Clinical Practice Guideline for an Infection Control/Exposure Control Program in the Oral Healthcare Setting
Personal Protective Equipment

Background

Pathogenic organisms in blood and OPIM may come in contact with skin; conjunctival and oral mucosal tissues; and respiratory epithelium by inhalation of airborne microorganisms, i.e., droplets or droplet nuclei suspended in air. Personal protective equipment (PPE) is designed to protect the skin and mucous membranes (eyes, nose and mouth) and respiratory epithelium of OHCP from exposure to a source or reservoir of pathogenic organisms by contact transmission, i.e., direct or indirect contact transmission; and respiratory transmission, i.e., inhalation of droplets or droplet nuclei (airborne transmission).

1. Personal protective equipment, which does not permit blood or OPIM to pass through to or reach street clothes, undergarments, skin, or mucous membranes under normal conditions of use and for the duration of time that the protective equipment is used, is provided for and is routinely worn by all OHCP.
   1. Protective clothing
      1. Gowns or lab coats with long sleeves are worn to protect the forearms when splash, spatter, or spray of blood or OPIM to the forearms is anticipated.
      2. Protective clothing is changed daily, whenever it becomes visibly soiled, and as soon as possible if penetrated by blood or OPIM.
      3. Protective clothing is removed before leaving the work area.
      4. Dirty protective clothing is placed in designated areas for disposal or washing.
   2. Task-specific gloves
   1. Non-surgical, surgical, or heavy-duty utility gloves are worn by all OHCP to prevent or reduce the risk of contaminating the hands with blood or OPIM and to prevent or reduce the risk of cross-infecting in the clinical process.
   1. To reduce the risk of latex-related allergies, only powder-free, low-allergen latex gloves; and non-latex, nitrile or vinyl gloves are available.
   2. Non-surgical and surgical gloves are single-use items, which are used for only one patient and are then discarded.
   3. When torn or punctured, gloves are changed as soon as possible.
   4. Gloves may not be washed because it can lead to wicking (penetration of liquids through undetectable holes in the gloves) and subsequent hand contamination.
   5. Double gloving is acceptable for extensive oral surgical procedures.
   6. Heavy-duty utility gloves are worn for all instrument, equipment, and environmental surface cleaning and disinfection.
   7. Wearing gloves does not eliminate the need for hand hygiene.
   3. Surgical masks
      1. Surgical masks that cover both the nose and the mouth are worn by all OHCP during clinical activities likely to generate splash, splatter, and aerosols.
      2. Surgical masks provided for routine use have filtration efficiency of 95% for microorganisms greater than 3 microns.
      3. When a mask becomes wet from exhaled air or contaminated with infectious droplets, spray, or from touching the mask with contaminated fingers it is changed as soon as possible (between patients or even during patient treatment).
   4. Particulate filter respirators
      1. When airborne infection isolation precautions are necessary (e.g., transmission-based precautions for patients with TB), a National Institute for Occupational Safety and Health (NIOSH)-certified particulate-filter respirator (N95, N99, or N100) is used, which have the ability to filter .3 µm particles with a filtering efficiency of 95, 99, and 99.7% respectively.
   5. Protective eyewear
      1. Protective eyewear with solid side shields or a face shield is worn by OHCP during the clinical process likely to generate splash, splatter, and aerosols.
      2. Protective eyewear with solid side shields is also provided for the patients to protect their eyes from spatter and debris generated during the clinical process.
      3. Protective eyewear is cleaned with soap and water between patients.
   6. Ventilation devices
      1. Mouthpieces, pocket masks, and resuscitation bags are used when CPR is administered.