Infection Control Fundamentals
Standard Precautions
- Hand hygiene is the single most effective method to prevent healthcare-associated infections and must be performed before and after every patient contact.
- Personal Protective Equipment (PPE) includes gloves, gowns, masks, and eye protection, worn based on anticipated exposure to blood, body fluids, secretions, and excretions.
- Safe injection practices require using sterile, single-use disposable needles and syringes for each injection, and single-dose vials when possible.
Key Points
- Apply standard precautions to ALL patients regardless of diagnosis
- Hand hygiene: 15-20 seconds with soap or alcohol-based sanitizer
- Don PPE before patient contact, remove after leaving room
Transmission-Based Precautions
| Type | Examples | PPE Required |
|---|
| Contact | MRSA, VRE, C. diff | Gloves + Gown |
| Droplet | Influenza, Pertussis | Surgical Mask |
| Airborne | TB, Measles, Chickenpox | N95 Respirator |
Memory Aid: "My Chicken Needs Masks" - Measles, Chickenpox, rubeola Need N95 masks (airborne precautions)
Patient Safety Fundamentals
Fall Prevention
- Assess fall risk using standardized tools (Morse Fall Scale, Hendrich II)
- Implement bed alarms, non-slip socks, and adequate lighting
- Keep call light within reach and respond promptly to requests
- Ensure pathways are clear and assistive devices are available
High-risk patients include those over 65, on sedatives/hypnotics, with history of falls, or experiencing orthostatic hypotension
Medication Safety
- Six Rights of Medication Administration: Right patient, drug, dose, route, time, and documentation must be verified before each administration.
- High-alert medications like insulin, heparin, and chemotherapy require double-checking by two licensed nurses before administration.
Memory Aid: "Please Don't Dare Risk Taking Drugs" - Patient, Drug, Dose, Route, Time, Documentation
Biologic/Chemical Warfare Response
Biologic Agents
- Anthrax presents as cutaneous lesions, inhalational symptoms, or gastrointestinal distress; treated with ciprofloxacin or doxycycline.
- Smallpox requires immediate isolation and vaccination within 3-4 days of exposure for effectiveness.
- Botulism causes descending paralysis starting with cranial nerves; treated with antitoxin and supportive care.
Clinical Scenario: Multiple patients present with sudden onset of flu-like symptoms, fever, and respiratory distress. Suspect bioterrorism and immediately notify infection control, isolate patients, and contact public health authorities.
Chemical Agents
- Nerve agents (sarin, VX) cause cholinergic crisis with SLUDGE symptoms; treated with atropine and pralidoxime.
- Vesicants (mustard gas) cause severe skin and respiratory burns; treatment is supportive with decontamination priority.
- Decontamination must occur before patient enters healthcare facility to prevent secondary contamination of staff and environment.
SLUDGE Memory Aid: Salivation, Lacrimation, Urination, Defecation, Gastrointestinal distress, Emesis
Study Tips & Quick Checks
Quick Check - PPE Removal Order:
- Gloves (most contaminated)
- Goggles/Face shield
- Gown
- Mask (least contaminated)
Remember: Most contaminated items come off first!
Common Pitfalls to Avoid
- Don't assume all respiratory infections need airborne precautions
- Never remove PPE inside patient room
- Hand hygiene is required even when gloves are worn
- Biologic agents may have delayed symptom onset
Self-Assessment Checklist:
- ☐ Can I identify appropriate precautions for common infections?
- ☐ Do I know the correct PPE donning/doffing sequence?
- ☐ Can I recognize signs of biologic/chemical exposure?
- ☐ Do I understand the difference between isolation and quarantine?