ER-IPC for
MD Students
Prof.Dr .Maha Shehata
Professor of Medical Microbiology &
Immunology
AFMG-Azhar University
By the end of these lectures , ER physician-MD student is able to :
• Be aware of international practice guidelines (IPGs) in ER regarding
occupational safety & infection prevention and control “IPC”.
• Recognize national (MOH- GDIPC), and international ( CDC,WHO)
Intended regulations &standards. Also, in Egypt ;the General Authority for
Healthcare Accreditation& Regulations “ GAHAR” .
Learning • Understand Facility Management & Safety “FMS” requirement in ER:
reception , triage area, fever clinic , isolation room , and be aware of
the standards of Occupational Safety in Healthcare Administration
Objective ”OSHA”.
• Know that ER-physician should get ; BLS, , ALS, CPR , BICSL training &
s “ILOs” licensing.
• Ensure that hospital IPC policy& procedure , is available in ER ; and
read,& understood by all ER staff.
• Assign an infection control ER officer physician/nurse ;responsible
for implementation of IPC measures.
• Know IPGs for ER manpower ( physician &nurses ) per bed
ratio.
• Ensure POCT-laboratory testing & portable X-ray unit in ER.
• Recognize the emerging endemics, epidemics, and pandemics
in the community, and how to prepare to face it in ER,
following updated MOH-IPC guidelines.
• Implement IPC special precautions, and patients’ pathway for
dealing with airborne respiratory infections : COVID-19,
ILOs MERS, SARS, H1N1 and all influenza epidemics,
meningitis ,pneumonia,and TB……..etc
• Ensure that new ER staff , get their IPC orientation program ,
N95 mask-size fit testing , practical training, and BICSL.
• Supervise monthly ER staff IPC competency testing , and their
attendance to hospital continuous medical education “ CME”.
• Implement IPC principles : H.H., PPE, proper waste disposal
( sharp objects, body fluids, tissues , contaminated dressings).
• Ministry of Health “MOH” , and General
Directorate of Infection Prevention &Control
“GDIPC” , are providing IPC standards , in
IPC accordance to international bodies : Centre for
Disease Control “CDC” ,and World Health
Guideline Organization “WHO”.
s , and • General Authority for Healthcare Accreditation
& Regulations “GAHAR”, provide manual to all
IPC governmental & private hospitals in Egypt,
Authoriz containing essential safety requirements “ESR”,
principal IPC requirements , and other medical
ation practice standards. GAHAR performs
scheduled survey visits to hospitals to check
the compliance , and approve the licensing /
renewal .
• In every hospital , ER must be located in the ground floor with
a special entrance & double door ,and security staff .
ER • ER must contain electronic management information system
“MIS”, connected to hospital information system “HIS”.
Facility • In ER ;patients’ full information should be documented , and
patients’ identification should be by his triple name, national
Manage ID number ,and file number / medical record number.
• ER safety practical training for fire, safety codes e.g. code
ment & blue , alarm system, extinguishing equipment, assembly
points & exit .
Safety • ER reception must contain barrier between staff and
customers/patients.
“FMS” • Patients’ safety, and Healthcare Workers (HCW)safety is our
target.
• ER reception should includes triage area ; an ER
nurse measures patients’ temperature –
digitally – and ask the patient a questionnaire
triage sheet ( from MOH) , about symptoms ,
perform scoring , and document it with
ER Triage signature.
& Fever • According to triage , the patient is directed to
ER sub-divisions :-obi-gynae , orthopedic,
Clinic cardiac , dialysis , or to ICU. But if the patient is
feverish ,he is directed to ER fever clinic.
• ER- Fever Clinic ; physician examine the patient
in fever clinic , request lab investigation and
radiology , for diagnosis.
• ER must include an isolation room for patients
with respiratory symptoms( !!! TB, influenza,
bacterial or viral pneumonia …….).
• ER isolation room requirement : negative
pressure (-2.5 pascal to -10 pascal ), HEPA
ER (high efficiency particulate air ) filters ,which
must be renewed every 6 months by general
Isolation maintenance staff( certificate & filing) ,
external monitor showing air cycle 12/hour
Room ( sheet & staff signature) , separate air exhaust
, and bathroom inside
• ER physician & nurse must wear complete
PPE ,whenever dealing with a patient in
isolation room.
• ER should have point-of care –testing “POCT”
laboratory investigation:
1. Glucometer ( professional not home glucometer).
2. Arterial blood gases “ABG”, lactate, Na,K
ER 3. PT, PTT , INR , and Hemoglobin measure.
POCT & 4. Cardiac markers ; CK-MB , Troponin, BNP , D-
dimer, procalcitonin.
Radiolog • Portable x-ray unit.
y • Crash card ; DC chock , pharmaceutical
medicines…………etc
N.B. if ER , main lab, x-ray departments are adjacent
to each other,and ER is less than 20 bed ; the above
mentioned are not required .
According to IPGs requirements :
• ER level 1: critical condition : Provider/
Patient is 1/ 2
• ER level 2: emergency condition: Provider
ER /Patient is 1/3
• ER level 3: acute illness : Provider / Patient
Manpowe is 1/ 4
r Ratio • ER nurse / patients is
1/ 4
• ER one specialist physician per shift.
• ER consultant is required if ER is more
than 50 bed capacity .
ER physician must attend , pass ,& get
licensed the following:
• Basic Life Support “ BLS”.
ER -Staff
• Advanced Life Support “ ALS”.
Training • Cardio-Pulmonary Resuscitation “ CPR”.
& • Basic Infection Control Skills License “
Licensing BICSL”.
And of course MOH –license .
• According to CDC , & WHO and MOH regulations :
• Sink every four beds , with detergents and hand
rub , and poster for H.H. steps and H.H. moments.
• ER bed- side hand rub.
ER - IPC • ER store for IPC consumables & PPE, dis-infectants.
Require • Proper waste management : sharp objects box,
biohazard bags waste , body fluids , tissues
ment containers .
• Contaminated instruments collected & delivered to
Central Sterilization Services Department “ CSSD”.
• Hospital approved IPC policy & procedure
should be available in ER.
• ER staff must be aware of IPC P&P.
ER - IPC • IPC department perform orientation
Policy & program and N95 mask-size fit test ;which is
registered in employee BICSL card .
Procedur • IPC staff provide monthly lecture and
e “P&P” practical training “ Annual IPC Educational
Program”, with signature and filing .
• ER staff should be tested , on monthly basis
for IPC competency.
