REFERENCE.

NO:

SUBJECT:Infection Control Policy, Guidelines and Services Management

DISTRIBUTION: Emergency Medical Services VERSION. NO: 1.0

ISSUE DATE:
DOCUMENT OWNER:
Emergency Medical Services Division
REVISION DATE:

Document Classification: (Public, Internal Use, Restricted, Confidential)

Related Laws, Policies,

Standards, Circulars, and
Guidelines:

Name: Signature: Date:

Prepared by:

Reviewed by: EMS Manager Neamah Aljizani 4th. April.2023

Approved by:

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INFECTION CONTROL POLICY, GUIDELINES AND SERVICE MANAGEMENT
CHHC KSA-HCM-POL-1001 V.1
 I. PURPOSE

Infection prevention and control programs in health care facilities maximize patient
outcomes and should be an integral part of health care facility management and
operations. It is a significant indicator of quality patient care in Emergency Medical
service. The frequency of patient being readmitted to the hospital and acquiring
communicable diseases in a EMS setting can be prevented if proper
implementation of infection control measures is applied.

A breach in infection control practices facilitates transmission of infection between

patients, EMS workers, other patients and attendants. It is therefore mandatory to
have an infection control plan, and policies, procedures, and guidelines as per
recognized standards in each EMS facility. The goal of the infection control policies
is to identify and reduce risks of acquiring and transmitting infections among
patients, staff and visitors. Therefore, this policy shall establish the guidelines and
procedures to be implemented in all Emergency Medical services being rendered by
the company. This policy aims to eliminate all the EMS acquired infection and
maintain patient’s optimum health. As per the company’s commitment in promoting
health and quality of life, the practice and strict implementation of this policy is of
great importance in providing quality Emergency Medical service.

II. SCOPE/RESPONSIBILITIES:

Since the company is a EMS provider, this policy shall apply to all Company employees,
patients and their family members.

a. Company Management
a. Promotes and support the implementation of infection control policy provided
that to preserve and maintain the quality of service in the EMS setting.
b. Participates and contributes in policy making, research, audit, root cause
analysis and training of the EMS staff.
c. Ensure the implementation and compliance with the approved infection
control policy.
d. Provide adequate resources for effective functioning of the infection control
program.

b. EMS Manager
a. Take lead of the Infection Control Committee
b. Review policies, health audits and infection control practices of the EMS to
ensure that the company follows the internationally recognize standards in
infection control.
c. Participates in planning, health audit, training, decision and policy making of
the Infection Control Committee.

c. EMS Manager
a. Ensure that the Infection Control is strictly implemented and complied.

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 b. . Conduct a health audit together with the Infection Control Team and
participate in the root cause analysis, planning of patient education, and
evaluation of the paramedics application of the infection control practices.
Notify the Infection Control Paramedic on any reportable case such as
needle prick injury, communicable diseases, and EMS related infection.
c. Conducts and participates in the routine infection control meeting.

d. Infection Control Paramedic

a. The infection control Paramedic conducts infection control risk
assessments for patient’s environment, equipment used by Paramedic
and patient.
b. Reports to the EMS Manager the infection control issues encountered in
the EMS setting that needs attention and intervention.
c. Plan, implement, manage and evaluate infection control and prevention
activities.
d. Conducts annual Infection Control meeting or monthly if necessary
e. The infection control Paramedic establishes accepted standards and
develops, implement, monitor and revises infection control policies and
procedures to assure compliance with the standards.
f. The infection control Paramedic educates colleagues, patients, and
relatives about the risk, prevention, transmission and control of infection,
disease specific care, appropriate precautions and assessments.
g. Performs annual infection control meeting in relation to the EMS
practices or whenever necessary.
h. Performs health audit in the EMS setting which includes EMS infection
practices and compliance with the infection control policy.

e. EMS Paramedic
a. Comply with the approved infection control policy.
b. All staff has an important role in the prevention and control of infection
which is an integral quality issue in the care and management of patients
and the health and safety of staff.
c. All staff needs to bring infection control issues to the attention of the EMS
Manager.
d. All staff needs to maintain a high standard of infection control as a matter
of good practice.

