Infection Control, PPE, and Bloodborne Pathogen Standards in Respiratory Therapy

Why Infection Control Is a Core Respiratory Therapy Competency

Respiratory therapists work at the airway — the body's most direct route for pathogen entry and exit. Every aerosol treatment, suctioning procedure, intubation, and bronchoscopy-assist places the therapist in close contact with respiratory secretions, blood, and body fluids. Protecting patients from healthcare-associated infections and protecting yourself from occupational exposure are equally important professional obligations. OSHA, CDC, and state licensing boards all hold you accountable for following established infection control standards.

Standard Precautions

Standard precautions are applied to every patient, every time, regardless of diagnosis. They treat blood, all body fluids (except sweat), non-intact skin, and mucous membranes as potentially infectious. Core elements include:

• Hand hygiene — the single most effective infection control measure. Perform it before and after every patient contact, before donning PPE, and immediately after removing PPE. Use alcohol-based hand rub or soap and water (required when hands are visibly soiled or after Clostridioides difficile exposure).
• PPE selection — choose equipment matched to the anticipated exposure.
• Respiratory hygiene/cough etiquette — instruct patients to cover coughs and place surgical masks on coughing patients when tolerated.
• Safe injection and sharps practices — never recap needles with two hands; use safety-engineered devices when available.
• Cleaning and disinfection of equipment between patients.

Transmission-Based Precautions

When a patient has a known or suspected pathogen that requires extra protection beyond standard precautions, CDC guidelines direct one or more transmission-based precaution categories:

| Category | Route | Examples | Key PPE Added |

|---|---|---|---|

| Contact | Direct or indirect touch | MRSA, C. diff, RSV | Gown + gloves upon room entry |

| Droplet | Large droplets (≤ 3 ft) | Influenza, pertussis | Surgical mask within 3–6 ft |

| Airborne | Small-particle nuclei that remain suspended | TB, measles, varicella | Fitted N95 (or higher) respirator; negative-pressure room |

Many respiratory procedures — including bronchoscopy, intubation, manual ventilation, nebulizer treatments, and high-flow oxygen — are considered aerosol-generating procedures (AGPs). During AGPs, upgrade to airborne precautions even when only droplet precautions are otherwise required.

The PPE Sequence: Donning and Doffing

The order in which you put on and take off PPE is not arbitrary — it is designed to prevent self-contamination.

Donning order (putting on):

1. Perform hand hygiene.

2. Put on the gown — tie at neck, then waist.

3. Put on the N95 respirator or surgical mask — perform a user seal check on the N95 (positive and negative pressure checks).

4. Put on eye protection or face shield.

5. Put on gloves — pull over gown cuffs.

Doffing order (taking off) — the highest-risk step:

1. Remove gloves — outside surface is contaminated; use a glove-to-glove, then skin-to-skin technique. Perform hand hygiene.

2. Remove face shield or goggles — handle by the strap or earpieces only.

3. Remove gown — untie waist first, then neck; roll the gown away from your body so the contaminated outer surface folds inward. Perform hand hygiene.

4. Remove mask or respirator — handle ties or ear loops; do not touch the front.

5. Perform hand hygiene immediately.

Critical rule: never touch your face or eyes during doffing. A single lapse can transfer pathogen from a contaminated surface directly to a mucous membrane.

N95 Respirators and Fit Testing

An N95 filters at least 95% of airborne particles when properly fitted. A surgical mask is a barrier, not a respirator — it does not protect against airborne transmission. OSHA's Respiratory Protection Standard (29 CFR 1910.134) requires that employees who use N95s be medically cleared, fit-tested annually, and trained on use and limitations. Fit testing must be conducted with the specific model you will use clinically.

OSHA Bloodborne Pathogen Standard

OSHA's Bloodborne Pathogen Standard (29 CFR 1910.1030) applies to all workers with occupational exposure to blood or other potentially infectious materials. Key requirements:

• Exposure Control Plan — employers must maintain a written plan, updated annually, documenting how exposure risks are controlled.
• Engineering and work practice controls — safer sharps devices, sharps containers at point of use.
• Hepatitis B vaccination — offered at no cost to exposed workers.
• Post-exposure follow-up — if a needlestick or splash occurs: wash the site immediately with soap and water; report to a supervisor; seek medical evaluation promptly. Time-sensitive decisions about post-exposure prophylaxis (PEP) may be made by the evaluating clinician.
• Annual training — required for all covered employees.

Decontamination of Respiratory Equipment

After a procedure such as bronchoscopy-assist, all reusable equipment follows a defined reprocessing sequence: pre-cleaning at the point of care, then transport to the reprocessing area, followed by cleaning, high-level disinfection or sterilization as indicated by the device's Spaulding classification, and proper storage. Single-use items (e.g., suction catheters, nebulizer cups) are discarded in appropriate waste containers — regulated medical waste containers for blood-contaminated items.

Safety Reminders for Practice

• Always perform a seal check every time you don an N95.
• Replace PPE that is torn, wet, or visibly soiled during a procedure.
• Dispose of sharps at the point of use — never carry unsheathed needles across a room.
• Know your facility's post-exposure reporting pathway before an exposure ever occurs.
• Patient safety and your own safety are inseparable: a contaminated therapist can become a vector for hospital-acquired infection.