Prehospital Emergency Care & Emergency Department
Prehospital Emergency Care
& Emergency Department
Introduction
In a prehospital and emergency care environment the risk of contamination with
infectious material may be higher than in the usual care settings. Staff working in
an ambulance or in the emergency department must anticipate managing
individuals before a full assessment can be completed and the nature of the care
requires prompt decisions and less time for patient care procedures. Therefore
preparation must include a thorough understanding of infection control measures
in order to protect the patient and the caregiver. 35
Risks for contamination and for potential spread of infectious agents may result
from the following conditions:
 Handwashing facilities are often non-existent in the field.
 Invasive procedures may be performed in an environment that is likely
to require frequent contact with blood and body fluids.
 Resuscitation equipment might be used on multiple patients during
emergency situations in the field.
 Sterile equipment and supplies may become contaminated during
emergency use.
 Infection control and prevention measures may appear secondary to
providing immediate life support measures. 35
Patient Care Issues
Infection Control
 Receiving department personnel (emergency department or patient
wards) should be informed if intravenous devices and lines were
inserted under emergency conditions. If feasible they should be
replaced within a maximum of 24 hours.
 Dressings applied in the field should be removed and wounds should
be irrigated, cleaned, and redressed using aseptic technique after
stabilization of the patient’s condition.
120
Prehospital Emergency Care & Emergency Department
 Stocks of equipment and supplies should be sufficient to provide
appropriate patient care and to permit staff to practice standard
precautions.15, 35
Equipment Cleaning and Disinfection
Nondisposable, noninvasive equipment
Equipment such as blood pressure cuffs, oxygen tank and tubes,
portable ECG, suction devices, ventilation/resuscitation bags and
masks, laryngoscopes and air way tubes, etc. used during an
emergency operation should be thoroughly cleaned followed by
disinfection and/or sterilization.
Reusable equipment
Reusable equipment should be reprocessed on the basis of its
classification as critical, semi-critical, or noncritical. [For detailed
guidelines on equipment reprocessing, see Part I: “Cleaning,
Disinfection, and Sterilization of Medical Equipment”]
Surfaces
All areas or surfaces contaminated with blood, body fluids, excretions,
or secretions must be cleaned and disinfected. [For detailed guidelines
on environmental cleaning, see Part I: “Environmental Cleaning”]
Sharps
All sharps should be disposed of in a rigid, leak proof, punctureresistant container. [For detailed guidelines on sharps disposal see
Part I: “Waste Management II”].35
Table 14: Examples of Equipment Cleaning and Disinfection
Equipment / device
Laryngoscopes and air
way tubes
Resuscitation masks
and bags
Blood pressure cuff
Cervical collar
Possible method for
cleaning / disinfection
Contaminated with saliva, Clean thoroughly
blood, sputum etc. followed by High level
after each use
disinfection (HLD) or
sterilization
Contacts mucous
Clean mask followed by
membrane
HLD or sterilization.
Clean bag exterior and
disinfect with alcohol after
each use
Blood may penetrate
Clean thoroughly case
seams and material
and disinfect rubber cuff
Blood may penetrate
Clean thoroughly followed
seams and material
by High level disinfection
(HLD) or sterilization
Issue
121
Prehospital Emergency Care & Emergency Department
ED Personnel
Hand Hygiene
 Since handwashing facilities (sink, running water and soap) are not
usually available in the field, “waterless” handwashing products
(alcohol handrubs) are acceptable. Note, these products do not
provide skin antisepsis if hands are visibly soiled with blood or other
organic matter. In the latter instance, remove soil with a clean towel,
apply waterless alcohol handrub and then perform patient care
procedure (e.g., insertion of an IV catheter).
 In the emergency department staff should wash hands with soap and
water or use other methods of hand hygiene as in any other ward or
department.
(For details please refer to Part I: “Hand Hygiene”)
Standard Precautions
 Follow standard precautions for care of all patients. Prehospital and
emergency department personnel should consider all patients’ blood
and body secretions (vomit, feces, urine, purulent drainage, etc.)
potentially infectious and use personal protective equipment and
barrier techniques accordingly.
 Always wear gloves when contacting blood and body fluids during
treatment of any patient (for details about how, when and what kind of
gloves to wear please refer to Part I: “Personal Protective Equipment”).
 Discard gloves and carry out hand hygiene after each patient treatment
and before leaving treatment area.
 Avoid unprotected mouth to mouth resuscitation for all patients.
Cardiopulmonary resuscitation (CPR) should be administered by using
a resuscitation mask and mechanical ventilation equipment (AMBU
bag).
 Include personal protective equipment (gloves, protective eyewear,
masks, gowns) in all emergency departments/supply units and
ambulances.
 For transport or care of patients with suspect or proven airborne
disease such as active pulmonary tuberculosis, personnel should wear
a mask (if available, a high filtration mask or particulate respirator
would be preferable). Also, encourage the patient to cover her/his
mouth when coughing and if possible, ask the patient to also wear a
mask.
122
Prehospital Emergency Care & Emergency Department
 Report any percutaneous or permucosal exposure (contamination,
sharps, needle sticks, etc.) to blood or other potentially infectious
materials to occupational health personnel.
Note:
Due to high frequency of contact with sharps, blood, and other potentially
infected material in the emergency field all emergency health care personnel
should be immunized with hepatitis B (HB) vaccine before beginning employment
as pre-hospital or emergency services personnel.
(See Part I: “Occupational Safety and Employee Health”)
Environmental Factors and Design Issues for
the ED and Prehospital Care
Fig. 17: Emergency department
patient station
Emergency Department
 Space
Adequate space around each bed
should be provided to ensure proper
patient management and rapid
movement of staff.
 Sinks
An adequate number of easily
accessible sinks should be available
for handwashing, including soap, and
disposable paper towels.
 Hand Hygiene dispensers
Waterless hand cleaning agents (alcoholic handrubs) should be
available to the staff.
 Protective equipment
Authorized personnel should be in appropriate attire, with adequate
containers for discarding contaminated gowns, gloves etc.
 Waste
Adequate containers for disposal of waste should be provided;
puncture resistant sharps disposal containers should be available at
each station and carried in the ambulance.
123
Prehospital Emergency Care & Emergency Department
 Windows
Windows in the Emergency Department should remain closed. For
facilities without air conditioning equipment ensure screens are
installed on any open windows.
Prehospital Emergency Care
 Waterless hand cleaning agents
Fig. 18: Ambulance
Handrub agents should be
available to all staff.
 Clean supplies and
equipment
Sufficient
equipment
and
supplies should be stocked and
adequate
amount
of
resuscitation equipment should
be carried in order to provide
safe patient care. If possible,
post transport cleaning and
restocking of clean supplies should be done immediately before
leaving the facility.
 Soiled Equipment
A location should be identified for cleaning and/or disinfecting
contaminated nondisposable, noninvasive items as described below.
 Surfaces
All horizontal ambulance surfaces (floors, shelves, counters, squad
seat, stretcher, mattress etc.) should be physically cleaned and
disinfected. Curtains should be machine washed if visibly soiled.
 Ventilation
For patients with proven/suspect airborne disease such as active,
pulmonary tuberculosis, the blower for air conditioning to the drivers
cab should not be set on recirculate.
124