SALAMAT HOSPITAL

INFECTION PREVENTION AND CONTROL DEPARTMENT

Basic Infection Control Skills License (BICSL) Quick Reviewer

Guidelines 2nd Edition

Elements of the Program:

1. Hand Hygiene (H.H).
2. Personal Protective Equipment (PPE).
3. Spill Kit.
4. Needle Stick Injury (NSI).
5. Transmission-Based Precautions.
6. Respirator Fit Testing.
7. Powered Air Purifying Respirator (PAPR).

Note:
Flu vaccine and Meningococcal vaccines were previously components of BICSL program.
But the updated program does not include them.
However, Flu vaccine is recommended annually for health care workers, and
Meningococcal vaccine is recommended every 3-5 years for HCWs recruited to work in Hajj
and also, laboratory workers according to CDC.

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Infection Prevention And Control Department
Basic Infection Control Skills License (BICSL) Quick Reviewer – Guidelines 2nd Edition
 Introduction:
BICSL stands for Basic Infection Control Skills License. It is a mandatory program providing basic skills in
infection control for health practitioners to be applied at health care facilities to reduce the risk of
transmission of infection and to create a safe working environment for the health workers, patients and
visitors.
The program is a mandatory for the following categories of healthcare workers:
1. All health care workers who are assigned to work on hajj duty.
2. All health care workers who have direct or indirect contact with the patients in hospitals.
3. All health care workers who have direct or indirect contact with patients with confirmed or
suspected respiratory infections in primary healthcare centers and other centers.
Aim of the Program:
Provide the staff with the basic principles and practices of infection control to prevent or reduce the risk of hospital-
acquired infections.
Responsibility of the Program:
The General directorate of infection prevention and control – Ministry of Health (GDIPC) is responsible for BICSL
training policies and regulations. In addition to, evaluation and certification of BICSL trainers and implementation of
audit visits to assess the training quality and find the weakness and areas of improvement.

Explain and demonstrate the BICSL components:

1. Hand Hygiene (H.H)
A. GENERAL PRECAUTION:
- Keep the number of microorganisms on your hands to minimum:
 Keep your nails short
 Don’t wear nail varnish
 Don’t wear false nails
 Don’t wear rings, wrist matches, or bracelets
B. DEFINE WHAT IS HAND HYGIENE
- Hand hygiene is defined as any method that removes or destroys microorganisms on hands.
- Is the term for Hand washing with Soap and Water or Disinfection of hands by Alcohol Hand Rub material very
simple action, remains the primary means to reduce HAI’s and the spread of antimicrobial resistant organism.
- According to the United States Centers of Disease Control and Prevention (CDC):
 “Hand washing is the single most important means of preventing the spread of infection.”
- Hand Transmission:
 Hands are the most common vehicle to transmit health care associated pathogens.
 Hand transmission requires 5 sequential steps
1. Presence of Germs
2. Transmission on Hands
3. Germs Survival on Hands
4. Defective Hand Hygiene
5. Cross Transmission of Germs
- Hand Hygiene is the single most effective measure to reduce health care-associated infections.
- HAND HYGIENE
C. Define What is H.H types and explain the difference between them &
D. Explain the H.H Technique and duration
HAND WASHING WITH SOAP
ITEMS ALCOHOL-BASED HAND RUB. SURGICAL HAND SCRUB.
AND WATER.
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Infection Prevention And Control Department
Basic Infection Control Skills License (BICSL) Quick Reviewer – Guidelines 2nd Edition
 is washing hands with soap Rubbing hands with an alcohol-
Define containing preparation -
and water
 Suspected or confirmed C. diff
Before surgical
Indication • hand Visibly 5 moment
procedure
contaminated
40 – 60 Seconds or
Duration 20-30 seconds 3-5 minutes
1 Full minute
How Many Steps 8 Steps 11 Steps 17 Steps
Material (s) Alcohol Based Hand Rub Water, Soap Antiseptic Solution

E. Explain the H.H 5 MOMENTS

2. BEFORE
1. BEFORE TOUCHING A 3. AFTER BODY FLUID 4. AFTER TOUCHING A 5. AFTER TOUCHING PATIENT
ITEMS CLEAN/ASEPTIC
PATIENT EXPOSURE RISK PATIENT SURROUNDINGS
PROCEDURE
To protect the patient To protect the To protect you from
To protect you from colonization
against colonization patient against colonization or To protect you from
with patient germs that may be
WHY?

and, in some cases, infection with infection with patient’s colonization with patient
present on surfaces / objects in
against exogenous harmful germs, harmful germs and to germs and to protect the
patient surroundings and to
infection, by harmful including his/her protect the health-care health-care environment
protect the health-care
germs carried on your own germs, entering environment from from germ spread.
environment against germ spread
hands. his/her body. germ spread.
Clean your hands
immediately before
accessing a critical Clean your hands as
When?

