Infection Control and Safety
Breaking the Chain
Infection control targets the chain of infection: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. Interrupt any link and transmission stops. Hand hygiene is the single most effective measure. Use soap and water when hands are visibly soiled and for C. difficile and norovirus, because alcohol rubs do not kill spores. Otherwise, alcohol-based rub is preferred.
Concepts to Master
- Standard precautions apply to all patients: hand hygiene, gloves, gown, mask, eye protection, sharps safety.
- Transmission-based precautions: contact (MRSA, C. diff, scabies), droplet (influenza, pertussis, meningitis), airborne (tuberculosis, measles, varicella) with N95 respirator and negative-pressure room.
- PPE order: don gown, mask/respirator, goggles, then gloves; remove gloves first, then goggles, gown, mask, and perform hand hygiene.
- Sterilization destroys all microorganisms (autoclave); disinfection reduces pathogens on surfaces.
- Safety: OSHA bloodborne pathogen rules, no recapping needles, sharps containers, SDS access, RACE for fire, PASS for extinguishers.
Traps
Exams love the C. diff exception, the order of PPE removal, and the difference between disinfection and sterilization. Contact precautions require gloves and gown on entry, not just gloves. Never recap a used needle, and never transport a needle without a secure container. Spills are cleaned from the outside inward with appropriate disinfectant and PPE.
Worked Example
A patient has suspected C. difficile diarrhea. Place on contact precautions, wear gown and gloves, and wash hands with soap and water after removal - not alcohol rub. Rule of thumb: “spore-forming organisms mean soap and water.”