Lifeline 16911 Ambulance Disinfection & Decontamination Cleaning Protocols 2020

LIFELINE 16-911
The 4 Clean Approach

Daily Cleaning and Decontamination
LIFELINE 16-911
The 4 Clean Approach
Daily Cleaning and Decontamination
LIFELINE 16-911 The 4-Clean Policy
Objective
To deliver high quality infection prevention and control practice throughout the area.
As a healthcare provider and prehospital leader in the industry, we are all
responsible for providing a safe environment for our patients and staff
Responsibilities
It is the responsibility of each staff assigned to the ambulance or room to ensure that
they carry out their cleaning duties between each patient. During the occasional
situations, such as significant spillage of bodily fluids, Lifeline staff should ensure
initial cleaning is completed before seeking further decontamination
Scope
This document outlines the procedure for cleanliness to ensure effective infection
prevention and control standards are met. It applies to all personnel, front line and
line management, logistics staff operations, duty and purchasing managers.
The responsibility for cleaning is shared and therefore all staff must familiarize
themselves with this document and ensure that the principles and policies are
always applied.
This procedure specifies the responsibilities, and cleaning frequencies, schedules

and methods required to maintain a standard that reduces the risk of infections and
contaminations and promotes a safe environment.
LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 3

LIFELINE 16-911 The 4-Clean Policy
1 Between Patient Clean

Between patient cleans are undertaken by Lifeline staff after conveyance of patients.
2 Turn Over Clean and Re-stock

The Team Leader is responsible for ensuring that a nightly clean of the vehicle is
performed before re-stocking. This is a methodical clean of specified areas as defined
in the Lifeline Standard Operating Procedure. This nightly clean and re-stock is carried
out by Outgoing Lifeline Ambulance Team and endorsed to the Incoming Ambulance
Team
3 The 6-weekly Deep Clean

The Duty Manager (DM) is responsible for ensuring that a general deep clean of the
ambulance is performed, either immediately prior to or following a service scheduled
currently on a six-weekly basis. The aim of the six-weekly deep clean is to ensure that
an ambulance is comprehensively cleaned at regular intervals. This is a thorough clean
of the vehicle. This clean is carried out by the ambulance crew in Central supervised
by either the Operations, Duty, Fleet or Purchasing Managers.
4 Unscheduled Deep Clean

(Ad-hoc clean following significant contamination)
The Team Leader is responsible for ensuring that an Ad-hoc clean of the vehicle and
performed before re-stocking. This is a methodical clean and full decontamination of
the entire ambulance as per Deep Clean Standard Operating Procedure. Use of UV
light and Dry Misting protocols are required before ambulance is permitted back in
service

LIFELINE 16-911 Policy 1 – Between Patient Clean
1 Between Patient Clean

If assessed to be appropriate:
▪ Ambulance Operational staff are responsible for cleaning
the area and associated equipment between each patient ▪ Significant contamination with Bodily Fluid spillage in
transfer or admission. This should include cleaning ambulance or room to be deep cleaned overnight. It is the
surfaces/medical equipment which have been used in the staff’s responsibility to remove as much of the contamination
treatment of patients and spillages of body fluids together as possible before leaving the ambulance or room for deep
with the safe disposal of consumable items clean.
▪ The cleaning procedures should be carried out as soon as ▪ Significant contamination with pests - In extremely rare
possible after patient has been admitted to receiving cases such as bed bugs where the patient is heavily
hospital infested, with visible bed bugs on trolley beds, floors and on
▪ Liquid Lysol / Sanitizing Wipes are used for in between crew uniform, a request for fumigation through the
patient clean; including removal of tiny spots/splashes of Operations Manager (OM).
body fluids ▪ Known infection with organisms of concern - An
▪ Small or contained spillages of blood or body fluids should unscheduled deep clean and disinfection of the ambulance
be dealt with using CIDEX PLUS or room is required following transportation of a patient with
a known infection with organisms of concern e.g. Avian Flu,
▪ Where there is a large significant spillage of blood or body MERS, Viral Hemorrhagic Fever, Covid19.
fluid (greater than 1L), where the spillage is not contained,
or following transfer of patients with significant infestation, ▪ It is advisable to label the ambulance or room ‘Don’t not use
an unscheduled Deep Clean may be required – awaiting Deep Clean’ to ensure that it is not used before
being deep cleaned

LIFELINE 16-911 Policy 2 – Shift Turn Over Every 12 Hours
2 Turn Over Clean and Re-stock

▪ The 12-hour clean is carried out by the ambulance
outgoing crew before endorsements. This is a methodical
clean of specified areas, prior to re-stocking by purchasing
manager and delivery of supplies. All staff should follow the
Standard Operating Procedures (SOPs), using cleaning
products and adhere to Infection Prevention and Control
(IPC) standards including hand hygiene and appropriate
use of Personal Protective Equipment (PPE)
▪ The cleaning of equipment and medical devices remains

the responsibility of the ambulance staff. They are also
responsible for the management and disposal of clinical
waste and sharps; the staff MUST complete this task prior
to turn over to next shift.
▪ The 12 hour clean of an ambulance or room will focus on

the flat (horizontal) surfaces and areas which are
frequently touched, but will also include the exterior of the
ambulance or room if heavily soiled, which helps to project
a professional image to the public
▪ It is not anticipated that blood or body fluids will be visible

during this clean as the ambulance and clinic staff will have
cleaned any spillages, however, if they are, small spots
may be cleaned using CIDEX plus sanitizing wipes or
solution.
▪ All staff will adhere to the standards and their SOPs and
follow the checklist accurately.

LIFELINE 16-911 Policy 3 – Six Week Deep Clean
3 The 6-weekly Deep Clean

▪ The ambulances or rooms are scheduled for Deep Clean
every six-weeks by the Duty Manager or Operations
Manager of the Lifeline. The schedule is monitored by the
DM and OM Manager. All staff should follow the Lifeline
SOPs, using approved cleaning products.
▪ Standards including hand hygiene and appropriate use of
Personal Protective Equipment (PPE)
▪ The aim of a six-weekly Deep Clean is to ensure that a
ambulance or room is comprehensively cleaned at regular
intervals. This is a thorough clean of the ambulance or
room, which has been stripped of all consumable items
and medical equipment, and following the cleaning
process, is disinfected using CIDEX plus and the ultra
violet (UV) lights or Dry Misting or both. Following the
planned Deep Clean, the staff will reload medical
equipment and consumables
▪ It is not anticipated that blood or body fluids will be present
during this clean, however, if they are, small spots may be
cleaned using CIDEX / sanitizing wipes, prior to
disinfections with UV and Dry Misting.
▪ Both management and staff will adhere to the Lifeline
protocols and standard operational procedure. (SOP)
▪ All removable items stripped, gurney, spine boards,
seating, shelves matting, consumables, bio hazard, suction
containers etc. Items are to be soaked, scrubbed and
wiped down. Interior is to be scrubbed and every inch of
the ambulance or room cleaned.

LIFELINE 16-911 Policy 4 – Ad-Hoc Deep Clean
4 Unscheduled Deep Clean (Ad-Hoc Clean)

▪ The ambulance or rooms are constantly in use to serve a Examples of scenarios where an unscheduled deep
myriad of patients and are often faced with additional clean is required:
challenges, e.g. following transfers of patients with severe
infestations of pests such as bed bugs, large blood and ▪ The ambulance or room has been significantly contaminated
bodily fluid spillages, or with infectious organism of with vomit, feces blood or any body fluid >1L.
consequence or drug resistance
▪ A patient has been carried with a known or suspected viral
▪ Depending on dynamic risk assessment of the situation gastro-enteritis e.g. Norovirus, has vomited or has been
regarding the level and risk of contamination, the incontinent of feces in the area or room, which was not
ambulance or room may or may not need to be closed for contained, contaminating the surfaces.
unscheduled deep cleaning to be undertaken, outside of
the routine program of cleaning ▪ Following conveyance of patients with C.Difficile diarrhea/
incontinence of feces that is not contained.
▪ In a few instances it may be necessary to undertake a
more thorough clean of an ambulance or room, to ▪ An MRSA patient who is widely colonized and has a skin
effectively remove large body fluids spillages that could not condition such as exfoliating dermatitis, is sputum positive
be easily contained, and/or following transport of patients with positive symptoms or has open, discharging infected
with potentially highly infectious microorganisms or wounds.
infestations. This is termed as an unscheduled deep clean,
and is currently provided when requested ▪ A patient with known highly infectious disease has been
admitted e.g. avian flu, MERS, SARS, COVID19 or viral
▪ Where a staff assessed and identified a potential need for hemorrhagic fever (VHF), or multi-drug resistant organism of
an unscheduled deep clean, they should discuss this with consequence.
the DM or the OM, ahead of closing the ambulance or
room. SOP is the same as Policy 3 – Deep Clean. Team ▪ Admission of patient with visible significant infestations of
leader to provide incident report as needed to document bed bugs which has contaminated interiors of the vehicle.
the reasons why vehicle or room required the ad-hoc deep
clean. This is to be used as on-going risk assessment
done by management.