III. DEFINITION/ ABBREVIATIONS:

ICC - Infection Control Committee

Company–Capital Ambulance and Medical Services
CDC - Communicable Disease Center

IV. POLICY, PROCEDURES, AND GUIDELINES

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 1. INFECTION CONTROL ORIENTATION AND TRAINING

1.1 All EMS staff shall be oriented of the infection control standards, practices,
guidelines and policies during their induction and orientation program
period. The orientation should be done prior to deployment to any EMS
service that the staff is required. This includes but not limited to EMS
providers (doctor, Paramedic, drivers, and cleaners).
1.2 The Infection Control Orientation Program shall include the following topics
as follows:
1.2.1 Concept and Definition of Infection Control
1.2.2 Chain of Infection
1.2.3 Infection Control Precautions
1.2.4 Standard Precaution
a. Aseptic Technique
b. Handwashing
c. 5 Moments of Handwashing
d. PPE, Personal protective equipment
e. Needle Stick Injury
f. Handling of Linen
g. Coughing Etiquette
h. Medical Waste Management
1.2.5 Transmission Based Precaution
a. Airborne Precaution
b. Droplet Precaution
c. Contact Precaution
1.3 As part of the professional commitment to be updated with the latest
standards in the internationally recognized guidelines, the Infection Control
Paramedic together with the members of the Infection Control Committee
shall perform routine refreshment of the infection control to the EMS
providers at least annually or if necessary.
1.4 Infection control orientation, training, seminars and CME (continuous
medical education ) shall be documented.
1.5 Infection control training certificates shall have duplicate copies to be part
of infection control file for all EMS patients for any auditing purposes.

2. IMMUNIZATION AND SCREENING

2.1 EMS staff shall be required to have the following mandatory immunization
as they are at High Risk of Infectious Diseases:
a. Hepatitis B vaccine (if unvaccinated)
b. MMR vaccine (if unvaccinated)

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 c. Influenza vaccine (annually)
d. Varicella vaccine (if no serologic proof or history of immunity
2.2 Vaccination will be required to the following staff but not limited to:
a. EMS Physicians
b. Paramedics
c. Ambulance Drivers
2.3 Required vaccination if done prior to employment to Company should have
proper documentation and must be submitted to the company for reference
of any further requirements for staff immunization.
2.4 Staff with undocumented or unrecalled vaccination for Hepatitis B or if the
vaccination was done 5 years ago will be advice to take Hepa Titer prior to
vaccination.
2.5 All mandatory vaccination shall be compiled for reference purposes and
reviewed regularly by the EMS Manager.

3. INFECTION CONTROL PRACTICES

3.1 Precautions
3.1.1Standard Precaution- involves work practices that are essential to
provide a high level of protection to patients, EMS workers and
patient’s family.It is designed to reduce the risk of transmission of
blood borne pathogens and pathogens from moist body
substances.

3.1.1.1 Standard Precaution must be applied to all patients and

should be comply by all EMS staff that is in contact with the
patient, patient equipment, and patient waste regardless of
their diagnosis or presumed infection status.This includes
the following practices:
3.1.1.1.1 Hand washing and antisepsis (hand hygiene);
3.1.1.1.2 Use of personal protective equipment as per the list
below:
a. gloves;
b. protective eye wear (goggles);
c. mask;
d. apron;

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 e. gown;
f. boots/shoe covers; and
g. cap/hair cover.
3.1.1.1.3 Appropriate handling of patient care equipment and
soiled linen;
3.1.1.1.4 Prevention of needle stick/sharp injuries;
3.1.1.1.5 Environmental cleaning and spills-management; and
3.1.1.1.6 Appropriate handling of waste.
3.1.1.1.7 Laundry management
3.1.1.1.8 Respiratory/Cough Etiquette

3.1.1.2 Procedures
3.1.1.2.1 Aseptic Technique
Aseptic technique means “without micro-organisms”. Aseptic
technique refers to the procedure used to avoid the introduction of
pathogenic organisms into the vulnerable body site. The principle aim
of an aseptic technique is to protect the EMS patient from
contamination by pathogenic organisms during medical and
Paramedics procedures.

3.1.1.2.1.1 Company EMS providers must strictly adhere to the

hand hygiene policy.
3.1.1.2.1.2 All items must be prepared and assembled prior to
every procedure.
3.1.1.2.1.3 Sterile items, such as needles and syringes, should
be opened carefully by peeling back the packaging
and not pushing it through the backing paper.
3.1.1.2.1.4 30 minutes allowance must be allotted after bed
making or domestic cleaning before exposing or
dressing wounds, or performing any other aseptic
procedure.
3.1.1.2.1.5 Soiled dressing must be removed carefully to avoid
dispersal of microorganism to the room air using
gloves.
3.1.1.2.1.6 Wound should be exposed to minimal time only.
3.1.1.2.1.7 In cases of contamination, gloves should be
change and hands should be decontaminated.

