BODY SUBSTANCE ISOLATION: isolating all body substances (blood, urine, feces, tears, etc.) of individuals undergoing medical treatment, particularly emergency medical treatment, who might be infected with illnesses such as HIV, hepatitis, or other communicable diseases, so as to reduce as much as possible the chances of transmitting these diseases.

Many agencies such as OSHA, Highway Safety, and the CDC all provide input on the workplace safety guidelines employed by EMS.

 

Hands in the Field

HANDWASHING: Since the principle means of dexterity and therefore the point of most contact is the use of hands, handwashing is the major first step in body substance isolation/elimination. Current handwashing guidelines suggest two ways to clean hands: alcohol-based hand sanitizer and washing with soap and water.

Guidelines suggest cleaning before eating, before and after having direct contact with a patient’s intact skin (taking a pulse or blood pressure, performing physical examination, lifting patient in bed); after contact with blood, body fluids or excretions, mucous membranes, non-intact skin, or wound dressings; after contact with inanimate objects (including medical treatment) in the immediate vicinity of the patient; if hands move from a contaminated body site to a clean body site during patient care; after glove removal; and after using a restroom.

• The primary purpose of hand soap is to remove germs and bacteria, not kill them, and clean the hands. When washing your hands with soap, dirt and germs trapped in the natural oils of the skin are lifted and suspended in water.
• Alcohol-based hand sanitizer, on the other hand, is proven to kill viruses and bacteria, but this is limited if the hands are visibly soiled.

CDC recommends cleaning hands in a specific way to avoid getting sick and spreading germs to others. The guidance for effective handwashing and use of hand sanitizer was developed based on data from a number of studies.

 

Alcohol-based Hand Sanitizer

Per the guidelines, alcohol-based hand sanitizer is used on dry hands by putting a quarter-sized amount of product in one palm and rubbing the hands together for approximately 20 seconds, covering all surfaces until hands feel dry,

 

Hand-washing with Soap and Water

Per the guidelines, washing hands with soap and water is performed by first wetting hands with warm water, then applying the amount of the soap product recommended by the manufacturer to the hands, and then rubbing hands together vigorously for at least 15-20 seconds, covering all surfaces of the hands and fingers, followed by rinsing hands with warm water and using disposable towels to dry and, finally, using disposable towels to turn off the faucet.

 

Personal Protective Equipment (PPE)

Current recommendations for personal protective equipment (PPE) include:

• always wearing gloves and changing gloves when treating a new patient,
• wearing eye, clothing and face protection during events where blood or other bodily fluids are expected, and
• wearing isolation masks--including N95 masks--when respiratory infectious diseases are expected or suspected.

PPE guidelines also include levels of PPE--ranging from gloves only to fully encapsulated suits with onboard oxygen supply that require special training.

• Level A - Full Hazmat Suit, 
• Level B - Chemical suit (for splashes), 
• Level C - Firefighter gear (for inhalational protection). 
• Level D - EMS uniform (no protection from chemical exposures)