Clean your hands site with infectious soon as the task Clean your hands when Clean your hands after touching
before touching a risk for the patient involving an exposure leaving the patient’s any object or furniture when living
patient when (e.g. a mucous risk to body fluids has side, after having the patient surroundings, without
approaching him/her. membrane, non- ended (and after glove touched the patient. having touched the patient.
intact skin, an removal).
invasive medical
device)
After contact with a A. After shaking hands,
mucous membrane and stroking a child’s
Before assisting a non-intact skin. forehead This Moment 5 applies in the
patient in personal care After a percutaneous B. After you have following situations if they
activities: to move, to injection or puncture; assisted the patient in correspond to the last contact with
take a bath, to eat, to Before dressing a after inserting an personal care activities: the patient surroundings, without
get dressed, etc... wound. invasive medical device to move, to bath, to eat, having touched the patient:
Examples

Before delivering care Before inserting an (vascular access, to dress, etc. A. After an activity involving
and other non-invasive invasive medical catheter, tube, drain, C. After delivering care physical contact with the patients'
treatment: applying device (nasal etc.); after disrupting and other non-invasive immediate environment: changing
oxygen mask, giving a cannula, nasogastric and opening an invasive treatment: changing bed bed linen with the patient out of
massage. tube, endotracheal circuit. linen as the patient is in, the bed, holding a bed trail,
Before performing a tube, urinary probe, After removing an applying oxygen mask, clearing a bedside table.
physical non-invasive percutaneous invasive medical device. giving a massage. B. After a care activity: adjusting
examination: taking catheter, drainage). After removing any D. After performing a perfusion speed, clearing a
pulse, blood pressure, form of material physical non-invasive monitoring alarm
chest auscultation, offering protection examination: taking C. After other contacts with
recording ECG. (napkin, dressing, pulse, blood pressure, surfaces or inanimate objects.
gauze, sanitary towel, chest auscultation,
etc.). recording ECG.

In Summary
Hand Hygiene is an EXPECTATION not an OPTION. We will never be able to improve our Hand
Hygiene compliance if not each and every one of us presumes that the patient to be touched
might be his/her father, mother, sister, brother or child

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Infection Prevention And Control Department
Basic Infection Control Skills License (BICSL) Quick Reviewer – Guidelines 2nd Edition
 2. Personal Protective Equipment (PPE)
A. Define what is PPE
- “Specialized clothing or equipment worn by an employee for protection against infectious materials” (OSHA,
2014).
- PPE Used in Healthcare Settings:
1. Gown/Aprons 4. Face Shields
2. Gloves 5. Goggles
3. Mask/Respirator 6. Power Air Purifying Respirators (PAPR)
- How to select your PPE
 Type if exposure anticipated.
- Splash/spray versus touch.
- Category of isolation precautions.
 Durability and appropriateness for the task.
 Fit
GOWN
GENERAL INDICATIONS FOR
TYPES HOW TO PUT A GOWN HOW TO REMOVE ISOLATION GOWN
USE
1. Protect from the 1. Select appropriate type and 1. Unfasten ties.
contamination of 1. Clean /Isolation gown: size. 2. Peel gown away from neck and
clothing with potentially used for isolation. 2. Opening is in the back. shoulder.
infectious materials. 2. Sterile gown: used for 3. Secure at neck and waist 3. Turn contaminated outside
2. Gown should be worn as performing invasive 4. If gown is too small, use two toward the inside.
part of Standard procedures, such as gowns 4. Fold or roll into a bundle.
Precautions or Contact inserting a central line  Gown #1 ties in front 5. Discard.
Precautions  Gown #2 ties in back 6. If contaminated perform H.H.

SURGICAL MASK
GENERAL INDICATIONS FOR USE HOW TO PUT A MASK HOW TO REMOVE ON A MASK
1. The front of the mask is considered contaminated and should notbe
touched.
1. Surgical Masks: protect nose 1. Place over nose, mouth 2. Remove by handling only the ties or elastic bands starting with the
and mouth from exposure to and chin. bottom then top tie or band.
respiratory secretions and 2. Fit flexible nosepiece over 3. Lift the mask away from the face and discard it into the designated
sprays of blood or body fluids. Nose Bridge. waste container.
2. Surgical Masks should be worn 3. Secure on head with ties 4. If contaminated perform hand hygiene.
as part of Standard Precautions or elastic. 5. Lift the bottom elastic over your headfirst.
or Droplet Precautions 4. Adjust to fit. 6. Then lift off the top elastic.
7. Discard.
8. If contaminated perform hand hygiene.

