The Use and Failure Rates of Protective Equipment to Prevent Blood and Bodily Fluid Contamination in the Obstetric Health Care Worker

Abstract

Objective:To determine the frequency of use and the failure rate of protective equipment by obstetric staff during common obstetric procedures.Methods: A prospective observational study was conducted of multiple obstetric procedures. The presence, area of specialty, level of training, and gender of each team member were recorded along with the use of protective equipment (cap, mask, eyewear, gown, gloves, and shoe protection). These observations were recorded by two trained observers. Blood and bodily fluid contamination of the protective equipment was quantified and recorded for each person. A forensic medicine reagent (Luminol; Cluefinders Inc., Tampa, FL) was used to detect trace amounts of blood on the inner surface of a selected subset of gowns that had gross external contamination but no obvious penetration.Results: Two hundred forty-one obstetric procedures were observed involving 1022 medical personnel. The use of at least one piece of protective equipment was noted 88% of the time. Compliance with universal precautions by attending and resident physicians in all deliveries (vaginal, forceps, vacuum, cesarean) was observed in 65 (25.2%) medical personnel. The use of protective equipment varied by the type of procedure, area of specialty, and level of training of the team member. In the gowns examined with the forensic medicine reagent, 44% of the cases demonstrated laboratory evidence of penetration. The frequency of gown failure varied with the type of surgical gown used.Conclusion: Despite the mandate in the medical community for universal precautions, the rate of compliance remains low. However, even among the compliant medical staff, protective equipment labeled as impenetrable has a high failure rate. (Obstet Gynecol 1998;92:131-6.

Factors associated with use of slip-resistant shoes in US limited-service restaurant workers

“…McCullagh et al 39 also found a higher prevalence of hearing protection use among men compared to women among farmers from Minnesota, Montana, North Dakota and South Dakota. A study of obstetric healthcare workers did not find differences in the use of PPE by gender 40. In the present study, women were more likely to wear slip-resistant shoes than men.…”

A Review of Single-Use and Reusable Gowns and Drapes in Health Care

“…Ahmad and colleagues demonstrated the following failure rates of gowns to prevent blood strike-through in obstetrical procedures: single-layer nonwoven fabric, 55.8%; reinforced fabric, 26.7%; reinforced fabric with highly resistant fabric in chest and forearms, 21.1%; and full length with impervious front panel and forearms and ther- Adapted from Moylan JA, et al 24 April 2001 mally sealed side seams, 16.7%. 56 Prolonged contact of gowns with blood may result in increased permeability when external pressure is applied. 57 A recent study of multiple hospitals in Germany demonstrated that deficiencies could be observed in the processed items (eg, 58% had holes in one or more individual items).…”

A Historical Review of Barrier Materials

“…In addition to the in vivo study noted earlier in which the levels of pressure were found to be in excess of 2 psi, 18 two other studies reported on the performance of two materials known to have passed the ASTM's tests. In the in vivo study, using a unique method to detect blood penetration, researchers reported that penetration occurred in six of 31 disposable gowns made of a plastic‐reinforced material in its critical areas 19 . In the in vitro study, a laminated, three‐ply fabric failed the mason jar test, including those instances when the material was tested before being laundered 20 …”