LIFELINE 16-911 UV Light Decontamination Protocols
Ultraviolet (UV) light in nature is electromagnetic radiation produced by the sun.
The most common forms are UV-A which is a long wave light and not absorbed by the ozone
layer (also called black light), UV-B which is a medium wave and mostly absorbed by the
ozone layer and finally UV-C which is a short wave light and completely absorbed by the
ozone layer. Modern science has been able to create UV-C lighting that are able to penetrate
the cell wall of microorganisms and alter the DNA structure such that the microorganism
becomes non-viable; unable to reproduce or infect a patient.
1. Clean ambulance thoroughly using lysol or cidex plus or surfanios disinfectant
2. Remove all garbage and dispose of properly. Note procedures on biohazard waste disposal
3. Leave all paperwork, cell phones, reusable PPE, money and other items on board ambulance
or room
4. Place UV light in center of ambulance or room and turn on
5. Close all doors and windows and leave for 4 hours unless otherwise directed by the DM
6. Remove UV and store
7. Pull out all the papers/documents, PPE's, Cellphone , money, etc and put everything in
proper order.
8. Ambulance back on 10-8.

LIFELINE 16-911 Ad Hoc Rapid Decontamination Dry Misting
Rapid Decontamination
▪ Lifeline decontamination team is available 24/7 for all
ambulances.
▪ Team leaders are to coordinate with the Duty Manager for

deployment on demand.
▪ 10mls of solution for the interior cabin for 3 mins and 2 ml

solution for drivers cabin (if cabin is divided)
▪ Ambulance, equipment, PPE, paperwork, money, cell
phones, radios, and any item that needs decontamination are
to be left inside while dry misting is performed.
▪ Ambulance must be sealed and all doors and windows closed

for a minimum of 30 minutes minimum.
▪ Duty Manager may request for a “double dose” of dry misting.

Follow procedures above times two (x2).
NOTE:
Do not bring any item that as been in contact with
patient outside of the ambulance until procedure is
completed. Dry Misting is safe for all electronics and
paperwork's on board.

LIFELINE 16-911 Policy 1 & 2 Between Patient Cleaning /Shift Change Checklist
Ensure that you have mop bucket, mops, wipes and brooms designated for decontamination. Remember to only use
clean towels.
▪ Clean all the interior mirrors and windows. There should be ▪ Clean the Plexiglas cabinets with glass cleaner, not
rolls of paper towels to be used with the glass cleaner. Wipe disinfectant
down the interior of the windows
▪ Put aside all loose equipment and linens
▪ Ensure the necessary documents and the clipboard are in
the proper bin or container. Make sure that the clipboard ▪ Check the sharps containers and trash cans and make sure
has all the forms, documents, waivers etc. to change it out. There should be spare empty containers
located in central. Like other supplies, if they are not readily
▪ Vacuum out the interior and clean up any loose trash. There available in the supply room, leave a note on the log book
should not be any used gloves, soda cans or trash and verbally advise dispatch at central of stocks needed
anywhere. The floorboards that are not carpeted may be
wiped out with the cleaner/degreaser if necessary. Do not ▪ Sweep and decontaminate the floor. After sweeping, spray
use the cleaner/degreaser on carpets the floor with disinfectant. Let it sit for a few minutes and
then mop the floor with clean water. Let the floor dry
▪ Wipe down all of the gurney rails and handles. Remove and
discard the sheets for laundry. Remove the mattress from
the frame and clean the entire mattress with disinfectant.
Wipe down the frame of the gurney making sure to check
the undercarriage
▪ Disinfect all of the surfaces. Disinfectant should NOT be

sprayed on any surface and left to dry completely. Wet
down contaminated surfaces and allow it to soak for several
minutes but DO NOT let disinfectant dry. Remember to
spray off door handles. Remember, DO NOT spray the
disinfectant directly onto electrical parts

LIFELINE 16-911 Policy 1 & 2 - Between Patient Cleaning/Shift Change Checklist
Equipment
Although it is not specifically stated on the checklist, there are numerous
other items that need to be decontaminated on a regular basis.
Monitor/Defibrillator Oxygen Caddy

Wipe down the lead cables, Clean out the interior of
the pulse ox probe and the the caddy and wipe down
face of the monitor the regulator
Immobilization Equipment Stethoscope and Blood Pressure Cuff

The backboards are head blocks need to be These items get used on every patient and rarely
wiped down on a regular basis. You would be get cleaned. Wipe down the stethoscope (ear
surprised how many of the backboards have pieces and bell) and lightly spray the surface of
dried blood inside the grab rails. This applies the BP cuff if necessary. Make sure that the BP
to KED’s and the Pedi-immobilizers as well cuff is dry
NOTE:
If you have any questions as to what needs to be cleaned, think about what items routinely come into contact with the patients or
your gloved hands. Use the disinfectant and towels at the PODS or on board to clean the equipment and the area as it is used.

LIFELINE 16-911 Policy 1 – 4 Exterior Body Clean
Using soap and water ensure the entire Ambulance, Charlie or Sierra assigned is thoroughly cleaned. All mud, dust and grime must be
removed. If ambulance is heavily soiled, request the duty manager for permission to take vehicle to car wash.
The exterior reflects the interior. Always be reminded that it is not only the patients that will notice, but the family and general public will
judge the Lifeline based on initial appearance.

LIFELINE 16-911 Infection Control
To provide guidelines for safety responding and transporting patients on isolation precautions to prevent; and/ or minimize infection
transmission.
Ensure that ambulance or rooms are properly cleaned after every usage in a standardized manner. This cleaning and disinfecting
procedure is required and essential to ensure employee safety as well as that of the patients that are treated daily.
Transport Procedure Personal Protective Equipment

1. Notify receiving facility of the patient isolation precaution ▪ The paramedic/EMT/ Registered Nurse should assess any
status procedure to be carried out and wear appropriate PPE.
2. If the patient is conscious and alert: instruct him/her of ways ▪ All essential PPE must be provided, i.e. gowns, surgical
he/she can assist in maintaining appropriate precautions to mask, clean and sterile gloves. In addition to N95 respirator
prevent transmission of the infection masks and disposable goggles for airborne precaution
(when applicable)
3. Dress wounds with impervious dressings as required
▪ All personnel accompanying airborne precautions cases must
4. Dress the patient in a clean gown (if applicable) be fit tested for N95 respirator masks
5. Explain to the patient the need for personal protective ▪ Discard all disposable contaminated PPE in medical waste,
equipment (PPE) he/she is required to wear (if applicable) according to company waste management policy
6. Make the patients that are on airborne isolation wear a ▪ Remove and appropriately dispose of PPE when they
surgical mask become soiled or torn.
7. Place the patient on a stretcher/wheelchair as appropriate
and cover stretcher/wheelchair with linen. NOTE:
Do not bring contaminated items into the station, or
8. Clean the gurney/stretcher/wheelchair with approved cleaning
the company facility unless properly handled.
and disinfection agents.

LIFELINE 16-911 Policy 1-4 Disinfection of Ambulance or Room
To provide guidelines to ensure maximum prevention from communicable diseases to patients, employees and relatives
(bystanders) before/after response and transport of patients.
1. Put on rubber gloves 13. Damp dust the fixtures and shelves
2. Place the required equipment and materials on the disinfecting 14. Wet mop the floor. Start from the insides working towards
tray or cart in an orderly manner outside near doors
3. Prepare the dry vacuum cleaner or broom. Make sure the dry 15. Clean and disinfect the door, and handles thoroughly
cleaner is safe and working properly
16. Allow sufficient time for the patient area to dry
4. Assemble wet mopping equipment and germicidal solution
17. Discard all disposable protective garments such as gloves and
5. Remove rubber gloves and wash hands thoroughly using skin face masks into a proper trash bin
disinfectant soap
18. Remove non disposable protective garments such as yellow
6. Wear appropriate protective garments – such as Isolation gowns and place them in a designated linen hamper in the
gowns, disposable gloves, masks, etc. soiled linen room of hospital, clinic or POD.
7. Move to assigned ambulance or room 19. Wash your hand thoroughly with soap containing skin
disinfectants and put on rubber gloves
8. Place the disinfecting trolley or cart, and dry vacuum cleaner or
broom adjacent to the entrance of the ambulance or room 20. Clean, disinfect and wipe dry all non-disposable equipment,
materials, and mop buckets
9. Place all loose trash in a small yellow plastic liner, and tie the
plastic liner securely before placing it in the yellow large waste 21. Return all the cleaned equipment, materials and mop buckets to
collection bag their proper place
10. Remove spots from hand surfaces 22. Remove rubber gloves, wash them and wash your hands with
soap containing skin disinfectant
11. Clean interior glasses and windows
23. Inform immediately control room, after completing the terminal
12. Remove dust from corners, shelves, floor, and underneath the cleaning of the ambulance or room
bed effectively using dry vacuum cleaner

