wear any type of fluid-resistant garment.

Hazards and risk of exposure

Classifying worker exposure to bloodborne pathogens

As with any type of personal protective equipment, the key to proper selection and use of gowns and coveralls is to understand the hazards and the risk of exposure. CDC has categorized three primary routes of transmission:

1. contact (direct and indirect)
2. respiratory droplets
3. airborne droplet nuclei1

Contact transmission is generally the most common and direct contact occurs when microorganisms transfer directly from one person to another. Airborne transmission occurs by dissemination of either airborne droplet nuclei or small particles in the respirable size range containing infectious agents. Droplet transmission refers to respiratory droplets generated through coughing, sneezing, or talking.

By using appropriate protective clothing, it is possible to create a barrier to eliminate or reduce contact and droplet exposure and therefore prevent the transfer of microorganisms between patients and healthcare workers.

Risk assessment

Employers should conduct a thorough risk assessment first to identify potential exposures to blood and body fluids.

The risk of exposure sometimes depends on the stage of the disease and severity of symptoms. For example, for Ebola virus disease, severe symptoms are strongly associated with high levels of virus production. In addition, close contact with the patient and invasive medical care can increase opportunities for transmission. This should be considered during the risk assessment, such as in the case of Ebola virus disease, as Ebola patients can release large volumes (as much as 8 liters/day) of body fluids (vomit, diarrhea2).

A complete assessment of the risks is outside the scope of this webpage collection, but resources are available. For example, the Association for the Advancement of Medical Instrumentation published a guidance document on selection and use of protective apparel in healthcare facilities, Technical Information Report 11.3 Some of the factors important to assessing the risk of exposure in health facilities include source, modes of transmission, pressures and types of contact, and duration and type of tasks.