Saftey and infection

What framework should I use for Safety & Infection questions?

HAZARD → PROTECT → STOP → ASSESS → ESCALATE → DOCUMENT

Ask:

• What is unsafe?

• Who is at risk?

• Is harm happening right now?

• Can I stop it?

• Did harm occur?

• Who needs notification?

• What needs documentation?

NCLEX RULE: Protect before reporting.

What is the biggest “FIRST action” rule in safety questions?

If danger is actively occurring:

STOP THE HARM FIRST.

Examples:

• Wrong med infusing → stop infusion

• Transfusion reaction → stop blood

• Coworker about to give wrong med → stop administration

• Defective equipment → stop using it

• Contaminated sterile item → replace it

Then assess → notify/escalate → document.

What is the general Safety priority hierarchy?

Prioritize:

1. Immediate life threat

2. Client actively being harmed

3. Serious/imminent injury

4. Infection exposure threatening multiple people

5. Unsafe treatment about to happen

6. Environmental hazards

7. Teaching/prevention

Active harm > potential future harm.

What are Standard Precautions and who gets them?

EVERY CLIENT.

Includes:

• Hand hygiene

• PPE based on expected exposure

• Respiratory hygiene

• Injection/sharps safety

• Environmental cleaning

• Safe equipment/linen/specimen handling

Don't wait for an infection diagnosis.

When is hand hygiene required?

Think BEFORE CLEAN + AFTER DIRTY/CONTACT.

• Before touching client

• Before aseptic procedure

• Before dirty → clean body site

• After client contact

• After environment contact

• After blood/body fluids

• After removing gloves

🚨 Gloves NEVER replace hand hygiene.

Alcohol hand rub vs soap and water?

Alcohol rub: most routine situations when hands aren't visibly soiled.

SOAP + WATER:

• Visibly dirty/soiled

• After restroom

• Before eating

• Think C. difficile/spores for NCLEX

C. DIFF =

CONTACT + GOWN/GLOVES + SOAP/WATER ASSOCIATION + SPORICIDAL CLEANING

What is the PPE DONNING order?

Gown → Mask/respirator → Goggles/face shield → Gloves

Remember:

GLOVES GO LAST.

When removing PPE:

• Avoid touching contaminated fronts

• Prevent self-contamination

• Hand hygiene

For airborne isolation, respirator is removed after leaving room and closing door.

What is the master isolation table?

A:

Precaution	PPE/Room	High-yield diseases
Contact	Gown + gloves	C. diff, scabies, draining wounds
Droplet	Surgical mask	Flu, pertussis, meningococcal meningitis, mumps, rubella
Airborne	N95 + negative pressure	Measles, TB, varicella

Airborne = MTV

Measles
TB
Varicella

🚨 Varicella = Airborne + Contact

What are the key CONTACT precaution associations?

Think TOUCH + SURFACES.

• C. difficile

• Scabies

• Uncontained draining wounds

• Certain MDROs/enteric infections

Use:

• Gown + gloves

• Dedicated equipment when possible

• Environmental cleaning

What are the key DROPLET associations?

• Influenza

• Pertussis

• Meningococcal meningitis

• Mumps

• Rubella

PPE = surgical/procedure mask

If client must leave room:

CLIENT WEARS SURGICAL MASK.

Limit unnecessary transport.

What are the key AIRBORNE rules?

MTV

• Measles

• TB

• Varicella

Use:

• N95

• Negative-pressure room

• Door closed

• Limit transport

During necessary transport:

CLIENT = surgical mask
Healthcare worker = appropriate respiratory protection

Negative pressure vs positive pressure?

NEGATIVE = protects EVERYONE OUTSIDE

Keeps infected air inside.

Think:
TB → negative pressure.

POSITIVE = protects CLIENT INSIDE

Keeps outside pathogens away from vulnerable/immunocompromised client.

Negative = contain infection.
Positive = protect vulnerable client.

Do I wait for test results before initiating isolation?

