Infection Control, Safety, and Mobility
Chain of infection and hand hygiene
Six links: pathogen, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. Hand hygiene breaks the chain best. Soap and water for at least 20 seconds is required when hands are visibly soiled and for C. difficile and norovirus, because alcohol does not kill spores.
Precautions and PPE
Standard precautions apply to every patient. Transmission-based precautions add: contact (private room, gown and gloves; MRSA, C. diff, scabies), droplet (mask within 3 to 6 feet; influenza, pertussis, meningitis), airborne (N95 plus negative-pressure room; TB, measles, varicella). Donning order is gown, mask, goggles, gloves; doffing removes gloves first, then goggles, gown, mask, with hand hygiene afterward. Never recap a needle; activate the safety device and dispose at the point of use. After a needlestick, wash with soap and water and report immediately.
Safety and mobility
Fall prevention: bed low and locked, call light in reach, non-skid footwear, frequent rounding. Restraints require a provider order, the least restrictive device, and frequent checks; never tie to side rails. Fire response uses RACE (rescue, alarm, contain, extinguish) and PASS for the extinguisher. A cane goes on the stronger side and advances with the weaker leg; with a walker, the patient moves the walker, then the weaker leg, then the stronger leg. Use a gait belt and bend your knees.
Worked example
You notice C. diff stool on your glove. Rule of thumb: soap and water, not alcohol sanitizer, because spore-formers survive alcohol.