Safety and Infection Prevention and Control
Precautions, error prevention, and keeping the room safe
Standard precautions apply to every patient, every time: hand hygiene before and after contact, gloves for any contact with blood or body fluids, and eye protection when splashes are possible. Everything else stacks on top of this baseline.
Transmission-based precautions
Contact precautions add a gown and gloves for organisms that spread by touch: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), C. difficile, scabies, and respiratory syncytial virus (RSV), with dedicated equipment kept in the room. Droplet precautions add a surgical mask within about three feet for illnesses carried on large respiratory droplets: influenza, pertussis, mumps, rubella, and meningococcal meningitis. Droplets fall fast, so a regular mask and a private room cover it.
Airborne precautions are the serious tier: an N95 respirator that you fit-tested, plus a negative pressure room with the door closed. The classic trio is measles, tuberculosis, and varicella. If the patient must travel, the patient wears a surgical mask, not the N95.
Airborne = MTV: Measles, TB, Varicella. If the stem mentions one of these three, the answer involves an N95 and a negative pressure room.
Alcohol-based hand gel does not kill C. difficile spores. After caring for a C. diff patient, wash with soap and water, and clean the room with a sporicidal agent such as bleach.
Sterile versus clean
Sterile technique is for anything entering a sterile body space: urinary catheter insertion, central line dressing changes, surgical procedures. Clean technique covers most everything else, including routine nasogastric (NG) tube insertion. On a sterile field, the outer one-inch border is contaminated, anything below your waist or out of your sight is contaminated, and reaching over the field contaminates it.
Error prevention
Two patient identifiers before every med, treatment, and specimen: usually name and date of birth, checked against the band. The room number is never an identifier, because patients move. Verbal and phone orders get written down and read back for confirmation, and the med rights (right patient, drug, dose, route, time, and documentation) get run every single pass.
Any answer choice that identifies a patient by room number, bed, or diagnosis is wrong. Any answer where the nurse repeats a verbal order back to the provider is usually right.
Falls and restraints
Fall prevention starts with screening, then layers: bed low and locked, call light in reach, nonslip footwear, clutter cleared, hourly rounding, and a bed alarm or a room near the station for high-risk patients. On the floor, most falls happen on the way to the bathroom, so toileting on a schedule is quiet gold.
Restraints are the last resort after alternatives fail, and they require a provider order that is never written as needed. For violent or self-destructive behavior the provider must evaluate in person quickly (within one hour under the Centers for Medicare and Medicaid Services (CMS) rules), orders expire and must be renewed, and the nurse checks circulation, skin, and needs at regular intervals, tying restraints with a quick-release knot to the bed frame, never the side rail.
Fire, codes, and equipment
Fire response is RACE: rescue anyone in danger, activate the alarm, contain by closing doors, extinguish or evacuate. Extinguisher use is PASS: pull, aim at the base, squeeze, sweep. Equipment safety is unglamorous but tested: three-prong grounded plugs, no frayed cords, and any malfunctioning device is removed from use, tagged, and reported, with the device saved if it was involved in an incident.