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Considerations for Selecting Protective Clothing used in Healthcare for Protection against Microorganisms in Blood and Body Fluids


Healthcare workers can be exposed to biological fluids that are capable of transmitting diseases. Those diseases, which are caused by a variety of microorganisms such as, Hepatitis B virus (HBV), Hepatitis C virus (HCV), Ebola Virus, and Human Immunodeficiency Virus (HIV) can pose significant risks to life and health. Healthcare workers wear protective clothing (e.g., surgical gowns, isolation gowns, and coveralls) to protect both patients and themselves from the transfer of microorganisms by blood and body fluids. A common misunderstanding among many end users is that they are protected from blood, body fluids, and other potentially infectious materials when they wear any type of fluid-resistant garment. This document provides an overview of scientific evidence and information on national and international standards, test methods, and specifications for fluid-resistant and impermeable gowns and coveralls used in healthcare. This document focuses on selecting protective clothing primarily on the basis of their barrier properties; it does not address all aspects of garments related to their design, integrity, durability, comfort, and functionality.

Classifying Worker Exposure to Bloodborne Pathogens

As with any type of personal protective equipment (PPE), the key to proper selection and use of gowns and coveralls is to understand the hazards and the risk of exposure. The Centers for Disease Control and Prevention (CDC) has categorized three primary routes of transmission: (i) contact (direct and indirect), (ii) respiratory droplets, and (iii) airborne droplet nuclei [Siegel 2007]. Contact transmission is generally the most common and direct contact occurs when microorganisms transfer directly from one person to another. Airborne transmission occurs by dissemination of either airborne droplet nuclei or small particles in the respirable size range containing infectious agents. Droplet transmission refers to respiratory droplets generated through coughing, sneezing, or talking. By using appropriate protective clothing, it is possible to create a barrier to eliminate or reduce contact and droplet exposure, and therefore prevent the transfer of microorganisms between patients and healthcare workers. This document provides information about protective clothing standard test methods and classification standards when the transmission of the microorganisms is through direct contact with blood or body fluids. Direct contact can occur through broken skin or mucous membranes located areas such as the eyes, nose, or mouth. In addition to blood, other body fluids can include (but are not limited to) urine, saliva, sweat, feces, vomit, breast milk, and semen.

Employers should conduct a thorough risk assessment first to identify potential exposures to blood and body fluids. The risk of exposure sometimes depends on the stage of the disease and severity of symptoms. For example, for Ebola virus disease, severe symptoms are strongly associated with high levels of virus production. In addition, close contact with the patient and invasive medical care can increase opportunities for transmission. This should be considered during the risk assessment, such as in the case of Ebola virus disease, as Ebola patients can release large volumes (as much as 8 liters/day) of body fluids (vomit, diarrhea) [Kreuels 2014]. A complete assessment of the risks is outside the scope of this document, but resources are available. For example, the Association for the Advancement of Medical Instrumentation (AAMI) published a guidance document on selection and use of protective apparel in healthcare facilities, Technical Information Report (TIR) 11 [AAMI 2005]. Some of the factors important to assessing the risk of exposure in health facilities include source, modes of transmission, pressures and types of contact, and duration and type of tasks.

Selecting Protective Clothing

Current Healthcare Protective Clothing Standards and Specifications

Several fluid-resistant and impermeable protective clothing options are available in the market place for healthcare workers. These include isolation gowns, surgical gowns, and coveralls. When selecting the most appropriate protective clothing, employers should consider all of the available information on recommended protective clothing, including the potential limitations. Employers should consult protective clothing manufacturers as needed in regards to availability and practicality for their facilities. A key step in this process is to understand the relevant standards and test methods. Descriptive information about each standard is provided in the body of this document.

References, Additional Reading, and Appendix