Proper Bag Technique

Your bag travels between homes. Done carelessly, it is the single most efficient way to carry an organism from one patient to the next.

Purpose: prevent contamination of the bag and equipment, avoid cross infection, and establish a clean work area — protecting patients, families, and you, and demonstrating compliance with federal, state, and local regulations, accreditation standards, infection control principles, and standard precautions.

What you are working with

• A laptop bag
• A rolling healthcare bag
• Disposable, single-use barriers

The inside and the contents of the bag are always considered clean. Every rule below exists to keep that true.

The procedure

1. Adhere to Standard Precautions at all times.
2. Transport the bag in a clean area of the car, preferably in a plastic or cardboard container designated for that use.
3. Once in the home, select a clean, flat, hard surface for the bag and your work area.
4. Place the bag on the barrier, clean side out, and tuck the handles or strap underneath the bag. Use discretion and consideration when placing it on the patient's furniture. Never place a non-rolling bag on the floor.
5. Perform hand hygiene using proper technique.
6. Remove the items you need, place them on the clean barrier at one corner of the work area, and close the bag. Enter the bag as few times as possible.
7. Prepare a receptacle — an impermeable plastic trash bag — for disposable items.
8. Decontaminate hands with sanitizer before re-entering the bag for any reason.
9. Keep the bag closed and fastened during the visit as much as possible.
10. After care: clean reusable items — blood pressure cuff, stethoscope — are returned to the bag. Disposables are discarded. Soiled reusable items must be cleaned and disinfected before returning to the bag.
11. If a soiled item cannot be cleaned in the home, bag and label it for transport to the designated area.
12. Decontaminate hands with sanitizer at the end of the visit, then repack and close the bag.
13. Dispose of sharps only in an approved sharps container. The container is kept in a separate "dirty" compartment or a designated sharps pouch. Never put used sharps directly in the bag.
14. On leaving, pick up the bag, put the barrier that was underneath it in the trash, and perform hand hygiene.

Choosing the work area

Homes differ enormously, so this is a judgement call every time. What you are looking for:

• Cleanliness of the surface and the area around it
• Adequate lighting — you cannot assess a wound you cannot see
• A low-traffic spot
• Away from direct air currents — open windows, heating and air conditioning vents
• Safe from pets and children

If none of those are available, that is a finding worth a note, not something to work around silently.

Packing and storing the bag

• Designate two clean compartments — one for clean disposables, one for patient records.
• Pack the bag before leaving for visits.
• Keep hand sanitizer, barriers, and supplies near the top or in a side pocket where you can reach them without digging.
• Plan ahead where you will discard disposables — carry impermeable trash or grocery bags.
• Store the bag in a clean storage container or a separate compartment in your car.

Keeping the bag clean and complete is your responsibility, not the office's. See Supplies and Car Stock for what to carry.

Cleaning schedule

Reusable equipment that has been in contact with bodily secretions: clean with soap and water, dry, then wipe with alcohol and allow to air dry. Clean items with Sani-Cloth or alcohol before repacking the bag.

Two standing preferences that cut the problem off at the source:

• Use disposable equipment whenever possible.
• Use the patient's own equipment — their thermometer, their BP cuff — whenever possible.

When the bag does not go in

Do not take the healthcare bag into infested homes, or into the homes of patients with antibiotic-resistant infections such as MRSA or VRE.

Take in only what you need for that visit, carried in a way you can discard or disinfect afterwards.

Soiled items that leave the home

Bag soiled reusable items that could not be cleaned in the home in an impermeable sealed plastic bag, placed on the floor of the car — not on a seat, and not in the same container as the clean bag — and transport them back to the facility for disinfection.

Do not put these items back into the healthcare bag.

Patients with active infectious organisms

• Teach the patient and caregiver the infection control precautions that apply, and how to reduce the risk of transmitting a communicable disease.
• Visit these patients last, or at the end of the day.
• Use disposable equipment, or leave the needed equipment in the home for that patient.
• Consider referral to an infectious disease clinic or a specific case manager, which reduces staff exposure and the risk of carrying the organism to other patients.
• Contact the local health department for further surveillance and management guidance where appropriate.

See Infection Control and the Infection Log.

What to document

On the visit report:

• Patient and caregiver instruction on infection control precautions, their response to teaching, and whether they are adhering to the recommendations
• Implementation of Standard Precautions
• Physician notification, if applicable
• Other pertinent findings
• Plan of care updated

After the visit

• Clean and disinfect what you used with Sani-Cloth, and perform hand hygiene.
• Take anecdotal notes on anything relevant to the patient's care while it is fresh — this is what you work from at case conference and at the next visit. See Case Conference and Interdisciplinary Communication.
• Make the next appointment before you leave — date, time, and purpose.

The habit that makes it work

The single behaviour that separates good bag technique from theatre is hand hygiene before every re-entry into the bag. Most contamination happens when a clinician realises mid-task that they need one more item, reaches into the bag with gloved or soiled hands, and carries whatever is on those gloves into a bag that goes to the next house.

Pack well, open once, sanitize before you reach in again.

Reference

• McGoldrick, M. (2009). Cleaning and Disinfection. Home Care Infection Prevention and Control Program.
• Rutala, W.A., Weber, D.J., and the Healthcare Infection Control Practices Advisory Committee (HICPAC). (2008). Guideline for Disinfection and Sterilization in Healthcare Facilities. CDC.
• Agency infection control policy.