Bag Technique in Nursing

The nursing bag has been a core tool for public and community health nurses since the early 20th century. It prevents the spread of infection and lets the nurse deliver safe, effective care in the field, especially on home and community visits. Bag technique is the systematic way you organize and use that bag of supplies and equipment.

What is Bag Technique?

Bag technique is the systematic approach a nurse uses to perform procedures efficiently during a visit, saving time and effort while preventing infection. It covers how you organize, use, and maintain a bag carrying all the supplies and equipment a visit needs.

The public health bag (also called the nursing bag or home visit bag) is indispensable to public health nurses on home visits and community interventions. It holds medical supplies, equipment, and documentation materials, and it is central to infection control, keeping care safe while minimizing cross-contamination.

Graduates of Memorial Hospital Training School in Richmond, VI, received a nursing bag and uniform at graduation (Training School Notes, 1905). The bag quickly became part of the district nurse's identity, as C. Keith noted in 1905: "They become acquainted with the nurse, recognize her visage, and identify her by the bag she bears."

Principles of Bag Technique

1. Infection control. The main goal is to minimize cross-contamination between patients and from nurse to patient. Effective bag technique for infection prevention was first discussed in a 1956 publication by Smendik and Kurtagh, which stressed keeping distance between the bag and the client, using newspaper as a barrier, and handwashing. In 1961, a public health nurse demonstrated improved shigellosis control to families using items from her bag to show handwashing and specimen management (Levin, 1961).

• Asepsis. Maintain aseptic technique and rigorous hand hygiene (soap and water or alcohol-based sanitizer) before and after patient contact.
• Barrier protection. Place disposable underpads or clean towels under the bag to avoid contamination from environmental surfaces.
• PPE. Use personal protective equipment as needed to protect patient and nurse.

2. Organization and accessibility. Keep the bag systematically organized so supplies are quick to find, which speeds care and reduces unnecessary handling. Regularly check and replenish stock, discarding expired or contaminated items promptly.

3. Minimize cross-contamination. Take out only the supplies the procedure needs. Do not reuse disposable items or return anything exposed to the patient environment to the bag. Dispose of used supplies and PPE in designated bags or containers.

4. Patient and environment safety. Place the bag on a clean, stable surface within reach and away from contaminants, and keep the patient's environment as clean as possible during care.

5. Documentation and monitoring. Keep accurate records of supplies used, procedures performed, and changes in condition. Routinely inspect the bag and contents for cleanliness and integrity, addressing contamination or wear immediately.

6. Education and training. Stay current on infection control and bag technique through ongoing professional development, and educate patients and caregivers on keeping a clean, safe environment.

Contents of a Public Health Nurse Bag

The Manual of Public Health Nursing standardized supply lists and guidance on bag care and use for public health nurses nationwide.

• Paper lining
• Extra paper for making a waste bag
• Plastic/linen lining
• Apron
• Hand towel
• Soap in a soap dish
• Thermometers (oral and rectal)
• 2 pairs of scissors (surgical and bandage)
• 2 pairs of forceps (curved and straight)
• Disposable syringes with needles (g. 23 & 25)
• Hypodermic needles (g. 19, 22, 23, 25)
• Sterile dressing
• Cotton balls
• Cord clamp
• Micropore plaster
• Tape measure
• 1 pair of sterile gloves
• Baby's scale
• Alcohol lamp
• 2 test tubes
• Test tube holders
• Solutions of:
  • Betadine
  • 70% alcohol
  • Zephiran solution
  • Hydrogen peroxide
  • Spirit of ammonia
  • Ophthalmic ointment
  • Acetic acid
  • Benedict's solution

*The BP apparatus and stethoscope are carried separately and never placed in the bag.

