Infection Prevention and Control
Domain 9 - Infection Prevention and Control
This domain tests the everyday practices that stop transmission: hand hygiene, standard and transmission-based precautions, personal protective equipment, cleaning and sterilisation, safe sharps handling, waste segregation and post-exposure management. It applies to every patient contact, not just known infections.
Core rules
- Standard precautions apply to all patients: hand hygiene, gloves when anticipating contact with blood or body fluids, gown, mask and eye protection for splash risk, safe sharps disposal, and safe handling of linen and waste.
- Hand hygiene at the five moments: before touching a patient, before a clean or aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching the patient's surroundings. Use alcohol rub for visibly clean hands and soap and water when soiled or after caring for a patient with Clostridioides difficile.
- PPE: put on gown, then mask, then eye protection, then gloves. Remove gloves first, then eye protection, then gown, then mask, performing hand hygiene between steps.
- Spaulding classification: critical items (entering sterile tissue) need sterilisation; semicritical items (contacting mucous membrane) need high-level disinfection; non-critical items need low-level disinfection.
- Transmission-based precautions: contact (gown and gloves, dedicated equipment), droplet (surgical mask, distance, cohorting), airborne (fit-tested respirator, negative pressure where available, or a well-ventilated single room).
- Never recap or bend needles. Sharps go straight into a puncture-resistant container filled to no more than three-quarters.
- Waste segregation by colour-coded bins according to local policy; never overfill or mix streams.
Worked example
A nurse sustains a needlestick from a used cannula. Reasoning: immediately encourage bleeding and wash with soap and running water - do not scrub or suck the wound. Report at once to the nurse in charge and occupational health. Assess the source patient's status with consent. Start HIV post-exposure prophylaxis as soon as possible, ideally within two hours and no later than 72 hours, after baseline serology. Check hepatitis B status; offer vaccine or immunoglobulin as indicated. Document the incident, and arrange follow-up serology at six weeks, three months and six months.
Traps
- Wearing gloves instead of performing hand hygiene.
- Removing a mask before a gown when doffing.
- Recapping needles to 'save the sharps box'.
- Using alcohol rub when hands are visibly soiled.
- Cohorting patients without considering the organism's route of transmission.