Preventive procedures for the emergency and reception department

Under supervision

- Prof. Dr. Mohamed Latif, CEO of the Egyptian Health Council

 Dr. Kawthar Mahmoud, Head of the Egyptian Nursing Syndicate - Member of the Senate

Supervised by

Dr. sherif wadie, advisor to the minster of health for emergency and urgent care

Prepared by 

1. Displaying posters and informative signs at entrances or patient registration desks, urging patients to inform the facility's staff if they are experiencing any symptoms of infection.

2. Conducting a documented risk assessment upon the patient's arrival (at the first point of entry into the facility), including the following:

• Elevated body temperature.
• Symptoms of respiratory infections such as coughing, sneezing, and increased nasal discharge.
• Presence of a rash.
• Vomiting or diarrhea.
• Previous infection or colonization with antibiotic-resistant microorganisms.
• Conditions leading to immunodeficiency.

1. Assessing the patient's need for isolation precautions and determining the type (airborne, droplet, contact, etc.) based on clinical signs (suspicion) without waiting for laboratory results.
2. If a patient is confirmed or suspected to have a contagious disease, they should be placed in a single isolation room (negative pressure for airborne isolation if possible) until medical services are provided, with priority given to their treatment. It is essential to encourage the patient to wear a surgical mask if confirmed or suspected of having diseases transmitted by airborne or droplet transmission.
3. If single isolation rooms are insufficient, priority should be given to airborne isolation cases (e.g., measles, chickenpox, tuberculosis).
4. Specific waiting areas should be designated for patients suffering from infectious diseases, keeping a minimum distance of one meter from other patient waiting areas, and necessary precautions should be applied to contain and prevent the spread of infections (e.g., advising respiratory infection patients to wear surgical masks, covering wounds and discharges, etc.).

Hand hygiene plays an important role in reducing contamination and preventing the spread of infections, as it is one of the most important and easiest precautions. It is sufficient, when performing non-invasive procedures, to clean the hands with regular soap and running water, while it is recommended to disinfect the hands using antiseptics when performing certain procedures that breach the body’s defenses inside outpatient clinics, provided that the hands are not visibly soiled. (For more information on hand hygiene, refer to the chapter “Hand Hygiene and Disinfection”).

2.  Using personal protective equipment:

Healthcare providers in emergency and outpatient clinics must wear appropriate personal protective equipment (such as surgical masks, eye protectors, face shields, gloves, medical gowns, and single-use plastic aprons, etc.) when performing various procedures. Personal protective equipment should be changed between patients.
• Gloves are used during procedures where contact with the patient’s blood, body fluids, mucous membranes, broken skin, or materials potentially carrying infection is expected.
• Plastic aprons and medical gowns are used to protect the skin and clothing of healthcare providers during procedures and activities where there is a risk of exposure to the patient's blood and body fluids.
• Surgical masks, eye protectors, and face shields are used to protect healthcare providers from procedures that may generate splashes of oral, throat, and other body fluids. (For more information, refer to the chapter “Personal Protective Equipment”).

3.  Safe Injection:

The process of injecting any medication into a patient must be done in a way that prevents contamination, ensuring that infections are not transmitted between patients or between the patient and the healthcare provider during the preparation or administration of the injection. This includes following the World Health Organization's guidelines for safe injections (hand washing, determining the injection site, preparing the skin at the injection site, using sterile drugs, solvents, and single-use sterile syringes, etc.). Since injection is one of the most common and risky procedures, applying safe injection practices prevents the transmission of bloodborne infections. Outpatient clinics are also one of the primary places for the early detection of community outbreaks. (For more information, refer to the chapter “Safe Injection”).

4.  Reprocessing of Equipment:

It must be ensured that multi-use medical devices (such as glucose meters, dressing tools, etc.) are properly reprocessed before being reused with another patient, in accordance with the manufacturer's instructions and infection control recommendations. As is the case with all medical instruments, emergency diagnostic and treatment tools are classified according to Spalding's classification into three categories: (high-risk, medium-risk, low-risk). This classification is based on the level of risk of infection transmission for each type and the need for reprocessing between uses. Emergency equipment and devices should be reprocessed in the central sterilization department. (For more information, refer to the chapter “Reprocessing of Medical Devices and Equipment”).