RESPIRATOR MASK
HOW TO REMOVE T A
GENERAL INDICATIONS FOR INSTRUCTIONS FOR N95
HOW TO PUT ON A PARTICULATE RESPIRATOR PARTICULATE
USE RESPIRATOR
RESPIRATOR
1. N95 respirators reduce the
1. Fit testing must be 1. Select a fit tested respirator.
wearer’s exposure to 1. Lift the bottom
done before using a 2. (Advise against) Put on respirator under the
airborne particles, from elastic over your
respirator in the veil or disposable veil.
small particle aerosols to headfirst.
workplace. 3. Place over nose, mouth and chin.
large droplets. These 2. Then lift off the
2. Achieving an 4. Fit flexible nose piece over Nose Bridge.
respirators filter out at top elastic.
adequate seal to the 5. Secure on head with elastic
least 95% of very small 3. Discard.
face is essential.  Adjust to fit
(0.3 micron) particles. 4. If contaminated
Conduct a user seal 6. Perform a user seal check
2. Respirators should be perform hand
check each time the  Inhale: respirator should collapse
worn as part of Airborne hygiene.
respirator is used.  Exhale: check for leakage around
Precautions.
face.

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Infection Prevention And Control Department
Basic Infection Control Skills License (BICSL) Quick Reviewer – Guidelines 2nd Edition
 EXTENDED USE OF N95 MASK
- Extended use refers to the practice of wearing the same
N95 respirator for repeated healthcare activities with
several patients, without removing the respirator between
patient healthcare activities.
- Extended use should be in one care area (ward or
department) with multiple patients infected with the same
respiratory pathogen for only one Shift (8 hours'
maximum).
- Extended use is favored over reuse because it is expected
to involve less touching of the respirator and therefore less
risk of contact transmission.
LIMITED RE-USE OF N95 MASK
- Reuse refers to the practice of using the same N95
respirator for multiple encounters with patients but
removing it (‘doffing’) after each encounter.
- The mask is used by one wearer and discard it after 5
times at most or according to manufacturer’ instructions.
- Keep respirator in a paper bag that can be closed without
bending. Label containers used for storing respirators to
reduce accidental usage of another person’s respirator.

RESPIRATOR OR N95 MASK

GENERAL INSTRUCTIONS
1. Clean hands with soap and water or an alcohol-based hand sanitizer before and after touching or adjusting the respirator.
2. Discard N95 respirators following use during aerosol generating procedures.
3. Discard N95 respirators contaminated with blood, respiratory or nasal secretions, orother bodily fluids from patients.
4. Discard N95 respirators following close contact with, or exit from, the care area of anypatient co-infected with an infectious
disease requiring contact precautions.
5. Consider use a disposable face shield over an N95 respirator and/or other steps (e.g., masking patients, use of engineering
controls) to reduce surface contamination.

GOGGLES
GENERAL
HOW TO PUT ON EYE
INDICATIONS FOR HOW TO REMOVE T A EYE PROTECTION
PROTECTION
USE
Position goggles over How to Remove Goggles or Face Shield :
Protect only eyes eyes and secure to - Using ungloved hands, grasp the “clean” ear or head pieces andlift
from splashes of the head using the away from face.
blood or body ear pieces or - If goggle or face shield are reusable, place them in a designated
fluids. headband container for later reprocessing. Otherwise, discard them in the
waste container. If contaminated perform hand hygiene.

GENERAL INDICATIONS FOR USE
1.
Protect face, nose, mouth, and eyes
when there is a risk of exposure to
splashes and body fluids.
2.
FACE SHIELDS
HOW TO PUT ON FACE
PROTECTION
Position face shield over
face and secure on brow
with headband.
Adjust to fit comfortably.
HOW TO REMOVE ON EYE PROTECTION
How to Remove Goggles or Face Shield :
- Using ungloved hands, grasp the “clean” ear or head
pieces and lift away from face.
- If goggle or face shield are reusable, place them in a
designated container for later reprocessing. Otherwise,
discard them in the waste container. If contaminated
perform hand hygiene.

