Unit 1: Scene Size-Up and Safety
Personal Protective Equipment & Infection Control
Protecting yourself from infectious diseases is an essential part of working as an EMT. This section of our NREMT study guide covers personal protective equipment (PPE), standard precautions, hand hygiene, and infection control procedures used in emergency medical services. After reviewing these important concepts, test your knowledge with five EMT practice questions and detailed answer explanations.
Emergency Medical Technicians (EMTs) regularly encounter blood, bodily fluids, and other potentially infectious materials. Using appropriate personal protective equipment and following infection control procedures helps protect EMTs, patients, and others from the spread of disease.
Infection prevention begins before patient contact and continues through cleaning equipment and preparing the ambulance for the next call.
Standard Precautions
Standard precautions are infection prevention practices used when treating every patient, regardless of whether an infectious disease is suspected or confirmed.
These precautions are based on the principle that blood, certain bodily fluids, nonintact skin, and mucous membranes may contain infectious organisms.
Important standard precautions include:
- Performing hand hygiene before and after patient contact.
- Wearing appropriate personal protective equipment.
- Avoiding direct contact with blood and potentially infectious materials.
- Handling needles and other sharp objects safely.
- Cleaning and disinfecting contaminated equipment and surfaces.
Standard precautions apply to every patient, including those who appear healthy.
Personal Protective Equipment (PPE)
Personal protective equipment creates a barrier between the EMT and potentially infectious materials. The type of PPE required depends on the anticipated exposure.
Common types of PPE include:
- Gloves: Protect the hands from contact with blood, bodily fluids, and contaminated materials.
- Eye protection: Protects the eyes from splashes and sprays.
- Face masks: Help protect against certain infectious respiratory particles and splashes, depending on the type of mask.
- Respirators: Properly fitted N95 or higher-level respirators protect against airborne infectious particles.
- Gowns: Protect clothing and exposed skin from contamination.
- Face shields: Provide additional protection for the face during procedures involving splashes or sprays.
For example, gloves are appropriate for routine patient contact involving potential exposure to bodily fluids. If blood or other fluids may splash, additional eye, face, and clothing protection may be necessary.
PPE must be selected according to the hazards present. Gloves alone are not sufficient for every situation.
Hand Hynegie
Hand hygiene is one of the most effective ways to prevent the spread of infection.
EMTs should clean their hands before and after patient contact, after removing gloves, and whenever their hands become contaminated.
Two common methods are:
- Soap and water: Required when hands are visibly dirty or contaminated. It is also preferred or required for certain infectious exposures.
- Alcohol-based hand sanitizer: Appropriate for many situations when hands are not visibly soiled.
Gloves do not replace hand hygiene. Hands may become contaminated when gloves are removed or if the gloves are damaged.
Preventing Disease Transmission
Infectious diseases can spread through several routes:
- Contact transmission: Direct contact with an infected person or contaminated surfaces.
- Droplet transmission: Respiratory droplets produced when a person coughs, sneezes, or talks.
- Airborne transmission: Small infectious particles that can remain suspended in the air.
Different routes of transmission may require additional precautions.
For example, suspected tuberculosis requires airborne precautions, including an appropriate respirator. A patient with a respiratory infection may also require a mask, when tolerated, to reduce the spread of infectious particles.
Follow current infection control guidance and local EMS protocols when determining the necessary precautions.
Safe Handling of Sharps
Needles, lancets, and other sharp instruments can transmit bloodborne pathogens if they puncture the skin.
To reduce the risk of injury:
- Never recap a used needle unless a specific approved procedure requires it.
- Dispose of used sharps immediately in an approved sharps container.
- Never reach into a sharps container.
- Do not overfill sharps containers.
If an accidental needlestick or other exposure occurs, immediately perform appropriate first aid, notify your supervisor, and follow your agency’s exposure reporting and medical evaluation procedures.
Cleaning and Disinfecting Equipment
Infection control continues after patient care.
Reusable medical equipment, ambulance surfaces, and other contaminated materials must be cleaned and disinfected according to agency procedures and manufacturer instructions.
Wear appropriate PPE while cleaning, and dispose of contaminated materials in designated containers.
Proper cleaning and disinfection help prevent infections from spreading between patients and protect the next EMS crew.
Key Tip
Use standard precautions with every patient, and select additional PPE based on the risk of exposure. Always perform hand hygiene after removing gloves, and never assume that gloves alone provide complete protection against infection.