NCLEX-RN Flashcards: Safety, Infection Control, Standard Precautions, Isolation

Standard precautions are infection control practices applied to all patients regardless of diagnosis or presumed infection status. They include hand hygiene before and after patient contact, use of personal protective equipment when contact with blood or body fluids is anticipated, safe injection practices, respiratory hygiene and cough etiquette, safe handling of contaminated equipment and surfaces, and proper sharps disposal. Standard precautions treat all blood, body fluids except sweat, non-intact skin, and mucous membranes as potentially infectious.

The three types are contact precautions, droplet precautions, and airborne precautions. Contact precautions require gown and gloves for diseases spread by direct or indirect contact, such as MRSA, C. difficile, and scabies. Droplet precautions require a surgical mask within six feet for diseases spread by large respiratory droplets, such as influenza, pertussis, and meningococcal meningitis. Airborne precautions require an N95 respirator and a negative pressure room for diseases spread by tiny airborne particles, such as tuberculosis, measles, and varicella.

Airborne precautions are required for diseases spread by tiny particles that remain suspended in the air and can travel long distances. The key diseases requiring airborne precautions are tuberculosis, measles also called rubeola, varicella also called chickenpox, and disseminated herpes zoster also called shingles in immunocompromised patients. The patient must be placed in a negative pressure airborne infection isolation room. Healthcare workers must wear an N95 respirator or higher-level respirator that has been fit-tested. The door must remain closed.

The correct order for donning, or putting on, PPE is gown first, then mask or respirator, then goggles or face shield, then gloves last. The correct order for doffing, or removing, PPE is gloves first because they are the most contaminated, then goggles or face shield, then gown, and then mask or respirator last. Hand hygiene is performed after removing gloves and again after removing all PPE. The doffing sequence minimizes self-contamination because the most contaminated items are removed first while cleaner items protect the hands and face during the process.

The chain of infection has six links: the infectious agent or pathogen, the reservoir where the organism lives and multiplies, the portal of exit from the reservoir, the mode of transmission, the portal of entry into a new host, and the susceptible host. Nurses can break the chain at any link: destroying pathogens through sterilization and disinfection, eliminating reservoirs through environmental cleaning, blocking portals of exit with wound dressings and respiratory hygiene, interrupting transmission with hand hygiene and PPE, protecting portals of entry with aseptic technique, and stre

Medical asepsis, or clean technique, reduces the number and spread of microorganisms through practices like hand hygiene, gloving, and environmental cleaning. It does not eliminate all organisms. Surgical asepsis, or sterile technique, eliminates all microorganisms from an object or area and is required for procedures that penetrate the skin or enter sterile body cavities, such as inserting urinary catheters, changing central line dressings, and performing wound irrigation.

Fall prevention requires identifying high-risk patients using a validated tool like the Morse Fall Scale, which assesses history of falls, secondary diagnoses, ambulatory aids, intravenous therapy, gait, and mental status. Interventions include keeping the bed in the lowest position with wheels locked, ensuring the call light is within reach, keeping the environment well-lit and free of clutter, assisting with ambulation, using non-skid footwear, providing toileting assistance on a schedule, and reviewing medications that increase fall risk such as sedatives, opioids, and antihypertensive

A gait belt, also called a transfer belt, should be used when assisting any patient who has weakness, unsteady gait, impaired balance, recent surgery, or a history of falls. It is placed snugly around the patient's waist over clothing and the nurse grips it from behind to support the patient during standing, walking, and transferring. The nurse should walk slightly behind and to the side of the patient. If the patient begins to fall, the nurse uses the belt to guide the patient slowly to the floor rather than trying to hold them upright. ---