UNCONTROLLED WHEN PRINTED

Ambulance-Patient Transfer to Hospital

Driver compartment is designated as the clean area and PPE (with exemption of airborne precautions) is not worn in this area as this practice may cause surfaces and equipment to become contaminated.

Patient compartment:

NO Infectious Disease risk identified in 3.1

  • Hand hygiene: Before, during and after patient care, following the 5 moments of hand hygiene, and after vehicle and equipment cleaning.
  • PPE: Standard precautions. Gloves, Glasses, Face Mask and Coveralls as required following risk assessment.
  • Linen: Remove linen from patient stretcher and place in the designated linen carrier at hospital. Place heavily soiled/contaminated linen in clinical waste bin. Only replace clean linen after the stretcher has been cleaned.
  • Waste: Place in general waste bin at hospital. Place waste contaminated with blood and bodily fluids into clinical waste bin.
  • Cleaning: After each patient transfer:
    • Clean visibly soiled areas, from most clean to dirty area.
    • Clean all patient care areas of the stretcher and ambulance. Clean the stretcher rails, handles, mattress, and any other high touch areas, including hand rails, seatbelts and monitoring equipment.
    • Clean personal items; including phone, iPad, pens and keys.
    • Use approved disposable impregnated detergent/disinfectant wipes.
    • Dispose of the wipes after use into hospital waste bin or clinical waste bin if excessively contaminated.

KNOWN OR SUSPECTED Infectious Disease risk identified in 3.1

  • Notify CSP in SOC if significant infection risk is present for further clarity and discussion – type of precautions (i.e. contact, droplet, airborne) being used so that appropriate patient hospital accommodation can be prepared. For specific advice on each condition access the quick reference guide.
  • Only essential people should travel in ambulance; specifically medical escorts or parents at the discretion of the clinical staff.
  • Ambulance air flow:
    • Refer to Workplace instruction for Ambulance Airflow
  • Patient – instructed to wear a surgical mask or non-vented P2 mask for droplet and airborne precautions. If patient requires oxygen therapy: High-concentration/low flow mask
  • Hand Hygiene: Before, during and after patient care, following PPE donning and doffing procedures. After vehicle and equipment cleaning.
  • PPE:
    • Nitrile gloves
    • Face mask (surgical for droplet precautions and P2 mask for airborne precautions)
    • Protective eyewear/face shield where available
    • Coveralls/Gown
    • Discard after patient handover.
  • Linen: Remove linen from patient stretcher and place in the designated linen carrier at hospital (before removal of gloves). Place heavily soiled/contaminated linen in clinical waste bin. Only replace clean linen after the stretcher has been cleaned.
  • Waste: Place in general waste bin at hospital (before removal of gloves). Place contaminated waste into clinical waste bin.
  • Cleaning: After each patient transfer:
    • Don new gloves and other appropriate PPE.
    • Clean visibly soiled areas, from most clean to dirty area.
    • Clean all patient care areas of the stretcher and ambulance. Clean the stretcher rails, handles, mattress, and any other high touch areas, including hand rails, seatbelts and monitoring equipment.
    • Clean personal items; including phone, iPad, pens and keys.
    • Use approved disposable impregnated detergent/disinfectant wipes.
    • Dispose of the wipes after use into hospital waste bin or clinical waste bin if excessively contaminated.
    • Remove gloves and appropriate PPE. 
    • Perform hand hygiene.

    During a Call 

    Minimise opportunities for contamination within the ambulance.

    If gloves become contaminated during patient care, remove them, perform hand hygiene, and don a new pair before touching the patient again.

    Note any equipment and surfaces contacted by the patient or clinical staff in the ambulance. These items will need to be cleaned and disinfected after the call.

    Place all reusable equipment which is contaminated (i.e. stethoscope, BP cuff, SPO2 probe) in designated “dirty zone” on incontinent pad after use to minimise contamination of ambulance surfaces. 

    Aseptic Technique and Invasive Procedures

    Aseptic Technique is a framework used in pre-hospital setting by clinical staff to minimise, as far as practicable, the patient’s risk of exposure to pathogenic microorganisms while the body’s natural defences are breached during invasive clinical procedures.

    Aseptic Technique describes the work practices taken during invasive clinical procedures to prevent the transfer of microorganisms from the clinical staff, procedure equipment or the immediate environment to the patient. 

