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5 PPE mistakes jeopardizing safety

Publish Date: 7/17/2013
A perioperative professional's responsibility is to protect patients. But nurses cannot protect patients if they are unable to come into their facility as a result of suffering on-the-job injuries, which makes proper use of personal protective equipment (PPE) critical to accomplishing this duty.

When PPE is used properly, it can minimize exposure to a variety of hazards, helping keep nurses safe and able to provide high-quality care. Proper use of PPE is also a regulatory requirement. But when PPE is used improperly or not used at all, perioperative nurses fall out of compliance and are more likely to injure themselves and possibly expose patients, other staff members and the public to hazards.

Sandy Berreth, RN, administrator of Brainerd Lakes Surgery Center in Baxter, Minn., and a surveyor for the Accreditation Association for Ambulatory Health Care, identifies five common PPE mistakes that compromise safety.

1. Manipulating PPE. One of the biggest mistakes made by perioperative nurses is to manipulate PPE to make caregiving easier.

"For example, I've seen nurses who will put on a pair of gloves and then pull the fingertips off of two fingers, claiming this allows them to 'feel' the vein better," Berreth says. "But now they're opening themselves up for problems when they compromise their own PPE to do a task they should do with gloves on."

2. Forgetting to follow proper practices. When perioperative professionals forget to follow proper PPE practices, it's likely attributable to trying to complete a task quickly — perhaps too quickly, Berreth says.

"So many nurses hurry because we're understaffed, or trying to turn an OR over quicker or find ways to be more efficient, which ultimately lead to taking shortcuts in ensuring our own protection. This is a particularly significant challenge for nurses in high-paced ambulatory surgery centers," she says. "In nursing, we treat every patient identically, with the highest level of concern for their safety and remembering 'universal precautions,' but we, the nurse, forget to do the same for our safety. It may mean that we have to slow down and make sure we are properly protecting ourselves."

3. Protecting against blood ... but nothing else. Perioperative nurses typically have very good PPE practices when dealing with blood. But when perioperative professionals are handling other chemicals, Berreth says PPE often becomes less of a priority.

"Sometimes we'll clean a room without putting on proper protection," she says. "We'll just grab a sterile wipe without putting on gloves and we'll start wiping down a table without a face shield. When you're in a hurry, there can be a splash up into your eyes when cleaning, so now instead of blood, you've put a mixture of bleach or cleaning product on to your hands and got it into your eyes.

"In another instance, if I'm a scrub nurse and I'm using a cleaning product without gloves on, I'm now causing a potential for skin breakdown to my hands," Berreth continues. "This can lead to infections that may eventually get back to your patients or prevent you from doing your job."

Perioperative nurses need to be careful of other non-cleaning chemical agents as well.

"We instill chemotherapy agents into the bladder for some urology cases, and then we drain that 'chemo agent' from the bladder," Berreth says. "You have to be very careful to protect yourself from these drugs. In a hurry, one may just think it's urine that is draining, but really it's a chemo agent that needs to be taken very seriously."

4. Counting on PPE to do more than it can. It's important for perioperative nurses to remember that PPE can only do so much in providing protection from hazards. Good practices are still the best way to remain safe, and should be considered a type of PPE, Berreth says.

"When we think about PPE, we think above gloves, masks, shields and barriers of some sort," she says. "We also need to think of it as practices, and look for ways to change practices to protect us. For example, if a physician hands me a needle in a hurry, a glove is not going to protect me from getting stuck with that needle. This is a case where we need to recognize the potential danger in the practice and work to make sure these incidents do not occur. The PPE we wear can only do what it's designed to do."

5. Permitting bad practices. A component of protecting patients is working to ensure they receive the best care possible. This can only be accomplished if all members of the OR team are able to provide care. While perioperative nurses must make sure they are following proper PPE practices, they also have a responsibility to ensure the other members of the team — including physicians — are doing the same, Berreth says.

"One of the biggest challenges for nurses in an OR is reminding physicians that face shields are important," she says. "They may believe their glasses will suffice, but perioperative nurses must remind them that splatters can happen under glasses, so they need to wear face shields. It's a matter of protecting our physicians, and that ultimately helps protect patients."

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