Nursing Law, Regulation and Infection Control
This domain combines the statutory framework you practise under with the precautions that stop transmission. Questions frequently join the two, for example a needlestick injury, an isolation decision, or a delegation that is unsafe. Expect exact sequences and exact precaution categories.
Regulation
- The Nurses Registration Ordinance (Cap. 164) establishes the Nursing Council of Hong Kong, registration and enrolment, and the disciplinary process for misconduct, professional incompetence and health matters.
- Delegation is lawful only when the task is within the delegator's scope, the delegate is competent, the patient is stable, and the delegator retains accountability. You cannot delegate accountability.
- The patient record belongs to the healthcare institution, but patients have rights of access under the Personal Data (Privacy) Ordinance. Record objectively, contemporaneously, and correct errors with a single line and signature, never by erasing.
- Report deaths that are unexpected, unnatural or occur within a defined period after admission to the Coroner.
Infection control
- Standard precautions apply to every patient regardless of diagnosis: hand hygiene, gloves, apron or gown, eye protection where splash risk exists, safe sharps handling and correct waste segregation.
- Contact precautions for MRSA, Clostridioides difficile and norovirus. Droplet precautions for influenza, pertussis and meningococcal disease. Airborne precautions for tuberculosis, measles and varicella, requiring a negative-pressure room and N95 respirator.
- Alcohol hand rub is ineffective against Clostridioides difficile spores and norovirus; wash with soap and water.
Worked example
A nurse sustains a needlestick from a hollow-bore needle after venepuncture. What is the correct sequence? Reasoning: encourage bleeding at the puncture site, wash with soap and running water, and do not scrub or squeeze hard. Report immediately and attend occupational health or the emergency department. The source patient is assessed for HIV, hepatitis B and hepatitis C with consent. HIV post-exposure prophylaxis should start as soon as possible, ideally within one to two hours and no later than 72 hours. Hepatitis B status determines whether immunoglobulin, vaccine or both are needed. Baseline and follow-up serology are arranged, and the incident is documented. Recapping the needle afterwards is never appropriate practice.
Traps that cost marks
- Using alcohol rub for Clostridioides difficile or norovirus.
- Believing gloves replace hand hygiene between patients.
- Placing a patient in a single room but omitting airborne precautions for tuberculosis.
- Delegating an unstable patient's assessment to an unregistered assistant.