Uses of the Items

• Paper lining: a clean surface for organizing supplies, away from environmental contamination.
• Extra paper for waste bags: for disposing of used supplies and biohazardous materials.
• Plastic/linen lining: a barrier between supplies and contaminated surfaces.
• Apron: protects the nurse's uniform from spills and soiling.
• Hand towel: for drying hands after washing.
• Soap in a soap dish: for handwashing, core to infection control.
• Thermometers (oral and rectal): measure body temperature to detect fever or hypothermia.
• Scissors (surgical and bandage): cut dressings, bandages, and tape.
• Forceps (curved and straight): handle sterile supplies and instruments aseptically.
• Disposable syringes with needles: administer medications, vaccines, or injectables.
• Hypodermic needles: various gauges for different sites and medication viscosities.
• Sterile dressing: a sterile covering that protects wounds from contamination.
• Cotton balls: clean wounds, apply topical medications, or remove debris.
• Cord clamp: clamps and secures the umbilical cord after birth.
• Micropore plaster: hypoallergenic tape that secures dressings without irritation.
• Tape measure: for growth monitoring, wound sizing, and device placement.
• Sterile gloves: protect the nurse's hands during invasive procedures.
• Baby's scale: measures infant weight for growth and nutrition monitoring.
• Alcohol lamp: a controlled heat source for sterilizing instruments.
• Test tubes and holders: collect, transport, and store specimens for lab testing.
• Solutions (Betadine, 70% alcohol, Zephiran, hydrogen peroxide, spirit of ammonia, acetic acid, Benedict's solution): for wound cleansing, disinfection, sterilization, or diagnostic testing.
• Ophthalmic ointment: prophylaxis for newborns against ophthalmia neonatorum, a bacterial eye infection transmitted during childbirth.

Best Practices for Bag Technique

1. Comprehensive preparation. Stock the bag with everything needed to handle emergencies in the field. After extensive experimentation, the Nurses' Settlement in New York (Henry Street Settlement) developed a district nurses' bag that proved comprehensive (Brewster, 1901).

2. Regular maintenance. Clean the bag and contents frequently and replace supplies as needed, so it is always ready for emergent situations.

3. Prevention of contamination. Keep the bag and contents away from potentially contaminated articles in the patient's home.

4. Differentiation of clean and contaminated items. Treat the bag and its contents as clean and sterile, and the patient's articles as dirty and contaminated.

5. Efficient organization. Arrange contents to the user's preferences so care flows smoothly and confusion is minimized.

6. Patient-centered approach. Tailor contents to the patient population, considering age, medical condition, and cultural preferences.

7. Documentation and accountability. Record supplies used, procedures performed, medications given, and changes in condition.

8. Adaptability and preparedness. Adapt contents to the setting and anticipate emergencies. The nursing bag has been essential to visiting nurses in the United States since the early 1900s, alongside the rise of public health nursing as a profession. Nurses at the Visiting Nurse Association of Chicago prepared their bags before a day of visits, customizing to the visit type; for a maternity client, that meant oakum pads for use as sanitary pads (Moore, 1900).

9. Communication and collaboration. Share information about the bag's contents and coordinate care with the healthcare team.

10. Continuous education and training. Stay current on bag-technique best practices and advancements. The contents evolved over time: when disposable items arrived, public health nurses at the Allegheny County Health Department in Pennsylvania ditched the "bulky, heavy, old bag" for a modern alternative, while noting that periodic reassessment by the nursing bag committee would keep it effective (Everett, 1965).

Steps in Performing Bag Technique

In 1970, UCOM Educational Inc. in Rochester, NY, released a self-instructional unit, "Nurse's Bag Technique," to teach proper technique to public health nurses and student nurses, emphasizing asepsis and familiarity with the bag's equipment (Sullivan & Weber, 1970).

1. On arrival, place the bag on a table lined with clean paper, clean side out, folded part touching the table, to prevent contamination.

2. Request a basin of water or a glass of drinking water if tap water is unavailable, for hand hygiene.

3. Take out the towel and soap and wash your hands thoroughly, then dry them. The Home Care National Patient Safety Goal 7 (The Joint Commission, 2007) calls for minimizing healthcare-associated infections in home care and following current CDC hand hygiene guidelines. The bag has historically been used to promote regular handwashing.

4. Put on the apron, clean side out, to protect your uniform.

5. Lay out all the articles the care task needs, within easy reach, to streamline delivery.

6. Close the bag and set it in a designated corner to prevent contamination.

7. Perform the necessary nursing care for the patient's needs.

8. Clean all used items and wash your hands to prevent cross-contamination.

9. Return cleaned items to their places and close the bag securely.

10. Remove the apron, folding it soiled side in, clean side out, and place it in the bag for disposal.

11. Document the data, observations, care rendered, and instructions, and educate the patient on care in your absence.

12. Schedule the next visit (home or clinic), noting the date and time.