areas and specify a minimum of 3 feet of separation between decontamination areas and clean work areas to prevent cross-contamination .”
“ Everybody says droplets go 3 feet ,” Ofstead says . “ There are many SPDs that have those red stripes , and you know the droplets stop right there on the red stripe ,” she adds , tongue planted firmly in cheek . “ There ’ s no evidence around that , and the only citation we found that backed up AORN guidelines is an outbreak in the ICU , where a sink had the pathogen in the drain and they found that with fluorescence , they could document that when you turn the faucet on , the drops from the drain area were kicking out at least 3 feet . They didn ’ t say droplets stop at 3 feet , just that they could detect them out to 3 feet , and we think they went further . So , I am dismayed that there ’ s no peer-reviewed research , no evidence , and yet we have built our protocols based on this idea that droplets only go 3 feet .”
Ofstead says the 3-foot distance originated in an outbreak investigation involving multidrug-resistant Pseudomonas aeruginosa that infected 36 patients in Canada due to contaminated sink drains in intensive care rooms . The investigators discovered that droplets traveled at least 1 meter away from sinks and hypothesized that smaller particles may have traveled farther but were too small to be observed . While this report was not conducted in the SPD , Ofstead says the findings have been used to support the recommendation that 3 feet of separation between dirty , wet areas and clean , dry areas is sufficient .
In their study , Ofstead , et al . ( 2022 ) observed visible droplets up to 5 feet away on vertical surfaces and the floor as well as on the face shield , gown , shoe covers , and on blue paper affixed to the chin and neck area below the face shield . Of importance is the conformation that PPE did not provide adequate barriers against skin exposure , as the researchers documented that extended-cuff gloves were not long enough , exam gloves did not fit snugly enough , and moisture was allowed to penetrate the PPE
Ofstead acknowledges that several factors come into play when SPD personnel are exposed .
“ I ’ ve conducted many audits in facilities where people weren ’ t wearing PPE or they weren ’ t wearing it correctly ,” she says . “ And I would have laid most of the responsibility for PPE not working on the lack of adherence by staff . In this study ,
Fig 1 . Evaluating fluorescent markers for the droplet dispersion pilot project : ( A ). Fluorescent marker applied around sink drain area ; ( B ). Fluorescent marker illustrating splash pattern after running the faucet ; ( C ). Attempting to remove fluorescent marker with wipes ; ( D ). Incomplete removal of marker . Courtesy of APIC / AJIC
Fig 2 . Splash pilot project set-up in SPD with blue droplet-detection paper : ( A ). Affixed to walls behind the sinks ; ( B ). Attached to carts using zip ties ; ( C ). Labeled with distance from sink ; ( D-F ). Affixed to PPE including face shields , face masks , gowns , and gloves . Courtesy of APIC / AJIC
Fig 3 . Splash generated when using a power sprayer : ( A ). Rinsing a stainless-steel basin ; ( B ). Substantial splatters behind the sink ; ( C ). Along the edge of the sink ; ( D ). On vertical surfaces 5 feet away from the sink ; ( E and F ). On the floor 4-5 feet away from the sink . Courtesy of APIC / AJIC