CONN'S CURRENT THERAPY Table of contents

Table of Contents
Section I Symptomatic Care Pending Diagnosis

1. Chest Pain

2. Constipation

3. Cough

4. Dizzines and Vertigo

5. Fatigue

6. Fever

7. Gaseousness, Indigestion, Nausea and Vomiting

8. Headache

9. Hematuria

10. Hiccups

11. Hoarseness and Laryngitis

12. Pain

13. Palliative Care

14. Palpitations

15. Pharyngitis

16. Pruritus

17. Rhinitis

18. Spine Pain

19. Tinnitus

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Section 2 Allergy

20. Allergic Reactions to Insect Stings

21. Anaphylaxis

22. Drug Hypersensitivity Reactions

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Section 3 Cardiovascular System

23. Acute Myocardial Infarction

24. Angina Pectoris

25. Aortic Disease: Aneurysm and Dissection

26. Atrial Fibrillation

27. Cardiac Arrest: Sudden Cardiac Death

28. Congenital Heart Disease

29. Congestive Heart Failure

30. Heart Block

31. Hypertension

32. Hypertrophic Cardiomyopathy

33. Infective Endocarditis

34. Mitral Valve Prolapse

35. Pericarditis

36. Peripheral Arterial Disease

37. Premature Beats

38. Tachycardias

39. Venous Thrombosis

40. Valvular Heart Disease

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Section 4 Digestive System

41. Acute and Chronic Pancreatitis

42. Acute Diarrhea

43. Bleeding Esophageal Varices

44. Calculous Biliary Disease

45. Chronic Diarrhea

46. Cirrhosis

47. Diverticula of the Alimentary Tract

48. Dysphagia and Esophageal Obstruction

49. Gastritis and Peptic Ulcer Disease

50. Gastroesophageal Reflux Disease (GERD)

51. Hemorrhoids, Anal Fissure, and Anorectal Abscess and Fistula

52. Hepatitis A and B

53. Hepatitis C

54. Inflammatory Bowel Disease: Crohn's Disease and Ulcerative Colitis

55. Intestinal Parasites

56. Irritable Bowel Syndrome

57. Malabsorption

58. Pancreatic Cancer

59. Tumors of the Colon and Rectum

60. Tumors of the Stomach

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Section 5 Endocrine and Metabolic Disorders

61. Acromegaly

62. Adrenocortical Insufficiency

63. Cushing's Syndrome

64. Diabetes Insipidus

65. Diabetic Ketoacidosis

66. Diabetes Mellitus in Adults

67. Gout and Hyperuricemia

68. Hyperaldosteronism

69. Hyperlipidemia

70. Hyperparathyroidism and Hypoparathyroidism

71. Hyperprolactinemia

72. Hyperthyroidism

73. Hypokalemia and Hyperkalemia

74. Hyponatremia

75. Hypopituitarism

76. Hypothyroidism

77. Obesity

78. Parenteral Nutrition in Adults

79. Pheochromocytoma

80. Thyroid Cancer

81. Thyroiditis



Section 6 Hematology

82. Acute Leukemia in Adults

83. Aplastic Anemia

84. Blood Component Therapy

85. Chronic Leukemias

86. Disseminated Intravascular Coagulation

87. Hemochromatosis

88. Hemolytic Anemia

89. Hemophilia and Related Conditions

90. Hodgkin Lymphoma

91. Iron Deficiency Anemia

92. Multiple Myeloma

93. Myelodysplastic Syndromes

94. Non-Hodgkin Lymphoma

95. Pernicious Anemia and Other Megaloblastic Anemias

96. Platelet-Mediated Bleeding Disorders

97. Polycythemia Vera

98. Porphyrias

99. Sickle Cell Disease

100. Thalassemia

101. Thrombotic Thrombocytopenic Purpura

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Section 7 Head and Neck

102. Dry Eye Syndrome　

103. Glaucoma

104. Ménière’s　Disease

105. Otitis Externa

106. Otitis Media

107. Red Eye

108. Rhinosinusitis

109. Temporomandibular Disorders

110. Uveitis

111. Vision Correction Procedures

112. Vision Rehabilitation

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Section 8 Infectious Diseases