    This is necessary to:

    • protect patients from endogenous and exogenous infection for all invasive procedures;
    • protect key-parts and key-sites from microorganisms transferred from clinical staff and the immediate surroundings;
    • use a risk assessment approach to select the appropriate method of aseptic technique
    • standardise clinical aseptic technique/practice; and 
    • deliver safe and efficient patient care.

    Aseptic Technique is achieved by:

    • Performing hand hygiene to reduce the number of microorganisms on the skin.
    • Using antiseptics for patient skin preparation before invasive procedures to reduces the number of microorganisms that could be introduced into the patient’s body. This should also be performed on medication port/cannula hub before medication administration.
    • Routine cleaning and disinfection of the environment and equipment to reduce microorganisms that could then be transferred from the equipment to a future patient or paramedic.
    • Wearing clean gloves when performing a procedure, and changing gloves after invasive procedures, or after touching the patient’s non-intact skin or mucous membranes, or when gloves are visibly soiled.
    • Wearing PPE; gloves, goggles, coveralls and faces hield (where available) when there is a possibility of blood/body-fluid splash.
    • Using the ‘No Touch’ method of wound dressing application to maintain the sterility of the dressing. This method involves manipulating the dressing by touching the outside only, so the side that contacts the patient’s wound remains sterile.
    • Avoiding contamination of sterile devices such as IV catheters, surgical airways, obstetrical kits, burn dressings, and chest needles. If a sterile device is contaminated before use, discard and use a new sterile device. Do not pre-open packages of equipment that are used for invasive procedures such as intubation. This contaminates the equipment and could introduce pathogenic material into the patient.

      Invasive Procedures

      Single Use

      To avoid cross-contamination between patients and avoid material degradation, bio-compatibility reactions or endotoxic reactions caused by residues from reprocessing and device failure the following principles are adhered to:

      • Single-use medications, solutions, injectables, equipment and other medical devices are used wherever the clinical situation dictates such practice.
      • Single-use labelled devices are discarded after each single use.
      • Single patient use labelled equipment and other medical devices are reprocessed in accordance with the manufacturer’s instructions and reused on the same patient only, not put into general supply.
      • Any single-use item or instrument that has penetrated the skin, mucous membrane or other tissue must be discarded after use or at the end of the procedure, whichever is more appropriate.

      Storage of Sterile Supplies

      There are a variety of sterile supplies that are used in pre-hospital care. The following is a non-exhaustive list of these supplies:

      • Pressure dressing
      • Gauze bandage
      • Airways
      • Suction catheters
      • Endotracheal tubes
      • All intravenous supplies
      • Syringes and needles. 

      Proper storage includes but not exclusively:

      • Closed cupboard doors at the Depot/Station
      • Designated Ambulance lockers
      • Protection from moisture
      • Protection from extremes of temperature
      • Protection from soiling
      • Protection from exhaust fumes
      • Checking all sterile equipment before and after opening packages to ensure the products are not damaged due to wear and tear, and are in date

        References

        References

        National Health & Medical Research Council and the Australian Commission on Safety and Quality in Healthcare. (2010). Australian guidelines for the prevention and control of infection in healthcare. Canberra, Australia: Commonwealth of Australia.

        Ontario Emergency Services Branch Ministry of Health and Long-Term Care. (2007). Infection Prevention and Control Best Practices Manual for Land Ambulance Paramedics.

        Australasian College for Infection Prevention and Control. (2012). Position statement: Single-use devices. Brisbane, Queensland: Australasian College for Infection Prevention and Control.

        Department of Health Government of Western Australia. OD 0531/14. Re-use of single use devices. Perth, Australia: Department of Health Government of Western Australia.

        National Health & Medical Research Council and the Australian Commission on Safety and Quality in Healthcare. (2010). Australian guidelines for the prevention and control of infection in healthcare. Canberra, Australia: Commonwealth of Australia.

        Ontario Emergency Services Branch Ministry of Health and Long-Term Care. (2007). Infection Prevention and Control Best Practices Manual for Land Ambulance Paramedics.

        Standards Australia/Standards New Zealand. AS/NZS 4815:2006. Office-based health care facilities. Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of the associated environment. Sydney, Australia: Standards Australia International Ltd and Standards New Zealand.

        The Association for Safe Aseptic Practice. (2014). The ANTT clinical practice framework for clinical practice. From surgery to community care (Version 3.3). United Kingdom: The ANTT Organization. 

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