INSTRUCTIONS FOR USE OF GOGGLES/FACE SHIELDS

a. Extended use of eye protection can be applied to disposable and reusabledevices.
b. Eye protection should be removed and reprocessed if it becomes visibly soiledor difficult to see through.
c. If a disposable face shield is reprocessed, it should be dedicated to one HCW.
d. Eye protection should be discarded if damaged (e.g., face shield can no longerfasten securely to the provider, if
visibility is obscured and reprocessing does notrestore visibility).
e. HCW should take care not to touch their eye protection. If they touch or adjust it, they must immediately perform
hand hygiene.

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Infection Prevention And Control Department
Basic Infection Control Skills License (BICSL) Quick Reviewer – Guidelines 2nd Edition
 GLOVES
GENERAL INDICATIONS FOR HOW TO PUT ON HOW TO REMOVE GLOVES
TYPES OF GLOVES
USE GLOVES
1. Sterile:
Step 1: How to Remove
1. Before a sterile - Mostly used for surgery they are
Gloves:
procedure. disposable, sterile, and individually
Grasp outside edge near
2. When anticipating wrapped items.
wrist
contact with blood or 2. Non-sterile: 1. Put on gloves
Peel away from hand,
another body fluid, - Disposable single use gloves (e.g., latex last.
turning glove inside-out
regardless of the gloves) and usually not individually Select correct type
Hold in opposite gloved
existence of sterile wrapped. They are used to protect and size.
hand.
conditions and against direct exposure to blood or 2. Insert hands
Step 2: How to Remove
including contactwith otherbody fluids and prior to contact into gloves.
Gloves:
non-intact skin and with contaminated equipment or 3. Extend gloves
Slide ungloved finger
mucous membrane. surfaces. over isolation
under the wrist of the
3. Contact with a patient 3. Utility gloves: or sterile
remaining glove.
(and his/her - Are used for handling contaminated gown cuffs.
Peel off from inside,
immediate items and waste and performing
creating a bag for both
surroundings) during environmental cleaning activities. They
gloves.
contact precautions. can be reused after decontamination
Discard.
but they should be discarded when
Perform hand hygiene.
punctured or torn.

B. KEY POINTS ABOUT PPE:

 Before donning PPE you should perform hand hygiene.
 Use carefully – don’t spread contamination.
 Remove and discard carefully.
 Immediately perform hand hygiene.

CORRECT SEQUENCE FOR DONNING & DOFFING OF PPE

DONNINING (PUT ON) OF PPE DOFFING (REMOVING) OF PPE
GLOVES
HH
HH
GOWN
FACE SHIELD OR GOGGLES
MASK OR N95 RESPIRATOR
GOWN
FACE SHIELD OR GOGGLES
MASK OR N95 RESPIRATOR
GLOVES
HH

CONTAMINATED AREAS OF PPE CLEAN AREAS OF PPE

 Contaminated – outside front.  Clean – inside, outside back, ties on head and back.
 Areas of PPE that have or are likely to have been in  Areas of PPE that are not likely to have been in contact
contact with body sites, materials, or environmental with the infectious organism
surfaces where the infectious organism may reside

DISPOSAL OF PPE
Principles of Safe removal of PPE: Recommendations for PPE
Safe removal of PPE to protect health care workers, patients, Ensure that PPE is:
and environment from exposure to contaminated materials. Safely dispose of personal protective equipment in the right
To remove PPEsafely, you must first be able to identify what place and in the right way.
sites are considered “clean” and what are “contaminated”.

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Infection Prevention And Control Department
Basic Infection Control Skills License (BICSL) Quick Reviewer – Guidelines 2nd Edition
 3. SPILL MANAGEMENT/SPILL KIT
A. Explain the cause of biological spills in health care settings
 Causes of biological spill in the health Care Settings - Biological spills may include blood, urine,
vomits, pus, faeces that may include diseases producing microorganisms.

B. EXPLAINS THE DIFFERENCE BETWEEN TYPES OF SPILL KITS:

Biohazard Spill kits Urine & Vomit Spill kits Chemical Spill kits Cytotoxic Spill kits
- For management of blood - For management of spills
spills of vomits & urine - For management of spills of cytotoxic drugs.
Note:
- Infection Control is involved only with management of biological spills including blood and other body fluids.
C. Components of Biological Spill Kit
1. PPE (Gown- Surgical mask or Face shield– Gloves). 5. Absorbance powder and Absorbent socks
2. Yellow Biohazards bag. 6. Chlorine Disinfectant
3. Forceps 7. Disposable Bags
4. Scoop & Scraper

Note:
- Urine & vomit spill Kit is not chlorine based and it is ideally used in the management of this spill types because
adding chlorine products to urine can produce particularly unpleasant odors. When used on vomit, chlorine-
based chemicals may give off extra chlorine gas.
D. EXPLAIN THE TYPES OF PPE USED IN MANAGEMENT OF SPILLS;
 Put on appropriate Personal Protective Equipment (PPEs)
- Disposable Gown
- Disposable face Mask with shield.
- Disposable Gloves
E. PROCESS OF SPILL MANAGEMENT
 Strategies for decontaminating spills of blood and other body substances (e.g., vomit, urine) differ
based on the setting in which they occur and the volume of the spill.
 Do not clean soft furnishings with a disinfectant such as sodium hypochlorite.
 Following cleaning of soft furnishings, they must be allowed to dry before reuse.
 Alcohol solutions should not be used to clean spillages.

