Fundamentals of Nursing and Infection Prevention
Fundamentals and infection prevention tests the bedrock of safe nursing: assessment, hygiene, asepsis, medication administration, mobility, wound care, and documentation. OMSB items often ask which action best prevents transmission or which step comes first in a procedure.
Core rules
- WHO 5 Moments for hand hygiene: before touching a patient, before clean/aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching patient surroundings. Alcohol rub is preferred for routine hand hygiene when hands are not visibly soiled; soap and water are required for C. difficile, norovirus, and visible contamination.
- PPE: don gloves and gown before contact; remove gloves first, then gown, then perform hand hygiene; remove mask/respirator by the straps, not the front. Gloves do not replace hand hygiene.
- Sterile technique: sterile field stays above waist level, avoid talking/coughing over it, and consider anything below waist or outside the field contaminated.
- Medication rights: right patient, drug, dose, route, time, and documentation; add reason and response. Check allergies and use two identifiers.
- Pressure injury prevention: reposition, offload, manage moisture, and inspect skin; stage by deepest visible tissue, not by size.
- Document objectively and contemporaneously; late entries must be marked as late.
Worked example
A nurse is about to suction a ventilated patient. Reasoning: perform hand hygiene, apply sterile gloves, use sterile suction catheter, preoxygenate, suction for no more than 10–15 seconds, and monitor for bradycardia and hypoxemia. Hand hygiene before the aseptic procedure and after body-fluid exposure are both required. Gloves alone do not protect the next patient.
Traps
Do not use alcohol rub for C. difficile spores. Do not turn away to answer a call while a sterile field is open. Do not chart a medication before giving it. Do not delegate assessment, teaching, or evaluation to unlicensed staff.