The Hierarchy of Controls
When conducting a hazard assessment to determine PPE, it is important to understand that PPE is only one control measure. In fact, PPE is the last safety measure to consider as you see in the illustration below. In long term care, we use a mix of measures to minimize occupational hazards. In OSHA’s vocabulary, this mix is known as the “hierarchy of controls,” which consists of FIVE levels: elimination, substitution, engineering controls, administrative controls, and personal protective equipment (PPE).
The most effective measures are at the top of the hierarchy, with elimination and substitution being the preferred methods. These involve removing the hazard entirely or replacing it with something less hazardous. Engineering controls come next, focusing on designing and isolating hazards. Examples of such controls in LTC might be negative pressure rooms or barrier walls for protection against airborne infectious agents. Administrative controls involve changing work practices and policies, including infection control procedures and hand-washing protocols.