LIFELINE 16-911 Disinfection of Ambulance or Room
REMEMBER: Skin and Nail Care:

• Germs can live under artificial fingernails both before and
▪ Disinfect/decontaminate the ambulance or room area as
after using an alcohol-based hand sanitizer and
soon as possible, after the area is been emptied
handwashing
▪ Effectively disinfect and clean interior floor, walls, windows, • It is recommended that healthcare providers do not wear
doors and shelves of patient area in the assigned artificial fingernails or extensions when having direct contact
ambulance or room with patients at high risk (e.g., those in intensive-care units
or operating rooms)
▪ Leave no dirt or trash in corners, shelves, floor, or beneath
seats • Keep natural nail tips less than ¼ inch long
• Some studies have shown that skin underneath rings
▪ Ensure that patient areas are free of dust, stains, odor, contains more germs than comparable areas of skin on
trash, and spots fingers without rings
• Further studies are needed to determine if wearing rings
results in an increased spread of potentially deadly germs
Hand Hygiene Guidance
Hand Hygiene means cleaning your hands by using either

handwashing (washing hands with soap and water), antiseptic
hand wash, antiseptic hand rub (i.e. alcohol-based hand
sanitizer including foam or gel), or surgical hand antisepsis
Cleaning your hands reduces:
The spread of potentially deadly germs to patients

The risk of healthcare provider colonization or infection caused
by germs acquired from the patient

LIFELINE 16-911 Hand Washing Guidance
Healthcare personnel should use an alcohol-based hand When using alcohol-based hand sanitizer:
rub or wash with soap and water for the following
clinical indications: Put product on hands and rub hands together
Cover all surfaces until hands feel dry
• Immediately before touching a patient
This should take around 20 seconds
• Before performing an aseptic task (e.g., placing an indwelling
device) or handling invasive medical devices
• Before moving from work on a soiled body site to a clean body site
on the same patient
• After touching a patient or the patient’s immediate environment
• After contact with blood, body fluids, or contaminated surfaces

• Immediately after glove removal
When using soap and water:
Lifeline Offices, PODS, Clinics & Facilities Should: • When cleaning your hands with soap and water, wet your
hands first with water, apply the amount of product
• Ensure that healthcare personnel perform hand hygiene with soap recommended by the manufacturer to your hands, and rub
and water when hands are visibly soiled
your hands together vigorously for at least 20 seconds,
• Ensure that supplies necessary for adherence to hand hygiene are covering all surfaces of the hands and fingers.
readily accessible in all areas where patient care is being delivered
• Rinse your hands with water and use disposable towels to
• Unless hands are visibly soiled, an alcohol-based hand rub is dry. Use towel to turn off the faucet.
preferred over soap and water in most clinical situations due to
evidence of better compliance compared to soap and water.
• Avoid using hot water, to prevent drying of skin.
• Hand rubs are generally less irritating to hands and, in the absence
of a sink, are an effective method of cleaning hands. • The focus should be on cleaning your hands at the right
times.

LIFELINE 16-911 When and How to use gloves:
When and How to use gloves: Disposable Gloves Donning
Wear gloves, according to Standard Precautions, when it can be
reasonably anticipated that contact with blood or other potentially
infectious materials, mucous membranes, non-intact skin, potentially
contaminated skin or contaminated equipment could occur.
Gloves are not a substitute for hand hygiene.

• If your task requires gloves, perform hand hygiene prior to
donning gloves, before touching the patient or the patient
environment.
• Perform hand hygiene immediately after removing gloves.
Change gloves and perform hand hygiene during patient care, if
• gloves become damaged, Disposable Gloves Removal
• gloves become visibly soiled with blood or body fluids following
a task,
• moving from work on a soiled body site to a clean body site on
the same patient or if another clinical indication for hand hygiene
occurs.
Never wear the same pair of gloves in the care of more than one
patient.
Carefully remove gloves to prevent hand contamination.

Dispose of gloves properly following Lifeline Bio-Hazard disposal
policy

LIFELINE 16-911 Cleaning and Disinfecting Your Ambulance
Cleaning Steps, Disinfectant Mixtures
How to clean and disinfect NOTE:

Wear disposable gloves to clean and disinfect • Diluted household bleach solutions may also be used if
appropriate for the surface. Check to ensure the product is not
past its expiration date. Unexpired household bleach will be
Clean effective against coronaviruses when properly diluted.
▪ Clean surfaces using soap and water. • Follow manufacturer’s instructions for application and proper
Practice routine cleaning of frequently ventilation. Never mix household bleach with ammonia or any
touched surfaces. other cleanser.
▪ High touch surfaces include: • Leave solution on the surface for at least 1 minute
• Gurney, equipment, seats, bags, BP • To make a bleach solution, mix:

monitors, cell phones, radios, Tables,
door handles, light switches, • 5 tablespoons (1/3rd cup) bleach per gallon of water
countertops, handles, desks, phones, OR
keyboards, toilets, faucets, sinks, etc.
Disinfect • 4 teaspoons bleach per quart of water
▪ Clean the area or item with soap and water or • Alcohol solutions with at least 70% alcohol.
another detergent if it is dirty. Then, use Lysol • CIDEX or SURFANIOS can be changed to potent disinfectants
or cidex plus disinfectant to wipe a second or that are used by partner hospitals.
third time.
▪ Recommend use of EPA-registered

disinfectant. Follow the instructions on the
label to ensure safe and effective use of the
product

LIFELINE 16-911
ROOMS & HOUSEHOLD
LIFELINE 16-911 DISINFECTION & DECONTAMINATION

20
PROTOCOLS 2020
LIFELINE 16-911 Cleaning and Disinfecting Ambulance or Room
Areas to be checked and cleaned
Soft Surfaces Electronics Laundry Trash

▪ For soft surfaces such as ▪ For electronics, such as ▪ For clothing, towels, linens and ▪ Dedicated, lined trash
carpeted floor, rugs, and tablets, touch screens, other items can: If possible,
drapes keyboards, remote dedicate a lined trash
controls, and ATM ▪ Wear disposable gloves can for the person who
▪ Clean the surface using soap machines is sick. Use gloves when
and water or with cleaners ▪ Wash hands with soap and water removing garbage bags,
appropriate for use on these ▪ Consider putting a as soon as you remove the gloves and handling and
surfaces wipeable cover on disposing of trash.
electronics ▪ Do not shake dirty laundry
▪ Launder items (if possible) ▪ Separate trash bags
according to the manufacturer’s ▪ Follow manufacturer’s ▪ Launder items according to the from the clean-up to
instructions. Use the warmest instruction for cleaning manufacturer’s instructions. Use the other regular waste and
appropriate water setting and and disinfecting warmest appropriate water throw them away
dry items completely setting and dry items completely
▪ If no guidance, use
▪ Put all used rags, mask
OR alcohol-based wipes ▪ Dirty laundry from a sick person can and gloves into the trash
or sprays containing be washed with other people’s bags
▪ Disinfect with an EPA-registered at least 70% alcohol. items
household disinfectant. These Dry surface ▪ Wash hands afterwards
disinfectants meet EPA’s criteria thoroughly ▪ Clean and disinfect clothes
for use against COVID-19 hampers according to guidance
above for surfaces

LIFELINE 16-911 Cleaning and Disinfecting Your Rooms
Hard (Non-porous) Surfaces
Wear disposable gloves when cleaning and disinfecting surfaces. Gloves should be discarded after each cleaning. If
reusable gloves are used, those gloves should be dedicated for cleaning and disinfection of surfaces for COVID-19
and should not be used for other purposes. Consult the manufacturer’s instructions for cleaning and disinfection
products used. Clean hands immediately after gloves are removed.
• If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to disinfection.
For disinfection, most common EPA-registered household disinfectants should be effective.
• A list of products that are EPA-approved for use against the virus that causes COVID-19 is available. Follow
manufacturer’s instructions for all cleaning and disinfection products for (concentration, application method and
contact time, etc.).
• Additionally, diluted household bleach solutions (at least 1000ppm sodium hypochlorite) can be used if
appropriate for the surface.
• Follow manufacturer’s instructions for application, ensuring a contact time of at least 1 minute, and allowing
proper ventilation during and after application.
• Check to ensure the product is not past its expiration date.
• Never mix household bleach with ammonia or any other cleanser. Unexpired household bleach will be
effective against coronaviruses when properly diluted.
Prepare a bleach solution by mixing:

• 5 tablespoons (1/3rd cup) bleach per gallon of water or
• 4 teaspoons bleach per quart of water
Bleach solutions will be effective for disinfection up to 24 hours.