F. THE FOLLOWING TABLE SHOWS THE APPROPRIATE PROCESSES FOR MANAGING SPILLS
Spot cleaning Small spills (up to 10cm diameter) Large spills (greater than 10cm diameter)
- Select appropriate
- Select appropriate PPE. - Select appropriate PPE - Cover area of the spill with
personal protective
- Wipe up spill immediately with absorbent an absorbent clumping agent and allow to absorb.
equipment (PPE).
material. - Use disposable scraper and pan to scoop up
- Wipe up spot
- Place contaminated absorbent material absorbent material and any unabsorbed blood or
immediately with a
into impervious container or plastic bag body substances.
damp cloth, tissue
for disposal. - Place all contaminated items into impervious
or paper towel.
- Clean the area with warm detergent container or plastic bag for disposal.
- Discard
solution, using disposable cloth or sponge. - Discard contaminated materials.
contaminated
- Wipe the area with sodium hypochlorite - Mop the area with detergent solution.
materials.
and allow to dry. - Wipe the area with sodium hypochlorite and allow
- Perform Hand
- Perform hand hygiene to dry - Perform hand hygiene.
Hygiene.

G. STEPS OF USING SPILL KITS

1. Control access to area: Prevent people 4. Contain spill: Use absorbent 6. Add one tablets of chlorine
from walking through affected area. granules or absorbent pads to disinfectant 2.5 gm/ 250 ml =
“Use the wet floor sign”. contain the spill. Sprinkle absorbent
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Infection Prevention And Control Department
Basic Infection Control Skills License (BICSL) Quick Reviewer – Guidelines 2nd Edition
2. Put on appropriate Personal Protective
Equipment (PPEs):
- Disposable Gown.
- Disposable face Mask with
shield.
- Disposable Gloves
3. Use plastic scoop or other mechanical
means to remove any broken glass or
other sharp objects from the spill area,
and dispose into the sharp container.
granules over the spill and leave for
two minutes or as per the
manufacturer’s recommended
contact time. Allow the spill to
solidify before removing.
5. Remove the solidified waste
material using the scoop and scraper
and carefully
dispose all contaminated materials
into the infectious waste bag.
5000 ppm which is effective
against any risky blood spill.
7. Use disposable wiping cloth to
wipe up all the disinfectant, and
then discard into the yellow
plastic bag.
8. Place all items including PPE into
yellow biohazard plastic bag.
9. lose the yellow biohazard bag
securely with fastener to
prevent leakage
10. Finally, Hand Hygiene

REMEMBER…
Always follow the manufacturer’s instructions Identify the difference between types of Spill Kits.

4. NEEDLE STICK INJURY (NSI)/SHAR[S INJURY MANAGEMENT

A. Define what is needle stick injury and possible causes in health care setting
- Needle stick and other sharps injuries are a serious hazard in any healthcare setting.
- Contact with contaminated needles, scalpels, broken glass, and other sharps may expose healthcare
workers to blood that contains pathogens which pose a grave, potentially lethal risk.

