Patient safety, quality improvement, and infection control
Domain 6 - Patient safety, quality improvement, and infection control
This domain tests systems thinking: how errors happen, how to measure and improve care, and how to prevent healthcare-associated infection.
Core rules
- Apply standard precautions to every patient and transmission-based precautions when indicated.
- WHO 5 Moments for Hand Hygiene: before patient contact, before an aseptic task, after body fluid exposure, after patient contact, and after touching surroundings.
- Use care bundles for CLABSI, CAUTI, ventilator-associated pneumonia, and surgical site infection.
- Report incidents; use root cause analysis for systems failures and PDSA cycles for improvement.
- Reconcile medications at transitions, label lines and specimens, and clean shared equipment.
Worked example
An ICU notes rising CLABSI rates. A PDSA cycle audits insertion-checklist compliance, observes hand hygiene, introduces chlorhexidine skin antisepsis, and adds daily line-necessity review. CLABSI per 1000 line days is measured before and after. If rates fall, the changes are standardized and auditing continues. The aim is system change, not blaming an individual.
Traps
- Blaming individuals for systems errors.
- Confusing surveillance definitions with clinical diagnosis.
- Skipping hand hygiene before aseptic tasks.
- Changing several things at once so improvement cannot be attributed.