Gloves for patient transport and contaminated linens

April 2, 2007

Ms. Caryl J. Carver, RN

[Recipient address omitted]

Dear Ms. Carver:

This letter is in response to your December 9, 2006 letter sent to the Department of Health and Human Services Centers for Disease Control and Prevention (CDC). Your letter was forwarded to the Occupational Safety and Health Administration's (OSHA's) Directorate of Enforcement Programs (DEP) for a response. We received your letter March 1, 2007. In your letter, you requested clarification of the CDC's requirements for the use of clean gloves during patient transport. Your paraphrased scenario is presented below, followed by our response. Please be aware that this response may not be applicable to any scenario or question not delineated within your original correspondence.

Scenario: On December 6, 2006, Kettering Hospital's operating room (OR) staff was informed by the Infection Control personnel that it was no longer acceptable for the OR employees to wear clean exam gloves while transporting patients, nor was it acceptable to wear clean exam gloves when transporting trash and linen to the decontamination area. The rationale offered for this policy was that if the patients were provided and are using clean gowns and linen, there was no need for gloves. Also, if the trash and linen bags were not soiled, then there was no need for gloves either. However, it is your belief that you and your fellow co-workers should protect yourselves by using clean gloves during all transport. Further, you were advised by your supervisor that you will be counseled on your behavior should you continue to wear clean exam gloves while performing the above mentioned duties.

Response: The personal protective equipment requirements of OSHA's Bloodborne Pathogen standard at 29 CFR 1910.1030(d)(3), are performance-oriented. As such, it is the employer's responsibility to evaluate the tasks and the types of exposure expected at his or her workplace and, based on the determination, select the "appropriate" personal protective equipment in accordance with paragraph 1910.1030(d)(3)(i) of the standard.

At a minimum, gloves must be used where there is reasonable anticipation of employee hand contact with blood, other potentially infectious material (OPIM), mucous membranes, or non-intact skin and when handling or touching contaminated surfaces or items. Please bear in mind that the term "contaminated" is defined as the presence or the reasonably anticipated presence of blood or other potentially infectious materials, rather than just "visibly" contaminated.

OSHA requires that disposable gloves be changed as soon as practical when contaminated and as soon as feasible when they are torn or punctured. These requirements protect the employee from exposure to the hazards of bloodborne pathogens. OSHA does not require that gloves be changed between patients if they are not contaminated and their barrier properties have not been compromised. However, as stated in the preamble to the standard, changing gloves between patient contacts is good infection control practice to eliminate patient-to-patient transmission of disease. Additionally, if the conditions you described in your letter are anticipated to occur, such as the chance of patients' tubes and catheters splashing employees during transport, then certainly, gloves must be used, to protect the employee from exposure to blood or OPIM. Further, employees who have contact with contaminated linen and trash must wear protective gloves which must be changed when contaminated.

In addition, please be aware that, should the situation arise where you or your fellow co-workers have to change your gloves and are denied and/or your supervisor retaliates, you may wish to contact the local OSHA Area Office. OSHA, in addition to investigating safety and health complaints, has authority under Section 11(c) of the Occupational Safety and Health Act to investigate and take appropriate action on an employee reprisal, if it resulted from filing a safety or health complaint with OSHA or a complaint to an employer.

The local OSHA office in your area can be contacted at:

Richard T. Gilgrist, Area Director

36 Triangle Park Drive

Cincinnati, Ohio 45246

Phone: (513) 841-4132

Fax: (513) 841-4114

Thank you for your interest in occupational safety and health. We hope you find this information helpful. OSHA requirements are set by statute, standards, and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. Also, from time to time we update our guidance in response to new information. To keep apprised of such developments, you can consult OSHA's website at http://www.osha.gov. If you have any further questions, please feel free to contact the Office of General Health Enforcement at (202) 693-2190.

Sincerely,

Richard E. Fairfax, Director

Directorate of Enforcement Programs