LIFELINE 16-911 Cleaning and Disinfecting Your Rooms
Soft (Porous) Surfaces

For soft (porous) surfaces such as carpeted floor, rugs, and drapes, remove visible contamination if present and
clean with appropriate cleaners indicated for use on these surfaces.
After cleaning:
• Launder items as appropriate in accordance with the manufacturer’s instructions. If possible, launder items
using the warmest appropriate water setting for the items and dry items completely.
• Otherwise, use products that are EPA-approved for use against the virus that causes COVID-19 and that are
suitable for porous surfaces.
Electronics:
For electronics such as cell phones, tablets, touch screens, remote controls, and keyboards, remove visible
contamination if present.
• Follow the manufacturer’s instructions for all cleaning and disinfection products.
• Consider use of wipeable covers for electronics.
• If no manufacturer guidance is available, consider the use of alcohol-based wipes or sprays containing at
least 70% alcohol to disinfect touch screens. Dry surfaces thoroughly to avoid pooling of liquids.

LIFELINE 16-911 Laundry
Linens, clothing, and other items that go in the laundry

Wear disposable gloves when handling dirty laundry from an ill person and then discard after each use. If
using reusable gloves, those gloves should be dedicated for cleaning and disinfection of surfaces for COVID-
19 and should not be used for other room, office or household purposes.
Clean hands immediately after gloves are removed.
• If no gloves are used when handling dirty laundry, be sure to wash hands afterwards.
• If possible, do not shake dirty laundry. This will minimize the possibility of dispersing virus through the air.
• Launder items as appropriate in accordance with the manufacturer’s instructions. If possible, launder
items using the warmest appropriate water setting for the items and dry items completely.
• Dirty laundry from an ill person can be washed with other people’s items.
• Clean and disinfect clothes hampers according to guidance above for surfaces. If possible, consider
placing a bag liner that is either disposable (can be thrown away) or can be laundered.

LIFELINE 16-911 Hand Washing & Other Preventive Measures
Hand hygiene and other preventive measures
Office or Household members should clean hands often, including immediately after removing gloves and after
contact with an ill person, by washing hands with soap and water for 20 seconds. If soap and water are not
available and hands are not visibly dirty, an alcohol-based hand sanitizer that contains at least 60% alcohol may be
used. However, if hands are visibly dirty, always wash hands with soap and water.
Employees should follow normal preventive actions while at work and home including recommended hand
hygiene and avoiding touching eyes, nose, or mouth with unwashed hands.
• Additional key times to clean hands include:

• After blowing one’s nose, coughing, or sneezing
• After using the restroom
• Before eating or preparing food
• After contact with animals or pets
• Before and after providing routine care for another person who needs assistance (e.g. a child)
Other considerations
Non-disposable food service items used should be handled with gloves and washed with hot water or in a
dishwasher. Clean hands after handling used food service items.
If possible, dedicate a lined trash can for the ill person. Use gloves when removing garbage bags, handling, and
disposing of trash. Wash hands after handling or disposing of trash.
Consider consulting with your local health department about trash disposal guidance if available.

LIFELINE 16-911 Cleaning and Disinfecting Your Facility Homecare
When cleaning:
▪ Wear disposable gloves and gowns for all tasks in the cleaning process,
including handling trash
• Additional personal protective equipment (PPE) might be required
based on the cleaning/disinfectant products being used and
whether there is a risk of splash
• Gloves and gowns should be removed carefully to avoid
contamination of the wearer and the surrounding area
Cleaning and disinfecting your building ▪ Wash your hands often with soap and water for 20 seconds
or facility if someone is sick • Always wash immediately after removing gloves and after contact
with a sick person
▪ Close off areas used by the sick person. • Hand sanitizer: If soap and water are not available and hands are
not visibly dirty, an alcohol-based hand sanitizer that contains at
▪ Open outside doors and windows to increase air circulation least 60% alcohol may be used. However, if hands are visibly
in the area. Wait 24 hours before you clean or disinfect. If 24 dirty, always wash hands with soap and water.
hours is not feasible, wait as long as possible.
• Additional key times to wash hands include:
▪ Clean and disinfect all areas used by the sick person, such
as offices, bathrooms, common areas, shared electronic • After blowing one’s nose, coughing, or sneezing
equipment like tablets, touch screens, keyboards, remote • After using the restroom
controls, and ATM machines.
• Before eating or preparing food
▪ If more than 7 days since the sick person visited or used the • After contact with animals or pets
facility, additional cleaning and disinfection is not necessary.
• Before and after providing routine care for another person who
▪ Continue routing cleaning and disinfection needs assistance (e.g., a child)

LIFELINE 16-911 Disinfectants & Ratios To Be Used
MetriCide OPA Plus High-Level

Alcohol Disinfectant
100% no dilution • Ortho-phthalaldehyde (OPA) based high-level
disinfectant that provides a broad spectrum of
protection against many microbials including TB,
Hepatitis A, Hepatitis B, HIV-1 and Poliovirus
Type 1.
• Fast, effective, value alternative to other OPA

Lysol Solution brands - provides up to 40% more reprocessing
cyclesin an automatic endoscope reprocessor
(AER) and has .05% more active ingredient
5 caps (2oz) of
Lysol to 1L of water • Fast acting! Disinfects in 5 minutes at 25°C in an
AER; 12 minutes at 20°C in manual
reprocessing
• Ready to Use! No mixing or activation
Ultraviolet (UV) Light • Increased productivity! Improves device

turnaround time and reduces reprocessing costs
• Unlike chemical approaches to water disinfection, UV provides rapid,
effective inactivation of microorganisms through a physical process. When • Gentle! Tested compatible with common
bacteria, viruses and protozoa are exposed to the germicidal wavelengths endoscopes and a wide variety of materials
of UV light, they are rendered incapable of reproducing and infecting. UV
light has demonstrated efficacy against pathogenic organisms, including • Long lasting! Up to 14-day reuse life when
those responsible for cholera, polio, typhoid, hepatitis and other bacterial, monitored with test strips
viral and parasitic diseases. In addition, UV light (either alone or in • 2 year shelf life and 75-day open bottle shelf life
conjunction with hydrogen peroxide) can destroy chemical contaminants
such as pesticides, industrial solvents, and pharmaceuticals through a • No harsh smell, unlike glutaraldehydes
process called UV-oxidation.
• Faster test strip development! 60 seconds
• Place the UV light in area of the patient. versus 90 seconds for other brands, with easier-
to-read pass/fail distinctions (magenta/yellow)
• Close all the doors and windows and leave light on for minimum 4 and up than other brands (purple/blue)
to 6 hours unless otherwise instructed by the Duty Manager

LIFELINE 16-911 Cleaning and Decontamination Guide
Patient Contact
Area/Item Frequency Method Standard
▪ Stretcher After every patient use Wipe all surfaces that may have come All parts should be visibly clean with
into contact with the patient using no blood or body substances, dust,
detergent wipes, paying particular dirt, debris or spillages
attention to the side handles and mattress
▪ Arm-lok immobilizer After every patient use Wipe all surfaces with detergent wipes / All parts should be visibly clean with
▪ Bedpan towels. no blood or body substances, dust,
▪ Carry chair dirt, debris or spillages
▪ Laryngoscope handle
▪ Peak flow meter
▪ Pulse oximeter probe
▪ Rescue board
▪ Scoop stretcher
▪ Stethoscope
▪ Vacuum mattress
▪ All exposed supplies and
equipment's on board
ambulance
▪ BP cuffs After every patient use Wipe all surfaces with detergent wipes. All parts (pay particular attention to
▪ Collars Equipment must be disposed of as Velcro areas) should be visibly clean
▪ Frac pack straps contaminated waste if Velcro becomes with no blood or body substances,
▪ Sphyg aneroid manometer contaminated with body fluids dust, dirt, debris or spillages
▪ Linen and single use items After every patient use Linen and single use items must be Linen and single use items must be
disposed of after every patient use disposed of after every patient use
▪ Patient’s clothes After every patient use Placed in double barrier and sent to Placed in double barrier and sent to
laundry services, for proper laundry laundry services, for proper laundry

LIFELINE 16-911 Cleaning and Decontamination Guide
Non-Patient Contact
▪ Airwaves equipment At least daily and if Wipe all surfaces with detergent wipes or All parts should be visibly clean with
▪ Defibrillator contaminated towels no blood or body substances, dust,
▪ Equipment bags dirt, debris or spillages
▪ Glucometer
▪ Mobile phone
▪ Pulse oximeter unit
▪ Resuscitator
▪ Scissors
▪ ECG Unit
Room
▪ Internal surfaces At least daily and if Wipe all surfaces with detergent wipes or All surfaces should be visibly clean
(ceiling, sides, cupboards, blinds, contaminated towels and free from body fluids, dust, dirt
brackets, fire extinguisher, grab or adhesive tape
rails, communications equipment,
work surfaces)
▪ Floor At least daily and if Mop with hypochlorite solution. Significant The complete floor including all
contaminated debris and dust should be vacuumed first skirting and edges are visibly clean
and free from dust, dirt or spillages
▪ Glass and mirrors At least weekly or more Clean with glass cleaner and cloth All surface should be visibly clean
often if necessary