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 3.1.1.2.1.8 Avoid cross contamination with soiled gloves
3.1.1.2.1.9 Aseptic technique should be done on the following
procedures but not limited to:
a. Intermittent catheterization
b. Wound dressing
c. IV cannulation & administration of medications
d. Intramuscular injections
e. Subcutaneous injections
f. Fasting glucose monitoring (finger stick)

3.1.1.2.2 Clean Technique

A ‘Clean’ technique is a modified aseptic technique that can be used
for dressing chronic wounds healing by secondary intention, e.g. pressure
sores, and for endo-tracheal suction.
3.1.1.2.2.1 Company EMS providers must strictly adhere to the
hand hygiene policy.
3.1.1.2.2.2 Clean, non-sterile gloves and a disposable plastic
apron should be worn.
3.1.1.2.2.3 Chronic wounds may be irrigated or cleansed using
Normal Saline Solution.
3.1.1.2.2.4 Minimize the break on the closed systems such as
urinary catheter, IV line and enteral feeding tubes.
3.1.1.2.2.5 Clean technique must be applied to the following
procedures but not limited to:
a. Bed Bath, oral hygiene & perineal washing
b. Emptying of urinary catheter bag
c. Administering enteral feeding
3.1.1.2.3 Hand washing
3.1.1.2.3.1 The EMS Paramedic must ensure that patient’s
care area have the following:
a. Hand/liquid soap at the sink
b. Disposable towel/tissue near the sink
c. Hand sanitizer at bedside
d. Hand washing posters in English and Arabic
3.1.1.2.3.2 All EMS staff rendering any kind of EMS service to
the patients must practice 5 moments of hand
washing as per WHO guidelines. This should be
done as follows:
a. Before touching the patient.

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 b. Before clean/aseptic procedure.
c. After body fluid exposure risk.
d. After touching the patient.
e. After touching the patient surroundings.
3.1.1.2.3.3 The practice of hand washing must be done as
follows:
a. Wet hands with water.
b. Apply enough soap to cover all hand
surfaces.
c. Rub hands palm to palm.
d. Right palm over left dorsum with interlaced
fingers and vice versa.
e. Palm to palm with fingers interlaced
f. Backs of fingers to opposing palms with
fingers interlocked
g. Rotational rubbing of left thumb clasped in the
right palm and vice versa.
h. Rotational rubbing, backwards and forward
with clasped fingers of right hand in left palm
and vice versa.
i. Rinse hands with water.
j. Dry hands thoroughly with a single use towel
or tissue paper.
k. Use the towel or tissue paper to turn off the
faucet.
l. Procedure c to h must be done with duration
of 15 – 20 seconds.
m. The entire procedure should have duration of
60 seconds.
3.1.1.2.3.4 All EMS staff must be able to effectively
demonstrate the hand washing technique during
health audit and return demonstration
3.1.1.2.3.5 The EMS Paramedic must educate patient’s family
and relatives on the proper hand washing
technique.
3.1.1.2.3.6 Paramedic on duty must ensure that all people
who will visit the patient must do handwashing
prior to having contact with the patient such as
family members and visitors.
3.1.1.2.4 Gloving Technique
3.1.1.2.4.1 Open Sterile Gloving Technique:

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 3.1.1.2.4.1.1Open sterile gloving technique should be
applied on clean/aseptic procedure such
as wound cleaning/dressing, PEG care,
tracheostomy care and suctioning.
3.1.1.2.4.1.2The principles of aseptic technique must be
applied when doing the open gloving
procedure.
3.1.1.2.4.1.3 Before washing hands, all wrist, and
ideally hand, jewelry should be removed.
Cuts and abrasions must be covered with
waterproof dressings. Fingernails should
be kept short, clean and free from nail
polish or nail extensions.
3.1.1.2.4.1.4 The open sterile gloving technique must
be done as per the following steps:
a. Hand washing must be done prior to
procedure.
b. Expose both gloves by folding back the
edges of the inner wrapper. Consider the
inner wrapper as a sterile field.
c. Using the thumb and the first two fingers
of the non-dominant hand, grasp the
folded edge of the glove cuff for the
dominant hand, touching only the inside
surface of the glove.
d. Stepping away from the sterile field,
carefully pull the glove over the dominant
hand. Avoid skin contact with the outside
surface of the glove.
e. Using the gloved hand, slide the fingers
under the cuff of the second glove.
f. Stepping away from the sterile field, pull
the second glove over the non-dominant
hand, keeping the cuff folded over the
glove.
g. Adjust the gloves as necessary.
3.1.1.2.4.1.5 Used gloves must be dispose in a yellow bag.