113. Amebiasis

114. Anthrax

115. Babesiosis

116. Bacterial Meningitis

117. Brucellosis

118. Campylobacter

119. Cat Scratch Disease

120. Chikungunya

121. Cholera

122. Chronic Fatigue Syndrome

123. Ebola

124. Food-Borne Illness

125. Giardiasis

126. HIV Disease

127. Infectious Mononucleosis

128. Influenza

129. Leishmaniasis

130. Leprosy

131. Lyme Disease

132. Malaria

133. Measles (Rubeola)

134. Methicillin-Resistent Staphylococcus aureus (MRSA)

135. Mumps

136. Necrotizing Skin and Soft Tissue Infections

137. Osteomyelitis

138. Plague

139. Pseudomembranous Colitis

140. Psittacosis

141. Q-Fever

142. Rabies

143. Rat-Bite Fever

144. Relapsing Fever

145. Rickettsial and Ehrlichial Infections (Rocky Mountain Spotted Fever and Typhus)

146. Rubella and Congenital Rubella

147. Salmonellosis

148. Severe Sepsis

149. Smallpox

150. Tetanus

151. Toxic Shock Syndrome

152. Toxoplasmosis

153. Typhoid Fever

154. Varicella (Chickenpox)

155. Yellow Fever

156. Whooping Cough (Pertussis)

157. Zika Virus



Section 9 Neurological System

158. Acute Facial Paralysis

159. Alzheimer's Disease

160. Brain Tumors

161. Gilles De La Tourette Syndrome

162. Head Injuries

163. Intracerebral Hemorrhage

164. Ischemic Cerebrovascular Disease

165. Migraine Headache

166. Multiple Sclerosis

167. Myasthenia Gravis

168. Optic Neuritis

169. Parkinsonism

170. Peripheral Neuropathies

171. Rehabilitation of the Stroke Patient

172. Seizures and Epilepsy in Adolescents and Adults

173. Sleep Disorders

174. Trigeminal Neuralgia

175. Viral Meningitis



Section 10 Psychiatric Disorders

176. Alcoholism

177. Delirium

178. Drug Abuse

179. Eating Disorders

180. Generalized Anxiety Disorders

181. Mood Disorders: Depression, Bipolar Disease, and Mood Dysregulation

182. Obsessive Compulsive Disorder

183. Panic Disorder

184. Post Traumatic Stress Disorder

185. Schizophrenia



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Section 11 Respiratory System

