Patient Safety, Infection Prevention, and Quality Improvement
Core concepts
Patient safety rests on systems thinking: most errors arise from process failures, not bad individuals. Know hand hygiene (WHO 5 Moments), standard precautions, transmission-based precautions (contact, droplet, airborne), aseptic technique, sharps and waste segregation, and post-exposure management. Learn the chain of infection and where to break it.
Quality improvement uses Plan-Do-Study-Act (PDSA) cycles, root cause analysis (RCA) for sentinel events, audit, and clinical indicators. Understand near-miss reporting, just culture, and hierarchy of controls (elimination > substitution > engineering > administrative > PPE - PPE is the last line, not the first).
Traps in questions
- Alcohol rub vs. soap and water: alcohol is preferred for routine hand hygiene but not when hands are visibly soiled or after exposure to spore-formers such as C. difficile.
- PPE order: don before contact, remove before leaving the area; gloves do not replace hand hygiene.
- Droplet vs. airborne: influenza and meningococcus are droplet; tuberculosis and measles are airborne (N95 and negative pressure).
- Blame vs. system: the "just culture" answer distinguishes reckless behaviour from honest error.
Rule of thumb
"Break the chain at the most reliable point." Prefer engineering and process controls over relying on individual vigilance.
Worked example
A needlestick from a known hepatitis B positive source: wash with soap and water (do not squeeze), report immediately, and follow local post-exposure prophylaxis protocol. Reporting is mandatory and time-sensitive; the injury is a system signal, not a personal failing.