Page 2 - Safety and Infection Control Study Guide for the NCLEX-PN Exam

Infection Control

Part of maintaining a safe client environment is ensuring that there is as little exposure to new infection as possible. There are many things a nurse can do to minimize the incidence of infection spread.

General Precautions

Infection control in healthcare is achieved through basic methods such as the prevention of disease spread with the proper precautions, proper equipment for specific precautions, appropriate cleaning agents for a specific contaminant, hand hygiene, and making sure clients and staff are educated on the prevention of infection/disease spread.

Communicable Diseases

As a nurse, it is vital to be well informed about all communicable diseases in our world for your safety as well as your clients’. You should be fully educated on the basics of the disease (what it is, symptoms, treatments) as well as the specific way each disease can be transmitted from person to person. This is the only way to truly prevent the spread of infection. Airborne, contact, and droplet precautions are the precautions to use, depending on how the disease is transmitted. These are used in addition to hand hygiene and universal precautions that are already in place. For example, a client with known or suspected Clostridium difficile (C. diff) would have additional contact precautions implemented due to the disease spreading via physical contact. (Specific precaution types are discussed below.)

Sources of Infection and Transmission

Prevention of infection is also about the elimination of the suspected germ in an environment. Equipment and client care areas are places where germs may be living, and these places need to be decontaminated during client care and in between clients.

Equipment Use

When using healthcare facilities’ equipment with numerous clients, it is very important to appropriately clean that equipment in between client use. Wiping down client beds, diagnostic equipment, and not reusing single-use items are examples of proper equipment use. Using only cleaning products that are evidence-based in best practice. It is also important to know what products are effective when exposure to a specific germ occurs.

Client Care Areas

Any object that comes in contact with a client’s room or bay turns into a potentially contaminated element that could become a source of infection. Having environmental control of these areas helps reduce the risk of this happening. For example, a contact precaution client should get disposable dining ware. Also, when assigning cohorts, the nurse should be thoughtful of the transmission route of any illness to prevent further spreading to that client’s neighbor.

Specific Precautions

Every healthcare facility has procedures in place to protect their clients and staff. To help prevent the spread of infection, universal precautions, also known as standard precautions, are utilized for every client regardless of his or her diagnosis. These precautions involve techniques that help prevent nosocomial infections and include these practices:

  • Wear gloves during tasks where exposure to bodily fluids is expected.
  • Employ proper hand hygiene.
  • Wipe down equipment in between clients.
  • Use needle safety procedures.

Isolation Precautions

Outside of the standard precautions used for every client, there are three types of transmission-specific precautions to fully understand: contact, droplet, and airborne. The type of precaution translates to how the disease is spread. When these precautions have been implemented for a client, it is just as important to understand what those precautions mean in terms of what you do as a nurse. These are the basic descriptions:

Contact precautions— Contact precautions involve the use of an isolation gown and gloves when performing client care. Nurses and clients should leave everything in the room, including disposable dinnerware, isolation gown and gloves, and necessary client equipment. Terminally clean client area with appropriate disinfectants to prevent the spread of infection on contact surfaces.

Droplet precautions— Nurses and staff should continue contact precautions and add a mask when in close proximity to the client, allow three to six feet of spatial separation, and have the client wear a mask during transport within the facility.

Airborne precautionsBuilding on contact and droplet precautions, clients should be placed in a private/negative air pressure room, healthcare staff should wear N95 masks, and the door should remain closed at all times.

A nurse should be fully knowledgeable in every detail of each precaution.

Hand Hygiene

Hand hygiene is probably one of the most important components in healthcare with regard to pathogen exposure and infection prevention. These are times that hand hygiene should be implemented:

  • Before/after removing gloves
  • Before/after client contact
  • Immediately if in contact with any bodily fluids
  • Between tasks or procedures with a client

To effectively apply hand hygiene:

  • Wash hands with hot water and soap for 30 seconds while scrubbing nails and palms up to mid-forearm.
  • Fingers should be interlaced and hands to wrists should be lathered up.
  • Turn off the faucet using the elbow or a barrier, such as a paper towel.
  • Keep wet hands elevated above elbows to prevent water from running back down.

Alcohol-based solution (hand sanitizer) is the alternative to washing hands. Rub together until the solution evaporates. The same implementation times used for handwashing apply to sanitizer use.

Protective Precaution Equipment

Protective precaution equipment, or PPE, is the term for the tools you need to implement a precaution. Gown, mask, goggles, and gloves are all PPE. They are also mentioned here in the order they should be donned. Removal of PPE goes in the order of gloves, goggles, gown, and mask.

Aseptic Technique

Aseptic technique goes a step further from clean techniques to sterile techniques, which have much stricter standards. This applies to circumstances where infection risk is very high (procedures such as Foley placement, surgery, wound care, etc.). Sterile gloves are the main tool used for this technique. Sterile gowns, masks, and surgical hats are also utilized for surgery.

The technique is performed as follows:

  • Apply a mask prior to scrubbing hands.
  • Scrub hands, wrists, and forearms with a brush for 2–3 minutes.
  • Dry off with a sterile towel.
  • Apply a sterile gown.
  • Don sterile gloves. When applying sterile gloves, only touch the inside with your hand by tucking your fingers in and touching the outside using the outside of the other sterile glove.

When setting up a sterile field, start by creating the field by opening a sterile cover stand, kit, or tray. When opening, only touch 1 inch of corners and open away from your body. When the sterile field is created, open sterile supplies and drop on the field. Keep supplies above your waist and do not touch sterile with clean or it is considered contaminated.

Additional Safety Practices

There are several other procedures that can enhance safety practices.

Client Knowledge

Knowing the risk factors for contracting any type of pathogen is also a way to prevent its spread—and you can help by educating your clients. If you have a client who is a known IV drug user, that client should know for what diseases he or she is at risk. Unsafe sex practices can lead to STDs (also known as STIs) such as gonorrhea, chlamydia, HIV, AIDS, etc. Educating your client on safe sex practices (limiting the number of partners, condoms, etc.), as well as educating clients on ways these diseases can be contracted (blood/body fluids including breast milk, IV drug users sharing needles, and sexual contact), is the responsibility of the nurse.

Other Staff Members

Ensure your team members follow precautions set in place and are made aware if new ones have been initiated for a client. Speak up if you see a fellow nurse using unsafe techniques such as “popping the glove”, where the fingertip of a glove is removed during IV or blood draw in order to better feel a vein. Also, ensure your colleagues are using safe practice for their clients. If sterile technique is broken and the team member continues with a procedure, it is your duty to stop the procedure to maintain sterility throughout client contact.

Immunocompromised Clients

Clients on medications that suppress their immune systems, like chemotherapy, autoimmune drugs, etc., are at higher risk for infection than the average individual. Herd immunity with the utilization of vaccines is one way these clients have been protected in the past. Neutropenic precautions (precautions to prevent infection in severely immunocompromised clients) when they are inclients is another method of protecting these clients.

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