Infection Control
Infection control is among the easiest scoring areas on the exam if you memorize a few hard rules, and the most commonly missed if you rely on instinct.
Core concepts
- Chain of infection: infectious agent, reservoir, exit, transmission, entry, susceptible host. Hand hygiene breaks more links than anything else you do.
- Hand hygiene: alcohol-based rub for most situations; soap and water when hands are visibly soiled and after caring for a resident with C. difficile or norovirus, because alcohol does not reliably kill spores.
- Standard precautions: apply to every resident every time, because you cannot tell who is infectious. Gloves for blood, body fluids, secretions, excretions, non-intact skin, and mucous membranes.
- PPE order - donning: gown, mask or respirator, goggles or face shield, gloves last. Doffing: gloves first, then goggles, then gown, then mask; hand hygiene afterward.
- Transmission-based precautions: contact (gown and gloves), droplet (mask), airborne (fit-tested N95 and a negative-pressure room, arranged by the nurse).
- Clean to dirty: clean surfaces before soiled ones. Never shake linens or hold them against your uniform. Do not share razors, toothbrushes, or washbasins.
Traps
"Wear gloves instead of washing hands" is always wrong - gloves are not a substitute for hand hygiene. So is "double bag all trash." Another trap is wearing the same gloves from one resident to the next, or leaving a room wearing gloves to open the door.
Rule of thumb
Clean hands before and after every resident contact and after removing gloves. Two exceptions require soap and water: visibly soiled hands, and C. difficile or norovirus.
Worked example
You are assigned a resident with C. difficile diarrhea. Correct sequence: wash hands with soap and water, don gown, don gloves, give care, remove gloves, remove gown, then wash hands again with soap and water - not the alcohol rub.