CHEST cheat sheet

Cleaning removes organic and inorganic soil; disinfection destroys most pathogenic microorganisms on inanimate surfaces; sterilization destroys all microbial life including spores.

Spaulding classification: critical items contact sterile tissue and require sterilization; semicritical items contact mucous membranes and require high-level disinfection; noncritical items contact intact skin and require low-level disinfection.

EPA-registered hospital disinfectants must be used according to label directions, including dilution and labeled contact time; surfaces must remain wet for the full contact time.

High-touch surfaces include bed rails, call buttons, television remotes, door handles, light switches, bathroom fixtures, and bedside tables; these require frequent cleaning and disinfection.

Terminal cleaning occurs after patient discharge or transfer and includes all surfaces and reusable equipment in the room; daily cleaning occurs while the room is occupied.

Clean from high to low and from clean to dirty areas, and change microfiber cloths or mop heads when soiled and between patient rooms to prevent cross-contamination.

Blood or body fluid spills are first contained and removed with absorbent material, then the area is cleaned and disinfected with an EPA-registered product effective against bloodborne pathogens following label contact time.

UV-C devices and hydrogen peroxide vapor systems are adjunct technologies; they do not replace manual cleaning and disinfection of visible soil.

Clean linen is stored in a clean, dry area; soiled linen is bagged at the point of use and never sorted or rinsed in patient care areas.

The chain of infection has six links: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host; breaking any link prevents transmission.

Standard precautions apply to all patients regardless of diagnosis and include hand hygiene, PPE, safe injection practices, and respiratory hygiene/cough etiquette.

Hand hygiene is performed before patient contact, before aseptic tasks, after body fluid exposure risk, after patient contact, and after contact with patient surroundings.

Contact precautions require gloves and gown; C. difficile also requires soap-and-water handwashing because alcohol does not reliably kill spores.

Droplet precautions require a surgical mask within about 3 to 6 feet; airborne precautions require an N95 or higher respirator and a negative-pressure room with the door closed.

PPE doffing sequence removes gloves first, then goggles or face shield, then gown, then mask or respirator, with hand hygiene after removal.

Transmission-based precautions are used in addition to standard precautions and are discontinued according to pathogen-specific criteria and facility policy.

Healthcare-associated infections may be tracked through NHSN; hand hygiene and environmental cleaning are core prevention measures.

Respiratory hygiene includes covering coughs, masking symptomatic patients, and spatial separation in waiting areas.

OSHA Hazard Communication Standard 29 CFR 1910.1200 requires labels, safety data sheets, and worker training for hazardous chemicals.

GHS labels include product identifier, hazard pictograms, signal word, hazard statements, and precautionary statements; SDSs have 16 sections.

Never mix bleach with ammonia or acids; mixing can release toxic chloramine or chlorine gas.

Bleach for blood or body fluid spills is commonly diluted 1:10 with water, about 0.5% sodium hypochlorite; contact time follows the product label.

Secondary containers must be labeled with the product name and hazard warnings; original manufacturer labels are not removed.

Fire response uses RACE: Rescue, Alarm, Contain, Extinguish or Evacuate; PASS means Pull, Aim, Squeeze, Sweep.

Safe patient handling uses lift equipment and avoids manual lifting when possible; ergonomic principles reduce musculoskeletal injury.

Wet floor signs are placed immediately and removed only after the floor is dry; spills are guarded until cleaned.

Needlestick or sharps exposure requires washing the site with soap and water, immediate reporting, and post-exposure evaluation per facility protocol.

Joint Commission Environment of Care standards cover safety, security, hazardous materials, fire safety, medical equipment, utilities, and emergency management.

CMS Conditions of Participation require hospitals to maintain a safe environment and comply with Life Safety Code NFPA 101 fire safety requirements.

The Life Safety Code addresses fire alarms, sprinklers, exit signs, egress paths, and fire drills; blocked exits are a common citation.

Environment of Care rounding identifies risks such as clutter, damaged equipment, expired supplies, and improper storage.

Documentation of cleaning, disinfection, and equipment maintenance must be accurate and contemporaneous because it can be audited.

TJC tracer methodology follows a patient's care experience to evaluate compliance with standards across departments.

OSHA requires an exposure control plan, hepatitis B vaccination offered to at-risk workers, and post-exposure follow-up under the Bloodborne Pathogens Standard.

Hazardous waste is segregated and labeled according to facility policy, EPA, DOT, and state rules; red bags are for regulated medical waste.

Regulatory surveys may include observation, interviews, and record review; staff must know their role in fire, disaster, and chemical spill response.

SBAR structures communication as Situation, Background, Assessment, Recommendation and is used for handoffs and escalation.

AIDET is a service framework: Acknowledge, Introduce, Duration, Explanation, Thank You.

HIPAA requires protecting patient health information; patient details are not discussed in hallways, elevators, or public areas.

Teach-back confirms patient understanding by asking the patient to explain information in their own words.

Service recovery includes listening, apologizing for the experience, resolving the issue, and following up.

Cultural competence includes respecting language, religion, health beliefs, and health literacy differences.

Bedside shift report includes the patient and family when appropriate and supports patient-centered communication.

Professional boundaries require avoiding personal relationships and social media disclosure of patient information.

Conflict resolution uses respectful, objective communication and escalation through the chain of command when patient safety is at risk.