Bag Technique 101 for Home Care Nurses

  1. Do you struggle with bag technique? This article explores the six basics principles for bag technique for the home care nurse.

    Bag Technique 101 for Home Care Nurses

    You enter Mrs. Jones' home to do your Start of Care assessment. She opens the door to reveal a maze of newspapers and other memorabilia that she's been keeping since at least 1929. You begin surveying the scene for a place to put your nursing bag.

    Just as you think you've found a spot on a table at the end of the couch, 4 cats pop out of nowhere and begin to inspect you and your bag. What do you do?

    Here are a few things you should know about bag technique in the home care setting.

    Is Bag Technique Important?

    There are no confirmed reports of patients becoming ill due to pathogens brought into their home on a nursing bag. However, there is some research about what grows on the outside and inside of your bag. One study reports that 83.6% of the exteriors of nursing bags cultured were positive for human pathogens and 15.9% of these pathogens were multidrug-resistant organisms.

    The inside of nursing bags was not clean either. The study found that 48.4% of the inside of nursing bags were positive for human pathogens, with 6.3% being multi-drug resistant. How do you limit the number of organisms you carry from one home to the next?

    It's simple - Bag Technique.

    What is Bag Technique?

    Bag technique is used to prevent the transmission of pathogens while making home visits. There are a few basic principles involved in bag technique:

    1. Hand hygiene
    2. Bag placement while in patient homes
    3. Bag placement during storage
    4. Cleaning interior and exterior surfaces of the bag
    5. Handling equipment and supplies in the bag
    6. Handling equipment and supplies after they are removed from bag

    Your home care agency will have a policy and procedure on the exact steps to take when performing bag technique. Here, we will explore the basic ideas behind the principles of getting in and out of your nursing bag.

    Hand Hygiene

    Your hands become a vector that can transmit pathogens from your bag to the patient. The reverse is true too. Similar to other clinical areas, hand hygiene is of the utmost importance.

    The CDC reports that healthcare providers clean their hands less than half of the times they should. They also recommend washing your hands before any contact with the patient.

    Your agency may also recommend that you wash your hands -with soap and water or hand sanitizer- before entering the inside of your nursing bag too. The more you wash your hands before contact with the patient and your bag the more you decrease the risk of transmitting bacteria to your patients.

    When working inside the bag, be sure to never place "dirty" items inside the bag. If you have a sharps container, place into an exterior compartment of the nursing bag, but never stored inside the bag.

    Bag Placement

    Place your bag on a clean, dry surface, if available. If not available, place a clean barrier down first before putting your bag on a table or other surface. Another option is to hang the bag from a doorknob or over a door. Keep the bag closed when you are not working inside of the bag, especially if there are pets near.

    If you have a bag with wheels, you can leave it on the floor with a barrier underneath. Pay close attention that items don't fall out onto the patient's floor and that exterior pockets never come in contact with the floor when they're unzipped.

    Vehicle Storage

    Your bag should be stored in your vehicle on a clean, dry surface. If you have supplies in your bag that may be temperature-sensitive, you will need to keep the bag inside your car versus the trunk. Be sure that the bag is always kept on the "clean" side of your vehicle.

    If you are concerned about bed bugs or other insects, place your bag inside a large plastic container inside your car.

    Cleaning the Bag

    The outside of your bag is important. Chose a bag that's made of smooth, non-canvas nylon or polyester or other materials that can be wiped down to decrease the number of pathogens you carry from one home to the next.

    When to Leave Your Bag in Your Vehicle

    There will be times when your nursing bag is best left in your vehicle. These times include:

    • Known infestations with bedbugs or other insects
    • Homes that are contaminated with excrement
    • Patients known to have a multi-drug resistant organism
    • Patients on transmission-based precautions

    You always have the right to leave your nursing bag in your vehicle. In these situations, double-bag all items so that you can throw one away in the patient's home and use the other to carry items back to your car. Be sure to disinfect all equipment in the bag before placing it back into your nursing bag.

    Do you have any tips and tricks you can share to help others use bag technique in their nursing practice?
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    About Melissa Mills, BSN

    Melissa is a Quality Assurance Nurse, professor, writer, and business owner. She enjoys empowering other nurses to find their passions and create a unique nursing career that fits their passions, desires, and gifts. She is owner of www. makingspace.company, a website dedicated to helping women find their creative passions through writing and co-owner of enursingresources.com, a start-up Nursing CE company that will offer online courses soon.

