Guidance on Personal Protective Equipment (PPE) Breaches

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This post is based on a course module and is designed as a reference for health care facilities looking to develop a personal protective equipment (PPE) breach policy. For guided visuals and detailed images on the process, please use the course module.

What is a Breach in Personal Protective Equipment (PPE)?

Personal protective equipment (PPE) must remain intact and in place to offer the level of protection expected by the wearer. A  PPE breach is a break in the integrity of the PPE ensemble or components that may create a risk for exposure to the pathogen of concern. Gaps, tears, holes, and sharps injuries should be addressed immediately to assess the exposure risk.

The risk posed by a PPE breach to the wearer will depend upon the timing and location of the breach, the ability to perform safe mitigation steps, and the pathogen involved. Risk assessments for the likelihood and impact of breaches should be based upon the roles and tasks of any personnel involved, including bedside clinicians, laboratory, cleaning, and waste handling personnel.

What is Contamination?

The risk of exposure to blood or other potentially infectious materials is dependent upon the ability of the PPE ensemble components to resist body fluid penetration. Contamination may not immediately present a risk to health care personnel. 

The risk of fluid penetration, environmental contamination, and the transfer of potentially infectious materials during movement and doffing should be considered. Not all components of a PPE ensemble may be amenable to disinfection while in use and may not be wipeable. While not a breach, the gross contamination of PPE should also be anticipated and addressed, and the mitigation of such contamination may require the assistance of additional personnel also in PPE.

How to Develop a Breach Plan

Each facility should create, maintain, and exercise breach protocols based on their chosen PPE ensemble, their physical infrastructure, and their facility exposure plan. 

Below are some general guidelines to prompt the development of your facility’s breach plan:

Assessment of breach, contamination, and risk

• Conduct a risk assessment for potential breaches within the patient care space, e.g., confused patient grabbing at PPE, sharp corners on counters, wall-mounted items such as hand gel or hooks, or PPE getting caught in bed mechanics such as bed rails. 

• Consider using a trained observer to assist in identifying breaches and directing staff through facility mitigation guidelines.

• Determine which breaches may be safely identified and mitigated, e.g., a tear or rupture of an outer layer of PPE, such as an outer glove, when the underlying layer remains intact will be managed differently than a tear to an inner layer of PPE that exposes skin or clothing.

• Consider which may require immediate doffing, e.g., needlestick injuries, torn or damaged PPE that no longer protects the wearer.

Mitigation

• Consider what steps may be taken by the wearer (moving to lower risk zone, cleaning exposed area, replacing the article of PPE).

• Consider interventions to reduce immediate risk (avoiding/warning of rough or sharp edges, assessing patient agitation/sedation, slowing donning process for outer gloves).

• Ensure supplies or equipment for mitigation (alcohol-based hand rub, hand washing station/sink, clean PPE supplies, EPA-approved disinfectant wipes) are available wherever a breach may occur.

• Ensure staff has ready access to a sink, shower, or eyewash station if required in your plan.

Reporting, treatment, and follow-up

• Consider when, how, and for which instances personnel should report a breach to facility occupational health, injury management team, or accountable partners.

• Consider reporting, retraining, or repair processes if the breach was caused by defective or incorrect use of supplies or equipment. 

• If there may be a continued danger to staff, ensure all team members are aware. Examples may include sharp edges and burrs as well as patient behavior (grabbing, pulling, aggressive, or delirious) and defective supply lots.

• Post-exposure prophylaxis plans should be in place, dependent on risk and pathogen.

Additional Support for Staff

Breaches to personal protection can occur anytime, and many will not expose health care personnel to harm. In high-risk environments, these breaks in PPE or PPE ensembles and incidents of gross contamination can be stressful and dangerous. 

Assessing the threat that these events pose to staff should be done carefully and methodically. The use of mirrors, and other assisting staff, such as trained observers, may aid in assessing portions of the PPE ensemble that may be difficult for the wearer to see. 

If contamination of clothing or skin occurs during the doffing of PPE, personnel may need to be guided through the safe removal of remaining PPE and garments by another assisting staff such as a doffing partner. Thorough washing, showering, or an eyewash station may be required. A plan for post-exposure care should be in place, which may require coordination with both facility occupational health and local public health authorities.

Scenarios for starting conversations about risk assessment in your facility.

Resources for Health Care Facilities

NETEC offers free training, resources, and consultation to help ensure that clinicians can safely and effectively care for patients infected with high consequence pathogens.