186. Acute Bronchitis

187. Acute Respiratory Failure

188. Asthma in Adolescents and Adults

189. Atelectasis

190. Bacterial Pneumonia

191. Blastomycosis

192. Chronic Obstructive Pulmonary Disease

193. Coccidioidomycosis

194. Cystic Fibrosis

195. Histoplasmosis

196. Hypersensitivity Pneumonitis

197. Legionellosis (Legionnaires' Disease and Pontiac Fever)

198. Obstructive Sleep Apnea

199. Pleural Effusion and Empyema Thoracis

200. Pneumoconiosis: Asbestosis and Silicosis

201. Lung Abscess

202. Primary Lung Cancer

203. Sarcoidosis

204. Tuberculosis and Other Mycobacterial Diseases

205. Venous Thromboembolism

206. Viral Respiratory Infections

207. Viral and Mycoplasmal Pneumonias



Section 12 Rheumatology and the Musculoskeletal System

208. Ankylosing Spondylitis

209. Bursitis and Tendonopathy

210. Common Sports Injuries

211. Connective Tissue Disorders

212. Fibromyalgia and Myofascial Pain

213. Juvenile Idiopathic Arthritis

214. Osteoarthritis

215. Osteoporosis

216. Paget's Disease of Bone

217. Polymyalgia Pheumatica and Giant Cell Arteritis

218. Rheumatoid Arthritis



Section 13 Sexually Transmitted Diseases

219. Chlamydia Trachomatis

220. Condyloma Accuminata

221. Genital Ulcer Disease: Chancroid, Granuloma Inguinale, and Lymphogranuloma

222. Gonorrhea

223. Nongonococcal Urethritis

224. Syphillis



Section 14 Skin Disease

225. Acne Vulgaris

226. Atopic Dermatitis

227. Bacterial Diseases of the Skin

228. Bullous Diseases

229. Cancer of the Skin

230. Contact Dermatitis

231. Cutaneous T Cell Lymphoma, Including Mycosis Fungoides and Sézary Syndrome

232. Cutaneous Vasculitis

233. Decubitus Ulcers (previously pressure ulcers)

234. Diseases of the Hair

235. Diseases of the Mouth

236. Diseases of the Nails

237. Erythema Multiforme

238. Fungal Diseases of the Skin

239. Keloids

240. Melanoma

241. Nevi

242. Papulosquamous Eruptions

243. Parasitic Diseases of the Skin

244. Pigmentary Disorders

245. Premalignant Lesions

246. Pruritus Ani and Vulvae

247. Psychocutaneous Medicine

248. Rosacea

249. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysisn

250. Sunburn

251. Urticaria and Angioedema

252. Venous Ulcers

253. Viral Diseases of the Skin

254. Warts (Verrucae)



Section 15 Urogenital Tract

255. Acute Renal Failure

256. Chronic Kidney Disease

257. Malignant Tumors of the Urogenital Tract

258. Primary Glomerular Diseases

259. Pyelonephritis

260. Renal Calculi

261. Trauma to the Genitourinary Tract

262. Urethral Strictures

263. Urinary Incontinence



Section 16 Men’s Health

264. Bacterial Infections of the Urinary Tract in Males

265. Benign Prostatic Hyperplasia

266. Epididymitis

267. Erectile Dysfunction

268. Prostatitis



Section 17 Women’s Health

269. Abnormal Uterine Bleeding

270. Amenorrhea

271. Bacterial Infections of the Urinary Tract in Women

272. Benign Breast Disease

273. Cancer of the Endometrium

274. Cancer of the Uterine Cervix

275. Contraception

276. Dysmenorrhea

277. Endometriosis

278. Infertility

279. Menopause

280. Ovarian Cancer

281. Pelvic Inflammatory Disease

282. Premenstrual Syndrome

283. Sexual Dysfunction

284. Uterine Leiomyomas

285. Vulvar Neoplasia

286. Vulvovaginitis



Section 18 Pregnancy and Antepartum Care

287. Antepartum Care

288. Ectopic Pregnancy

289. Hypertension in Pregnancy

290. Postpartum Care

291. Vaginal Bleeding Late in Pregnancy



Section 19 Children’s Health

292. Acute Leukemia in Children

293. Adolescent Health

294. Asthma in Children

295. Attention-Deficit Hyperactivity Disorder

296. Bronchiolitis

297. Care of the High-Risk Neonate

298. Diabetes Mellitus in Children

299. Encopresis

300. Epilepsy in Infants and Children

301. Failure to Thrive

302. Hemolytic Disease of the Fetus and Newborn

303. Nocturnal Enuresis

304. Normal　Infant Feeding

305. Parenteral Fluid Therapy for Infants and Children

306. Pediatric Sleep Disorders

307. Resuscitation of the Newborn

308. Traumatic Brain Injury in Children

309. Urinary Tract Infections in Infants and Children

　

Section 20 Physical and Chemical Injuries

310. Burns

311. Disturbances due to Cold

312. Heat-Related Illness

313. High Altitude Sickness

314. Marine Poisonings, Envenomations, and Trauma

315. Medical Toxicology

316. Spider Bites and Scorpion Stings

317. Venomous Snakebite



Section 21 Preventive Health

318. Immunization Practices

319. Travel Medicine



Section 22 Appendices and Index

320. Biologic Agents

321. Popular Herbs and Nutritional Supplements

322. Toxic Chemical Agents Reference Chart - Symptoms and Treatment

Decontamination

Decontamination
This section is broken down into several sections and includes cleaning and disinfection of
healthcare equipment and the healthcare environment.
Definitions and application of processes
The term ‘decontamination’ refers to the combination of processes by which pathogenic
microorganisms, including bacterial spores, are removed from an item, making it safe
to handle, use or discard. Decontamination is a three-step process that involves cleaning,
disinfection and sterilisation (in that order).
CLEANING Cleaning is a process that uses detergent and water to remove visible
contamination.
It does not necessarily destroy microbes. Effective cleaning is essential
before disinfection or sterilisation. It is imperative that detergent is used to clean, not
disinfectant.
Detergent is crucial in cleaning as it breaks up dirt and grease, making it easier for the
water to remove any contamination. The combination of detergent and water removes
around 80% of microorganisms from surfaces.
Drying after cleaning is as important as cleaning itself in order to prevent growth of
microorganisms not removed during the cleaning process; this is true for hands and
surfaces.
DI S I N F E C T I O N Disinfection is a process that uses chemical agents or heat to eliminate
many or all pathogenic microorganisms on inanimate objects, with the exception of bacterial
spores.
Disinfectants should only be used when there is a risk of transmission of infection, e.g.
when a patient has an infection. They are not required routinely; cleaning with detergent
alone is adequate.
Disinfectants should be used to disinfect. They should be applied to clean surfaces – they
must not be used to clean (with the exception of products used for blood/body fluid
spillage management).
Alcohol is a disinfectant (not a cleanser) and should not be used for cleaning. Alcohol
acts as a fixative to proteins (which are present in blood and tissue) and makes them stick
to surfaces.
S T E R I L I S AT I O N This is the complete elimination or destruction of all forms of microbial
life, including bacterial spores.
I N F E C T I O N R I S K S A ND DECONTAMINATION REQUIREMENTS It is important
when buying equipment to check with the manufacturer how it should be decontaminated
and that the recommended method is achievable, as to deviate from manufacturer’s guidance
may invalidate the product warranty and transfer liability for the product (should it fail
or cause harm) to you as the user.
Decontamination of reusable medical devices should be undertaken in a dedicated facility
that ensures segregation of dirty and clean items, has a defined workflow, moving from
dirty to clean, and supports tracking and tracing of individual items, with documentation
that supports this, e.g. a sterile services department (SSD). Local decontamination at ward
level should be avoided.
The level of decontamination an item requires is dependent on how it is used – noninvasive
items require a lower level of decontamination than invasive items (see Table 2).
Table 2 Infection risks and decontamination requirements
Level of risk Application
Level of decontamination
required Examples
High Invasive items
Items in close contact with a
break in the skin or mucous
membrane
Items introduced into a sterile
body area
Sterilisation
High-level disinfection may
be adequate for some items
Surgical instruments
Dressings
Catheters
Prosthetic devices
Intermediate Items in contact with intact
mucous membranes, body fluids
Items contaminated with
particularly virulent or readily
transmissible organisms
Items for use on highly
susceptible patients or sites
Disinfection Endoscopes
Respiratory equipment
Low Items in contact with normal/
intact skin
Cleaning and drying
Disinfection is required if
there is a known risk of
infection
Washbowls
Toilets
Bedding
Minimal Items not in contact with the
patient/their immediate
surroundings
Cleaning and drying Floors
Sinks
Walls
S I N G L E U S E O N LY Items designated ‘single use only’ by the manufacturer must not be
reused under any circumstances, despite any cost concerns. Figure 2 shows the ‘single use
only’ symbol

When the ‘single use only’ symbol is seen on a medical device or its packaging the item
must be used once only and discarded. This is different from single-patient use items that
can be reused with the same patient.
If single-use items are reprocessed (decontaminated) and reused, the product liability is
transferred from the manufacturer to the reprocessor, who becomes responsible for the
item’s performance. This means that if a product fails to operate properly or causes harm or
injury it is the responsibility of the reprocessor.
Decontamination of healthcare equipment
• All items of equipment should be cleaned after each use/between patients.
• Manufacturer’s guidance must be adhered to when cleaning healthcare equipment.

