Infection Control and Asepsis
Chain of infection and hand hygiene
There are six links: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. Hand hygiene breaks the most important link. Wash with soap and water when hands are visibly soiled and after caring for a resident with C. difficile, because alcohol does not kill spores; use alcohol-based rub otherwise. Clean hands before and after every resident contact, after removing gloves, before eating, and after toileting.
Standard precautions and PPE
Treat all blood and body fluids as infectious. Wear gloves for contact with moisture, a gown if splashing is likely, and a mask with eye protection if fluid could spray. Donning order: gown, mask, goggles, then gloves. Doffing order: gloves first, then goggles, then gown, and the mask last, handled by the ties. Never wear the same gloves from one resident to the next, and never use gloves as a substitute for handwashing.
Transmission-based precautions
Contact precautions (MRSA, C. difficile, scabies) require gown and gloves and dedicated equipment. Droplet precautions (influenza, pertussis) require a mask; the door may stay open. Airborne precautions (tuberculosis, measles, disseminated shingles) require an N95 respirator, a negative-pressure room, and a closed door.
Traps
Putting gloves on before the gown, or removing the mask before the gown. Forgetting to clean shared equipment such as a blood pressure cuff or stethoscope. Recapping a used needle. Delaying a report after a needlestick or splash.
Rule of thumb
Gloves go on last and come off first; the mask comes off last.