CAUSES OF NSI MANAGEMENT OF NSI

 The majority of needle stick injuries occur during the use
of the device, and following use but prior to Disposal.
 Common causes of injuries attributable to improper
work practices
include:
Passing sharps between health care workers.
Transferring sharps to a different location.
Recapping sharps.
Decontamination or processing of used devices.
Most needle stick injuries occur in patient wards,
operating room and recovery, during injections and
suturing, and with hollow-bore needles.
SAFE INJECTION & PREVENTIVE MEASURES
 Eliminate unnecessary injections: Whenever possible,
use oral, topical, or rectal medications instead of
injectable medications.
 Prepare injections properly in a designated clean area.
 Ensure lighting is adequate to prepare the injection
safely.
 Use aseptic techniques, including proper hand hygiene,
when preparing or administering injections.
 Cleanse the access diaphragm of medication vials with
70% alcohol before inserting a needle into the vial.
 Never administer medications from the same syringe to
multiple patients, even if the needle is changed.
 Immediate measures according to the MOH or health facility'
policy
- Do not be panic.
- Stop immediately the procedure you perform.
- Dispose properly the contaminated gloves.
- Dispose the sharp instrument in the sharp container.
- Encourage the wound to bleed, ideally by holding it under
running water.
- Clean the wound with running water/ soap.
- Apply waterproof dressing.
- In case of splashes to the eyes, nose or mouth irrigate
with clean water, saline, or sterile irrigants.
- Identify the patient involved so that they can be
evaluated for an infection.
- Immediate reporting.
REPORTING PROCESS OF NSI
 Immediately report to (To whom? according to the policy).
 Fill the facility’s incident reporting form including at
least the following Information:
- Date and time of incident.
- Job classification of exposed staff.
- Location in the worksite where incident occurred.
- Procedure being performed by exposed staff.
- Type of used device
- Engineering controls including the use of safety syringe.
- Personal Protective Equipment used during the incident.

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Infection Prevention And Control Department
Basic Infection Control Skills License (BICSL) Quick Reviewer – Guidelines 2nd Edition
 5. TRANSMISSION BASED PRECAUTIONS
A. Define what Transmission-Based Precautions
- Transmission-Based Precautions are the second tier of basic infection control and are to be
used in addition to Standard Precautions for patients who may be infected or colonized with
certain infectious agents for which additional precautions are needed to prevent infection
transmission.
B. Define what are categories of Transmission-Based Precautions
- Transmission-based Precautions: based on routes oftransmission divided into the three
subgroups of airborne, droplet, and contact precautions.

ITEMS CONTACT DROPLET AIRBORNE

 Used to reduce the risk of
Used to reduce the risk of transmission of
transmission of microorganisms
microorganisms transmitted by large particle Used to prevent or reduce the
transmitted by contact with the
Indications

droplets (larger than 5 micron in size) which transmission of microorganisms

patient or the patient's
are generated from the source person during that are 5 micron or smaller in size.
environment.
coughing, sneezing, or talking, and during the Includes such diseases as
Such as vancomycin-resistant
performance of certain procedures such as pulmonary tuberculosis, measles,
enterococci (VRE), methicillin-resistant
suctioning and bronchoscopy and includes and varicella (Chicken Pox).
Staphylococcus aureus (MRSA),
diseases as influenza, rubella, and mumps.
Clostridium difficile, etc.
Single rooms are preferred; however,
Type of

A single room is preferred; however, Airborne infection isolation room

room

patients with the same disease may share a

patients with the same disease or (AIIR) with negative air pressure
room. Patients must be spatially separated by
organism may share a room. relative to the corridor.
at least 6 feet.
Wear a surgical mask on room entry. Wear a fit-tested National
Personal protective Wear a gown and gloves on room Handle items contaminated with respiratory Institute for Occupational Safety
equipment (PPE): entry. secretions (e.g., tissues, handkerchiefs) with and Health (NIOSH)-approved N95
gloves. or higher-level respirator.
Hand Hygiene Always use hand hygiene before and after use of PPE and after touching environmental surfaces
Limit patient transport outside the room to medically necessary purposes. Inform the receiving department of the status of
the patient.
Patient transport:

 Cover or contain potentially
infectious body fluids before
transport.
 Don clean PPE to handle the
patient at the destination.
 Gown and gloves before room
entry to clean and disinfect the
Environmental service workers should don:
If the patient must leave the room, instruct the patient to wear a surgical mask and
follow respiratory hygiene and cough etiquette.
Transport personnel do not need
N.B. Once the patient is masked, the patient to wear respiratory protection
transporter does not need to wear a surgical during transport if the patient is
mask. masked and all skin lesions are
covered.
 N95 respirator on room entry.

patients room.
 Clean daily with a focus on high
 After the patient has left
touch areas, patient bathrooms, the examination room
and areas close to the patient. or the patient room, the
Environmental service workers room should remain
should don gown and gloves
unoccupied for enough
before room entry to clean and
disinfect the patient's room. time to allow for
Surgical mask before room entry
 Some viruses and spore- complete air exchange
forming organisms are to occur. In some
resistant to traditional facilities, this time could
disinfectants, and use of a be 1 hour or less,
1:10 dilution of bleach depending on the air
solution is recommended. handling capacity of the
e.g. C. difficile. facility.