3.1.1.2.5Clean Gloving
3.1.1.2.5.1 All Company patient’s EMS setting should have
available clean gloves at all times.
3.1.1.2.4.2 Hand washing must be done prior to procedure.
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 3.1.1.2.5.3 Clean gloving procedure must be applied when
doing procedures that would put the EMS provider
in contact with patient’s body fluids, excretions, or
secretions. This includes the following but not
limited to:
a. Bed bath, change of linen
b. Draining urine output from a urinary
drainage bag
c. Diaper change or perineal care
d. Suctioning
e. Blood extraction of any kind (RBS,
venipuncture, ABG)
f. Enteral feeding
g. Cleaning body fluid spills or blood spills
3.1.1.2.5.4 Aseptic or clean technique must still be applied
when clean gloving done to perform any EMS
procedure.
3.1.1.2.5.5 Used gloves must be dispose in a yellow bag and
must not be reuse.
3.1.1.2.6Patient Care Equipment:
3.1.1.2.6.1 EMS Paramedic should do regular patient equipment
disinfection daily.
3.1.1.2.6.1 Equipment included for regular disinfection are the
following but not limited to:
a. Equipment use for taking patient’s vital signs (BP
apparatus, thermometer, pulse oximeter, thermometer).
b. Equipment for doing Paramedics procedure (IV infusion
pump, feeding pump, suction machine, nebulizer
machine, ECG machine, AED (Automated external
defibrillator) , glucometer, IV stand).
c. Equipment use by the patient such as bed, urinal,
bedpan & kidney basin.
3.1.1.2.6.1 Proper hand hygiene must be perform before and after
the procedure
3.1.1.2.6.1 Clean gloving must be applied when cleaning patient’s
equipment.
3.1.1.2.6.1 EMS Paramedic should clean patient’s equipment
using alcohol wipes.

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 3.1.1.2.6.1 Cleaning of equipment should be done and
documented in the patient care equipment checklist
daily.
3.1.1.2.6.1 Used alcohol wipes and gloves must be dispose in a
yellow bag.
3.1.1.2.7Handling of Sharps/Sharps Management:
3.1.1.2.7.1 It is the user’s responsibility to dispose used sharps
immediately after use if possible. ‘You use it, you bin
it’.
3.1.1.2.7.2 All Company EMS patients should be provided with
sharps bin. The EMS Paramedic should request for
the sharps bin if not available in the patient’s house.
3.1.1.2.7.3 Clean gloving must be applied when handling sharps.
3.1.1.2.7.4 Handling of sharps as per the following procedure:
a. Avoid the use of sharps if possible.
b. Sharp containers must be assembled correctly with
identification label signed including the name of patient,
residence, date and signature of EMS Paramedic who
will send the bin in the office.
c. Never discard needles / syringes / sharps in a polythene
bag
d. Discard sharps at the point of use into a sharps
container immediately after use.
e. Discard disposable syringes and needles wherever
possible as a single unit, into sharps container. Avoid
manual removal of the needle. Remove the needle only
if there is a removal device available.
f. Sharps such as small quantities of broken glass, drug
vials, used needles, razors, blades etc. must be
carefully disposed of into approved sharps containers
g. Never attempt to decant contents of small sharps
containers into larger containers
h. Never dispose of sharps in containers used for storage
of other wastes, or place used sharps containers in
clinical waste bags
i. Never leave sharps lying around
j. Never insert fingers / hand past the level of the lid
k. Close the aperture on the disposal of each sharp at the
patient’s bed side
l. Ensure sharp containers are free from protruding
sharps.

