Use of PPE

Personal Protective Equipment (PPE) represents the last line of defense in the hierarchy of safety controls. While engineering controls (such as safety needles and biosafety cabinets) remove the hazard from the employee, and work practice controls (such as hand washing) alter the manner in which a task is performed, PPE places a physical barrier between the laboratory scientist and the hazardous material. Under the OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030), employers are mandated to provide appropriate PPE at no cost to the employee, ensure it is accessible, and require its use whenever there is a reasonable anticipation of exposure to blood or other potentially infectious materials (OPIM)

Hand Protection (Gloves)

In the Hematology laboratory, gloves are the most frequently used item of PPE. They serve a dual purpose: protecting the laboratory scientist from direct contact with bloodborne pathogens during phlebotomy or specimen processing, and protecting the patient/specimen from contamination

• Material Selection: Latex gloves were historically standard but have largely been replaced by Nitrile gloves in many institutions. Nitrile offers superior chemical resistance (protecting against reagents like Drabkin’s solution or Wright’s stain fixatives) and eliminates the risk of latex sensitization/anaphylaxis for both staff and patients. Vinyl gloves are generally discouraged in high-risk areas as they are more prone to micro-tears
• Mandatory Usage: Gloves must be worn during all vascular access procedures (phlebotomy), when handling automated analyzer waste lines, during instrument maintenance, and when handling any blood tube or slide. In Hematology, handling glass slides with immersion oil requires gloves to prevent absorption of the oil and contact with the potentially infectious blood film
• Proper Technique
  • Donning: Gloves should be the last item of PPE put on, pulled over the cuffs of the lab coat to create a seal
  • Change Frequency: Gloves must be changed immediately if they become torn, punctured, or heavily soiled. They must also be changed between patients during phlebotomy
  • Prohibitions: Gloves must never be washed or decontaminated for reuse, as this degrades the barrier integrity. “Double-gloving” is an acceptable practice during high-risk procedures (e.g., changing a sample probe on an analyzer) to provide an extra layer of protection

Body Protection (Laboratory Coats & Gowns)

Laboratory coats in the Hematology section are designed to protect the laboratory scientist’s skin and street clothing from splashes, spills, and droplet contamination. They prevent the “carry-over” of infectious agents from the laboratory to public areas or the employee’s home

• Design Specifications: OSHA requires that the protective clothing be appropriate for the task. In Hematology, coats should be fluid-resistant (impervious to liquids, unlike cotton which acts as a sponge). They must have long sleeves and, ideally, knit cuffs. Knit cuffs are crucial in Hematology to prevent the loose sleeve from dragging across a slide or dipping into a specimen rack
• Usage Protocols
  • Coats must be fully buttoned or snapped closed at all times while in the technical area. An open coat offers no protection to the front of the body
  • PPE must be removed immediately upon leaving the work area. This includes trips to the restroom, cafeteria, administrative offices, or break room
• Laundering: The employer is responsible for cleaning, laundering, or disposing of personal protective equipment. Employees are strictly prohibited from taking contaminated lab coats home to wash in their personal laundry machines

Face & Eye Protection

Mucous membranes (eyes, nose, and mouth) are major portals of entry for bloodborne pathogens. In Hematology, the risk of aerosolization and splashing is significant during specific manual tasks, such as uncapping tubes, making wedge smears, or processing body fluids

• Options for Protection
  • Face Shields: Chin-length face shields offer the highest level of protection as they cover the eyes, nose, and mouth simultaneously. They are often worn over a mask
  • Goggles and Mask: If a face shield is not used, the laboratory scientist must wear a combination of safety goggles (with side shields) and a surgical mask. Standard prescription eyeglasses are not considered PPE as they lack side protection and do not seal the eye area
• High-Risk Hematology Tasks
  • Manual Slide Making: The “push” technique of creating a wedge smear can generate fine droplets of blood at the end of the slide. Face protection is required
  • Uncapping Tubes: Removing the rubber stopper from a vacuum tube releases a fine aerosol mist (the “pop” effect). If not performed behind a splash shield, face protection is mandatory
  • Body Fluid Analysis: Processing cerebrospinal fluid (CSF) or synovial fluid for cell counts poses a risk of splashing. If a Biosafety Cabinet (BSC) is not used, face protection is required

Respiratory Protection

While standard surgical masks protect against droplets, they do not protect against airborne droplet nuclei. In general Hematology operations, respiratory protection is rarely required unless specific risks exist

• N95 Respirators: If the Hematology laboratory processes body fluids (like pleural fluid) from patients with suspected Tuberculosis (TB), or if there is a risk of aerosolizing meningococcal organisms, an N95 respirator may be required
• Fit Testing: Unlike masks, respirators require an annual “fit test” to ensure a tight seal against the user’s face. Using an N95 without a fit test is a violation of safety protocols

Footwear

Although often overlooked, footwear is a regulated component of PPE in the laboratory environment

• Requirements: Shoes must cover the entire foot. Sandals, open-toed shoes, or shoes made of porous material (like canvas or mesh) that allows liquid to soak through are prohibited
• Rationale: In Hematology, the risk involves dropping heavy glass bottles (diluent/lyse reagents), dropping sharps (glass slides/tubes), or spilling blood. Leather or fluid-resistant synthetic material is required to prevent injury and exposure

Donning & Doffing Sequence

To prevent self-contamination, a strict order of operations must be followed when putting on (donning) and taking off (doffing) PPE

• Donning (Clean to Dirty)
  1. Gown/Lab Coat
  2. Mask or Respirator
  3. Goggles or Face Shield
  4. Gloves (extended over the wrist of the gown)
• Doffing (Dirty to Clean): Removal is the most critical step for infection control
  1. Gloves: Considered the most contaminated item. Remove first, turning them inside out
  2. Goggles/Face Shield: Handle by the strap or ear pieces only (the front is contaminated)
  3. Gown: Unfasten ties/buttons and peel away from the neck and shoulders, turning it inside out
  4. Mask: Remove by the ear loops last
  5. Hand Hygiene: Wash hands immediately after PPE removal