What is Personal Protective Equipment in Healthcare?
Personal protective equipment in healthcare (PPE) is equipment worn to minimize exposure to occupational hazards that cannot be eliminated or mitigated by engineering and administrative controls. Healthcare organizations have legal and ethical obligations to ensure workforce members have access to the types of healthcare PPE necessary to perform their roles safely.
Healthcare workers are exposed to a wide range of work-related safety and health hazards that can result in adverse outcomes such as injury, illness, disability, and death. To mitigate the risk of adverse outcomes, healthcare organizations are required by the OSHA General Duty Clause to identify and eliminate recognized hazards. When hazards cannot be eliminated, risks should be mitigated by implementing engineering and administrative controls.
When it is not possible to isolate members of the workforce from recognized hazards (engineering controls) or change working practices to reduce the risk of adverse outcomes (administrative controls), healthcare organizations are required to provide appropriate personal protective equipment (or Enhanced Barrier Protections in certain circumstances), train members of the workforce on its correct use and disposal, and monitor compliance with safety policies.
Common Types of Personal Protective Equipment in Healthcare
In 2023, the National Institute for Occupational Safety and Health (NIOSH) developed a course for promoting safety cultures in healthcare settings. In the module related to the prevention and control of work-related injuries and illnesses, NIOSH lists seven types of personal protective equipment in healthcare according to the body areas they protect.
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- Eyes (e.g., safety glasses, goggles, laser protective eyewear)
- Ears (e.g., ear plugs or muffs)
- Face (e.g., face shield)
- Hands (e.g., exam gloves, chemotherapy gloves)
- Feet (e.g., shoe coverings)
- Torso/body (e.g., fluid resistant gowns, impervious splash suit, laser protective clothing)
- Lungs/respiratory tract (e.g., N95 filtering facepiece respirator, elastomeric half-mask respirator, surgical mask, and protective shields and barriers).
According to OSHA’s General Requirements for Personal Protective Equipment (§1910.132), healthcare organizations are required to select the most appropriate types of healthcare PPE for each type of risk, communicate the decision to use PPE to each affected member of the workforce, and provide training on:
- When PPE is necessary,
- What PPE is necessary,
- How to properly don, doff, adjust, and wear PPE,
- The limitations of the PPE and,
- The proper care, maintenance, useful life, and disposal of the PPE.
Refresher healthcare PPE training must be provided whenever there is a material change to workplace operations, when there are changes to the types of healthcare PPE being used, or when a member of the workforce displays inadequate knowledge to use PPE in the way it is intended. In addition, some OSHA standards have mandatory annual training requirements – i.e., the bloodborne pathogens standard.
Specialist Types of PPE in Healthcare
In addition to the common types of PPE in healthcare, there are several specialist types of PPE that are used in specific healthcare settings. These include:
- Powered Air-Purifying Respirators (PAPRs) provide a higher level of respiratory protection by filtering out contaminants and supplying clean air.
- Hazmat suits provide full-body protection against hazardous materials, including infectious agents and chemicals.
- Lead aprons are used in radiology departments to protect healthcare workers from exposure to ionizing radiation during imaging procedures.
- Cryogenic gloves are designed to protect hands from extreme cold when handling cryogenic materials.
- Flame-resistant clothing may be worn in environments where there is a risk of exposure to fire or high temperatures.
- Chemical-resistant suits provide protection against chemical spills and splashes, and are often used in laboratories and during decontamination procedures.
Legal and Ethical Obligations for Workplace Safety
In addition to complying with OSHA’s requirements for personal protective equipment in healthcare, compliance with workplace safety regulations is a condition of participation in Medicare, a condition of licensure, and a condition of Joint Commission accreditation. Some state health departments have legal requirements for workplace safety that are more stringent than OSHA’s requirements for personal protective equipment in healthcare.
With regards to ethical obligations, there are four ethical principles defined by NIOSH that healthcare organizations must take into account when deciding what types of PPE in healthcare are appropriate to mitigate against adverse outcomes. The four ethical principles are:
- Autonomy – the right to self-determination and the individual’s right to make informed decisions.
- Nonmaleficence – the “no harm principle” not to place employees at risk of harm without protection.
- Beneficence – mitigating or preventing harm and creating practices and environments that help others achieve their maximum health potential.
- Justice – treating employees equally and without discrimination with regards to their health status, gender, ethnicity, social aspects, and the like.
To help healthcare organizations comply with the legal and ethical obligations, in 1988 the Centers for Disease Control and Prevention (CDC) published “Guidelines for Protecting the Safety and Health of Healthcare Workers”. Although the guidelines were published nearly forty years ago, many are still relevant to determining suitable types of PPE for preventing work-related injuries and illnesses.
Healthcare organizations who require further advice on personal protective equipment in healthcare, or who require assistance with workforce training, are advised to contact their local OSHA Office or speak with an independent healthcare safety professional.
