Infection Control and Safety Practices
Standard Precautions First
Every patient is potentially infectious, so standard precautions apply to all patients regardless of known status - not only to those with a reported bloodborne disease. Hand hygiene is the single most important step: soap and water for at least 20 seconds when hands are visibly soiled or after contact with spore-forming organisms such as C. difficile, and alcohol-based hand rub in other situations. Alcohol rubs do not kill spores.
PPE and the Environment
Don PPE before contact and remove it before leaving the treatment area: mask, eye protection, gown, and gloves last. Gloves never replace hand hygiene and must not be washed. Clinical contact surfaces receive an EPA-registered hospital-level disinfectant or a barrier; housekeeping surfaces need only low-level disinfection.
Sterilization Logic
Classify items by use. Critical items (surgery, bone, bloodstream) must be sterile. Semicritical items (contact with mucous membranes) need at least high-level disinfection - sterilize when heat tolerant. Noncritical items need low-level disinfection. A gravity steam cycle typically runs 121 °C at 15 psi for 15–20 minutes, or 132 °C for about 4 minutes. Check every load with a chemical indicator and run a biological spore test with Geobacillus stearothermophilus at least weekly for steam.
Traps
Favorite distractors: two-handed recapping (use a one-handed scoop or a recapping device), “disinfect” for an instrument dropped on the floor, and flash cycles used as routine sterilization rather than for an emergency.
Worked Example
A bur falls on the floor. It is contaminated: clean it, then sterilize it - never just wipe it with disinfectant. Rule of thumb: if it enters sterile tissue or the bloodstream, it must be sterilized, full stop.