Safe and Effective Care Environment: Safety and Infection Control
Safety and Infection Control
This domain tests prevention of harm and transmission: standard precautions, isolation, environmental safety, restraints, and emergency response. Questions often hinge on a single infection-control detail or a sequencing step.
Core rules
- Standard precautions apply to every client: hand hygiene, gloves for body fluids, gown/mask/eye protection when splash is likely.
- Transmission-based precautions: contact for C. difficile, MRSA, scabies; droplet for influenza, pertussis, mumps, meningococcal meningitis; airborne for tuberculosis, measles, varicella, and disseminated shingles.
- Airborne precautions require a fit-tested N95 or higher respirator and a negative-pressure room. Droplet precautions require a surgical mask within about 3 feet.
- Use soap and water for C. difficile and norovirus because alcohol rub is not sporicidal.
- Restraints need a provider order, the least restrictive device, frequent monitoring, and timely reassessment. Fire response: RACE (rescue, alarm, contain, extinguish); PASS for extinguisher use.
Worked example
A client has frequent watery stools and is suspected of having C. difficile. Place the client in a private room under contact precautions; wear gown and gloves; use dedicated equipment; perform hand hygiene with soap and water after contact. Alcohol-based rub is not adequate because spores survive it. Do not stop contact precautions just because the stool culture is pending; initiate precautions empirically.
Traps that cost marks
Using alcohol rub after C. difficile care; wearing gloves without hand hygiene; using a surgical mask for tuberculosis; applying restraints without an order; documenting restraint checks without actually assessing circulation and skin.