LIFELINE 16-911 UV Light Disinfection – How it Works
VIRUS AND ULTRAVIOLET TREATMENT(Germicidal Lamps)
A virus is not a living organism but a protein molecule covered by a protective layer of fat or lipid, which when absorbed by the cells,
changes the genetic code or mutates it and convert it to aggressor and multiplier cells.
Since the virus is not a living organism but a protein, it is not killed but decays on its own.
Viruses are very fragile. The only thing that protect it is a thin layer of fat. by dissolving the fat layer, the protein molecule disperses and
breaks down on its own. If dehumidified, dry, warm, and bright environment will degrade it too.
Also, with a proper ULTRAVIOLET LIGHT WAVELENGTH (measured in nanometers) the heat produced by UV melts fat. This is why it is so
good to use UV treatment in neutralizing viruses and other harmful micro organism using UV light above 265nm wavelength.
Q: Do germicidal lamps kill most viruses, yeast, bacteria, mold spores, fungi, etc
A: Yes. UV with wavelengths of 200-280nm can kill and prevent the growth and multiplier effect of viruses, bacteria, yeast, molds, fungi. Etc
RECOMMENDED ULTRAVIOLET LIGHT EXPOSURE
. MATERIAL UV WAVELENGTH Nanometers(nm) SAFE EXPOSURE Y/N EXPOSURE TIME
Metal 256nm Y 2 hours

Plastic 256nm Y 2 hours
Fabric 256nm Y 2 hours
Paper 256nm Y 30mins
Food 254nm Y 2-3mins
Water 254nm Y 2-3mins
* simple and inexpensive UV light can kill food borne pathogens on the surface of certain fruits such as apples, pears,
** UV lights which cannot penetrate Opaque and solid objects can be effective in sanitising surfaces
*** for human beings, prolonged skin exposure to UV light can lead into rapid sunburn and skin cancer. Exposure to this UV radiation can produce extremely painful inflammation of
the cornea and temporary vision impairment including permanent blindness due to damaged retinas

LIFELINE 16-911 Types of UV Lights Available
Various types of UV light treatment are available.

• It is important that the light type of UV light, placement and wattage is
used for the type of area that is being treated.
• Personnel deploying the UV light treatment must familiarize themselves
with the protocols.
• For Lifeline Ambulances UV light is used for deep cleaning or after any
infectious patient transfers
• Ambulance is wiped down using approved disinfectants

• All reusable PPE, Paperwork's and other items left on board
• Portable UV light is then placed inside the cabin and turned on
• Doors and windows closed
• UV light is left on for minimum 4 and maximum of 6 hours
depending on the case.
• Ambulance is opened and allowed to air out for a 5 mins
• Ambulance interior is wiped down again with disinfectant.

LIFELINE 16-911 Dry Misting Decontamination Protocols
How It Works
Features Effective against:
The 99S disinfectant solution is transformed into an extremely fine mist, ▪ Fast and effective at an average ▪ COVID-19
made up millions of ultrafine droplets. of 30 mins disinfection time ▪ SARS-CoV
▪ Dry mist disinfection means there ▪ MERS-CoV
The extremely small size of the droplets allows the high efficacy of the 99S is no need to clean or prep the ▪ Adenovirus
solution to be delivered to every targeted area, even the most difficult to area before or after the ▪ Poliovirus
reach ones. procedure, furniture need not be ▪ E.Coli
99S is specifically formulated so that it lies on contaminated areas with covered, fabrics will not get wet, other viruses
an unparalleled degree of uniformity that leaves no place for pathogens floors and walls will stay dry and bacteria
to escape their destruction. ▪ FDA and ISO Registered
▪ Currently used by premier tertiary
The ultrafine mist evaporates in a matter of hundreds of a second leaving hospitals in Manila
no moisture or humidity on the disinfected targets.
Once evaporated, the disinfectant properties of 99S are prolonged by the

Where It Should be Used
• Hospitals/ Clinics/ Ambulances
coating provided by silver cations present in the formula. • Condominiums/Apartments
• Houses
Lifeline Decontamination Teams are equipped and ready to respond to all • Offices
needs 24/7. Please coordinate with the duty manager for dispatch. • Commercial Spaces
When It Should be Used

Process for Dry Misting Ambulance: • To prepare areas for self-
quarantine/isolation for those
• Ambulance wiped down with soap, water and disinfectant who need to avoid getting sick
• To decontaminate areas where
• Machine is placed in center of cabin possible or confirmed COVID-19
patients have been
• Solution is applied for 3 mins
• Ambulance is left with all windows and doors closed for 30 mins.
• Ambulance ready for use again.

LIFELINE 16-911 Bio – Hazard & PPE Protocols & Back Up Plans

LIFELINE 16-911 Biohazard Protocols
Ebola
This SOP can serve as a model to standardize the procedures and responsibilities
for the decontamination and disinfection of an area or room that has a person under
investigation (PUI) for Ebola or a patient with confirmed Ebola. It is highly
recommended that the procedures and responsibilities for decontamination and
disinfection to be clearly defined before admitting a PUI. All personnel should be
trained in donning and doffing (putting on and taking off) techniques for personnel
protective equipment (PPE)
The following key assumptions are being made:

▪ All healthcare workers who are involved will have
received education and training and demonstrated
the necessary competencies for management of
patients with serious communicable diseases
▪ Healthcare facilities have procedures for
management of patients with serious
communicable diseases
▪ This guidance complements the other CDC
guidance for management of patients with serious
communicable diseases

Personal Protective Equipment
LIFELINE 16-911 (PPE)
REMEMBER:
PPE SAFETY
FIRST
Always wear your
PPE when
handling highly
infectious and
contagious
patients.
There is no room
for error

LIFELINE 16-911 Personal Protective Equipment

Safety
Ebola is transmitted through contact with infected body fluids, so infection control measures must
be implemented that prevent contact with blood or infectious body fluid throughout the
decontamination process. Corona Virus, TB, SARS, MERS CoV are airborne and spread and
transmitted in the air. Masks and other respiratory PPE is essential when handling patients.
For Ebola this process is designed for a 3-person team. Two people will be donned in PPE and
perform the decontamination. A third person, not donned in PPE, will be available to document the
decontamination and for other assistance as needed. If Corona virus or other respiratory
contagions all crew must wear full PPE.
Decontamination Site Setup

▪ Establish a secure perimeter for safety of the public and decontamination personnel including
considerations for waste management, security plan, public perception, and media visibility when
decontaminating
▪ Define and mark hot, warm, and cold zones of decontamination around the ambulance or room that
require PPE to enter
Notes:
The hot zone is considered an area that is known or suspected to be contaminated and has a high risk of exposure. It should
only be entered with full PPE. In ambulance decontamination, this would be the vehicle and an area about a meter beyond the
ambulance.
The warm zone can be considered a transitional area between the hot and cold zones that has no known contamination but
has a moderate risk of exposure. It should only be entered when wearing full PPE. This is also the area where one begins the
initial portion of the doffing process (following a full suit wipe down within the hot zone) when leaving the hot zones. For
ambulance decontamination, the warm zone can also be the place where waste barrels are pre-positioned so that the waste bags can
be placed directly into the containers without entering the hot zone.
The cold zone is considered an area that has no contamination and no potential risk for exposure. The individuals in this area
are not required to wear PPE, although the cold zone will often also serve as the PPE donning area.

Before Decontamination
▪ To limit the number of people exposed to potentially contaminated materials, the patient care provider or ambulance will be responsible for
decontamination and disinfection of the ambulance or room. However, a separate specialty team may also be used to do this in the cases of
epidemic or pandemic situations to ensure safety of all concerned. Lifeline provides a standing ready decontamination team 24/7 in these situations
▪ All waste, including PPE, drapes, and wipes, should be considered Category A infectious substance, and should be packaged appropriately for
disposal
▪ PPE should be donned and doffed according to organizational protocols
▪ PPE selection should consider worker protection for biological exposures and potential chemical exposures based on disinfectant used
During Decontamination
▪ Disinfect the outside of any prepositioned but unused medical equipment (still inside the protective bags they were placed in) and pass it to the warm
zone. If the equipment was removed from a protective bag in transit, assess the equipment to determine if it can be properly decontaminated and
disinfected, or disposed of
▪ Any areas that are visibly contaminated with the patient’s body fluids should be decontaminated first with an approved EPA-registered disinfectant
for the appropriate contact time before soaking up the fluid with absorbent materials
▪ If the interior of the ambulance or room was draped, remove the draping by rolling the drapes down outside in, from the ceiling to the floor of the unit
▪ To facilitate packaging and transport, drapes can be gently cut into segments. It is important that all drape materials are in sections that are small
enough to facilitate the insertion of the biohazard bags into an autoclave or pre-determined Category A infectious substance packaging for disposal
▪ Two people in PPE should manually disinfect the interior of the patient care area with particular detail to high touch surfaces such as door handles
and steps using care to limit mechanically generated aerosols and using the surface wipe method to disinfect
▪ Once manual interior wipe down has been completed, collect and package all waste as Category A waste
▪ Manually wipe down the exterior of the ambulance or room’s door and handles, and any areas that may have been contaminated, with disinfectant
▪ Once the outside of all surfaces (including waste gabs) have been wiped with disinfectant, then doffing can occur

