A nurse is caring for multiple patients on a medical-surgical unit. Which action by the nurse demonstrates the most appropriate infection control practice?

Hand hygiene before and after each patient contact, even with gloves, is the most appropriate practice as it prevents cross-contamination and is a cornerstone of standard precautions. Other options either reuse gloves, use hand sanitizer inappropriately, or are condition-specific measures.

Correct Answer: 4

Analysis of Each Option

Option 1: Wearing the same pair of gloves while taking vital signs for three patients in the same room is a critical breach in infection control. Gloves are a single-use item intended for one patient and one episode of care. Changing gloves and performing hand hygiene between patients is a fundamental principle to prevent cross-contamination. Research on hand hygiene compliance highlights that healthcare workers often misunderstand the relationship between glove use and hand transmission; wearing the same gloves across multiple patients creates a direct vector for the spread of healthcare-associated infections (HAIs) ^[3].

Option 2: Using alcohol-based hand sanitizer after removing gloves is a correct action, but the phrasing of this option limits its appropriateness. While hand hygiene is essential after glove removal, it is not the most comprehensive demonstration of infection control practice. Studies evaluating hand hygiene behavior show that compliance is often lower after glove removal because a false sense of protection leads to missed hand hygiene opportunities . The core issue is that this option describes a single moment, whereas best practice requires a more consistent, multi-moment approach.

Option 3: Placing a patient with active tuberculosis in a private room with the door closed is a necessary transmission-based precaution, but it is incomplete. For active pulmonary tuberculosis, an airborne infection isolation room (AIIR) with negative pressure is the standard of care, not simply closing the door of a standard private room. While this action addresses a specific pathogen, it does not represent the foundational, universally applied practice that prevents the majority of HAIs. The scoping review on hand hygiene knowledge confirms that while specific isolation protocols are important, basic hand hygiene remains the single most critical measure for preventing transmission across all settings ^[3].

Option 4: Correct. Performing hand hygiene before and after each patient contact, even when gloves are worn, is the cornerstone of standard precautions and the most appropriate infection control practice. This action directly aligns with the World Health Organization's "5 Moments for Hand Hygiene" framework, which is the global standard for preventing HAIs. A digital-based observational study using eye-tracking technology confirmed that compliance with these specific moments—particularly before touching a patient and after body fluid exposure—is often suboptimal and requires objective reinforcement . Furthermore, a mixed-methods study utilizing the Consolidated Framework for Implementation Research (CFIR) demonstrated that role-stratified interventions significantly improve compliance with this exact practice, underscoring its fundamental importance regardless of a healthcare worker’s specific duties . The sustainability of this practice is critical; a retrospective study on the post-pandemic legacy of hand hygiene found that while overall compliance rates fluctuated, the ingrained habit of performing hand hygiene before and after patient contact is the primary behavioral target for maintaining long-term reductions in multidrug-resistant organism transmission . This practice acknowledges that glove use does not replace hand hygiene, as hands can become contaminated during glove removal through microscopic defects or improper doffing technique.