Product Evaluation and Purchasing: PPE

What are the primary considerations decision-makers should keep in mind when evaluating and purchasing your category of PPE-related products/services?

The selection of personal protective equipment (PPE) should begin with hazard assessment. Once you identify and measure the hazards, you can determine the appropriate controls, including the PPE most appropriate to protect your employees, achieve compliance and be comfortable for the employee. You may also look for products, e.g., N95 particulate respirators, that have been NIOSH approved, as well as FDA cleared as surgical masks for use in the operating room environment. Comfort is a key consideration for the employees who will be wearing the PPE. Of course, cost is also a big factor. And there could well be other considerations based on a variety of factors, such as the environment or company policies. Overall, though, you should seek out options that meet your employee’s needs and comfort requirements or else they won’t want to wear the PPE.

-- Kelly Huppert, technical service specialist, 3M Infection Prevention Division

Establishing a multidisciplinary product evaluation and selection committee is an important step in developing a standardized product selection and implementation process, in addition to product-specific evaluation tools. The committee should obtain information on new or existing products from either professional resources or manufacturers. Both resources have access to information about products that are currently available, while manufacturers can provide both technical and clinical data related to their specific products. When selecting PPE, there are many different factors to be considered by decision-makers, including compliance with federal, state and local regulatory agencies and contractual agreements. In addition, the product selection committee should consider the following:

  • The type of anticipated exposure, such as touch, splashes or sprays, or large volumes of blood or body fluids that might penetrate the clothing;
  • The durability and appropriateness of the PPE for the task. This will affect, for example, whether a glove needs to be sterile or non-sterile or deemed appropriate for work with chemotherapy agents;
  • End-user comfort and effective individual fit.

    -- Latisha Richardson, MSN, BSN, RN, clinical consultant, Ansell

    Purchasing PPE products today is not what it was 10 years ago. The sophistication of the materials and how products are constructed, as well as OSHA/CDC regulations/guidelines play a huge role in ensuring these products are adequate to protect the individuals who use them. Some considerations involved in the choices made should encompass the following key points:

  • Does the product adhere to OSHA/CDC guidelines
  • Does the product provide adequate barrier protection properties as stated
  • Is there an ease of use to enable compliance
  • Are instructions for use clear and succinct
  • Is the product durable and appropriate for the intended task
  • What is the expected/anticipated risk of exposure
  • Splash/spray versus touch
  • Category of isolation precautions
  • Is the range of sizes available to adequately fit staff
  • What education is available to staff and how is it best delivered
  • Is the product/range of products cost effective
  • Is the product readily available for delivery to your facility

    -- Caroline Ginn, MSN, BSN, RN, CNOR, and Mary Cross, RN, MBA, CWCMS, Cardinal Health

    Determine and ask yourself if it complies with regulatory and/or facility guidelines. Is it single-use or do you need to reprocess it? What type of job are you performing and what kind of protection do you need from contaminants with which you are working in the sterile processing department. Is it covering/protecting your exposed areas?

    -- Matthew Smith, marketing manager, Healthmark Industries

    Decision-makers need to be aware of changing regulations and make sure they have the appropriate resources to help them be compliant. Educating themselves is another action. Oftentimes, clinicians, and even leadership, don’t understand the different levels of protection (AAMI). Rising exposure to multidrug-resistant TB seen around 2009 taught healthcare a lot about how easy transmittable infectious diseases can be in any setting. Ebola in 2014 continued to heighten our awareness and from that, we knew we had to approach PPE differently. Healthcare organizations must have tools and products readily available for clinicians to do the right thing. For example, visual cuing can help caregivers under-stand the appropriate level of protection. Healthcare organizations must be in a perpetual state of readiness, so PPE must be part of a leader’s strategic plan. They must invest in high quality solutions in order to protect their greatest assets, their employees.

