Proper Glove Use in the Prep Area of the SPD

By Nancy Chobin, RN, AAS, ACSP, CSPM

Q: Are we allowed to use latex gloves in the decontamination area?  Is there any documentation in AAMI or OSHA that dictates the use of latex gloves in the decontamination area? Secondly, are we allowed to wear gloves in the sterile prep area while putting together trays?

A:  According to the Occupational Safety & Health Administration (OSHA)'s Blood Borne Pathogen Ruling (2001), “Personal protective equipment (i) Provision. When there is occupational exposure, the employer shall provide, at no cost to the employee, appropriate personal protective equipment such as, but not limited to, gloves, gowns, laboratory coats, face shields or masks and eye protection, and mouthpieces, resuscitation bags, pocket masks, or other ventilation devices. Personal protective equipment will be considered “appropriate” only if it does not permit blood or other potentially infectious materials to pass through or reach the employee’s work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time that the protective equipment will be used. Accessibility. The employer shall ensure that appropriate personal protective equipment in the appropriate sizes is readily accessible at the work site or is issued to employees. Hypoallergenic gloves, glove liners, powderless gloves, or other similar alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided.”

Therefore, there is no requirement that gloves must be latex. As a matter of fact, the Food and Drug Administration (FDA) is now recommending that latex gloves no longer be used due to the potential for latex allergy. 

The major issue is when procedure gloves are used for cleaning versus a decontamination glove.  A decontamination glove is thicker (provides greater protection), may have non-slip fingertips (so instruments do not fall out of your hand) and in many cases are offered in 12- and 18-inch lengths to offer greater protection when manually cleaning in a sink filled with water and detergent. Therefore, you should be using a glove specifically designed for decontamination activities.  There are many manufacturers who provide decontamination gloves.  It is recommended to obtain samples from several companies for the staff to evaluate to see which glove best suits their needs.

Regarding using gloves in the prep area when assembling trays, why does the staff feel the need for this?  If the answer is that the sets are not always clean then the bigger issue is solving the inadequate cleaning problem. Does your department have all the specific manufacturer’s instructions for cleaning?  Are they readily available for the staff to use and reference? Has the staff been in-serviced in the instructions?  It is inexcusable for sets to be improperly cleaned.
There are two major issues with this. Number one is that the staff will wear gloves because they feel “safer” when handling improperly cleaned instruments.  This practice is an unnecessary expense. Number two, the staff usually performs the “cleaning” in the prep area either at a handwashing sink or at the prep table. NOTE:  A good indication cleaning is taking place in the prep area is the presence of cleaning brushes and detergent at the sink or on the prep tables. Furthermore, this is an OSHA violation since cleaning should only be performed in the decontamination area under controlled conditions and while wearing PPE. When cleaning is performed in the prep area, the work area as well as staff scrub attire can become contaminated.

In summary: A thorough investigation of the cleaning issues should be performed and the problem(s) rectified. Cleaning issues should not be ignored. Staff should be in-serviced that if any instrument is found to be soiled, it should immediately be returned to the Decontamination Area for re-cleaning. Continued issues with cleaning failures need to be addressed. The use of decontamination gloves for maximum staff protection is recommended.

Nancy Chobin, RN, AAS, ACSP, CSPM, is a sterile processing consultant and educator.
 

References:
Association for the Advancement of Medical Instrumentation, ST-79, Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities, 2013.

Occupational Safety & Health Administration. Occupational exposure to blood-borne pathogens (29 CFR Part 1910.1030)1; §1910.1030 Blood-borne pathogens.