Hygiene and Infection Control Notes (Week 2)

Hygiene and patient well-being

Hygiene helps prevent infection, maintain comfort and dignity, protect skin/mucous membranes, and support overall health.

Individualized hygiene care

Provide privacy, promote independence, maintain safety and warmth, anticipate needs, and adapt to the patient's condition.

Inflammatory response sequence

Injury → chemical mediator release → vasodilation → increased capillary permeability → white blood cell migration → phagocytosis → healing and repair.

Histamine in inflammation

Promotes vasodilation and increased capillary permeability.

Prostaglandins in inflammation

Contribute to pain and fever.

Cytokines in inflammation

Help regulate the immune response.

Vasodilation findings

Widened blood vessels increase blood flow, producing redness and warmth.

Increased capillary permeability

Fluid and proteins leak from vessels into tissues, causing swelling.

First white blood cells at many infection sites

Neutrophils arrive early to help fight infection.

Phagocytosis

White blood cells engulf pathogens; macrophages help clean up damaged tissue and debris.

Mucous membranes as a defense

Mucous membranes line the respiratory, digestive, and urinary tracts; mucus traps pathogens and limits entry into tissues/blood.

Skin as a defense

The skin is the body's first line of defense against pathogens.

Dermis function

Connective tissue gives skin strength and elasticity; the dermis also contains nerves.

Teeth and infection risk

Oral bacteria can damage enamel, contribute to infection, and increase the risk of tooth loss.

Nails as a defense

Keratin protects fingers/toes; keep nails clean and dry to limit bacterial growth.

Before hygiene care

Assess the patient's abilities, preferences, usual routine, safety risks, and ability to participate.

Hygiene care and independence

Offer choices and encourage the patient to perform the parts of care that can be completed safely.

Nurse safety during hygiene care

Raise the bed to a safe working height, use help when needed, and avoid leaving vulnerable patients unattended.

Hemiparesis

Weakness or reduced strength on one side of the body, often affecting the face, arm, or leg.

Hemiplegia

Paralysis affecting one side of the body.

Stroke and affected side

A stroke on one side of the brain generally causes motor impairment on the opposite side of the body.

Dressing a patient with unilateral weakness

Put clothing on the affected/weak side first, using the unaffected arm to help.

Undressing a patient with unilateral weakness

Remove clothing from the unaffected/strong side first, then remove it from the affected side.

Preferred bathing method for stroke patients

Showering is preferred when it is safe and appropriate for the patient's mobility, balance, and condition.

Older-adult bathing frequency

Older adults may have a less frequent bathing routine; individualize care according to preference and skin condition.

Older-adult skin

Older adults often have thinner, drier skin and may require gentler care.

Older-adult bathing water and soap

Use warm—not hot—water and avoid harsh soaps or cleansers.

Daily oral assessment

Inspect for dryness, sores, redness, bleeding, or other oral abnormalities.

Oral care and bleeding risk

Use extra-gentle brushing for patients taking blood thinners or with low platelets; avoid flossing unless approved.

Oral care for patients unable to brush

Use oral swabs or sponge brushes, maintain hand hygiene, and protect the airway.

Aspiration precautions during oral care

Use positioning that protects the airway, keep suction available, and never leave an at-risk patient alone with oral-care supplies.

Frequent oral moisture in dependent patients

Keep oral mucosa moist every 1-2 hours and provide thorough oral care every 8-12 hours or according to facility policy.

Chlorhexidine oral swabs

Use according to facility policy when indicated; verify the correct product and patient situation.

Denture cleaning

Remove carefully and clean daily with a soft brush and mild denture cleaner or soap; avoid abrasive regular toothpaste.

Denture storage

Store dentures in a clean, labeled container with water when not worn to prevent drying/cracking.

Denture handling safety

Do not place dentures on the meal tray; rinse thoroughly before reinsertion and confirm proper fit.

Foot-care assessment cues

Assess skin color, temperature, lesions, bruising/ecchymosis, nails, heels, mobility/gait, and sensation.

Nail cutting and facility policy

Do not cut a patient's nails unless an order or facility policy specifically permits it.

Diabetic foot care

Patients with diabetes require specialized foot care and careful assessment of skin, circulation, and sensation.

Drying feet after hygiene care

Dry the feet thoroughly, especially between the toes, to reduce trapped moisture.

Lotion and feet

Lotion may be applied to the feet, but do not place lotion between the toes.

Nail filing direction

If permitted, file nails with a straight edge rather than rounding the corners.

Foot-care water temperature

Use lukewarm water.

Foot color and temperature cues

Changes may suggest vascular or perfusion problems.

Foot lesions

May indicate an open wound, injury, skin cancer concern, or other breakdown requiring assessment.

Foot bruising/ecchymosis

May suggest injury or repeated falls at home.

Changes in foot sensation

May suggest vascular/perfusion problems or diabetes-related sensory changes.

Heel assessment

Check whether heels are moist, dry, cracked, irritated, or showing pressure-related changes.

Perineal hygiene principle

Provide privacy and perform care from cleaner areas toward more contaminated areas to limit spread.

Perineal care purpose

Clean the genital and anal areas to reduce urinary infection, skin irritation/breakdown, and discomfort while preserving dignity.

