By Nancy Chobin, RN, AAS, ASCP, CSPM, CFER
Personal dress code and hygiene play an important role in infection prevention of staff and patients. Sometimes, we do not always take the time to ensure compliance, which is unacceptable. To understand this better, let’s look at the recommendations and their importance.
Good personal hygiene involves keeping all parts of one’s external body clean and healthy. Developing and maintaining good personal hygiene habits is important for an individual’s physical and mental health. It is critical that employees of the GI/endoscopy suite demonstrate good personal hygiene. Individuals with poor personal hygiene provide an ideal environment for the growth of microorganisms, leaving the body vulnerable to infection. Conversely, when an individual maintains good personal hygiene, the body sheds fewer bacteria into the environment, which is important in an area where medical devices are being processed. Reprocessing flexible endoscopes is arduous and requires stamina, so reprocessing technicians should strive to maintain good health by eating a well-balanced diet and getting plenty of sleep.
According to the Centers for Disease Control, good personal hygiene includes body hygiene, frequent hand hygiene and nail hygiene.
All personnel entering the processing area should change into clean surgical scrub attire provided by and donned at the facility. Reusable scrub attire should be laundered by a healthcare-accredited laundry (ANSI/AAMI ST65:2008, ANSI/AAMI ST79:2017, ANSI/AAMI ST91:2021, AORN 2021b). This is important to keep the microbial level to a minimum.
Attire should be changed daily or more often as needed (i.e., when wet, grossly soiled, or visibly contaminated with blood or other body fluids). All head and facial hair (except for eyebrows and eyelashes) should be completely covered with a facility-approved head covering. Personnel should remove and discard head coverings whenever they leave the decontamination area. Upon reentry to the area, they should apply a new head covering. Fallout from head and facial hair can contaminate devices after they have been cleaned. Therefore, compliance is recommended.
Shoes worn in the processing area must be clean, have non-skid soles, and be sturdy enough to prevent injury if an item drops on the foot. Open-toed and clog-type shoes should not be permitted because they will not protect the feet from injuries that could occur when items are dropped. Liquid-resistant shoe covers should be worn if there is potential for shoes becoming contaminated and/or soaked with blood or other bodily fluids (29 CFR 1910.1030).
Jewelry (including earrings, necklaces, rings, bracelets, and wristwatches) that cannot be contained within the surgical scrub attire should not be worn in the decontamination, preparation, high-level disinfection, sterilization, or sterile storage areas. Jewelry should not be worn because it is not easily or routinely cleaned on a daily basis. In addition, it can harbor microorganisms, can become dislodged and fall into processed items, and can cause holes in gloves or other barrier protection.
Wristwatches and rings can catch on equipment or instruments, injuring personnel or damaging the item or packaging. Rings can also interfere with effective hand hygiene. One study found a tenfold higher median skin-organism count on the hands of healthcare providers wearing rings (AORN, 2021b). Another found that finger rings increased skin surface bacterial counts; although hand hygiene reduced bacterial counts, there were more bacteria under the rings than on the adjacent skin or on the opposite hand (AORN, 2021b).
Cloth head coverings or long-sleeved jackets should be laundered in the same manner as surgical-scrub attire (i.e., either by designated facility personnel or by a healthcare-accredited laundry service). Home laundering processes cannot be standardized and might not be sufficient to eliminate pathogenic (disease-producing) organisms from scrub attire. The OSHA Bloodborne Pathogens Standard states that if a uniform becomes soiled with blood or body fluids, it must be laundered at the facility; the employee is not permitted to take the uniform home for laundering (29 CFR 1910.1030).
Whether employees should wear cover apparel (e.g., cover gowns, lab coats) when they leave the sterile processing area to travel to other areas of the healthcare facility should be determined by each facility and should comply with state and local regulations. If cover apparel is worn, it should be clean (AORN, 2021b). Employees should change into street clothes when they leave the healthcare facility or when traveling between buildings located on separate campuses. (ANSI/AAMI ST91:2021, AORN, 2021b) .
Personal Protective Equipment (PPE)
Wearing PPE is essential to personnel safety. PPE includes fluid-resistant jumpsuits and gowns, hair coverings, impermeable shoe coverings, surgical masks and face shields, eye protection, and gloves. PPE must not permit blood or other fluids to pass through to the employee’s clothing, skin, mouth, eyes, or mucous membranes under normal working conditions. And of course, PPE must be worn when necessary.
OSHA Regulations: PPE
The OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) requires employers to identify tasks that might put employees at risk for exposure to blood and/or other body fluids and to take appropriate measures to protect them from exposure. The type of PPE worn by an employee may vary, consistent with the tasks to be performed.
According to OSHA, the selected PPE must “not permit blood or other potentially infectious materials to pass through or reach the employee’s work clothes, street clothes, undergarments, skin, eyes, mouth or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used” (29 CFR 1910.1030(d)(3)(i)).
PPE use is not optional. It is the responsibility of the employer to provide appropriate PPE, ensure that it is used, and document and investigate failure to comply. Designated facility personnel should provide education and training for all employees regarding the appropriate PPE that should be worn for the tasks they perform and the potential health and disciplinary consequences for failure to do so. This training should be documented and routinely verified as part of the departmental competencies. The training should include the correct steps in donning and doffing PPE.