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    8 Comments

  3. by   Libby1987
    There are also considerations to how equipment is removed, placed next to the patient, disinfected and replaced in the bag as well as clean and dirty pockets of the bag and which equipment goes where.

    Hanging a bag on a doorknob is not an option with our policy, fomite on the bag strap promotes transfer of pathogens. Our bags are wheeled and dental drapes for a clean and dirty surface barrier and disinfectant wipes are provided for management of all equipment. Our staff receive routine education on proper bag technique and they are expected to follow our policy.
  4. by   Melissa Mills
    Libby1987 - Thanks for the extra thoughts. Yes, each agency will have their own policies and should be followed first and foremost. ~Melissa
  5. by   Elfriede
    The bag in a car...
    I hate to leave it in the car.
    Especially when bag and/or car are recognizable HomeHealth.
    Such cars are faster broken up as you can turn around.
    After a looong negotiation with our management we´ve got "neutral" cars, bags and rags. - Frieda
  6. by   Melissa Mills
    Quote from Elfriede
    The bag in a car...
    I hate to leave it in the car.
    Especially when bag and/or car are recognizable HomeHealth.
    Such cars are faster broken up as you can turn around.
    After a looong negotiation with our management we´ve got "neutral" cars, bags and rags. - Frieda
    Elfriede - I agree that leaving the bag in your car is not always the best answer. Trying placing it in a bin with a lid. This keeps pests from roaming around you car and keeps others from recognizing the bag as something that belongs to a nurse.

    Melissa
  7. by   Kitiger
    The outside of the bag should be waterproof and easily cleaned. In addition, the bottom should be sturdy. I don't understand why a bag cannot be placed on the floor - the same floor that we walk on. Is it because the bottom of the bag can carry pathogens that my shoes do not carry?
  8. by   Libby1987
    Quote from Kitiger
    The outside of the bag should be waterproof and easily cleaned. In addition, the bottom should be sturdy. I don't understand why a bag cannot be placed on the floor - the same floor that we walk on. Is it because the bottom of the bag can carry pathogens that my shoes do not carry?
    I used to have that same question!

    Bags can be placed on the floor if they're consistently placed on the floor ie wheeled bags.
  9. by   Melissa Mills
    Quote from Kitiger
    The outside of the bag should be waterproof and easily cleaned. In addition, the bottom should be sturdy. I don't understand why a bag cannot be placed on the floor - the same floor that we walk on. Is it because the bottom of the bag can carry pathogens that my shoes do not carry?
    Kitiger - These is likely agency specific. However, the reasoning behind not placing the bag on the floor is related to the amount of pathogens and just general dirt that you will find on floors. If you leave a bag on the floor, it must have a barrier under it, unless it is on wheels (which keeps it up off of the floor). For me, I would have never put my bag on the floor for several reasons:
    1. The dirt
    2. The bending - I was in and out of my bag alot, especially if I had dressing changes or other skills that required me to get supplies out.
    3. You don't want the outside of your bag to touch the ground and become contaminated and then you take that with you to other places.

    I think if you always put it on the ground, as you would with a wheeled-bag, it might be one thing. But, you would not want to leave it on the floor of one home and then place it on the kitchen table of the next.

    As for shoes - lots of things can stay on your shoes (especially bed bug eggs - they wedge up in the tread of the sole of the shoe) - but you are not touching your shoes throughout your day, as you do with you bag. However, when I was doing home visits daily, I never wore my shoes in my home. I left them on the porch in the summer or in the basement in a tub in the winter and disinfected them often. I never wanted to bring home extra "friends".

    Hope this makes sense. Again, each agency is going to have their own policies on this - this is solely my experience. ~Melissa
  10. by   Kitiger
    Quote from melissa.mills1117

    I think if you always put it on the ground, as you would with a wheeled-bag, it might be one thing. But, you would not want to leave it on the floor of one home and then place it on the kitchen table of the next.
    I fully agree. My bag is always on the ground. I would no more put it on the table than I would stand on the table, and for the same reason.

    I do private duty home care, not home visits.

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