Patient Positioning, Safety, and Infection Control
What the exam tests
Patient Positioning, Safety, and Infection Control tests pressure injury prevention, nerve protection, fire safety, and aseptic practice.
Core rules and concepts
- Pad all pressure points and keep the body in neutral alignment. Protect eyes, ears, breasts, genitals, and bony prominences.
- Common nerve injuries: brachial plexus with arm abduction or Trendelenburg, ulnar nerve at the elbow, common peroneal nerve at the fibular head.
- Prone position: protect eyes from pressure, support the chest and pelvis, allow abdominal freedom, and check all lines.
- Fire triad: oxidizer, fuel, ignition. Let alcohol skin prep dry, avoid electrosurgery in an oxygen-rich field, and keep drapes loose around oxygen.
- Infection control: hand hygiene, PPE, clean versus sterile technique, disinfection of laryngoscope blades, single-use items, and safe sharps disposal.
Worked example
A patient is prone for lumbar surgery and the head is turned to the left. Reasoning: the dependent eye and orbit are at risk of pressure ischemia; the brachial plexus is at risk if the arm is over-abducted. Reposition the head, check eyes and ears, pad the arms, and confirm no pressure on the abdomen.
Traps
Do not place arms beyond 90 degrees of abduction. Do not allow alcohol prep to pool under drapes. Do not reuse a single-use airway device. Do not ignore a reddened pressure area at handover. Do not let oxygen accumulate under drapes during head and neck surgery.