Infection Control, Patient Safety and Quality Improvement
Infection Control, Patient Safety and Quality Improvement is examined through scenarios where one action breaks the chain of transmission or prevents a never event. Expect items on standard precautions, sterilisation levels, post-exposure management and care bundles.
Breaking the chain
Standard precautions apply to all patients regardless of diagnosis: hand hygiene, gloves, gown, mask and eye protection according to anticipated exposure, safe sharps handling and clean linen. Transmission-based precautions add contact, droplet or airborne measures. Gloves never replace hand hygiene.
Sterilisation and disinfection
Spaulding classification: critical items enter sterile tissue and need sterilisation; semicritical items contact mucosa and need high-level disinfection; non-critical items touch intact skin and need low-level disinfection. Steam autoclave at 121 °C, 15 psi for 15 minutes uses Geobacillus stearothermophilus spores as the biological indicator.
Worked example
A nurse sustains a needlestick from a patient known to be HIV positive. Reasoning: wash the site with soap and water without squeezing or milking, report immediately, and start post-exposure prophylaxis as soon as possible, ideally within two hours and no later than 72 hours, after baseline testing and counselling.
Patient safety and bundles
Core safety goals include correct patient identification, effective communication, safe high-alert medication use, safe surgery, infection reduction and fall prevention. Central line bundles use chlorhexidine skin antisepsis and maximal barrier precautions; ventilator bundles use head-of-bed elevation of 30–45 degrees and daily sedation interruption; catheter-associated urinary infection is prevented by early removal.
Traps that cost marks
- Recapping needles or milking a needlestick wound.
- Wearing gloves in place of hand hygiene between patients.
- Treating a near miss as nothing to report, when it is the cheapest warning available.