Infection Prevention and Control
Infection Prevention and Control tests how you break the chain of infection in every setting - ward, operating theatre, dialysis unit and community clinic. Egyptian MOHP infection-control standards and the national hepatitis C programme make this domain high-yield, especially for bloodborne virus prevention.
Chain of infection and standard precautions
Agent, reservoir, portal of exit, transmission, portal of entry, susceptible host - break any link. Standard precautions apply to every patient regardless of diagnosis: hand hygiene, gloves, gown, mask and eye protection according to risk, safe sharps handling, clean equipment and correct waste disposal. Hand hygiene follows the WHO 5 Moments and uses alcohol-based rub for visibly clean hands; wash with soap and water when hands are soiled and for Clostridioides difficile or norovirus.
Transmission-based precautions
- Contact: MRSA, C. difficile, scabies and multidrug-resistant organisms - single room, gloves and gown, dedicated equipment.
- Droplet: influenza, pertussis, meningococcal meningitis and mumps - mask within one to two metres and cohort patients.
- Airborne: tuberculosis, measles and varicella - fit-tested N95 or FFP2 respirator, negative-pressure room and closed door.
Spaulding classification
Critical items enter sterile tissue or the vascular system (surgical instruments, catheters) and must be sterilised. Semicritical items contact mucous membranes (endoscopes, laryngoscopes) and need high-level disinfection. Non-critical items contact intact skin (stethoscopes, BP cuffs) and need cleaning with low-level disinfection.
Sharps and waste
Never recap, bend or break needles; dispose immediately at the point of use into a puncture-resistant sharps container filled to no more than three-quarters. Colour coding varies by facility - yellow for infectious waste, black for general and red for sharps in many Egyptian hospitals - so know your facility policy.
Needlestick injury: immediate steps
Wash the wound with soap and water without squeezing or scrubbing, allow bleeding, apply antiseptic, report immediately, and assess the source and your hepatitis B vaccination status. HIV post-exposure prophylaxis should start within hours, ideally under two hours; hepatitis B immunoglobulin plus vaccine is given if non-immune; arrange baseline and follow-up serology.
Worked example
A nurse sustains a needlestick from a patient known to have hepatitis C. What is the correct response? Reasoning: wash with soap and water, apply antiseptic, report to occupational health immediately, test the source and the nurse, and arrange follow-up. There is no vaccine and no routine post-exposure prophylaxis for hepatitis C, so early detection with direct-acting antivirals is the priority. Ignoring a low-risk injury or waiting for symptoms is wrong.
Traps that cost marks
- Using alcohol rub when C. difficile is suspected.
- Removing PPE in the wrong order - gloves last, after hand hygiene.
- Reusing single-use vials or lancets.
- Leaving a sharps container to overflow.