PPE

The Protective Function of PPE in Phlebotomy

Personal protective equipment (PPE) is a critical component of standard precautions in phlebotomy. PPE serves as a barrier between the phlebotomist and potentially infectious materials, including blood, body fluids, and contaminated surfaces[1]. Proper PPE use reduces the risk of occupational exposure to bloodborne pathogens such as hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV)[2]. On the Phlebotomy Technician Certification exam, understanding when and how to use specific types of PPE is high-yield, as is correct donning and doffing technique to prevent self-contamination.

Important PPE Terms for Phlebotomy Certification

  • Personal protective equipment (PPE): Specialized clothing or equipment worn to minimize exposure to hazards. In phlebotomy, typical PPE includes gloves, gowns, masks, and eye protection[1].
  • Standard precautions: A set of infection-control practices applied to all patient care, regardless of suspected or confirmed infection status. PPE is a cornerstone of these precautions[3].
  • Bloodborne pathogens (BBP): Pathogenic microorganisms present in human blood that can cause disease. OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) mandates the use of PPE to reduce occupational exposure[2].
  • Doffing: The process of safely removing contaminated PPE to prevent pathogen transfer to the skin, mucous membranes, or clean areas[4].
  • Donning: The correct sequence of putting on PPE before patient contact or a procedure[4].

Step-by-Step PPE Application and Removal

Selecting the Right PPE for Phlebotomy

The choice of PPE depends on the anticipated exposure risk. For routine venipuncture, gloves are the minimum requirement[1]. Additional PPE is indicated when there is a risk of splashing or spraying of blood or body fluids.

  • Gloves: Wear clean, non-sterile gloves for every venipuncture. Change gloves between patients and after any contact with contaminated surfaces[1].
  • Gown or lab coat: Wear a fluid-resistant gown if there is a risk of blood or body fluid splash (e.g., arterial puncture, uncooperative patient). A standard lab coat provides minimal fluid barrier but is acceptable for low-risk procedures[3].
  • Mask and eye protection (face shield): Use when splashes or sprays are likely (e.g., drawing from an agitated patient, performing point-of-care testing involving open tubes)[2].
  • Respiratory protection (N95 or higher): Not routinely required for phlebotomy unless the patient is on airborne precautions (e.g., tuberculosis, measles). Check facility isolation policies[3].

Proper Donning (Putting On) Sequence

  1. Remove jewelry, watch, and other accessories. Perform hand hygiene[4].
  2. Put on gown (if indicated). Tie at neck and waist.
  3. Apply mask (and respirator if needed). Secure over nose and mouth.
  4. Put on eye protection (goggles or face shield).
  5. Apply gloves – ensure they cover the cuffs of the gown[4].

Exam tip: The order is: Gown, Mask, Eyewear, Gloves. Remember the mnemonic "G-M-E-G".

Proper Doffing (Taking Off) Sequence

  1. Remove gloves first – grasp one glove at the cuff and peel it off inside out. Hold it with the gloved hand, then slide two fingers of the bare hand under the other glove cuff and peel it off, trapping the first glove inside. Discard[4].
  2. Perform hand hygiene immediately after glove removal.
  3. Remove eye protection by handling only the side pieces or headband. Place in designated receptacle for reprocessing.
  4. Remove gown by untying the neck and waist ties, pulling it away from your body while turning it inside out. Roll and discard.
  5. Remove mask by handling only the ties or ear loops – avoid touching the front. Discard.
  6. Perform hand hygiene again[4].

Exam tip: The doffing sequence order is: Gloves, Eyewear, Gown, Mask (remember "G-E-G-M"). Always perform hand hygiene after removing gloves and after removing all PPE.

Critical Safety Reminders for PPE Use

  • Never reuse disposable PPE. Discard after each patient encounter or procedure[2].
  • Inspect gloves for tears or punctures before use. If a glove is compromised during the draw, remove and replace immediately, performing hand hygiene in between[1].
  • Avoid contaminating clean surfaces during doffing. Do not touch the outside of used gloves to your face, clothing, or clean items[4].
  • Keep gloved hands away from your face – even with gloves, microorganisms can transfer if you touch mucous membranes[3].
  • Be aware of latex allergies. Use nitrile or vinyl gloves if the patient or phlebotomist has a known latex allergy[2].
  • Remove PPE before leaving the patient's room or phlebotomy area to prevent contaminating the environment[3].

Essential Exam Guidance on PPE Protocols

  • Memorize the donning and doffing sequences – these are frequently tested on certification exams (e.g., NHA CPT, ASCP PBT).
  • Remember that hand hygiene must be performed before donning PPE and after doffing (including after glove removal).
  • Understand that gloves must be changed between every patient even if they appear clean. Do not wash or reuse disposable gloves[1].
  • For routine venipuncture, only gloves are required. Additional PPE is reserved for splash-generating procedures or isolation precautions[3].
  • Be aware of the OSHA Bloodborne Pathogens Standard – it mandates that employers provide appropriate PPE at no cost to the employee[2].
  • Know that PPE is part of standard precautions, not transmission-based precautions, unless additional barriers are needed for certain pathogens (e.g., N95 for airborne).
  • Mnemonic for items always required for phlebotomy: "PPE" = gloves, pen (sharps container), patient (identification).

References & Sources

  1. Centers for Disease Control and Prevention (CDC). Standard Precautions: Personal Protective Equipment. Updated 2020. https://www.cdc.gov/infection-control/hcp/basics/standard-precautions.html
  2. Occupational Safety and Health Administration (OSHA). Bloodborne Pathogens Standard (29 CFR 1910.1030). https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030
  3. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee (HICPAC). 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Centers for Disease Control and Prevention. https://www.cdc.gov/infection-control/hcp/isolation-precautions/?CDC_AAref_Val=https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html
  4. World Health Organization (WHO). How to Put On and Take Off Personal Protective Equipment (PPE). WHO, 2020. https://www.who.int/publications/i/item/

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