Infection Prevention
Every clinical station can lose marks here. The exam expects standard precautions applied to birth, not a memorised list of disinfectants.
Standard precautions
Assume every woman is infectious. Perform hand hygiene at the WHO five moments, glove for blood and body fluids, protect eyes where splashing is likely, and never recap needles. Clean visible soiling before disinfection. Sterilise by autoclave at 134 °C for 3–4 minutes or 121 °C for 15 minutes at 15 psi, with chemical indicators and periodic biological controls.
Birth-specific practice
Clean delivery kit, clean hands and perineum, no unnecessary vaginal examinations, aseptic technique for episiotomy and repair, safe sharps disposal, and correct waste segregation. Where neonatal mortality is high, chlorhexidine cord care reduces infection.
Blood-borne exposure
Wash the wound with soap and water, do not squeeze it, apply antiseptic and report immediately. HIV post-exposure prophylaxis should start within two hours and no later than 72 hours, with baseline and follow-up testing; hepatitis B vaccination and immunoglobulin follow the national schedule.
Worked example
A midwife sustains a needlestick while repairing a perineum for a woman of unknown HIV status. Reasoning: test the source with consent, take the midwife's baseline, and start prophylaxis without waiting for the result when risk is significant. Follow-up serology at six weeks, three months and six months.
Traps
Double gloving instead of safe device practice; alcohol rub against C. difficile spores; skipping hand hygiene because gloves were worn; delaying prophylaxis while awaiting a source result.