10.2 Supplies, PPE, Cleaning, and Infection Control

Standard Precautions and PPE Selection

Standard precautions (also called body substance isolation) mean treating every patient's blood and body fluids as potentially infectious, regardless of known diagnosis. You do not wait to learn a patient's status before protecting yourself. Personal protective equipment (PPE) is part of scene entry, not an afterthought you add once care is underway.

Match the PPE to the anticipated exposure route, not to a label:

A common exam trap is choosing PPE based on whether the patient "looks sick." The correct logic is the task: arterial bleeding and airway suctioning create splash risk, so eye and face protection are indicated even if the patient seems stable. PPE is also donned before entering the contaminated area and removed after leaving it, and the order of removal matters — take off the most contaminated items (gloves, gown) first and clean your hands last, so you do not transfer contamination to your face or clothing while undressing.

Cleaning, Disinfection, and Waste

After a call, equipment must be returned to a safe state in a defined order. Know the hierarchy and what each level achieves:

• Cleaning — soap, water, and mechanical scrubbing to remove visible blood, dirt, and debris. Always the first step; you cannot disinfect over grime.
• Disinfection — a chemical agent (e.g., an EPA-registered disinfectant) that kills most pathogens on hard surfaces and reusable, non-critical equipment such as a BP cuff or backboard.
• Sterilization — destroys all microorganisms, including spores; reserved for instruments that enter the body. EMRs rarely sterilize but should recognize the term.

Waste handling is tested directly:

Never recap needles by hand and never overfill a sharps container. A contaminated or damaged supply — torn, wet, or expired packaging — is removed from service because the sterile barrier is broken and the item is no longer safe for the next patient. Expired items lose their guarantee of sterility or potency and are treated the same way: pulled and replaced, never used to save time.

Exposures, Restocking, and Scene Hazards

If you sustain an exposure — a needlestick, a splash to the eyes, nose, or mouth, or contact with non-intact skin — the steps are immediate: stop, wash the area (or flush mucous membranes copiously with water/saline), report to your supervisor, and follow the system's exposure-control plan, which may include source testing, post-exposure prophylaxis evaluation, and documentation. Time matters, so reporting is not optional or deferred.

Restocking closes the loop: after cleaning and disinfecting, replace every consumable you used or discarded so the unit is ready for the next call. This ties infection control back to equipment readiness from section 10.1 — a clean kit that is also fully stocked.

Finally, infection control overlaps scene safety. A scene with a chemical odor and multiple people reporting symptoms is not an infection-control problem you solve with gloves — it is a possible hazardous-materials scene. The correct first action is to stay out, move upwind/uphill, deny entry, and request specialized resources. PPE for routine body fluids does not protect against chemical or airborne toxic hazards, and recognizing that distinction is a frequently tested judgment.

Routes of Transmission and the Diseases Behind the Precautions

Understanding why the precautions exist makes the right answer obvious. Pathogens reach an EMR through predictable routes, and the PPE choice blocks the route:

• Bloodborne (contact with blood/body fluids through broken skin, mucous membranes, or a sharp): hepatitis B (HBV), hepatitis C (HCV), and HIV. Gloves, eye/face protection, and sharps discipline block this route. HBV is highly transmissible, which is why hepatitis B vaccination is offered to responders.
• Droplet (large respiratory droplets from coughing/sneezing within a few feet): influenza, pertussis, meningococcal disease. A surgical mask on you — and ideally on the patient — interrupts droplet spread.
• Airborne (tiny particles that linger and travel): tuberculosis (TB), measles, varicella. These require an N95 respirator, not a simple surgical mask.
• Contact (direct or via surfaces): MRSA, C. difficile, scabies. Gloves, hand hygiene, and surface disinfection control this route.

Hand hygiene is the single most effective infection-control measure — wash with soap and water (preferred for visibly soiled hands or after contact with spore-forming organisms) or use alcohol-based hand rub. Glove use does not replace handwashing; gloves are removed and discarded after each patient and hands are cleaned, because gloves can have micro-tears and contamination occurs during removal. Pairing the route to the disease to the correct PPE is the reasoning the exam expects rather than rote memorization of a PPE list.