After Decontamination
▪ A third person who has been in the cold zone should supervise doffing, which should be performed according to organization doffing
protocols
▪ Dispose of all waste according to organization protocols as well as local and federal regulations for Category A infectious substances
▪ Additional cleaning methods can also be used. While not required, this may provide additional assurance to personnel and public prior
returning to room availability. Ultraviolet germicidal irradiation, chlorine dioxide gas, or hydrogen peroxide vapor can be used for an
additional disinfection step. However, these should not replace the manual disinfection, as their efficacy against organisms in body
fluids has not been fully established and these methods may require specialized equipment and PPE
▪ The ambulance or room is ready for occupancy

LIFELINE 16-911 PPE - COVID-19, SARS, MERS CoV Recommendations
Patient Care for Patients Suspected Aerosol Generating Procedures1

Patient Care for Patients Not or Positive for COVID-19 on Patients Suspected for
Suspected for COVID-19 (If interaction requires being within 3 ft of the patient, COVID-19 AND Airway
the patient should wear a surgical mask) Procedures on ALL patients
When: When: When:
▪ Patient has COVID-19 symptoms ▪ Patient has COVID-19 symptoms OR has a ▪ Aerosol generating procedures1 are
▪ Closer than 6 ft from patient for more COVID-19 test pending or with positive result being performed
than 1 minute
Where: Where:
Where: ▪ Ambulatory Clinics ▪ Ambulatory Clinics
▪ Ambulatory Clinics ▪ Emergency Department ▪ Emergency Department
▪ Emergency Department ▪ Acute Care Units ▪ Acute Care Units
▪ Acute Care Units ▪ Intensive Care Units ▪ Intensive Care Units
▪ Intensive Care Units ▪ Procedural Areas ▪ Procedural Areas
▪ Procedural Areas
PPE Required: PPE Required:
PPE Required: ▪ Eye protection/face shield ▪ PAPR OR N95 Respirator + Face
▪ Surgical/ear loop mask ▪ Surgical/ear loop mask Shield/Eye Protection
▪ Gown ▪ Surgical/ear loop mask
▪ Gloves ▪ Gown
▪ Gloves
Note for all categories shown: Hand hygiene required upon entry and exit, regardless of whether the patient is under
isolation, or PPE is worn
1Aerosol Generating Procedures include but are not limited to: laryngoscopy/intubation, non-invasive ventilation, CPR, bronchoscopy, open suction, nasotracheal suction,
nebulizer treatments
PPE for Specimen Collection: Nasopharyngeal swabs often generate a strong cough reflex. Standard/Contact/Droplet precautions are recommended,
Please see extended and re-use guidelines for N95 respirators.

LIFELINE 16-911 Gold Standard Face Masks
▪ Lifeline under normal patient transfers or emergency runs use 3-ply Surgical Masks approved
by the FDA, WHO and DOH
▪ N95 masks are used for any patient transfers that involve contagious illnesses
▪ Back up to the N-95 is the K-95 masks
▪ At worst case scenario when no masks are available. Reusable, washable masks are deployed.
Proper washing and decontamination protocols must be followed at all times. Reusable masks, gowns
and other PPE are to be decontaminated using the UV light or Dry Misting protocols and placed in the
ambulance or room while decontamination is in progress
Face masks comparisons
N95 Respirator Surgical Mask

▪ Reduces exposure to ▪ Fluid resistant, protects wearer
small particles against large droplets
▪ Filters out at least 95% ▪ Does not protect against
of airborne particles smaller airborne particles
▪ Tight fitting, allows ▪ Loose fitting - allows leakage
minimal leakage around the edges

LIFELINE 16-911 Difference of Face Masks
Surgical Mask N95 Respirator Elastomeric Half Facepiece Respirator
Testing and Cleared by the US Food and Drug Evaluated, tested and approved by NIOSH as per the requirements in 42 CFR Evaluated, tested and approved by NIOSH as per
Approval Administration (FDA) Part 84 the requirements in 42 CFR Part 84
Fluid resistant and provides the wearer

protection against large droplets, splashes
Intended Use Reduces wearer’s exposure to particles including small particle aerosols and Reusable device made of synthetic or rubber
or sprays of bodily or other hazardous
and Purpose large droplets (only non-oil aerosols) material
fluids. Protects the patient from the
wearer’s respiratory emissions
Face Seal Fit Loose-fitting Tight-fitting Tight-fitting
Fit Testing
No Yes Yes
Requirement
Designed
No No Yes
for Reuse
User Seal
No Yes. Required each time the respirator is donned (put on) Yes. Required each time the respirator is donned
Check
Does NOT provide the wearer with a
May be equipped with filters that block 95%, 99%
reliable level of protection from inhaling
Filtration Filters out at least 95% of airborne particles including large and small particles or 100% of very small particulates. Also may be
smaller airborne particles and is not
equipped to protect against vapors/gases
considered respiratory protection
When properly fitted and donned, minimal
Leakage occurs around the edge of the When properly fitted and donned, minimal leakage occurs around edges of the
Leakage leakage occurs around edges of the respirator
mask when user inhales respirator when user inhales
when user inhales
Ideally should be discarded after each patient encounter and after aerosol-
generating procedures. It should also be discarded when it becomes damaged or
Use Disposable. Discard after each patient Reusable and must be cleaned/disinfected and
deformed: no longer forms an effective seal to the face; becomes wet or visibly
Limitations encounter stored between patient interaction
dirty; breathing becomes difficult; or if it becomes contaminated with blood,
respiratory or nasal secretions or other bodily fluids

LIFELINE 16-911 Proper Sequence of Wearing PPE
The type of PPE used will vary based on the level of precautions required, such as standard and contact,
droplet or airborne infection isolation precautions. The procedure for putting on and removing PPE should be
tailored to the specific type of PPE
Gown Googles or Face shield

▪ Fully cover torso from ▪ Place over face and
neck to knees, arms to eyes and adjust to fit
end of wrists and wrap
around the back
▪ Fasten in the back
of neck and waist
Mask or Respirator Gloves

▪ Secure ties or elastic ▪ Extend to cover wrist
bands at the middle of of isolation gown
head and neck
▪ Fit flexible band to
nose bridge
▪ Fit snug to face and
below chin
▪ Fit-check respirator
Use safe work practices to

protect yourself and limit the ▪ Keep hands away from face ▪ Change gloves when torn or heavily contaminated
▪ Limit surfaces touched ▪ Perform hand hygiene
spread of contamination

LIFELINE 16-911 Proper Sequence of Removing PPE
There are variety of ways to remove PPE without contaminating your clothing, skin, or mucous membranes
with potentially infectious materials. Here is one example. Remove all PPE before exiting the patient room
except a respirator, if worn. Remove the respirator after leaving the patient room and closing the door.
Remove PPE in the following sequence:
Gloves Goggles or face shield

▪ Outside of gloves are contaminated ▪ Outside of goggles or face shield are contaminated
▪ If your hands get contaminated during glove removal, ▪ If your hands get contaminated during goggle or
immediately wash your hands or use an alcohol-based face shield removal immediately wash your hands or
hand sanitizer use an alcohol based hand sanitizer
▪ Using a gloved hand, grasp the palm area of the other ▪ Remove goggles or face shield from the back by
gloved hand and peel off first glove lifting head band or ear pieces
▪ Hold removed glove in gloved hand ▪ If the item is reusable, place in designated
▪ Slide fingers of ungloved hand under remaining glove receptacle for reprocessing. Otherwise, discard in a
at wrist and peel off second glove over first glove waste container
▪ Discard gloves in a waste container

LIFELINE 16-911 Proper Sequence of Removing PPE
There are variety of ways to remove PPE without contaminating your clothing, skin, or mucous membranes
with potentially infectious materials. Here is one example. Remove all PPE before exiting the patient room
except a respirator, if worn. Remove the respirator after leaving the patient room and closing the door.
Remove PPE in the following sequence:
Gown Mask or respirator Wash hands or use an