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 m. Sharp containers should not be filled above the fill line.
Replace when sharp container is ¾ or 75 %full.
n. Once full the container aperture is locked, tagged and
identification label signed.
o. The person locking the sharps container must tag the
Sharps container.
p. Use sharps with safety devices or engineering control to
prevent percutaneous injuries as far as possible.
q. Do not bend, break or manipulate used needles by
hand.
r. Avoid recapping of needles as far as possible.
s. If needles need to be recapped, use devices or
methods which eliminate the risk of percutaneous injury
“Scoop Method” or “One hand scoop method”
3.1.1.2.7.5 In cases of needle prick injury, the following procedure
should be followed:
a. Immediately, report the incident to the direct available
superior and to the Infection Control paramedic or
Paramedic Supervisor giving the details of the incident
in order to direct and advice the injured personnel, as
well as to document and follow –up the condition.
b. An incident report must be done stating the details of
the injury.
c. The Infection Control Paramedic should document the
injury in the Sharp Injury Log.
d. A root cause analysis must be done to investigate what
exactly happened during the injury.
e. A Needle Stick Injury Form will be filled up by the
concerned personnel if the cause of injury is a used
needle.
f. A blood sample must be collected from the source (if
not screened for hepatitis and HIV on admission) and
the injured. Consent from the patient must be obtained
prior to screening.
g. Company personnel who sustained the injury must be
subjected to Hepatitis and HIV screening within but not
beyond 7 days of the date of injury. The Company shall
coordinate with the third party laboratory to facilitate the
screening. “Needle Prick Injury” should be written
clearly on both the laboratory request form and the
blood sample.
h. The injured personnel shall be scheduled for the
laboratory.

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 i.
Results of the blood screening shall be disclosed
confidentially to the injured personnel.
j. Positive Hepatitis and HIV result shall be referred to the
EMS Physician for further consultation. The Infection
Control Paramedic shall also need to report the case to
the CDC and awaits advice.
3.1.1.2.7.6 Poor and negligible handling of sharps shall be
considered a major violation of the Infection Control
policy.
3.1.1.2.8Blood Spills Management
3.1.1.2.8.1 Medical staff or EMS personnel who will have in
contact with patient’s blood or blood products
should report to the Paramedic Supervisor or
Infection Control paramedic immediately.
3.1.1.2.8.2An incident report must be done by the exposed
personnel stating exactly what happened.
3.1.1.2.8.3A root cause analysis must be done to investigate
what exactly happened during the injury.
3.1.1.2.8.4The incident should be log in the Blood Exposure
Monitoring Sheet by Infection Control paramedic.
3.1.1.2.8.5A Company personnel who was exposed to blood
spills must be subjected to Hepatitis and HIV
screening within but not beyond 7 days of the date
of injury. The Company shall coordinate with the
third party laboratory to facilitate the screening.
“Blood Spills” should be written clearly on both the
laboratory request form and the blood sample.
3.1.1.2.8.6The Company personnel involve shall be scheduled
for laboratory.
3.1.1.2.8.7 EMS personnel who had contact with patient’s
blood or blood products should be seen by
Company Doctor for proper consultation.
3.1.1.2.8.8The staff will be requested to undergo blood
screening (HIV, HBV, and HCV).
3.1.1.2.8.9The patient will be also requested to undergo
screening if no screening was done previously
after patient sign the consent form. Patient or
family’s consent should be secured prior to
screening.
3.1.1.2.8.10The result will be confidentially disclosed to the
exposed personnel.

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 3.1.1.2.8.11Positive Hepatitis and HIV result shall be referred
to the EMS Physician for further consultation. The
Infection Control Paramedic shall also need to
report the case to the CDC and awaits advice.
3.1.1.2.8.12Positive Hepatitis and HIV result shall be referred
to the EMS Physician for further consultation. The
Infection Control Paramedic shall also need to
report the case to the CDC and awaits advice.
3.1.1.2.9 Laundry Management
3.1.1.2.9.1 Patient’s family shall be responsible in the patient’s
laundry. Health education shall be conducted by
the EMS Paramedic on how to do the
management and handling of patient’s laundry.
3.1.1.2.9.2 EMS Paramedic should monitor on how the family
is handling patient’s laundry and do the following
health education as follows:
a. Aseptic/clean technique must be applied.
b. Linens should be handled using PPE such
as gloves and gowns.
c. Place used linen in appropriate bags or
hamper separated from any of the linens
generated by the household members.
d. Contain linen soiled with body substances
or other fluids within suitable impermeable
bags and close the bags securely for
movement or transfer from patient’s room to
the laundry room.
e. Handle all linen with minimum agitation to
avoid aerosolisation of pathogenic micro-
organisms.
f. Separate clean from soiled linen and
transport/store separately. · Wash used
linen (sheets, cotton blankets) in hot water
(70°C to 80°C) and detergent, rinse and dry
preferably in a dryer or in the sun.
g. Wash woolen blankets in warm water and
dry in the sun.
3.1.1.2.9.3 Change of linen must be documented by the EMS
Paramedic in the patient’s chart.
3.1.1.2.10Respiratory/Cough Etiquette