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Infection Prevention And Control Department
Basic Infection Control Skills License (BICSL) Quick Reviewer – Guidelines 2nd Edition
 Patient care When possible assign non-critical patient care equipment (e.g., stethoscope, pressure cuff, etc.) to use only in the isolation
equipment and room.
instruments/devices
use for isolation
patient
When possible, assign non-critical patient care equipment (e.g., stethoscope, pressure cuff, etc.) to use only in the isolation
Patient Equipment
room.
Waste Management According to patient’ diagnosis ( see the table below)
All HCWs should be instructed to do All HCWs should be instructed to do the All HCWs should be instructed to
the following: following: do the following:
A. Before entering into the A. Before entering into the patient A. Before entering into the
patient room: room: patient room:
1. Practice hand hygiene 1. Practice hand hygiene 1. Practice hand hygiene
2. Wear ISOLATION GOWN 2. Wear SURGICAL MASK before 2. Wear N95 MASK before
AND GLOVES before entering into the patient room. entering into the patient
entering into the patient B. Before leaving from the patient room.
room. room: B. Before leaving from the
Instructions for B. Before leaving from the 1. Remove surgical mask patient room:
Health Care patient room: 2. Perform hand Hygiene 1. All PPE must be removed
Workers and 1. Remove gown and gloves Except N95 mask
visitors: 2. Perform hand Hygiene 2. Perform hand hygiene
C. After exit from the patient
room:
1. Remove N95 mask
2. Perform hand hygine
Before leaving the patient room:
All PPE must be removed Except
 Remove gown and gloves.  Remove surgical mask. N95 mask Perform hand hygiene.
 Perform hand hygiene.  Perform hand hygiene After exit from the patient room:
Remove N95 mask Perform Hand
Isolation signs and Contact isolation sign and Droplet isolation sign and transportation card Airborne isolation sign and
Transportation Card transportation card (Green) (Red) transportation card (Blue)

6. RESPIRATORY FIT TEST:

A. Types of Fit test:
There are two Types of respirator Fit test: Quantitative and Qualitative
 Qualitative fit testing is a pass/fail test method that uses sense of taste or smell or reaction to an
irritant to detect leakage into the respirator face piece.
 Quantitative fit testing uses a machine to measure the actual amount of leakage into the face piece
and does not rely on sense of taste, smell, or irritation to detect leakage. It produces a numerical
result called a “fit factor.” A fit factor of at least 100 is required for half-mask respirators.
Note:
Which type is BETTER?
- Quantitative respirator Fit test IS PREFERRED to be used if the two types of fit test kits are available in the health facility.
B. Indication of fit testing:
All health care workers with potential exposure to airborne transmissible diseases that necessities
the use of N95 respirator.
Timing and frequency of fit testing:
 Fit testing must be performed before starting the use of respirator and must be repeated every ONE YEAR
according to Occupational Safety and Health administration (OSHA).
 Fit testing must be repeated at any time when there is a change of respirator or there is facial change. Examples:
the use of a different size or model of respirator, weight loss, cosmetic surgery, facial scarring, the installation of
dentures or absence of dentures that are normally worn by the individual.

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 C. Types of Fit tests:
1. Qualitative Respirator Fit Test:
A. (Contents of Qualitative fit test kit)
1. One Hood 4. Nebulizer #2 (Fit Test) 7.Sensitivity Solution (#1)
2. One Collar Assembly 5. Two Sets Replacement 8. Fit Test Solution (#2)
3. Nebulizer #1 (Sensitivity) 6. Nebulizer Inserts

B. The trainer should follow the instructions of Qualitative Respirator Fit Test as follows:
1. Procedure: 2 parts (Sensitivity & Fit test)
1.1. Sensitivity Test:
a. Confirm that the participant does not eat, drink (except water) and smoke or chew
gum for 15 minutes before the test.
b. Ask the test person to put the hood on and collar assembly without a respirator.
Note: Don’t forget to test to breathe through his/her mouth with tongue extended and remind
him throughout.
c. Ask the participant to breathe through his/her mouth with tongue extended and remind him
throughout.
d. Use Nebulizer #1 with Sensitivity Test Solution, after that inject the aerosol into the hood
through the hole in the hood window.
e. The nebulizer should be held in an upright position with the nozzle directed away from the
mouth and nose of the test person.
f. Inject ten squeezes of the bulb.
g. Ask the participant to report at any time during the test if he/she can detect the sweet taste
of the solution and remind him during the procedure.
h. The trainer should note the number of squeezes as 10, once the test person reports the
taste regardless of no. of squeezes (1- 10).
i. Inject an additional shot of 10 squeezes of the aerosol into the hood If not tasted in step 1,
and noted as 20 once the test person reports the taste regardless of no. of squeezes (11-20).
j. If still not tasted, the trainer should inject additional 10 squeezes, and he should be noted as
30 once the test person reports the taste regardless of no. of squeezes (21-30).
k. Write the results of sensitivity test as no. of squeezes required for the participant to detect
the taste as 10, or 20, or 30.
l. Remove the test hood, and give the test person instructions to rinse his/her mouth with
water and wipe his/her face and wait for a few minutes to clear the taste from his/her
mouth.
REPORTING INSTRUCTIONS FOR THE RESULTS OF SENSITIVITY AND FIT TEST
SENSITIVITY TEST FIT TEST
Number of Squeezes Number of Squeezes for a
Number of Squeezes for Initial Dose
Needed in Part 1 Replenishing Dose Every 30 Seconds
1-10 10 5
11-20 20 10
21-30 30 15
1.2. Fit testing
a. Ask the participant to don the respirator and perform a user seal check.
b. Ask the participant to put the hood on and position the test hood and breathe through his/her
mouth with tongue extended and remind him occasionally during the procedure;
c. The test should be done in upright position.
d. The trainer should use stopwatch to regulate the time required for each activities and time for
additional squeezes.
e. The trainer should use Nebulizer #2 with Fit Test Solution; and he should inject the fit test aerosol
using the same number of squeezes as required in the Sensitivity Test (10, 20, or 30). A minimum
of ten squeezes is required (Table 6).