▪ Gown front and sleeves are contaminated ▪ Front of mask/respirator is alcohol-based hand
▪ If your hands get contaminated during contaminated – DO NOT TOUCH! sanitizer immediately
gown removal, immediately wash your ▪ If your hands get contaminated after removing all PPE
hands or use an alcohol-based sanitizer during mask/respirator removal,
▪ Unfasten gown ties, taking care that immediately wash your hands or
sleeves don’t contact your body when use an alcohol-based hand
reaching ties sanitizer
▪ Pull gown away from neck and shoulders, ▪ Grasp bottom ties or elastics of
touching inside of gown only the mask/respirator, then the ones
▪ Turn gown inside out at the top and remove without
▪ Fold or roll into a bundle and discard in a touching the front
waste container ▪ Discard in a waste container
Perform hand
hygiene
between steps if
hands become
contaminated
and
immediately
after removing
all PPE

LIFELINE 16-911 Information and Protocols for COVID-19
Coronavirus PREVENTION SYMPTOMS

Reduce transmission by:
Health Advisory
Washing your Runny Nose
CORONAVIRUS (CoV) hands often with
A large family of viruses that cause illness ranging soap and water
from the common Sore Throat
cold to more severe diseases such as Pneumonia, Avoiding touching
SARS, kidney failure and even death your eyes, nose
Headache
or mouth
TRANSMISSION Fever
Human coronaviruses most commonly spread Avoiding
from an infected person to others through: animal contact
• The air by coughing and sneezing Cough
• Close personal contact, such as touching or Drinking a lot
shaking hands of water
• Touching your mouth, nose or eyes after Malaise
touching an object or surface with the virus on it
• Rarely, fecal contamination
See your healthcare provider if you
are concerned with your symptoms
PROTECTION If you are mildly sick, keep yourself
Avoiding close contact
There are currently no vaccines available against hydrated, stay at home and rest
with people who are sick
human coronavirus infection.

COVID-19 Prevention: Protocols before entering your home
Have hand sanitizer or Leave your Take off your mask and Sanitize your shoes
alcohol near the entrance belongings in a gloves and throw them away and leave them
of your home box at the entrance carefully, wash hands after outdoors
Take off your Shower immediately Clean your phone Clean the surfaces of items
outer clothing and or wash all exposed areas and glasses with with bleach/soap or
put them in a well if unable to do soap and water water/alcohol before bringing
laundry bag so right away or alcohol them inside your home

COVID-19 Prevention: Sanitize your footwear

The corona virus may survive and cling
to pavement and shoe surfaces for
up to 9 hours
Use only one pair of shoes

for going out
Sanitize them before entering
your workplace or your home
Leave them outside of your
house after disinfecting them
Don't let the virus into your home!

Household Cleaning and Disinfecting when caring for someone with COVID-19
High-touch surfaces
(e.g. tables, hard-backed chairs, doorknobs, light switches, remotes, handles, desks, toilets, sinks)
Wear disposable gloves Disinfect surfaces
to be discarded after cleaning or gloves dedicated for COVID-19 with diluted bleach solution or 70% alcohol solution
Clean dirty surfaces Clean soft surfaces

with soap or detergent before disinfection like carpet, rugs, and drapes, launder then dry completely
Clothing, towels, linens and other laundry items

Wear disposable gloves Use warmest water setting
when handling dirty laundry or gloves dedicated for COVID-19 appropriate as per manufacturer’s instructions, dry completely
Do not shake dirty laundry Disinfect clothes hampers

to minimize the possibility of dispersing virus through air after cleaning, place a disposable or washable bag liner
Disinfect clothes of ill household members with bleach You may iron fabrics after drying
then rinse after washing with the usual laundry procedure with the appropriate setting as per manufacturer’s instructions
Other considerations
Feed the ill in their room Dedicate a lined trash can
non-disposable food service items should be handled with gloves and washed in hot water for the ill person, use gloves when removing and disposing the garbage bags

Household Cleaning and Disinfecting when caring for someone with COVID-19
Follow Five Steps to Wash Your Hands the Right Way

Clean hands can stop germs from spreading from one person to another and throughout an entire community
Wet your hands Lather your hands by Scrub your hands for Rinse your Dry your hands
with clean, rubbing them together at least 20 seconds. hands well using a clean
Wash Your Hands Often running water with the soap. Lather Need a timer? Hum under clean, towel or air dry
(warm or cold), the backs of your hands, the “Happy Birthday”
to Stay Healthy turn off the tap, between your fingers, song from beginning
running water them
Before, during, and after preparing food and apply soap and under your nails to end twice
Before eating food
Before and after caring for someone at
home who is sick with vomiting or diarrhea
Before and after treating a cut or wound
After using the toilet
How to Use Hand Sanitizer
After changing diapers or cleaning up a You can use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available
child who has used the toilet Rub the gel over all
After blowing your nose, coughing, or Apply the gel
the surfaces of your
sneezing product to the palm Rub your
hands and fingers
After touching an animal, animal feed, or of one hand (read hands
until your hands are
animal waste the label to learn together
dry. This should take
After handling pet food or pet treats the correct amount)
around 20 secs
After touching garbage

Disinfection and Sterilization Protocol for all washable and reusable PPEs
Discard PPEs to its Wash items with soap, Dry suit after and place it
appropriate bin bleach with bactericidal and under UV light for 30-60 mins
virucidal effect
Sterilized it using Place items in a Note the date of sterilization,

autoclave ziplock or sterile time and list the items inside
machine plastic bag the bag and dispense it properly

COVID-19 Decision Tool YES
PATIENT UNDER
INVESTIGATION (PUI)
For Hospital
History of Admission and
Exposure?* NO Management
*Exposure Criteria
YES
YES Contact with a confirmed
or probable case of
History of YES Appropriate Treatment
NO COVID-19 infection
Travel History to Areas
Exposure?*
with Issued Travel Manage Health worker or caregiver
Restrictions? NO
Patient of a COVID-19 patient
Accordingly Working together in close
proximity with a
WITH SYMPTOMS? PERSON UNDER
MONITORING (PUM)
COVID-19 patient
Traveling together in
YES
close proximity with a
Home COVID-19 patient
History of Quarantine
Living together with a
for 14 days
YES Exposure?* NO COVID-19 patient
NO Health worker on a
Health Facility where
History of YES No Immediate a COVID-19 patient
NO Medical Action was managed
Exposure?*
Travel History to Areas
Practice & observe
with Issued Travel general preventive
Restrictions? NO measures

LIFELINE 16-911 Additional Information and Protocols for COVID-19
Homecare and Doctor-On-Call Protocols

Admission Follow Return
Follow or Home Decontamination to Pod
NO DOH Quarantine Protocols
Full PPE
PUI Guidelines
all staff
Check &
Charlie evaluate
Follow Return
patient PUI Treat Standing to Pod
Patient Lifeline
Protocols
Patient Call Dispatch Admission Follow Return

Follow or Home Decontamination to Pod
NO DOH Quarantine Protocols
Full PPE
PUI Guidelines
all staff
Check &
evaluate
Follow Return
patient PUI Treat Standing to Pod
Patient Lifeline
Protocols
Alpha

LIFELINE 16-911 Back up and Redundancy Plan

LIFELINE 16-911 Back up and Redundancy Plan In Cases of Pandemics
In the event of stock depletion and

hoarding in the market, it is vital that
back up plans are in place and
activated immediately.
The following is back up PPE and

disinfection plans of Lifeline 16-911

LIFELINE 16-911 Back Up Reusable PPE
How to Wear Cloth Face
Should cloth face coverings be washed or otherwise
Coverings cleaned regularly? How regularly?
Cloth face coverings should Yes. They should be routinely washed depending on the
frequency of use
▪ fit snugly but comfortably against the
side of the face How does one safely sterilize/clean a cloth face
covering?
▪ be secured with ties or ear loops
A washing machine should suffice in properly washing a
▪ include multiple layers of fabric cloth face covering
▪ allow for breathing without restriction How does one safely remove a used cloth face covering?
Individuals should be careful not to touch their eyes, nose,
▪ be able to be laundered and machine
and mouth when removing their cloth face covering and
dried without damage or change to
wash hands immediately after removing
shape
Materials
• Two 10”x6”
rectangles of cotton
fabric
• Two 6” pieces of
elastic (or rubber Cut out two 10x6” Fold over the long Run a 6” of 1/8” wide Gently pull on the
bands, string, cloth rectangles of cotton sides ¼” and hem elastic through the elastic side so the
strips, or hair ties) fabric wider hem on each knots are tucked inside
Fold the double layer side of the cloth face the hem
• Needle and thread
Stack the two and over 1/2” along the covering
(or bobby pin)
sew into one short side and stitch Securely stitch the
• Scissors You can use hair ties elastic in place

LIFELINE 16-911 Reusable PPE Protocols for COVID-19 & Others

Construction Details of Actual Sample (apply if you have the special machines required)
Optional: You may add

duct tape or secured
adhesive tapes on all Shoulder Seam and Centerback Seam
seams at the exterior Sleeve Overarm 504 Overedge
side. Apply only if the 504 Overedge (3-Thread Overlock)
adhesive available will (3-Thread Overlock) or 514 Overedge
not tear after wash or
or 514 Overedge (4-Thread Overlock)
any abrasion
(4-Thread Overlock)
Centerfront Seam,
ZiPROTECTIVEr
edge to crotch Inseam
SPI:
Plain Seam, 301 Single 504 Overedge Overlock: 8-10 spi
Needle Lockstitch (3-Thread Overlock)
extended by 2” to back or 514 Overedge Single and Double
crotch for reinforcement) (4-Thread Overlock) Lockstitch: 6-8 spi

