Safety, Quality Improvement, and Infection Control
Core concepts
Safety content includes fall prevention, restraint use, medication safety, pressure injury prevention, and safe patient handling. Quality improvement uses structured models - Plan-Do-Study-Act, root cause analysis, and failure mode analysis - and relies on measurement, benchmarks, and reporting without blame. Infection control covers the chain of infection, hand hygiene as the single most effective measure, standard and transmission-based precautions (contact, droplet, airborne), personal protective equipment sequence (donning and doffing), aseptic technique, sterilization versus disinfection, and safe sharps handling. Antimicrobial stewardship and immunization reduce resistance and transmission.
Traps
Common errors include confusing airborne (negative pressure, N95) with droplet (surgical mask) precautions, doffing PPE before hand hygiene, and using alcohol rub when hands are visibly soiled (wash with soap and water). Another trap is treating incident reporting as punitive - reporting exists to improve systems. Also, restraints require a time-limited order, ongoing monitoring, and the least restrictive alternative first.
Rule of thumb
Clean hands, correct precaution, clear documentation. For precautions, ask: how does it spread? Contact = gown and gloves; droplet = mask; airborne = N95 and negative pressure.
Worked example
A patient with suspected pulmonary tuberculosis is admitted. Airborne precautions apply: a negative-pressure room, an N95 respirator fit-checked before entry, and a surgical mask on the patient during transport. The distractor "droplet precautions with surgical mask" is incorrect because transmission is airborne.