Chapter 12: Personal Protective Equipment

Copyright © 2017, Elsevier Inc. All Rights Reserved.
Personal Protective Equipment
Chapter 12
1

Learning Objectives
Lesson 12.1: Personal
Protective Equipment
1. Describe the protective value of gloves and
list their uses, types, limitations, and the
harmful reactions that can occur from their
use.
2. Describe the value of masks, protective
eyewear, and protective clothing and list
their uses, types, and limitations.
3. List the sequence of donning and removing
personal protective barriers and the
properties of protective equipment.
2

 Barriers important to prevent exposure to
microorganisms:
 Gloves
 Masks
 Protective eyewear
 Protective clothing
 OSHA requires the employer to be
responsible for maintaining, cleaning, and
disposing of these barriers
3

 Although intact skin is an excellent barrier to
disease agents, a small or even invisible cut
appears like the Grand Canyon to
microorganisms.
 Thus, small cuts and abrasions can serve as
routes of entry of microorganisms into the
body, causing a skin infection or other more
widespread diseases.
4

Protective Value of Gloves
 Protection of dental team
 Protection of patients
5

 Microorganisms are present on just about
every surface in the office that has not just
been cleaned and disinfected.
 Contaminated hands serve as a very
common means of spreading microbes.
6

 Dental professionals should wear disposable
gloves during all patient care activities where a
potential exists for direct hand contact with saliva,
blood, or other oral fluids, mucous membranes,
and nonintact skin and when handling items or
surfaces contaminated with body fluids or
potentially infectious materials.
 Cuts on unprotected hands are suggested to be
an important reason for the high occurrence of
hepatitis B in dental and medical personnel who
do not use gloves routinely.
7

Examples of Gloves
8
There are several types of
gloves available for
various uses in the dental
setting.
Figure 12.1 shows
examples of gloves used
in dentistry.
A, Examination gloves.
B, Utility gloves.
C, Heat-resistant gloves.

Uses and Types of Gloves
 Disposable gloves should be worn during all
patient care activities
 Gloves used for patient care should not be
reused on subsequent patients
 Torn or punctured gloves should be removed
as soon as possible
9

Uses and Types of Gloves
 See Box 12.1 for various types of gloves.
 If the dental professional leaves the chairside
during patient care, the best procedure is to
remove the gloves and don a fresh pair upon
returning to chairside.
 Sterile latex or vinyl gloves are used during
surgical procedures, but nonsterile gloves are
appropriate for most other dental procedures.
10

Limitations of Gloves
 Manufacturing process for patient care gloves
can result in a low level of pinholes
 FDA has strict requirements to ensure high quality
 High level of protection against direct contact
with infectious agents
 Little protection against injuries with sharp
objects
 Contaminated sharps must be handled safely
even when wearing gloves.
 Do not reuse heavy utility gloves if they are
peeling, cracking, or torn.
11

Harmful Reactions to Gloves
 Some health care workers have harmful
reactions from latex gloves or airborne glove
materials
 Three types of reactions may occur with
gloving
 Irritant contact dermatitis
 Allergic contact dermatitis
 Latex allergy
 The manufacturing process of latex gloves
causes some allergic reactions.
 200 different chemicals can be used.
12

Irritant Contact Dermatitis
 Nonimmunological irritation of the skin from
nonlatex chemicals in the gloves
 Hands become dry, reddened, itchy, or even
cracked
 To prevent recurrence, need to identify the
irritant and perform proper glove hygiene
 One should also consider changing gloves or
handwashing agent brands.
 Failure to dry hands thoroughly and
excessive perspiration on hands can also
aggravate this dermatitis.
13

Allergic Contact Dermatitis
 Four types of immunological
hypersensitivities (allergies) occur (I to IV)
 Allergic contact dermatitis (type IV) most
frequently occurring reaction to gloves
 Limited to the areas of contact
14

Allergic Contact Dermatitis
 Poison ivy is also a type IV hypersensitivity.
 Eliminating contact with the sensitizing agent
is the only way to prevent allergic contact
dermatitis.
 Glove manufacturers attempt to control the
addition of chemicals to latex products.
 Hypoallergenic just means reduced levels of
certain chemicals, not necessarily free of all
potentially harmful reactions.
15

Latex Allergy
 What are NRL products? (Natural rubber
latex products; if a latex-sensitive person
inhales airborne latex proteins when gloves
are donned or removed, that person may
have a serious respiratory or systemic
reaction.)
 If the dental team uses latex gloves, they
should be the powder-free reduced-protein
type.
16

Latex Allergy
 A type I hypersensitivity
 Symptoms usually occur within 20 minutes
after contact with NRL products
 Exposure to NRL protein allergens present in
the glove cornstarch powder is a concern
17