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 3.1.1.2.10.1 Infection control measures should be implemented at
the first point of contact with patients with respiratory
symptoms to prevent transmission of respiratory
infections in the EMS settings.
3.1.1.2.10.2 Family members with symptoms of cough should be
advice by the EMS Paramedic to minimize patient
contact. If a family member with symptoms insisted on
visiting the patient appropriate infection control
measures should be advised:
a. Hand hygiene
b. PPE such as surgical mask
3.1.1.2.10.3 Coughing etiquette should be advise by the EMS
Paramedic as follows:
a. Cover mouth and nose when coughing or
sneezing
b. Use tissue paper to contain respiratory
secretions and dispose of them in lidded
receptacles.
c. Perform hand hygiene after hands have been in
contact with respiratory secretions.
d. Encourage persons with respiratory symptoms
to sit away from others.

3.1.2 Transmission Based Precaution- additional infection control

precautions in health care, and the latest routine infection
prevention and control practices applied for patients who are
known or suspected to be infected or colonized with infectious
agents, including certain epidemiologically important pathogens.
This includes the following:
3.1.2.1 Airborne Precaution - designed to reduce the transmission
of diseases spread by the airborne route. It occurs when
droplet nuclei (evaporated droplets) <5 micron in size are
disseminated in the air.
3.1.2.1.1 Airborne Precaution must be applied to the
following communicable diseases but not limited
to:
a. open/active pulmonary tuberculosis (TB)
b. Measles
c. chicken pox

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 d. pulmonary plague
e. hemorrhagic fever with pneumonia
3.1.2.1.2 Airborne Precaution must be done as per the
following procedures:
a. Implement standard precautions.
b. Isolate patient in a well-ventilated room.
Advise the patient’s family to install an
exhaust fan in the patient’s room.
c. Keep doors closed.
d. Wear N-95 Mask. Wearing of N-95 Mask
should be done as per the following
procedure:
i. A fit test must be done.
ii. Wear masks 6ft of a sick person.
iii. Position strings to fit firmly the
nose, mouth and chin. Avoid
touching the mask again until you
remove it.
iv. Immediately properly throw away
the mask after using in the
biohazard-labeled containers.
v. Do not wear the mask more than
once.
3.1.2.1.3 Limit the movement and transport of the patient
outside the room for essential purposes only. If
transport is necessary, minimize dispersal of
droplet nuclei by masking the patient with a
surgical mask.
3.1.2.2 Droplet Precaution - Occurs when there is adequate contact
between the mucous membranes of the nose and mouth or
conjunctivae of a susceptible person and large particle droplets
(> 5 microns). Usually generated from the infected person during
coughing, sneezing, talking or when health care workers
undertake procedures such as tracheal suctioning.
3.1.2.2.1 Droplet Precaution must be applied to the following
communicable diseases but not limited to:
a. pneumonia
b. pertussis
c. diphtheria
d. influenza type B
e. mumps
f. meningitis
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 3.1.2.2.2 Droplet Precaution must be done as per the
following procedures:
a. Standard Precaution
b. Single room
c. Wear a surgical mask when working within 1-
2 meters of the patient
d. Place a surgical mask on the patient if
transport is necessary
e. Patient’s room must be well ventilated. Advise
the patient’s family to put an exhaust fan in
the patient’s room.
3.1.2.3 Contact Precaution - Diseases which are transmitted by this route
include colonization or infection with multiple antibiotic resistant
organisms, enteric infections and skin infections.
3.1.2.3.1 Contact Precaution must be applied to the following
communicable diseases but not limited to:
a. MRSA
b. All types of infectious diarrhea
c. Hepatitis B
d. HIV

3.1.2.3.2 Contact Precaution must be done as per the

following procedures:
a. Standard Precautions
b. Single room
c. Wear clean, non-sterile gloves when entering
the room
d. Wear a clean, non-sterile gown when entering
the room if substantial contact with the
patient, environmental surfaces or items in
the patient’s room is anticipated
e. Limit the movement and transport of the
patient outside the patient’s room
3.2 Prevention of EMS Related Infection

3.2.1 Prevention of Catheter Associated Urinary Tract Infection

3.2.1.1 It is recommended to avoid urinary catheterization for EMS
patient if possible to reduce the incidence of catheter
associated urinary tract infection.