According to ANSI/AAMI ST91:2021, because of the potential for soaking clothing, splashing, and the aerosolization of fluids and contaminants, and the consequent need to protect employees from exposure to both microorganisms and chemicals, appropriate PPE in the endoscope cleaning area includes the following items:
- General-purpose utility gloves. Processing personnel should wear a style of glove that prevents contaminated water from contacting skin or personal clothing. General-purpose or higher-level utility gloves that are fitted at the wrist should be used. Gloves that are too short, do not fit tightly at the wrist, or lack cuffs do not provide adequate protection. Likewise, exam gloves should not be used for decontamination. Many glove manufacturers offer decontamination gloves, some of which are 18 inches long.
- A long-sleeved, impervious (fluid-proof) or fluid-resistant gown or jumpsuit. When there is a possibility that attire can become soaked with blood or other potentially infectious material, a Level 4 gown (as defined by ANSI/AAMI PB70:2012) should be worn.
- A fluid-resistant face mask and eye protection. PPE worn to protect the eyes from splash and/or splatter may include goggles, full-length face shields, or other devices that prevent exposure from all angles. Face masks provide protection for the mouth and nose.
- Fluid-protective shoe covers with slip-proof bottoms. Shoe covers are recommended when there is a potential for shoes to become contaminated with blood or other body fluids (OSHA 29 CFR 1910.1030). Shoe covers should be removed before leaving the endoscope reprocessing area.
Reusable gloves, glove liners, aprons, and eye-protection devices should be decontaminated according to the manufacturer’s written IFU after each use. If the integrity of an item has been compromised, it should be discarded.
Personnel should remove torn gloves and thoroughly wash their hands before donning new gloves. After completing processing activities, they should remove PPE and wash their hands. Before handling processed endoscopes, personnel should don clean PPE (ANSI/AAMI ST91).
Before leaving the decontamination area, personnel should remove all PPE and wash their hands, being careful not to contaminate skin or the clothing worn beneath PPE. Designated facility personnel should educate and train employees about how to correctly don and doff PPE and ensure that designated areas and containers for clean and used PPE are provided.
The CDC offers an instructional poster for donning and doffing PPE. Developed during the Ebola outbreak a number of years ago, it continues to be used today. The only PPE not covered in the poster are shoe covers. The poster is available at:
The facility/department should have a policy on required dress code and ensure staff compliance. In addition, the policy should be referenced to AAMI and OSHA standards and AORN or SGNA Guidelines. There should also be a policy on the required PPE and since this is a regulation, monitoring staff compliance is critical.
According to the OSHA webpage on penalties, “Any serious violation (which non-compliance with PPE is considered) the potential fine is $15,625 per violation. Employers can be cited for violation of the General Duty Clause if a recognized serious hazard exists in their workplace and the employer does not take reasonable steps to prevent or abate the hazard. The General Duty Clause is used only where there is no standard that applies to the particular hazard. The following elements are necessary to prove a violation of the General Duty Clause: The employer failed to keep the workplace free of a hazard to which employees of that employer were exposed;
- The hazard was recognized;
- The hazard was causing or was likely to cause death or serious physical harm; and
- There was a feasible and useful method to correct the hazard.
Therefore, PPE must be provided, in-serviced in its use and monitored for compliance for employee and patient safety.
Nancy Chobin, RN, AAS, ACSP, CSPM, CFER, is the president and CEO of Sterile Processing University, LLC, of Lebanon, New Jersey. Her company was founded in 1996 and provides SPD and GI consultations, competency assessments, design of sterile processing areas (in hospitals, surgery centers and endoscopy processing areas), on-site training, and online training courses for ambulatory surgery, SPD and endoscopy processing personnel.
Chobin consults for dental and medical offices where sterilization is performed. She has authored three textbooks and two workbooks, has provided chapters, and served as an editor for other textbooks on sterile processing. Chobin has lectured extensively in the United States; Latin, Central and South America; Mexico; and in Asia and Europe. Chobin has published numerous articles in a variety of professional magazines.
- Association for the Advancement of Medical Instrumentation. Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. ANSI/AAMI ST79:2017. Arlington (VA): AAMI, 2017.
- Association for the Advancement of Medical Instrumentation. Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. ANSI/AAMI ST79:2017, Amendment 1:2020. Arlington (VA): AAMI, 2020.
- Association for the Advancement of Medical Instrumentation. Flexible and Semi-Rigid Endoscope Processing in Health Care Facilities. ANSI/AAMI ST91:2021. Arlington (VA): AAMI, 2022.
- Basics of Flexible Endoscope Reprocessing 3rd Edition, 2022, Sterile Processing University, LLC, Lebanon, NJ.
- Centers for Disease Control and Prevention. (December 1, 2022). Personal Hygiene. Retrieved from https://www.cdc.gov/hygiene/personal-hygiene/index.html
- Occupational Safety and Health Administration. (December 20, 2022). OSHA Penalties. Retrieved from https://www.osha.gov/penalties
- Occupational Safety and Health Administration. (December 18, 2003). Standard Interpretations. Retrieved from https://www.osha.gov/laws-regs/standardinterpretations/2003-12-18-1