Safety and Infection Control
What this domain tests
This domain covers preventing harm - falls, medication errors, restraint use, and transmission of infection. You must know standard precautions (applied to all clients: hand hygiene, gloves, gown, mask, eye protection based on exposure risk) and transmission-based precautions: contact (MRSA, C. difficile, scabies), droplet (influenza, pertussis, meningococcal meningitis), and airborne (tuberculosis, measles, varicella).
Concepts to master
- Chain of infection and where each intervention breaks it; hand hygiene is the single most effective measure.
- Personal protective equipment donning and doffing order, and when to remove gloves.
- Isolation room requirements: negative-pressure room with N95 for airborne; private room or cohorting for contact and droplet.
- Fall prevention: bed low and locked, call light within reach, non-skid footwear, hourly rounding.
- Restraints as a last resort, with a provider order, time limits, and frequent monitoring.
- Safe medication practices: the rights of administration, two-client identifiers, and high-alert medication double-checks.
Traps
C. difficile requires soap-and-water handwashing because alcohol gel does not kill spores. Droplet precautions require a mask within about 3 feet but not an N95. Never apply restraints for convenience or staffing. Do not skip standard precautions for a client with no known infection.
Rule of thumb
Name the route of transmission, then pick the precaution that blocks it. If unsure, standard precautions plus client-specific judgment is the safe default.
Worked example: A client with active pulmonary tuberculosis is admitted. The nurse places the client in a negative-pressure room, wears an N95 respirator, and keeps the door closed - airborne precautions. A surgical mask on the client is added when transport is necessary.