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 3.2.1.2 EMS patient should only be catheterize as per the
following indications:
a. Acute urinary retention or bladder outlet
obstruction
b. Need for accurate measurement of urinary output
for critically ill patients
c. To assist in healing of open sacral or perineal
wounds in incontinent patients
d. Patient requires prolonged immobilization (e.g.,
potentially unstable thoracic or lumbar spine,
multiple traumatic injuries such as pelvic fractures)
e. To improve comfort for end of life care if needed.
3.2.1.3 Company EMS patients must not be catheterize for the
following reasons:
a. As a substitute for paramedics care of the patient
or resident with incontinence.
b. As a means of obtaining urine for culture or other
diagnostic tests when the patient can voluntarily
void.
3.2.1.4 Use Standard Precaution at all times when doing
Paramedics procedure with patient’s catheter.
3.2.1.5 For patient requiring intermittent catheterization, strict
application of aseptic technique is required.
3.2.1.6 Properly secure indwelling catheters after insertion to
prevent movement and urethral traction.
3.2.1.7 Maintain a close drainage system.
3.2.1.8 If breaks in aseptic technique, disconnection, or leakage
occur, replace the catheter and collecting system using
aseptic technique and sterile equipment.
3.2.1.9 Maintain unobstructed urine flow. Keep the catheter and
collecting tube free from kinking.
3.2.1.10 Keep the collecting bag below the level of the bladder at
all times. Do not rest the bag on the floor.
3.2.1.11 Empty the collecting bag regularly using a separate,
clean collecting container; avoid splashing, and prevent
contact of the drainage spigot with the non sterile
collecting container.
3.2.1.12 Urine specimen must be collected from the needleless
sampling port if available with strict application of aseptic
technique.
3.2.1.13 Strict hand hygiene must be observe before and after
doing paramedics procedure related to urinary catheter.

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 3.2.1.14 Appropriate PPE must be worn when doing catheter
care.
3.2.1.15 The EMS Paramedic must note the following when caring
for a patient with urinary catheter:
a. Date the urinary catheter was inserted
b. Size and type of urinary catheter
c. Doctor’s orders in the care of urinary catheter
d. Doctor’s orders for removal or change.
3.2.1.16 Routine catheter hygiene should be done during patient’s
daily bathing and perineal hygiene. Antiseptic is not
recommended to be use when doing the procedure.
3.2.1.17 EMS Paramedic should educate the patient and family on
the care of the catheter.

3.2.2 Prevention of PEG Associated Infection

3.2.2.1 Observe strict hand hygiene when preparing the feeding
solution.
3.2.2.2 Store the feeding solution as per manufacturer’s
preference.
3.2.2.3 Apply the principles of aseptic technique and standard
precaution for any Paramedics procedure related to PEG
tube.
3.2.2.4 Maintain a close system especially when the patient is
receiving continuous feeding via feeding pump.
3.2.2.5 Clean PEG site regularly every shift using aseptic
technique with normal saline solution. Apply topical
antiseptic solution or cream only when indicated or when
advised by the patient’s physician.
3.2.3 Prevention of Tracheostomy Associated Infection
3.2.3.1 Observe strict hand hygiene.
3.2.3.2 Regular dressing of tracheostomy must be done by the
EMS Paramedic using Normal Saline Solution at least
every shift.
3.2.3.3 Observe clean technique when doing tracheostomy
procedure such as suctioning and dressing.
3.2.3.4 Keep all equipment clean such as suction machine and
nebulizer.
3.2.3.5 Regular changing of suction catheter must be done at
least every shift.
3.2.3.6 Apply respiratory etiquette to family members with
symptoms of cough or flu.

