Safety and Infection Control
Safety and Infection Control
This domain tests routine practices, additional precautions, PPE, hand hygiene, sharps safety, restraint use, falls prevention, and environmental safety. The exam favours the action that breaks the chain of infection or prevents harm before it occurs.
Routine practices and hand hygiene
- Perform hand hygiene at the four moments: before client contact, before aseptic procedure, after body fluid exposure risk, and after client contact.
- Use soap and water for 20-30 seconds when hands are visibly soiled or when caring for a client with C. difficile; use alcohol-based hand rub for 20-30 seconds otherwise.
- Don PPE in order: gown, mask or respirator, eye protection, gloves. Doff: gloves, eye protection, gown, mask; hand hygiene between steps.
- Routine practices apply to every client, not only those with a known infection.
Additional precautions
- Contact: MRSA, VRE, C. difficile; gown and gloves, dedicated equipment, bleach for C. difficile.
- Droplet: influenza, pertussis, mumps, rubella; surgical mask, eye protection, distance about 2 metres.
- Airborne: tuberculosis, measles, varicella; N95 fit-tested respirator, negative-pressure room, door closed.
- Aerosol-generating medical procedures (intubation, suctioning, nebulizers, CPR) require airborne precautions plus eye protection.
Sharps, restraints, and falls
- Never recap needles; activate the safety device and dispose immediately. After a needlestick: wash, report, seek post-exposure prophylaxis, document.
- Restraints are a last resort: obtain an order, monitor circulation every 15 minutes, release and reposition every 2 hours, offer food, fluids, and toileting, and document.
- Falls prevention: Morse Fall Scale, bed low and locked, call bell in reach, non-skid footwear, toileting schedule, clutter-free room.
Worked example
A client has frequent watery diarrhea and is suspected of having C. difficile. The PN places the client on contact precautions, wears gown and gloves for entry, uses soap and water for hand hygiene, uses dedicated equipment, and cleans the environment with bleach. Alcohol hand rub is not enough because C. difficile spores are not killed by alcohol.
Traps that cost marks
- Wearing gloves instead of performing hand hygiene.
- Using alcohol rub after C. difficile care.
- Choosing a surgical mask for tuberculosis or measles.
- Leaving the door open for an airborne client.
- Applying restraints without an order or monitoring.