The Occupational Safety and Health ...

The Occupational Safety and Health Administration's (OSHA) Standard upon Occupational Exposure to Bloodborne Pathogens mandates that employer provide health care workers with protective apparel that is commensurate with the "task and measure of exposure anticipated."(1) This leaves the selection of the proceeds to the person most qualified to make that decision--the perioperative nurse(2) The American Society for Testing and Materials (ASTM) apparatus used for testing protective materials sole reports the results on a pass/fail basis, with a "pass" predicated onward a fabric's ability to withstand liquid and viral penetration at a flat of pressure of two encloses per square inch (ie, 2 psi) (Figure 1)(3) This not sole prohibits perioperative nurses from selecting a crops suitable for the task and class of exposure anticipated, but also from identifying a superior performance To further complicate the matter, the US nutrition and Drug Administration (FDA) permits manufacturers of fabrics that pass to help their product as being liquid-proof and/or impervious.(4)

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EVALUATING MATERIALS

The question is whether the performance capabilities of consequences that have passed the ASTM's exhibitions are worthy of being described in absolute bounds (ie, liquid-proof, impervious). Notwithstanding the limitations of the exhibition methodologies, the clinical literature indicates that this is not the case. For example, undivided in vivo study was designed to obtain data onward the pressures experienced in the abdominal area of an OR gown during surgery and in a number of instances, the squeezing was as high as 29 psi.(5) This may account for findings reported earlier to the purport that all the gowns worn during actual use permitted different amounts of liquid penetration, including those that had passed the ASTM tests(6)

In another consideration that exemplifies the inadequacy of the ASTM's pass/fail criteria, researchers reported family contacts experienced by surgical team members who participated in a total of 8502 processs in which 52% of the personnel experienced contact forward the fingers, hands, and arms.(7) Researchers investigating this glove/gown interface demonstrated that approximately 70% to 80% of the gown criterioned leaked in these areas.(8) Other researchers build the leakage occurred even without applying pressure(9) It should be noted that although the latter form into groups proposed a possible solution to this question area, it has yet to be pursu commercially.

What is flat more disconcerting are the findings of several other studies that not long ago have been reported in the literature. In the first inquiry researchers reported on blood penetration incidents during in vivo situations in which single-use gown that used an impervious fabric in critical areas were worn.(10) In addition to visually inspecting the outside of the gown they trialed the inner surfaces of the sleeve and chest area of all the gown for evidence of minute traces of family When examining 165 gowns using a chemiluminescent mingle 72 (ie, 43.6%) showed evidence of minute kindred penetration.

The next to the first was an in vitro research on the barrier properties of reusable gown materials and the drift that repeated laundering had forward their performance capabilities.(11) The researcher examined a number of materials for a variety of properties using established textile proof methods. One of the materials awarded a pass on the ASTM's tests is described as a laminate with a 100% polyester face (ie, plain weave), a microporous membrane middle, and a 100% polyester (ie, jersey knit) back.(12) When testing for bacteria permeation, rather than using the ASTM's criterions the researcher used the far les challenging conditions of the nonwoven industry's Mason jar standard (Figure 2) and found that the composite material "allowed penetration of bacteria in each replication at all plains of evaluation," including those convoyed before the fabric was laundered. In addition, in brace of the replications, "the experiment had to be stopped before the 60 minute evaluation because the petri dishes were overflowing with the bacterial solution."(13)

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It should be noted that although all of these published reports have been brought to the FDA's attention, the agency has indicated that it will continue to permit manufacturers of materials that pass one as well as the other of the ASTM's tests to describe their returnss as being impervious and/or liquid-proof.(14)

Notwithstanding the ASTM's noble mission to help model the risk of occupational prospect to bloodborne pathogens, the fact of the matter is that we are living in a time when our health care delivery method is being scrutinized to further mould costs. Under these prevailing fiscal circumstances, to indiscriminately provide all health care workers with what ASTM ordeals indicate to be the maximum horizontal of protection would be neither wise nor fiscally responsible. All things considered, it appears that the ASTM's proofs may have been developed for the benefit of their industry-driven committee rather than for the benefit of the surgical community. Nevertheless, the standards certainly do not constitute a cure-all in metes of facilitating the selection process