3.2.4 Prevention of CVC Associated Infection

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 3.2.4.1 Strict hand hygiene and asepsis must be observe when
doing any paramedics procedure with the CVC.
3.2.4.2 CVC dressing should be done as follows:
a. Use either sterile gauze or sterile, transparent,
semipermeable dressing to cover the catheter site.
b. If the patient is diaphoretic or if the site is bleeding or
oozing, use a gauze dressing until this is resolved.
c. Replace catheter site dressing if the dressing becomes
damp, loosened, or visibly soiled.
d. Do not submerge the catheter or catheter site in water.
Showering should be permitted if precautions can be
taken to reduce the likelihood of introducing organisms
into the catheter (e.g., if the catheter and connecting
device are protected with an impermeable cover during
the shower).
e. Replace dressings used on short-term CVC sites every
2 days for gauze dressings.
f. Replace dressings used on short-term CVC sites at
least every 7 days for transparent dressings, except in
those pediatric patients in which the risk for dislodging
the catheter may outweigh the benefit of changing the
dressing.
g. Replace transparent dressings used on tunneled or
implanted CVC sites no more than once per week
(unless the dressing is soiled or loose), until the
insertion site has healed.
h. Monitor the catheter sites visually when changing the
dressing or by palpation throughan intact dressing on a
regular basis, depending on the clinical situation of the
individual patient. If patients have tenderness at the
insertion site, fever without obvious source, or other
manifestations suggesting local or blood stream
infection, the dressing should be removed to allow
thorough examination of the site.

3.3 Housekeeping Procedure

3.3.1 Patient’s Home
3.3.1.1 Family members and housemaids must observe. Clean technique
should be applied either the cleaning will be done in Company office
or at patient’s home.

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 3.3.1.2 The EMS Paramedic must train the family members and housemaids
on applying clean technique when cleaning the patient care area.
3.3.1.3 Tools for cleaning patient care area must be separated from the
household cleaning tools. Cleaning tools for patient’s toilet must be
separated from the household cleaning tools.
3.3.1.4 Appropriate PPE must be worn when cleaning the patient care area
such as mask, gloves and apron.
3.3.1.5 Daily cleaning must be adviced to patient’s family.
3.3.2Company Office
3.3.2.1 Observe strict hand hygiene.
3.3.2.2 Appropriate PPE must be worn such as gloves, mask and apron.
3.3.2.3 Office cleaning tools must be separated to EMS cleaning tool use for
cleaning equipment etc.
3.3.2.4 Toilet cleaning tools must be separated from office cleaning tools.
3.3.2.5 Cleaning must be done twice (9am & 4pm).
3.4 Personal Hygiene
3.4.1 Company EMS providers must be neat and clean at all times. Keep
uniforms clean and neat. Hair should not touch the uniforms. Keep
nails clean and clipped at all times.
3.4.2 Wear uniform properly, fastened and keep it apart from outdoor
clothing.
3.4.3 Uniform should not be worn during off duty hours.
3.4.4 Wear surgical mask when having respiratory symptoms. Exclude from
duties and seek medical advice immediately when having fever or
other symptoms suggestive of infectious diseases.
3.4.5 Perform hand hygiene often and always before leaving the patient’s
residence.
3.4.6 Adhere to Company Hand Hygiene policy.
3.4.7 Never eat and drink in patient’s bedside.
4. Reporting of Notifiable Communicable Diseases

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 4.1 All Company EMS providers must report any notifiable communicable
diseases whenever there is a confirmed diagnosis from the patient’s
physician to the Infection Control Paramedic (please see Appendix 1).
4.2 Infection Control paramedic must report the case to MOH
4.3 The Infection Control Paramedic must document the reported case.
4.4 For cases of EMS providers exposed to airborne pathogens (Eg.
Tuberculosis) the following procedures must be done:
a. Documentation of all staff exposed to the EMS provider rendering
care to the infected patient even in the absence of symptoms.
b. Documentation of all staff rendering care to the infected patient even
in the absence of symptoms.
c. Documentation of all staff exposed to a confirmed diagnosed EMS
provider even in the absence of symptoms.
d. Staff listed on the above mentioned procedure must be subjected to
appropriate diagnostic work up for clearance. A confirmed diagnosis
of the physician must be attained prior to re-deployment to their EMS
duties.
e. Confirmed diagnosis will be advice to have medical consult and
treatment before being re-deployed to their respective duties.

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