“ It ’ s not a theoretical risk that they might get exposed to droplets like it is in the ER , for example ,” Ofstead says . “ In the SPD they are doused from head to toe with hazardous solutions and potentially infectious material all day , every day . [ SPD personnel ] told us they were given one mask a day , and they were supposed to re-don it . They are taking splashes to the face all day , so they need new masks . When it comes to dispersing PPE , the SPD must be prioritized because it is not a theoretical risk of a low-probability splash happening , it is something real they face every day . At the time of the study , people also told us they also were expected to reprocess single-use gowns .”
Ofstead says that reusing gowns might be more acceptable at the reception desk or in the admissions department , but not in the SPD . She also says she bristles over the issue of barriers that are erected for the sake of appearances only .
“ I think that in many healthcare facilities and in all kinds of institutions , there ’ s a lot of safety theater ,” Ofstead says . “ For
Every institution I visited in the last year and a half or two years have these extensive plexiglass barriers in the reception areas and admissions departments , and yet they do not have them in sterile processing .” example , if you think about the reception area in a doctor ’ s office or the admission office , almost all of them have installed plexiglass barriers . Sometimes whoever installed them really meant it because it goes from the counter all the way to the ceiling and barely has a little slot where you can pass paperwork back and forth . Every institution I visited in the last year and a half or two years have these extensive plexiglass barriers in the reception areas and admissions departments , and yet they do not have them in sterile processing . There is a theoretical risk that a patient might come in and cough at the reception area , but so far , in places I ’ ve gone to , all patients and families have to wear masks when they approach ; so , you have masked persons – including staff — and presumed source control in place , so the theoretical risk is greatly reduced , especially when presumably there is a counter or a desk that provides at least 2 , 3 or 4 feet of physical distance . Facilities provide engineering controls to protect people where there ’ s probably not even really a risk . And then you go to sterile processing , where they ’ re plunging their arms into sinks full of hazardous materials and they ’ re going to take splashes to their face and neck of hazardous and potentially infectious material , and yet there are little to no engineering controls at all . That , to me , is a serious problem .”
Ofstead says she witnesses examples of inappropriate safety theater in other areas of the hospital as well . “ I continue to see healthcare workers who don gloves to do paperwork or to take someone ’ s pulse or blood pressure . With those kinds of tasks , you ’ re probably not going to get that much infectious material , and the alcohol gel would take care of it . So , we don ’ t have ample supplies of properly sized , effective gloves in the decontamination area in the SPD , but you ’ re going to take somebody ’ s blood pressure with gloves on . This is not right . So , our goal with raising this issue is to start shining light on where the real risk is . And not perform the safety theater around these mostly theoretical , extremely low-risk situations .”
Suiting Up in the SPD
The Central Service Technical Manual from the Healthcare Sterile Processing Association ( HSPA ) outlines the following PPE for sterile processing staff :
● Hair covering
● Eye protection , such as goggles or a chin-length face shield
● A gown with reinforced cuffs and a front that serves as a barrier to fluids
● Strong general-purpose utility gloves that cover the cuffs of the reinforced gown which can resist cuts and tears
● Skid-resistant decontamination show covers
● Employer-provided cloth scrub attire that is changed at the end of each shift or when wet or soiled
In their study conducted in the SPD of a large urban hospital , the researchers taped moisture-detection paper to environmental surfaces such as counters and floors adjacent to sinks , as well as affixing the paper to articles of PPE , including face shields , masks , gowns , gloves , and shoe covers . To assess droplet dispersal , the researchers asked SPD personnel to perform several routine cleaning tasks in a work area that was thoroughly cleaned , terminally disinfected , and dried using non-linting wipes before initiating pilot activities . These tasks included filling an empty sink ; gently placing instruments into water , brushing lumens of scopes , using a power sprayer to rinse a stainless-steel basin , and using a sonication system . The researchers documented the droplet generation through photography , videography , and observation by researchers , who noted any visible droplets , recorded the distance of visible droplet dispersal , and documented PPE exposure to droplets .
The researchers found that visible droplets were generated during every reprocessing activity except running the sonication sink . Droplets traveled at least 3 feet when filling a sink , brushing scopes and using a power sprayer . Some reprocessing activities dispersed droplets up to 5 feet from the sink , the researchers found , and most notable was that PPE was splashed during most reprocessing activities and did not prevent skin exposure , despite being worn properly .
Ofstead and her team emphasize in their study that while their findings are eye-opening , there is precedence , and the potential for exposure to splashes and airborne droplets has long been recognized , going all the way back to the mid-1970s and a case report describing an endoscopist who was exposed to herpes-laced patient fluids that splashed out of the biopsy port of a gastroscope and into the provider ’ s eye , triggering a systemic herpes infection ( Kaye , 1974 ). Fast-forward to 2019 , where a study by Johnston , et al . found that almost half of face shields worn by endoscopists were contaminated during gastrointestinal procedures , and droplets were found on 21 percent of face shields affixed to procedure room walls approximately 6 feet away .
The researchers note further that “ standards and guidelines recommend several practices to minimize reprocessing personnel exposure to splashes , such as brushing and scrubbing instruments while they remain under the surface of the cleaning solution and the use of PPE including shoe covers , gowns , gloves , face masks , eye protection , and head coverings . In addition , guidelines recommend physical enclosure of decontamination