Latex Allergy
 See Box 12.2 for examples of items that may
contain latex, and Box 12.3 for
recommendations for preventing latex
allergies.
 See Box 12.4 for a list of appropriate
questions about latex allergy to include in the
patient medical history
18

Masks Are a Must
 Wearing a mask protects against inhalation of
disease agents that might be present in
sprays, spatter, or even some aerosols
 Protects mucous membranes of the nose and
mouth of dental team
 Masks worn by dental team also help give
some protection to the patients.
19

Uses and Types of Masks
 Should be worn during patient care activities
involving:
 High-speed or low-speed handpieces
 Ultrasonic scalers
 Air/water syringes
 Oral irrigators
20

 Masks should be changed with every patient.
 Face masks are composed of synthetic
material that serves to filter out at least 95%
of small particles that directly contact the
mask. The filterability of masks is referred to
as Bacterial Filtration Efficiency (BFE) or
Particle Filtration Efficiency (PFE).
21

 The surgical masks commonly used in
dentistry are dome shaped or pliable. They
may be secured with an elastic band, ear
loops, or ties.
 Should replace wet masks approximately
every 20 minutes to maintain high flexibility.
22

Examples of Surgical Masks
23

N95 Respirator Mask
24
Protection against
airborne infection
requires the use of a
respirator mask that fits
in such a way that forces
inhaled air to pass
through the filter rather
than the edge of the
mask.
More difficult to breathe
through, and training is
required to use.

Protective Eyewear
 Protects against:
 Infectious disease (herpes simplex and hepatitis B)
 Physical damage to the eyes
 Patients should be offered eye protection as
well
25

Protective Eyewear
 Your eyes have open mucous membranes, making
them vulnerable to infectious disease agents and
flying debris that can cause physical damage.
 Eyewear protects against propelled objects such as
tooth fragments or small pieces of a restorative
material exiting a patient’s mouth during cavity
preparation.
 Impact damage to the eyes can occur from any
polishing, grinding, or buffing procedure, whether
performed in a patient’s mouth, at chairside, or in
the dental laboratory.
26

Uses and Types of Eyewear
 Goggles
 Glasses (with or without shields)
 Face shield
27

Uses and Types of Eyewear
 See Table 12.1 for comparison of eye protection
devices.
 Protective eyewear worn by dental team should be
decontaminated thoroughly before reuse with
subsequent patients.
 Goggles that may be used by themselves or over
prescription glasses may not be attractive, but they
give the greatest eye protection against front and side
splashes and impacts.
 Although glasses give protection against front
splashes and impacts, side protection is poor unless
they have solid side shields. 28

Protective Clothing
 The outer layer of clothing that protects/covers
underlying work clothes or skin
 Dental team members can also be
contaminated chairside by sprayed
microorganisms on the forearms, chest area,
and the lap
 Disposable gowns with long sleeves are a
convenient approach
29

Protective Clothing
 Potentially infectious microorganisms may be
present in the aerosols, sprays, spatter, and
droplets from the oral fluids of patients.
 Outer protective clothing can protect against this
contamination, which otherwise may lead to
infection through nonintact skin or at least to
spread of the contamination from office to home or
elsewhere on unprotected clothing.
 Changing of obviously contaminated protective
clothing before providing care for the next patient
is perceived as providing patient protection.
30

Example of Protective Clothing
31
Figure 12.7 shows
disposable protective
clothing.
Other examples of
protective clothing
include uniforms, clinic
jackets, lab coats, and
aprons.
Materials with the
greatest resistance to
fluids provide the
greatest protection.

Protective Clothing (Cont.)
 Protective clothing should be removed when
leaving clinical areas
 OSHA’s bloodborne pathogens standard
applies to protective clothing
32

Protective Clothing (Cont.)
 Employees cannot take home contaminated
clothing and linens for laundering.
 Laundering is the responsibility of the
employer through laundering in the office or
by contracting with a commercial laundering
service.
 Although not required by any law, dental
team members also should consider having
work shoes to wear only in the office.
33

Placing and Removing
Equipment Barriers
 Putting on and taking off barriers should be
done in a sequence that limits further spread
of microorganisms
34

Placing and Removing
Equipment Barriers
 See Box 12.5 for the order of putting on and
removing equipment.
 Just before performing a treatment, one should
wash, rinse, and dry hands and put on gloves.
One should not touch any contaminated items or
surfaces with the gloves before they go into the
patient’s mouth.
 Viruses can survive on objects of PPE for hours,
so care is necessary when removing to prevent
the spread of contamination.
35

Properties of Protective Equipment
 There are many properties to consider before
making a selection
 See Box 12.6 for various options when choosing
gloves, masks, eyewear, and protective clothing.
 Although performing dentistry on Ebola patients or
persons under investigation for Ebola is unlikely,
PPE that covers the clothing and skin and
completely protects the mucous membranes is
required when caring for such patients.
36

Chapter 12: Personal Protective Equipment

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