Personal Protective Equipment (PPE)

The Clinical Center's Infection Control Guidelines provide instructions for the use and availability of personal protective equipment that must be utilized by LP and CC staff.  Appropriate PPE (gloves, gowns, masks, eye protection, etc.) is provided and maintained in a sanitary and reliable condition in all laboratory sections in which blood or body substances are handled. 

Indications for, and limitations of, glove use:

1. Gloves are worn for all contact with blood, body fluids, and other potentially infectious materials, and non-intact skin.
2. Hand contamination may occur as a result of small, undetected holes in gloves.
3. Contamination may occur during glove removal.
4. Wearing gloves does not replace the need for hand hygiene.
5. Failure to remove gloves after caring for a patient may lead to transmission of microorganisms from one patient to the other.
6. Supervisors and safety officers of each area should monitor hand hygiene technique and provide feedback to employees as needed.

Latex sensitivity or allergy: Gloves are the most utilized PPE in the laboratory setting. Personnel are protected from allergic reaction due to job-related exposure to natural rubber latex gloves and other products. The LP Safety Committee may assist with selection of products and implementation of work practices that reduce the risk of allergic reactions and help educate employees regarding latex allergies. Important information for healthcare professionals regarding natural rubber latex (NRL) allergy is provided at the National Institute for Occupational Safety and Health (NIOSH) website. If latex gloves are used, the supervisor should provide reduced protein, powder-free gloves. Employees with latex allergies should report to Occupational Medical Services (OMS) for medical evaluation. OMS can diagnose an employee with latex allergies and help with prevention and control strategies.

Lab coats are cleaned using the an LP-contracted Laundry Service:

1. Using indelible ink, write your name and room number on the tag of your lab coat.
2. Complete a laundry slip. Each section has a location to drop off dirty labcoats to be laundered by an LP contract service.
3. Place lab coats in a laundry bag or plastic bag.
4. The LP laundry contractor picks up bags every other week. 
5. Clean lab coats will be delivered back to the room number on the lab coat.

Minimal PPE per Clinical Service

The following text details the required use of barrier protection and infection control measures for routine laboratory procedures by all LP staff. PPE is to be made available to laboratory visitors when appropriate.

Autopsy Service

1. Performing or assisting in an autopsy:
   • Full barrier protection required: mask, gloves, goggles, gown, plastic apron, and shoe covers.
   • Particulate respirators are available, and are required for autopsies with a history of Mycobacterium tuberculosis.
2. Blocking or photographing fixed autopsy tissues:
   • Required barriers: gloves
3. Photographing unfixed autopsy specimens:
   • Required barriers: gloves, plastic apron
   • Extensive dissections on large specimens may require additional barriers.
4. Attending a gross autopsy conference:
   • No additional barriers are required, unless fixed tissues are handled (see above).
5. Histological preparation of fixed, paraffin-embedded tissues:
   • No additional barrier protection is required.

Surgical Pathology Service

1. Processing or blocking unfixed surgical specimens:
   • Required barriers: gloves, plastic apron
   • Extensive dissections of large specimens or specimens with potential for sudden release of body fluids (large cystic masses) may require goggles, mask, and gown.
2. Preparing and examining frozen sections:
   • Required barriers: gloves
3. Histological preparation of fixed, paraffin-embedded tissues:
   • No additional barrier protection required.
4. Examining histologic slides:
   • No additional barrier protection required.

Cytopathology Service

1. Preparing specimens:
   • Required barriers: gloves, lab coats, masks, and protective eyewear.
2. Performing, or assisting in the performance of fine needle aspirations:
   • Must wear gloves, gown, or lab coat. Recapping of needles is not permitted. Needles must be disposed of in biohazard labeled puncture-resistant receptacles (e.g., red “SharpSafe” boxes).

Hematopathology Section

1. Preparing cell suspensions from tissues:
   • Use gloves while preparing specimens in microbiological hood.
   • Wear protective eye cover.
2. Dissecting, blocking, and snap-freezing tissues:
   • Required barriers: gloves
3. Staining or manipulating (counting, etc.) viable cells:
   • Required barriers: gloves

Molecular Diagnostics and Chromosome Pathology Unit

1. Processing fresh tissues or cells for culture and cytogenetics:
   • Use gloves while preparing specimens in microbiological hood.
2. Processing glutaraldehyde-fixed tissues or cells.
   • Additional barrier protection not required.

Flow Cytometry Unit

1. Transporting sealed/contained specimens eg. specimens or stained tubes in sealed secondary transport containers or bins; etc.
   
   • Minimum barrier:  NONE; remove all PPE and wash hands before transporting sealed secondary transport container through public areas
2. Opening secondary specimen transport containers eg. transport bag, ice bucket, shipping container/envelope/cylinder, etc.
   
   • Minimum barriers:  lab coat, gloves; suggested barrier for frozen aliquots:  insulated gloves
3. Opening primary specimen container for processing eg. vacutainer tube, syringe, media tube, collection bottle, etc.
   
   • Minimum barriers:  lab coat, gloves, manipulation within laminar flow cabinet fitted with absorbent mat
4. Aliquoting viable cell suspensions between containers (1ml or more total volume) for processing eg. staining tube, counting chamber, frozen storage vial, etc.
   
   • Minimum barriers:  lab coat, gloves, manipulation within laminar flow cabinet fitted with absorbent mat
5. Transferring open container(s) of viable or fixed cell suspensions between processing stations (< 1ml suspension / container)
   
   • eg. charged chamber to Countess FL or microscope; staining tubes to centrifuge, incubation, LWA/cytometer rack, refrigerator, cytometer SIT; etc.
   • Minimum barriers:  lab coat, gloves; suggested barrier: eye protection
6. Disposing of specimens (primary or processed; viable or fixed; open container or sealed; etc.) and exposed waste (liquid or solid) to biohazard bins or chemical waste carboys
   
   • Minimum barriers:  lab coat, gloves; suggested barrier: eye protection