Recommended Construction Details for DIY Protective (apply if available machine is single lockstitch)
Optional: You may add

duct tape or secured
adhesive tapes on all Shoulder Seam and Centerback Seam
seams at the exterior Sleeve Overarm Plain Seam, 301
side. Apply only if the Plain Seam, 301 Single Needle
adhesive available will Single Needle Lockstitch
not tear after wash or
Lockstitch
any abrasion
Centerfront Seam,
ZiPROTECTIVEr
edge to crotch SPI:
Inseam
Plain Seam, 301 Single Overlock: 8-10 spi
Plain Seam, 301
Needle Lockstitch
Single Needle Single and Double
Reinforce with 301 Single
Lockstitch Lockstitch: 6-8 spi
Needle Lockstitch 2”
to the back crotch and
2” to the front crotch

Construction Details of Actual Sample (Apply if you have the special machines required)
Hoodie Opening Hoodie

3/4” Single Turnback Centerback Seam
with 1/4” Double Overedge
Needle Edgestitch (3-Thread Overlock)
(see next page) or 514 Overedge
(4-Thread Overlock)
Neckline
Seam
(Attachment
of Hood)
SPI:
Overedge
Overlock: 8-10 spi
(3-Thread Overlock)
or 514 Overedge Single and Double
(4-Thread Overlock) Lockstitch: 6-8 spi

Front Back Side

LIFELINE 16-911 Back Up Reusable PPE – Pattern Templates
Notes for Cutting and Layout:
SELVEDGE
1. Please stick to the advised
layout- of pattern on the fabric
to maximize or materials.
Layout for cutting is 2-way
2. Please do not pin the pattern
onto the fabric. Use weights or
clamps to secure the pattern
onto fabric lay/spread. We are
trying to avoid unnecessary
holes.
3. Please keep all endcuts (retaso)
to be used for mask making
SELVEDGE


4 overlock stitching on top

seams plus a single need Re-enforced
runner for strength single needle
Wide band for

more comfort Extra long cap ties
for easy closure

Construction details of actual sample (Apply if you have special machines required)
Sleeve and Bottom Hem

Overedge (3-Thread Overlock) or
514 Overedge (4-Thread Overlock)
with rubber elastic or mobilon insert
Measurement on flat (relax):

Sleeve hem: 4”
Bottom hem: 5 ½” Exterior View
Full opening measurement:

Sleeve hem: 8”
Bottom hem: 11”
SPI:
Overlock: 8-10 spi
Single and Double

Lockstitch: 6-8 spi Interior View

Construction details of Actual Sample (apply if you have the special machines required)
Operations Breakdown (Assembly):
1. Joint Front and Back body at inseam with 504 or 514 overedge with 3/8” sewing allowance
2. Attach sleeve to body (with seam at the overarm) with 504 or 514 overedge with 3/8” sewing allowance
3. Close the shoulder seam and sleeve overarm seam continuously from neckline to sleeve hem with 504 or
514 overedge with 3/8” sewing allowance
4. Join centerback seam up to the ziPROTECTIVEr bottom edge placement at centerfront with 504 or
514 overedge with 3/8” sewing allowance
5. Attach 26” ZiPROTECTIVEr at centerfront with 301 single needle lockstitch with 3/8” sewing allowance
6. Hood: join left and right hood at centerback with 301 single needle lockstitch with 3/8 sewing allowance.
Finish hood opening with ½” single turnback/fold, ¼” double needle edgestitch leaving a 3/8 wide tunnel for
drawstring. Insert 41”-long drawstring. Knot the end of the string to secure
7. Attach hood to neckline with 504 or 514 overedge with 3/8” sewing allowance. Secure hood at CF neckline
with ¼” single lockstitch/reinforcement stitch (bartack)
8. Finish hem with 504 or 514 overedge with 3/8” sewing allowance with rubber elastic tape or mobilon insert.
Elastic length: (a) Sleeve Hem: 8” long plus 3/8” allowance on each end, (b) Bottom Hem: 11” plus
3/8” allowance on each end

Secure hood at CF
neckline with ¼”
single lockstitch for
reinforcement
(bartack) Tunnel for
Drawstring Tie
for hood: 3/8”
Attach Ziprotectiver to from CF neck
3/8”
body with 301 single
needle lockstitch Insert 41” long
string, knot each
end to secure
SPI:
Overlock: 8-10 spi
Single and Double

Lockstitch: 6-8 spi

Hood Opening
¼” Double
Needle Topstitch
Edgestitch
3/8” at interior
1/16” from
interior edge
SPI:
Overlock: 8-10 spi
Single and Double

Lockstitch: 6-8 spi
Exterior View Interior View

LIFELINE 16-911 Alcohol Disinfectant Back Up
In the event of market depletion such as what occurred in

the 2020 COVID19 world pandemic. It is important to note
back up plans to continue our vital services. Isopropyl Alcohol VS Ethyl Alcohol
Lifeline was one of the first in the Philippines to contact
home and micro breweries to convert “drinking” alcohol
into “disinfectant” Alcohol. Isopropyl Alcohol Ethyl Alcohol
The process is just a matter of the boiling degree in which
the distilling process occurs. By heating up the process
this process is easily adopted by any one with a distilling
capability.
Isopropyl is a secondary alcohol Ethyl alcohol is a primary
since –OH is attached to the alcohol since –OH is attached
If this event occurs again. Contact any brewery or 2nd carbon to the 1st carbon
distilling firm and request for the conversation
immediately. It is imperative that the supply of alcohol
remains uninterrupted.
Boiling point: -82.4°C Boiling point: 78°C
Melting point: -89.5°C Melting point: -115°C
Not drinkable Used as a beverage
Used as a solvent, disinfectant,

Used as a solvent, disinfectant
biological specimen
and a cleaning agent
preservative etc.

Lifeline 16911 Ambulance Disinfection &amp; Decontamination Cleaning Protocols 2020

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LIFELINE 16-911

The 4 Clean Approach

This procedure specifies the responsibilities, and cleaning frequencies, schedules

LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 3

1 Between Patient Clean

2 Turn Over Clean and Re-stock

3 The 6-weekly Deep Clean

4 Unscheduled Deep Clean

LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 4

1 Between Patient Clean

LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 5

2 Turn Over Clean and Re-stock

▪ The cleaning of equipment and medical devices remains

▪ The 12 hour clean of an ambulance or room will focus on

▪ It is not anticipated that blood or body fluids will be visible

LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 6

3 The 6-weekly Deep Clean

LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 7

4 Unscheduled Deep Clean (Ad-Hoc Clean)

LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 8

1. Clean ambulance thoroughly using lysol or cidex plus or surfanios disinfectant

4. Place UV light in center of ambulance or room and turn on

6. Remove UV and store

8. Ambulance back on 10-8.

LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 9

▪ Team leaders are to coordinate with the Duty Manager for

▪ 10mls of solution for the interior cabin for 3 mins and 2 ml

▪ Ambulance must be sealed and all doors and windows closed

▪ Duty Manager may request for a “double dose” of dry misting.

LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 10

▪ Disinfect all of the surfaces. Disinfectant should NOT be

LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 11

Monitor/Defibrillator Oxygen Caddy

Immobilization Equipment Stethoscope and Blood Pressure Cuff

LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 12

LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 13

Transport Procedure Personal Protective Equipment

LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 14

LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 15

REMEMBER: Skin and Nail Care:

Hand Hygiene Guidance

Hand Hygiene means cleaning your hands by using either

Cleaning your hands reduces:

The spread of potentially deadly germs to patients

LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 16

• After touching a patient or the patient’s immediate environment

• After contact with blood, body fluids, or contaminated surfaces

LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 17

Gloves are not a substitute for hand hygiene.

Carefully remove gloves to prevent hand contamination.

LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 18

How to clean and disinfect NOTE:

• Gurney, equipment, seats, bags, BP • To make a bleach solution, mix:

▪ Recommend use of EPA-registered

LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 19

ROOMS & HOUSEHOLD

LIFELINE 16-911 DISINFECTION & DECONTAMINATION

Soft Surfaces Electronics Laundry Trash

LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 21

Prepare a bleach solution by mixing:

LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 22

Soft (Porous) Surfaces

LIFELINE 16-911 DISINFECTION & DECONTAMINATION PROTOCOLS 2020 23

Linens, clothing, and other items that go in the laundry

Lifeline 16911 Ambulance Disinfection & Decontamination Cleaning Protocols 2020

Lifeline 16911 Ambulance Disinfection & Decontamination Cleaning Protocols 2020