    -- Martie Moore, chief nursing officer, Medline

  • Protection level required for application: There are generally four key factors to consider when selecting PPE:

    1. Fluid or contaminant exposure levels determining material and barrier protection attributes and fluid resistance

    2. Regulatory standards and protocol for PPE usage at your facility, dictating whether AAMI or certain ASTM testing standards are required

    3. Duration and any special parameters of use for each application to determine durability needed

    4. Maintaining reasonable levels of user comfort and breathability, while ensuring key protective priorities are preserved

  • Product design and features: Selecting products with specific features that ensure proper coverage, secure and ideal fit, and to maximize compliance and facilitate proper donning/doffing procedures. Quality materials and construction ensure reliable, consistent protection and performance with every use. Proper fit helps to ensure minimal restriction of movement and potential stress points that can compromise barrier protection; minimizing bulky fit areas maximizes apparel/gown safety and reduces chance of PPE interfering with the task.

  • Manufacturer and product supply chain integrity: Choosing a supplier and manufacturer with a proven, well-controlled and sophisticated Global Supply Chain system will help to ensure quality and consistency of manufacturing, uninterrupted supply for disposable single-use PPE products, and strong service excellence.

    -- Edmund S. Tai, vice president of healthcare, Tronex International Inc.

    What are some suggestions for how to effectively introduce and educate on PPE-related products/services to healthcare workers?

    First, having employee buy-in is important. Educating your workers about the hazards and need for PPE, the options available, the features, the benefits, and comfort concerns – all of these are significant, but allowing them to try PPE on a trial basis to see how it feels and performs goes a long way toward getting your staff to adopt new PPE. They need to feel comfortable with the change. PPE is very personal because it is worn by the worker and because of what is at stake. Like most workers, healthcare staff take their health very seriously and want to feel reassured they’ve been protected throughout the day. A PPE supplier may provide training materials for you on proper use and fit testing, and may also provide ongoing support/training to facilities who use their PPE to help ensure compliance and confidence. This includes considering the Industry Guidelines, including AORN for the operating room environment, CDC for updated pandemic details and OSHA standards for occupational safety information.
    -- Kelly Huppert, technical service specialist, 3M Infection Prevention Division

    While it’s important to have the appropriate PPE on hand, ensuring that staff can correctly utilize the equipment is equally important to the safety of the healthcare workers, patients and the community. Healthcare workers should be trained to: recognize the type of PPE necessary for the procedures to be performed; understand the different material options and how this effects protection; and demonstrate the proper usage of the applicable equipment. Regulatory agencies, like the Centers for Disease Control and Prevention (CDC), have educational material, including videos, posters and handouts, available to help facilities train staff regarding the appropriate use of PPE. Further, it’s important to utilize a variety on teaching methods to ensure every learning style is addressed. Using interactive teaching methods, like return demonstrations and simulated patient scenarios, allows staff to experience possible outbreak situations, gives staff the ability to practice in a safe environment and brings training sessions out of a two-dimensional learning platform. It also allows educators and trained observers to pinpoint possible ongoing issues with proper PPE usage and correct them before actual clinical use.

    -- Latisha Richardson, MSN, BSN, RN: clinical consultant, Ansell

    Everyone knows Universal Precautions are infection control guidelines designed to protect workers from exposure to diseases spread by blood and certain body fluids. Yet little is known about how healthcare workers use PPE and if they are using it effectively. A study in AJIC, (Vol. 45, (2017) pp.17-23) noted, even with subjects being observed, errors in donning/removal occurred. Compliance and proper use of PPE is the result of effective education surrounding barrier protection, appropriate product selection and proper technique to don/doff. Users need to have a clear understanding of what level of protection is warranted and which protective items are needed for Universal Precautions, i.e. gloves/facial protection/gowns. The best method to learn involve hands-on exercises and return demonstrations. Visual reminders and info graphics help reinforce correct selection and proper technique. Everyone wants to be safe, every day, all day. With diligent reinforcement by the infection preventionist and team, and on-going follow up to comply with the institution’s guidelines, every healthcare worker can be safe. Benchmarking education and understanding key drivers in learning will aid in forming an effective/cohesive program to educate all of the parties involved who wear PPE products. Stick protocols and frequent checks need to be up into place for an effective program to be successful. Additionally, in the market there are multiple CE programs as well as tool kits provided by the CDC which enable the end users the means to under-stand protocols and precautions. It does have to be said that these methods are only as effective if the end users utilize the PPE products appropriately i.e. correct wearing of the gloves /facial/ gowns protect.

    -- Caroline Ginn, MSN, BSN, RN, CNOR, and Mary Cross, RN, MBA, CWCMS, Cardinal Health