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, and standard precautions.

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. Use discretion and consideration when placing the bag on the patient's furniture. Never place a non-rolling bag on the floor. Use a barrier under the bag.
5. Perform hand hygiene using proper technique.
6. Remove the items you need, place them on the clean barrier, 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.

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.
• Store the bag in a clean storage container or a separate compartment in your car.

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.

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

Agency infection control policy. Barrier guidance per McGoldrick, 2009.