5.  Handling of Textiles and Linens:

• Individuals responsible for collecting and transporting linens in emergency and outpatient clinics should receive the necessary training, and they must also wear the required personal protective equipment.
• Soiled linens should be lifted with great care and calmness, minimizing movement and vibrations as much as possible to prevent the spread of microorganisms in the air and on surrounding surfaces. No step of reprocessing the linens (sorting, soaking, cleaning, etc.) should be performed in patient care areas.
• Bed sheets in outpatient clinics should be changed and reprocessed between each patient. Linens should be treated as contaminated even if there are no visible contaminants. It is prohibited to leave soiled linens on chairs, examination tables, or other surfaces.
• The linens should be placed in highly durable and liquid-impermeable bags.
• It is prohibited to transport bags containing soiled linens to the hospital laundry by hand. They must be moved using carts or containers with a secure cover designated for this purpose.
• Linens used by chemotherapy patients with blood or body fluid spills in large quantities should be treated as radioactive waste.

6.  Cleaning and Disinfection of the Environment and Work Surfaces:

Daily Cleaning and Disinfection: This includes cleaning beds, work surfaces, equipment, floors, door handles, and drawers at least twice daily and whenever they are contaminated.
• A daily cleaning schedule should be established for outpatient clinics.
• Daily cleaning must be performed according to the hospital's policy, and all surfaces should be wiped with a cloth dampened with water and a cleaning agent or disinfectant.
• Blood spills and other body fluids should be addressed immediately.
• Approved cleaning and disinfecting agents with known concentrations and sources must be used, and it is not necessary to use disinfectants for routine environmental cleaning.
• Cleaning agents and disinfectants should be stored in closed containers and under appropriate storage conditions, with attention to their expiration dates.

Periodic Cleaning and Disinfection:
Comprehensive cleaning should be done for all clinics at least every two weeks, including ceilings, walls, floors, doors, storage areas, and air conditioning filters. Cleaning tools should be cleaned after use and stored dry and properly. (For more information, refer to the chapter "Environmental Cleaning").

7.  Waste Management:

Since waste disposal remains an ongoing issue, it is essential to establish procedures for waste management according to the hospital's policy:
• Sharp objects that can puncture waste bags or expose workers to needlesticks and injuries (such as scalpels, needles, syringes, etc.) should be placed in designated safety boxes. It is prohibited to bend or cover needles after use.
• Hazardous non-sharp waste should be disposed of in leak-proof infectious waste bags.
• Ordinary waste should be disposed of in black bags.
• All types of waste collection containers should be securely closed before being moved from the clinic to the temporary waste storage room.
• Labeling explanatory tags on all waste collection containers should specify the type and source of the waste. (For more information, refer to the chapter "Waste Management").

8.  Etiquette of Sneezing and Coughing:

 These are practices followed to contain respiratory secretions from individuals exhibiting respiratory symptoms (such as sneezing, coughing, congestion, and increased secretion from the nose and respiratory system). It is essential to adhere to these practices during the time spent in clinics. Since emergency departments and outpatient clinics are places where patients are present before their condition is diagnosed, they can be sources of transmission for infections to many people present in the clinic, including both patients and healthcare providers. Therefore, the following practices should be applied:

• Displaying posters about the protocol for dealing with respiratory symptoms and educating staff accordingly.
• Designating specific waiting areas for patients exhibiting respiratory symptoms.
• Ensuring patients cover their mouth and nose while coughing or sneezing.
• Using tissues to dispose of respiratory secretions.
• Ensuring hand washing after any contact with respiratory secretions.
• Providing sufficient quantities of tissues.
• Placing hand-washing stations and supplies near patient waiting areas.
• Providing necessary respiratory protection for use.

(For further information, please refer to the chapter on respiratory health precautions and cough etiquette.)