Table 3 Healthcare equipment and decontamination methods
Item
Decontamination method – all items require
decontamination after each use
Beds Wash bed frame with detergent and water
If disinfection is required use a chlorine-releasing agent at 1000 parts per
million available chlorine strength
Bed cradles Wash with detergent and water
If disinfection is required use a chlorine-releasing agent at 1000 parts per
million available chlorine strength
Commode frame Clean with detergent wipes
If disinfection is required use a chlorine-releasing agent at 1000 parts per
million available chlorine strength
Commodes should be disassembled for cleaning and disinfection
Commode pan Wash with detergent and water
If disinfection is required use a chlorine-releasing agent at 1000 parts per
million available chlorine strength
Reusable bedpans Wash in an automated washer–disinfector with a heat disinfection cycle that
reaches 90 °C, or reaches 80 °C and maintains the temperature for 1 minute
OR
Wash in detergent and water then disinfect with a chlorine-releasing agent at
1000 parts per million available chlorine strength
Bedpan holder (used
with disposable liners)
Wash with detergent and water
If disinfection is required use a chlorine-releasing agent at 1000 parts per
million available chlorine strength
Blood pressure cuffs Wipe with a detergent wipe
If disinfection is required use a chlorine-releasing agent at 1000 parts per
million available chlorine strength
Dressings trolleys Wash with detergent and water
To disinfect wipe with 70% alcohol after cleaning
Incubator Wash with detergent and water
If disinfection is required use a chlorine-releasing agent at 125 parts per
million available chlorine strength or wipe surfaces with 70% alcohol
Mattresses Wash with detergent and water avoiding excess wetting
If disinfection is required use a chlorine-releasing agent at 1000 parts per
million available chlorine strength
Nailbrushes Sterilised by heat disinfection in SSD
Pillows Wash with detergent and water avoiding excess wetting
If disinfection is required use a chlorine-releasing agent at 1000 parts per
million available chlorine strength
Portable suction unit Wash bottle in detergent and water after emptying, after each use
If contents were blood stained, disinfect after washing with a
chlorine-releasing agent at 10 000 parts per million available chlorine
Sheets Send for laundering at patient discharge/when soiled/stained/contaminated/
creased, at least twice a week
Thermometers After removal of protective sleeve disinfect with an alcohol wipe
Toys Wash hard toys with detergent and water
If disinfection is required use a chlorine-releasing agent at 1000 parts per
million available chlorine strength and rinse or wipe with 70% alcohol
Urine bottles Wash in an automated washer–disinfector with a heat disinfection cycle that
reaches 90 °C, or reaches 80 °C and maintains the temperature for 1 minute
OR
Wash in detergent and water and then disinfect with a chlorine-releasing
agent at 1000 parts per million available chlorine strength
Wash bowls (plastic) Wash with detergent and water and dry thoroughly