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 f. The trainer should do fully collapsing and allowing the bulb to expand fully on each squeeze.
g. The nebulizer must be held in an upright position to ensure aerosol generation with the nozzle
directed away from the mouth and nose of the test person.
h. The trainer should Inject one-half the number of squeezes (5, 10, or 15) every 30 seconds for the
duration of the fit test procedure. (Table 6).
i. The trainer should ask the participant to report at any time during the test if he/she can detect the
sweet taste of the solution and remind him occasionally during the procedure.
j. The trainer should approve the type of tested respirator when all exercises are done without the
participant detecting the sweet taste of the aerosol.
Remember:
- After the initial injection of aerosol, the trainer instructs the test person to do the following test exercises for 60
seconds each (see Figure 19):
1. Normal breathing 4. Moving head up & down 7. Normal breathing: same as exercise 1.
2. Deep breathing 5. Bending over
3. Turning head side to side 6. Talking

7. Powered Air-Purifying Respirator (PAPR)

Definition:
- A powered air-purifying respirator (PAPR) is a type of
respirator used to safeguard workers against
contaminated air.
- Provide 99.97% particulate filtration efficiency that is
used for protection of HCWs in health care facilities
against respiratory airborne pathogens.
Indication of use :
- Non- fit participant (Employee has failed fit testing with
all available masks.
- Employee has facial hair (e.g., beard) or facial deformity
that interferes with N95 mask use.
- The approved N95 mask is unavailable or unknown fit
test.

BEFORE USE TRAINER MUST CONFIRM THAT:

 Maintenance of all parts.
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Basic Infection Control Skills License (BICSL) Quick Reviewer – Guidelines 2nd Edition
  The battery is fully chargeable. All PAPRs must be charged according to the manufacturer’s instructions.
Many batteries require a minimum of 16 hours to attain a full charge.
 Airflow is adequate (typically 6 CFM).
PAPR assembly and check for airflow and charging
- the trainer must demonstrate how to check

Proper DONNING of the PAPR - The trainer must practice and explain the Proper donning
1. PREPARATION OF PAPR: 2. PREPARATION OF THE PAPR
a. Hand hygiene. a. Connect a hose to the battery and mask.
b. Gloves. b. Turn PAPR on by pressing and holding a small button until it
c. Clean PAPR with Wipes. vibrates.
d. Discard gloves. c. Put on a hood and attach a belt.

Proper DOFFING of the PAPR - The trainer must practice and explain the Proper doffing
1. Inside room - clean PAPR (as mentioned before).
2. Remove gloves and gown.
3. Hand hygiene.
4. Exit room & re-glove.
5. Remove & clean PAPR steps.
6. Tilt the head slightly forward, remove the PAPR hood.
7. Using alcohol-based wipe, clean the PAPR beginning with the inside of the Hood.

Cleaning and Disinfections of thePAPR parts

Cleaning of all parts with a clean soft cloth dampened with warm water and mild detergent. Then
disinfection with either 0.5 % chlorine solution or Alcohol 70 % after each use

INFECTION CONTROL IS EVERYONE'S

RESPONSIBILITY

Prepared by:

Lilian Castor
Dominic Barrameda
Nourah Saud Alshammari
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Basic Infection Control Skills License (BICSL) Quick Reviewer – Guidelines 2nd Edition