Barrier Precautions and Reprocessing Recommendations for Prehosptial Providers
|Bureau of EMS Policy Statement|
|Policy Statement #||88-22|
|Subject||Barrier Precautions and Reprocessing Recommendations for Prehosptial Providers|
New York State Department of Health Bureau of Emergency Medical Services
The New York State Emergency Medical Services Program has received numerous requests for guidance on the topic of infection control for EMS personnel, specifically dealing with the issues of proper barrier protections and reprocessing of equipment or supplies commonly used in the field.
Following are recommendations developed with the assistance of the New York State Department of Health's Division of Epidemiology.
Recommendations For Reprocessing Medical Equipment Used In The Prehospital Health Care Setting
|TYPE OF EQUIPMENT||STERILIZATION||HIGH LEVEL DISINFECTION||GENERAL DISINFECTION|
|*Clean, then soak in alcohol or tincture of iodine.|
|Reusable devices that contact mucous membranes: (e.g., lyringoscope, EOA mask and tube, ET stylette)||Yes||Yes||No|
|Reusable, noninvasive equipment that contacts intact skin: (e.g., splints, stethoscopes)||No||No||Yes|
|Reusable materials which may be laundered: blood pressure cuffs, linen, MAST (with bladders removed)||No||No||Yes|
|Other ambulance equipment: stretchers, stairchair, head immobilizers, etc.||No||No||Yes|
SPECIAL NOTE: Dispose of all disposable equipment after single use, e.g., oral and nasal airways, suction catheters and tubing, bite sticks, oxygen masks and cannulae, disposable pocket masks and bag valve masks.
- Destroys: All forms of microbal life.
- Method: Steam (autoclave), gas (ethylene oxide), dry heat, immersion in EPA approved chemical "sterilant" for period specified by product manufactuer (e.g. 10-18 hours).
- Use: Disposable invasive equipment eliminates need to sterilize many items in EMS setting. When indicated, arrangements should be made with a health facility for this level of reprocessing.
High Level Disinfection
- Destroys: Most forms of microbial life, some spores may not be eliminated by this method.
- Method: Immersion in an EPA approved chemical "sterilant" (e.g., 2% activated glutaraldehyde) for the shorter contact time specified by the product manufacturer (e.g., 30-45 minutes).
- Use: Reusable devices that contact mucous membranes.
- Destroys: Most viruses, bacteria, and fungi; may not be as effective against M. tuberculosis and does not kill spores.
- Method: Application of or immersion in any of the following:
- 1:10 to 1:100 dilution of sodium hypochlorite (bleach)
- phenol products
- quaternary ammonium chlorides
- 2% gluteraldehyde (10 minutes)
- Environmental surfaces which have become soiled should be cleaned and disinfected using any cleaner/disinfectant agent which is intended for environmental use.* Such surfaces include floors, woodwork, ambulance seats, countertops, etc.
*Do not use 1:10 dilution on plexiglass, i.e., cabinet doors or EKG monitor screens. It will fog them permanently. Use a 1:100 solution or preferably another disinfectant recommended by the manufacturer.
Recommended Barrier Precautions For Infection Control
In The Prehospital Health Care Setting
|PROCEDURE OR TYPE OF CONTACT||DISPOSABLE GLOVES||GOWN||MASK||PROTECTIVE EYEWEAR|
|Blood drawing or starting an IV||Yes||No||No||No|
|For direct contact with feces or urine||Yes||Yes, if soiling is likely||No||No|
|Endotracheal intubation, EOA, EGTA||Yes||No||Yes, if splashing is likely||Yes, if splashing is likely|
|Bleeding control procedures with spurting blood/emergency childbirth||Yes||Yes, if soiling is likely||Yes||Yes, if splashing is likely|
|Bleeding control procedures with minimal bleeding||Yes||No||No||No|
|Oral/nasal suctioning, manually cleaning airway||Yes||No||Yes, if splashing is likely||Yes, if splashing is likely|
|Taking a temperature||No*||No||No||No|
|Giving an injection||No*||No||No||No|
|Handling and cleaning soiled instruments||Yes (utility)||Yes, if soiling is likely||No||No|
|Taking a blood pressure||No*||No||No||No|
*While gloves are not necessary for these procedures, it is likely they will be worn because of other activities which require their use.
**Ambulance and first response agencies should use either bag valve mask, resuscitators or a pocket mask with a one-way valve on all patients.
Issued by: Robert Elling, Assistant Director for Program Development
Authorized by: Michael Gilbertson, Director