• General purpose detergent and water/detergent wipes should be suitable for cleaning
the majority of items. Consult your infection control team and decontamination manager
for further advice and always follow manufacturer’s guidance when cleaning equipment
in order to avoid causing damage.
• Wear an apron and gloves when cleaning.
Table 3 sets out the cleaning and disinfection methods for items of healthcare equipment
commonly used at ward level. This guidance may differ from local policy – please refer to
infection control guidance in your place of work.
Note that disinfection is required if an item was used with an infectious patient. If contamination
with high-risk blood or body fluid occurs, a chlorine-releasing agent at 10 000
parts per million available chlorine strength should be used to disinfect. Check manufacturer’s
guidance beforehand for compatibility and refer to the subsection on management
of blood and body fluid spillages and splashes.
Decontamination of the healthcare environment
GENERAL S TANDARDS
• All areas must be kept free of unnecessary equipment and clutter to facilitate cleaning.
• The healthcare environment and all patient equipment must be visibly clean and free
from dust, dirt, debris and blood/body fluid contamination/ stains.
• The floor should not be used for storage – floors must be kept clear to facilitate cleaning.
• The fabric of the environment should be maintained and any damage or defects should
be repaired/replaced.
• Every bed space/single room should be cleaned with detergent and water when a patient
leaves before the next patient is admitted.
• Cleaning schedules should be displayed publicly.
I S O LATION ROOMS
• Isolation rooms should be cleaned last after all other areas in the ward to prevent the
spread of microorganisms and transmission of infection.
• The domestic should wear disposable gloves and an apron when cleaning in an isolation
room. These should be removed in the room immediately before leaving, discarded into
the clinical waste bag and hands should be washed.
• On a daily basis the room should be cleaned with detergent and water and then disinfected
using a chlorine-releasing agent at 1000 parts per million available chlorine
strength or cleaned and disinfected in one step with a chlorine-based detergent at 1000
parts per million available chlorine strength.
• After discharge of an infectious patient the room should be cleaned with detergent and
water and then disinfected using a chlorine-releasing agent at 1000 parts per million
available chlorine strength or cleaned and disinfected in one step with a chlorine-based
detergent at 1000 parts per million available chlorine strength.
• Curtains should be changed after the patient is discharged/transferred from the ward.
CURTA I N S
• Curtains should be changed when soiled/contaminated, after outbreaks of infection, after
discharge of an isolated patient and otherwise every three months as a minimum.
• Fabric curtains should be laundered every three months and disposable curtains should
be changed every three months as a matter of routine.
• If curtains become stained, contaminated or soiled they must be changed immediately.
• No curtain should be stained – curtains with old stains that are set into the fabric should
not be used.
E Q U I P M E N T U S ED F O R C LEANING
• The domestic should wear heavy-duty gloves for cleaning, not disposable clinical gloves,
unless working in an isolation room.
• Mops and buckets should be stored clean, dry and upside down to allow drying and to
avoid dust and debris from accumulating inside. Buckets should be stacked in a pyramid
style, not inside one another.
• Cleaning materials used by the ward domestic should be stored in the domestic service
room and not in any other area of the ward.
• Cloths used to clean and disinfect isolation rooms should be disposable or laundered immediately
after cleaning the isolation room. They must not be used to clean another area.
• All mop heads and cloths should be laundered daily.
COLOUR CODI N G F O R H Y G I E N E The following colour-coding scheme should be
applied to all cleaning materials (gloves, mop handles, buckets, cloths):
Red: bathrooms, washrooms, showers, toilets, basins and bathroom floors
Blue: general areas including wards, departments, offices and basins in public areas
Green: catering departments, ward kitchen areas and patient food service at ward level
Yellow: isolation areas
DO M E S T I C S E RVI C E R O O M ( C L E A N E R ’ S C U P B O A RD) The domestic service room
should be used solely to prepare and clean equipment used for cleaning; there should be no
personal belongings stored and food should not be consumed there. The domestic service
room is regarded as a dirty environment in the same way that the sluice room is, and to
consume food there presents a risk of infection to the member of staff.
CL E A N I N G F R E Q U E N C I E S
Blinds and curtains
In a hospital setting, curtains and blinds should be changed every three months and immediately
upon soiling, staining or contamination.
Floors
Floors should be washed daily with detergent and water. Spillages should be cleaned (and
disinfected if necessary) immediately.
Horizontal surfaces
All horizontal surfaces should be cleaned daily with detergent and water.
Lockers, bed tables
Lockers and bed tables should be washed daily with detergent and water. Spillages should
be cleaned (and disinfected if necessary) immediately.
Showers
Shower curtains should be cleaned daily with detergent and water and changed every three
months – sooner if contaminated.
Toilets
Toilets should be cleaned daily as a minimum and more frequently during outbreaks of
diarrhoeal illness, when they should be disinfected with a chlorine-releasing agent at 1000

parts per million available chlorine strength. Toilets should be cleaned at any time that
they are soiled.
Walls
In theatres walls should be cleaned every 6 months. In other areas there is no requirement
to wash walls with any specified frequency other than to spot-clean any areas that become
dirty using detergent and water.
Wash hand basins
Wash hand basins should be cleaned daily as a minimum and more frequently during outbreaks
of diarrhoeal illness, when they should be disinfected with a chlorine-releasing
agent at 1000 parts per million available chlorine strength.
Windows
Window cleaning is usually done by an external contractor and there is no recommended
frequency.
Managing blood and body fluid spillages and splashes
Blood and body fluids have different levels of risk in terms of their infectivity – see the
subsection on infectivity of body fluids.
In the event of a blood/body fluid spillage it is essential to disinfect the affected area as
described here in order to avoid transmission of bloodborne viruses. Hepatitis B can survive
on surfaces for at least seven days and it is possible to pick it up from inanimate objects;
therefore careful disinfection of spillages and contamination is essential.
HAND H Y G I E N E , G LOVE S , A P R O N S , VI S O R S A ND MASKS
• When disinfecting spillages gloves and an apron should be worn.
• If there is any risk of splashing to the face a surgical mask and eye protection should also
be worn.
• After dealing with the spillage the gloves, apron, etc., should be removed and hands
should be washed.
DI S I N F E C T I N G T H E S P I LLAGE Hypochlorite preparations should be used to disinfect
spillages, at the following concentrations:
• 1000 parts per million available chlorine for urine, vomit or faeces.
• 10 000 parts per million available chlorine for blood/body fluid spillages.
• If hypochlorite solution at 10 000 parts per million available chlorine has already been
prepared and the weaker solution has not, it is acceptable to use the stronger solution to
disinfect following spillage of urine, vomit or faeces – preparation of a separate solution
is not strictly necessary.
Hypochlorite granules should be used for fresh blood/body fluid spillages; these absorb the
spillage whilst disinfecting with 10 000 parts per million available chlorine.
• Do not apply hypochlorite granules to urine or vomit spillages, as the chemical reaction
that occurs causes chlorine gas to be released.
A wide range of products are available for managing blood and body fluid spillages,
including biohazard kits, impregnated wipes – make sure you are familiar
with the products available in your organisation and how to use them

