Hand hygiene is the single most effective action to prevent pathogen transmission and healthcare-associated infections (HAIs) [2]. The statement in option 1 reflects the foundational standard of the World Health Organization's 'Five Moments for Hand Hygiene,' requiring hand hygiene before touching a patient, before a clean/aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching patient surroundings. Performing hand hygiene before and after patient contact, even when gloves are worn, is critical because glove use does not replace the need for hand hygiene; hands can become contaminated during glove removal or through micro-perforations. A multicenter observational study in Greece found that hand hygiene compliance was suboptimal, and inappropriate glove use often led to missed hand hygiene opportunities [2]. Furthermore, research in surgical settings demonstrated that alcohol-based hand rub and hand washing both significantly reduce microbial colonization on nurses' hands, reinforcing the necessity of the mechanical and chemical removal of pathogens between every patient encounter .
Option 2: Using the same stethoscope for all patients after wiping it with an alcohol pad between uses is an unsafe practice. While disinfecting shared equipment is a component of infection prevention, the stethoscope diaphragm and tubing can harbor pathogens, including MRSA. For patients in contact isolation, dedicated disposable equipment or single-patient-use stethoscopes should remain in the room to prevent cross-contamination. The scenario specifically includes a patient with an MRSA wound infection, making shared equipment a significant transmission risk, even with intermediate cleaning.
Option 3: Wearing gloves throughout the entire shift represents a severe breach of infection control. Gloves are indicated for specific tasks involving potential contact with blood, body fluids, or contaminated surfaces and must be changed between patients and between different procedures on the same patient. Wearing the same pair of gloves continuously leads to the accumulation of pathogens on the glove surface, turning them into a vehicle for cross-contamination. A study on hand hygiene and glove use highlighted that inappropriate glove use is a barrier to proper hand hygiene, as healthcare workers often neglect hand hygiene moments when gloves are worn [2].
Option 4: Removing an isolation gown outside the patient's room is incorrect. The proper sequence for doffing personal protective equipment (PPE) for a patient in contact isolation requires removing the gown and gloves inside the patient's room, immediately before exiting. The outside of the gown is considered heavily contaminated. Removing it in the hallway risks contaminating the environment and other individuals. Hand hygiene must be performed immediately after removing PPE inside the room. Long-term care studies emphasize that institutional infection prevention and control capacity, including proper PPE doffing protocols, is essential to modifying individual behavioral factors and improving overall hand hygiene performance .
Perform hand hygiene before and after every patient contact, even if gloves are worn. Gloves are not a substitute for handwashing; hands can become contaminated during glove removal or through micro-perforations.
For patients in contact isolation, use dedicated equipment (e.g., stethoscope, thermometer) that remains in the room. If equipment must be shared, it must be thoroughly cleaned and disinfected before use on another patient.
Never wear the same pair of gloves for multiple patients or tasks. Remove and discard gloves inside the patient's room, and perform hand hygiene immediately. Remove isolation gowns inside the room to prevent contaminating the hallway.
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