Perineal care direction

Clean from front to back and use a clean section of the washcloth or wipe for each stroke.

Perineal care supplies and safety

Use warm water and mild soap or perineal wipes, wear gloves, perform hand hygiene before/after, explain the procedure, and provide privacy.

Chain of infection: six links

Infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host.

Infectious agent

The pathogen causing disease, such as a bacterium, virus, fungus, or parasite.

Reservoir

The person, object, or environment where a pathogen lives and multiplies.

Portal of exit

How a pathogen leaves the reservoir, such as coughing, sneezing, blood, urine, or wound drainage.

Mode of transmission

How a pathogen spreads: direct/indirect contact, droplet, airborne, or vector-borne transmission.

Portal of entry

How a pathogen enters another host, such as broken skin, respiratory tract, mucous membranes, or urinary tract.

Susceptible host

A person at increased infection risk because of age, chronic illness, weakened immunity, poor nutrition, stress, or fatigue.

Breaking the chain of infection

Hand hygiene, PPE, cleaning/disinfection, isolation, vaccination, and proper wound care interrupt transmission.

Infection assessment findings

Fever, malaise, anorexia, erythema, edema, warmth, pain, altered drainage/mucus, and elevated white blood cells.

Normal white blood cell count

5,000-10,000/mm³.

Leukocytosis

An elevated white blood cell count that may support infection or inflammation assessment.

Erythrocyte sedimentation rate (ESR)

A nonspecific laboratory marker used to monitor inflammation.

Culture timing

Obtain ordered urine, blood, sputum, or wound cultures before starting antibiotics when possible.

Infection in older adults

New confusion, restlessness, or "fidgety" behavior may be an important infection cue.

Hand hygiene with alcohol-based product

Used in routine care when hands are not visibly soiled, including before patient/device contact, after environmental contact, and after glove removal.

Hand hygiene with soap and water

Required when hands are visibly soiled and after caring for a patient with infectious diarrhea such as C. difficile.

Medical asepsis

Clean technique: practices that reduce the number and spread of microorganisms.

Surgical asepsis

Sterile technique: practices that prevent contamination of a sterile field or item.

CLABSI prevention examples

Use sterile technique for central-line insertion/dressing and follow the central-line care bundle.

CAUTI prevention examples

Avoid unnecessary urinary catheters, maintain appropriate catheter care/hygiene, and follow the urinary-catheter bundle.

CAUTI: catheter necessity

Insert a urinary catheter only when medically necessary and remove it as soon as possible.

CAUTI: closed drainage system

Maintain a closed drainage system and avoid disconnecting catheter tubing.

CAUTI: drainage-bag placement

Keep catheter tubing free of kinks and the drainage bag below bladder level to reduce backflow.

CAUTI: catheter hygiene

Clean the insertion area daily with approved wipes or warm water/mild soap and perform hand hygiene before and after care.

SSI prevention examples

Maintain sterile technique, administer prescribed prophylactic antibiotics on time, assess the incision, and provide discharge education.

VAP prevention examples

Provide oral care and suctioning according to the ventilator-associated pneumonia prevention bundle.

Standard Precautions

Minimum precautions for all patients: hand hygiene, respiratory etiquette, task-based PPE, cleaning, safe laundry handling, and sharps safety.

When gloves are needed

Potential contact with body fluids, nonintact skin, or mucous membranes.

When eye protection is needed

Risk of splash or spray, such as suctioning, irrigating, coughing, or body-fluid exposure.

When a gown is needed

When the task may contaminate clothing or scrubs with infectious material.

Hand and nail infection-control guidelines

Avoid artificial nails, gel nails, and chipped nail polish.

Contact precaution transmission

Direct or indirect contact with the patient or contaminated environment/equipment.

Contact precaution organisms

MRSA, VRE, scabies, and Clostridioides difficile.

Contact precaution PPE

Gown and gloves; use dedicated/disposable equipment and follow room-cleaning policy.

C. difficile hand hygiene

Use soap and water; alcohol hand gel is not sufficient for spore-related precautions.

C. difficile environmental cleaning

Use a sporicidal disinfectant on contaminated objects and equipment.

Droplet transmission distance

Respiratory droplets generally travel approximately 3-6 feet.

Droplet precaution organisms

Influenza, meningitis, pertussis, and RSV.

Droplet precaution PPE

A surgical mask; add other PPE when the task or exposure requires it.

Transporting a droplet-precaution patient

Place a surgical mask on the patient when leaving the room.

Airborne transmission

Small particles remain suspended and can travel more than 6 feet through airflow.

Airborne precaution organisms

Tuberculosis, varicella/chickenpox, disseminated herpes zoster, and measles.

Airborne precaution room

Use an airborne-infection isolation room (AIIR), ideally private, and keep the door closed.

Airborne precaution respirator

Use a fit-tested N95 respirator and remove it outside the room.

Airborne precautions: PPE for suspected measles

Wear a fit-tested N95 respirator, gown, gloves, and eye protection when indicated by the patient-care situation.

Transporting an airborne-precaution patient

Place a surgical mask on the patient for necessary transport.

Dedicated patient equipment

Keep dedicated equipment such as a stethoscope with the patient or use disposable equipment.

MRSA

Methicillin-resistant Staphylococcus aureus, an organism resistant to many antibiotics.