20 DECONTAMINATION
BLOOD/ B LOOD- S TA I N ED B ODY F L U IDS
Fresh spillages
1. Apply hypochlorite granules to the affected area and leave for two minutes.
2. Clear up the spillage and granules with paper products, i.e. disposable items, and
discard into clinical waste.
3. Wash the affected area using general purpose detergent and water or detergent wipes
to remove residual hypochlorite.
4. Dry the affected area thoroughly.
Dried blood/blood-stained body fluids/splashes/
environmental contamination
1. Apply hypochlorite solution at 10 000 parts per million available chlorine strength to the
affected area using paper products. Allow two minutes contact time for disinfection
to take place. Where this is not practicable, e.g. splashes on equipment, hypochlorite
solution should be used to wipe the equipment to remove the contamination.
2. Discard all paper products used to clear up the spillage into a clinical waste bag.
3. Wash the affected area using general purpose detergent and water or detergent wipes
to remove residual hypochlorite.
4. Dry the affected area thoroughly.
U R I N E , VOMIT AND FAECES
1. Clear up the urine/vomit/faeces with paper products and discard into a clinical waste bag.
2. Disinfect the affected area using paper products and hypochlorite solution at 1000 parts
per million available chlorine strength.
3. Wash the affected area using detergent and water or detergent wipes to remove residual
hypochlorite and then dry thoroughly.
4. A chlorine-based detergent at 1000 parts per million available chlorine strength can be
used instead of steps 2 and 3.
I N F E C T IVI T Y O F B ODY F L U IDS Body fluids are regarded as being ‘high risk’ or
‘low risk’ in terms of infectivity. Urine, vomit and faeces are low risk; the following are
high risk:
• Blood/blood-stained body fluids
• Semen
• Vaginal secretions
• Synovial fluid
• Cerebrospinal fluid
• Amniotic fluid (liquor)
• Peritoneal fluid
• Pleural fluid
• Breast milk.
CARE WITH HYPOCHL O R I T E P R E PARAT I O N S
• Always prepare hypochlorite solution(s) in the container(s) provided by the manufacturer.
There should be two available to you – one for 10 000 parts per million available chlorine
concentration and another for 1000 parts per million available chlorine concentration.
• Follow manufacturer’s guidance on preparation of the solution(s).
• Prepare with cold water.

• Do not decant the solution into another vessel.
• Do not shake the container whilst waiting for the tablets to dissolve as to do so may lead
to the contents spraying out when the lid is removed.
• Hypochlorite solutions lose their strength after 24 hours – discard any unused solution(s)
after 24 hours and prepare a fresh batch the next time it is needed.
• Keep the lid of the container – the container should not be used without a lid.
• Hypochlorite solutions are COSHH substances and should be stored securely.
• Hypochlorite is corrosive to metal and therefore prolonged contact with metal should be
avoided.
• Manufacturer’s guidance should be consulted before applying hypochlorite solution to
any item of equipment.
• Do not apply hypochlorite to carpets and soft furnishings as it will strip out the colour;
instead clean with general purpose detergent and water and use steam to disinfect.
• Heavily soiled/contaminated items that cannot be cleaned and disinfected must be
discarded.
• The products used to clear up spillages must all be disposable – mops and buckets should
not be used.

Visors and goggles (eye protection), headwear and footwear

Visors and goggles (eye protection), headwear
and footwear
CHOOSING Goggles should protect you against splashes to your eyes. They should wrap
around the eye area to ensure side areas are protected.
Visors may be worn instead of a mask and goggle combination when there is a high risk
of splattering or spray of blood or other body fluids.
USING
• Visors/goggles should be worn to protect the eyes whenever there is a risk of splashing
to the face. They should be removed when no longer required.
• Visors/goggles should be worn during aerosol generating procedures (intubation, oro/
nasopharyngeal suctioning, tracheostomy care, chest physiotherapy, bronchoscopy/
cardiopulmonary resuscitation).
• Visors/goggles should be worn by all theatre staff directly participating in an invasive
procedure where there is a risk of splashing to the face.
• Torn or otherwise damaged face protection should not be used and should be removed
immediately (safety permitting) if this occurs during a procedure.
REMOVI N G Remove goggles/visors promptly after use, avoiding contact with most likely
contaminated areas, e.g. the front surface. This should be done by handling the straps/ear
loops/goggle legs only (manufacturers’ instructions should be followed).
HEADWARE Theatre hats should be worn in theatres, sterile services departments and
clean rooms. They should cover the hair entirely and should be changed between sessions
or if contaminated with blood or body fluids.
FOOTWARE Footwear should be clean and well maintained. It should support and
cover the whole foot to protect from dropped sharps and blood/body fluid spillages.
Footwear dedicated to a specific clinical area, such as theatre, should be removed before
leaving that area.
Summary of when to use PPE
The guidance contained within Table 1 is not exhaustive; it offers examples of common care
activities where blood/other body fluid exposure may occur and protection must be worn.
As standard, a risk assessment must be undertaken to consider the risks of blood/other
body fluid exposure prior to activities. For further information refer to your local infection
control team/policy.
Table 1 Summary of when to use PPE
Activity
Aprons/gowns
(depending on
significant splashing/
exposure)
Face, eye, mouth
protection
(surgical masks,
goggles) Gloves
Contact with intact skin – no
visible blood/ body fluids, rashes
Not required Not required Not required
Sterile procedures Required Risk assessment Required
Contact with wounds, skin lesions Required Risk assessment Required
Managing spillages of urine and
faeces
Required Risk assessment Required
Potential exposure to blood/other
body fluids, e.g. performing
suctioning, cleaning up spillages,
taking specimens
Required Risk assessment Required
Venepuncture/cannulation Required Not required Required
Vaginal examination Required Not required Required
Applying topical creams, etc. Not required Not required Required
Touching patients with unknown
skin rash
Risk assessment Not required Required
Emptyichanging urinary catheter
bags, urinals, bedpans, etc.
Required Risk assessment Required
Handling specimens Required Not required Required
Handling used instruments Required Not required Required
Using disinfectants, cleaning
agents
Required Risk assessment Required
General cleaning of clinical
areas and equipment
Risk assessment Not required Risk
assessment
Bed making, dressing patients Risk assessment Not required Risk
assessment
Oral care Risk assessment Risk assessment Required
Feeding patient Required Not required Risk
assessment
Handling waste Risk assessment Risk assessment Required

