Standard Precautions in EMS
Standard precautions (formerly called universal precautions) are the foundation of infection control in EMS. The principle is simple: treat all blood and body fluids as potentially infectious, regardless of the patient's known or suspected infection status. This approach protects both you and your patients by creating a consistent barrier against disease transmission.
The chain of infection requires six elements: an infectious agent, a reservoir, a portal of exit, a mode of transmission, a portal of entry, and a susceptible host. Breaking any link in this chain prevents infection. As an EMS provider, your primary strategies for breaking the chain are personal protective equipment (barriers), hand hygiene (reducing agents on your skin), and equipment disinfection (eliminating reservoirs).
Selecting Appropriate PPE
PPE selection depends on the anticipated exposure risk:
- Gloves: Required for all patient contact. Change gloves between patients and when gloves become torn or visibly contaminated. Nitrile gloves are preferred over latex due to allergy concerns.
- Eye protection: Required when there is risk of splash or spray of blood or body fluids. This includes procedures like airway management, childbirth, and arterial bleeding control. Safety glasses with side shields or face shields are acceptable.
- Masks: A surgical mask protects against droplet transmission (flu, meningitis). An N95 respirator is required for airborne transmission (tuberculosis, measles, COVID-19). You must be fit-tested for N95 respirators before using them.
- Gowns: Required when significant splashing is anticipated, such as during childbirth or major trauma with arterial bleeding.
Hand Hygiene
Hand hygiene is the single most effective measure for preventing infection transmission. Wash hands with soap and water for at least 20 seconds before and after every patient contact, after removing gloves (gloves are not a substitute for hand washing), and after contact with potentially contaminated surfaces. Alcohol-based hand sanitizer (at least 60% alcohol) is acceptable when hands are not visibly soiled but is not effective against certain organisms like Clostridium difficile and norovirus, which require soap and water.
Exposure Management
If you experience a needlestick, splash to mucous membranes, or other exposure to blood or body fluids, take immediate action. Wash the affected area with soap and water (for skin) or flush with water (for eyes or mucous membranes). Report the exposure to your supervisor immediately. Document the incident including the time, circumstances, and source patient information. Seek medical evaluation within 2 hours; post-exposure prophylaxis (PEP) for HIV is most effective when started within 72 hours. Follow up with your occupational health provider for baseline and follow-up testing as recommended.