Masks CHOOSING

Masks
CHOOSING
• A wide range of masks are available: reusable and disposable surgical and FFP3 masks;
masks with visors; masks without visors, etc. Make sure you know what is available in
your place of work, how to wear it and how to use it – always follow the manufacturer’s
guidance on use, make sure each item fits comfortably and check expiry dates.
• If there is any possibility that blood, body fluids, medications or fluids of any type may be
splashed in your face, you should wear a surgical mask.
• If you are caring for someone with an infection that is transmitted via the airborne route,
e.g. influenza, and will be performing an aerosol generating procedure such as intubation,
oro/nasopharyngeal suctioning, tracheostomy care, chest physiotherapy, bronchoscopy/
CPR, etc., you should wear an FFP3 mask.
• Manufacturers’ instructions should be adhered to while donning masks to ensure the
most appropriate fit and optimum protection.
USING The purpose of wearing a mask is to prevent splashes from going in your mouth
or up your nose. Specialist masks also filter the air you breathe. Torn or damaged masks
should not be worn as they may not provide the desired level of protection.
SURGICAL MASKS These provide a physical barrier against splashes to the mouth and
nose. They do not filter the air you inhale and are not an effective barrier for fine aerosol
droplets that float through the air and are inhaled. Care should be taken to ensure that
surgical masks fit snugly around the nose and chin.
Surgical masks are single-use, disposable items and should be removed when no longer
required. They should not be worn around the neck and should be changed when moist/
wet/contaminated.
F I LT E R I N G FA C E P I E C E M A S K S ( F F P M A S K S ) These provide a physical barrier
against splashes to the mouth and nose and also filter the air you inhale. They are capable
of filtering fine aerosols. FFP3 masks are the mask of choice, providing a higher level of
filtration than FFP2 masks.
FFP3 masks should be worn when aerosolising procedures are underway with patients
with infections transmitted via the airborne route, e.g. influenza, tuberculosis, etc. They
must be fitted to ensure the best possible fit on to your face. A ‘fit test’ should be carried
out to check how well the mask fits (Box 1).
Box 1 Fit test for masks
FFP3 mask fit testing
• Fit testing is a one-off test but should be repeated if facial shape changes/following
significant weight gain/loss.
• FFP3 fit testing is a legal requirement.
• The wearer must achieve an adequate fit with each specific model of FFP3.
Factors affecting face seal
• Jewellery – may need to be removed.
• Facial markings, e.g. scar/mole.
• Safety or prescription glasses (should be worn during fit test).
• Facial hair. A small goatee or beard than will be covered by the mask may be okay,
otherwise staff must be clean shaven for a proper fit and face seal. Otherwise,
those with facial hair should shave/do not perform aerosolising procedures/use a
hood with powered extraction.
Carry out a fit check before the fit test
• Cover the mask surface with flat hands. For valved masks inhale sharply and for
unvalved masks exhale sharply. If leaks around the seal are detected, correctly fit
the mask before entering a hazardous area

Aprons and gowns CHOOSING

Aprons and gowns
CHOOSING
• Aprons and gowns should be water repellent and should allow you a full range of movement
when worn and not interfere with your clinical activity.
• Check expiry dates on sterile gowns before use – never use an out of date gown.
USING
• An apron or gown should be worn when contamination of your clothing or uniform
might occur.
• Disposable aprons and gowns are single-use items and should be disposed of via the
clinical waste stream immediately after use.
• Disposable, single-use plastic aprons should be worn when there is a risk of contact with
blood/body fluids.
• An impermeable gown should be worn rather than a plastic apron when there is a risk
of significant splashing of body fluids, e.g. in an operating theatre or during invasive
procedures.
• Disposable long-sleeved gowns should be worn when caring for patients known or
suspected to have scabies or any other parasitic skin infestation.
• Colour-coded aprons and gowns are often worn for different tasks in a ward setting, e.g.
a specific colour may be worn when patients are isolated and another for serving meals –
ensure that you wear the correct colour for the task in hand in accordance with local policy.
• Reusable gowns, such as those worn in operating theatres, should be worn once and
then laundered. They must be changed between patients.
• Disposable aprons and gowns must never be cleaned and reused.
• An apron or gown should be worn for one patient and then removed. It may be necessary
to change your apron or gown between tasks on the same patient to prevent
cross-contamination.
• A torn or damaged apron or gown should not be used and should be removed immediately
(safety permitting) if this occurs during a procedure.
• An apron or gown should be removed as soon as the task for which it was worn is complete,
before touching non-contaminated and clean areas, items, environmental surfaces
and contact with other patients and staff.
REMOVI N G
• When removing an apron or gown you should avoid touching the most heavily soiled/
contaminated areas. You should also take care not to touch your clothing or uniform
worn underneath to avoid contamination.
• Turn the outer contaminated side of the gown inward, roll the aprons or gown into a ball
and dispose of it via the clinical waste stream.

Gloves

Gloves
CHOOSING Gloves are a medical device and should be treated as such:
• Choose the right size to ensure a good fit in order to avoid friction, excessive sweating,
finger and hand muscle fatigue and interference with dexterity.
• Check the expiry date of the gloves you use – never use gloves that are out of date
(glove material can deteriorate over time and an out of date glove might not perform
as well).
• Never use disposable latex gloves containing powder (due to the risks associated with
aerosolisation and latex allergies).
USING
• Gloves should be donned before commencing a procedure where you might come into
contact with blood/body fluids/chemicals/therapeutic creams/lotions and as required for
the preparation of medications.
• Gloves should be changed if they become punctured, damaged or torn, or if damage to
the glove is suspected.
• Two pairs of gloves should be worn (double gloving) during some exposure prone procedures
(EPPs), e.g. orthopaedic and gynaecological procedures.
• Gloves should be removed promptly after use (as soon as the procedure is complete)
before touching non-contaminated/clean areas/items, environmental surfaces or other
persons (including yourself), with hands washed immediately afterwards.
• Gloves being worn for a procedure/activity should not be worn to handle or write on
charts, or to touch any other communal, clean surfaces.
• Gloves should not be decanted from the original box to ensure the expiry date is known
and the integrity maintained.
• Gloves should never be washed or have alcohol handrub applied to them. Instead, 
should be removed, hands cleansed and a new pair of gloves donned, if required.
• Wearing gloves does not mean that hands do not need to be washed – hands should be
washed before donning gloves and after removing them.
• Jewellery should not be worn under gloves. Plain metal bands are generally tolerated
but stoned rings may tear the glove material and should not be worn during clinical
activity.
REMOVI N G Care should be taken when removing used gloves to avoid contamination.
Holding the wrist end of the glove, pull it down over itself so that it goes inside out as you
pull it down your hand. Hold the removed glove in the hand that pulled it down. Now using
the ungloved hand, slowly pull the other glove down, inside out, in the same way, over the
fingers and the first glove and dispose of them into the clinical waste as a wrapped
package.
• Gloves should be changed between patients and between procedures on the same
patient to prevent cross-contamination.
• Torn, punctured or otherwise damaged gloves should not be used and should be
removed immediately (safety permitting) if this occurs during a procedure

Gloves, aprons, visors and masks – personal protective equipment (PPE)

Gloves, aprons, visors and masks – personal
protective equipment (PPE)
This section is broken down into smaller sections on general principles of PPE use – gloves,
aprons and gowns, masks, visors and goggles, headwear and footwear – and a summary
of when to use PPE is included.
General principles
The principles described here apply to all situations and all clinical settings. The term PPE
refers to gloves, aprons, gowns, masks, goggles and visors. The appropriate use of PPE is
essential for infection control. The benefit of wearing PPE is twofold in that it provides
protection to both the wearer and the patient.
Before donning PPE you should risk assess the situation – which items are most appropriate
for the task/situation, depending on what you might be exposed to, e.g. blood/other
body fluids? Not all items will be required each time.
You should also consider sensitivities and the risk of latex allergy (your infection control
team and occupational health department will be able to advise you on local policy).
ORDE R O F A P P L I C AT I O N A ND REMOVAL The order of applying PPE is less critical
than the order of removal – remember that when removing PPE each item is contaminated
and it is important to take each item off in the correct order for your protection.
PPE should be applied in the following order:
1. Apron/gown.
2. Mask.
3. Goggles.
4. Gloves.
PPE should be removed in the following order:
1. Gloves.
2. Apron/gown.
3. Goggles.
4. Mask.
After removing PPE you must wash your hands. This is necessary to ensure that any microorganisms
that may have got on to your hands when wearing and removing PPE are not
transmitted to other surfaces/patients/staff that you come into contact with.
PPE should be appropriate, fit for purpose and suitable for the person using/wearing it,
with supplies located close to the point of use. It is your responsibility to ensure you have
what you need, that it fits you properly and you know how to wear/use it.
PPE should be worn only when required and removed when no longer required, with
hands washed immediately afterwards.
PPE should not be worn by staff when transferring patients.
Disposable gloves, aprons, gowns and masks are single-use items and their packaging
will clearly state this. They should never be reused. They should be removed and disposed
of when the task for which they were worn is completed, with hands washed immediately
afterwards.
Reusable masks and visors must be cleaned after each use. Soapy water or a detergent
wipe may be used unless blood/body fluid contamination has occurred, in which case disinfection
with hypochlorite solution at 10 000 parts per million available chlorine strength
is required. See the section on spillage management
Face protection should not be touched whilst being worn as this can lead to hand
contamination.

Manufacturer’s guidance on the use of PPE should always be adhered to.