NO.

If strongly suspected:

CONTROL EXPOSURE FIRST.

Examples:

TB symptoms → mask + separate + airborne precautions.

Possible meningococcal meningitis → droplet.

Severe unexplained infectious diarrhea → consider contact.

Suspicion can be enough to begin precautions.

What should I know about room assignments?

Best when needed = private room.

Cohort only when appropriate, generally same organism/infection.

Protect:

• Immunocompromised clients

• Open wounds

• Severe neutropenia

from infectious roommates/exposures.

Why is fever especially important in a neutropenic client?

Neutropenic clients may NOT show normal infection signs.

They may lack:

• Pus

• Strong redness/inflammation

• High WBC response

Therefore:

FEVER can be the major warning sign.

Don't wait for dramatic infection symptoms.

Medical asepsis vs surgical asepsis?

MEDICAL = CLEAN
→ reduce number/spread of microorganisms.

SURGICAL = STERILE
→ prevent microorganisms from contaminating sterile areas.

Sterile technique used for things such as:

• Urinary catheter insertion

• Central-line procedures

• Sterile wound care

• Invasive procedures

What are the MASTER sterile-field rules?

Memorize:

• Outer 1 inch = contaminated

• Below waist = contaminated

• Out of sight = contaminated

• Sterile touches sterile only

• Wet field = contamination concern

• Never reach over sterile field

• Never turn back/leave unattended

• When in doubt → contaminated

🚨 NCLEX does NOT want you gambling with sterility.

What do I do if sterile technique is broken?

STOP + CORRECT IT.

Examples:

Catheter touches bed → replace catheter.

Sterile glove touches bedrail → contaminated.

Object drops below waist → contaminated.

Field becomes wet → contamination concern.

Never choose:

“Continue because you're almost finished.”

Safety > convenience.

How do I open a sterile package?

1. Farthest flap first

2. Side flaps

3. Closest flap last

Why?

Prevents reaching across sterile field.

What is the master safe-injection rule?

ONE NEEDLE + ONE SYRINGE + ONE PATIENT

A used syringe is contaminated even if you change the needle.

Also:

• Single-dose vial = one patient

• Insulin pen = one patient

• New sterile needle + syringe every multidose-vial entry

• Never re-enter vial with contaminated syringe

What are the major sharps safety rules?

• Activate safety device

• Dispose immediately

• Use sharps container

• Don't overfill container

• Never reach inside

• Never leave needles around

Do NOT routinely recap used needles.

If unavoidable → approved one-handed technique.

What do I do after a needlestick?

WASH + REPORT IMMEDIATELY

1. Wash with soap/water

2. Report immediately

3. Follow exposure protocol

4. Evaluation/testing

5. Post-exposure treatment if indicated

Don't:

• Hide it

• Wait for symptoms

• Aggressively squeeze wound

• Wait until end of shift

How do I safely identify a client?

Use TWO appropriate identifiers.

Examples:

• Full name

• DOB

• Medical record identifier

🚨 Room number is NOT an identifier.

Before:

• Medications

• Blood

• Procedures

• Specimens

• Treatments

What if barcode scanning or the computer conflicts with what I know?

STOP + INVESTIGATE.

If:

• Barcode doesn't match

• Medication looks wrong

• Information conflicts

• Order seems unsafe

Do NOT bypass safety because:

“The computer is probably wrong.”

Technology ≠ replacement for nursing judgment.

What if a medication order conflicts with a serious allergy?

HOLD + CLARIFY.

Verify:

• Allergen

• Reaction

• Severity

Remember:

Nausea may be side effect.

Hives/airway swelling/anaphylaxis = hypersensitivity pattern.

A provider order does NOT remove your responsibility to protect the client.

What do I do with an unsafe/questionable order?

1. Review order

2. Review client data

3. Hold unsafe intervention if necessary

4. Clarify with provider

5. If unresolved → chain of command

Never blindly carry out a dangerous order.

A medication error already reached the client. What comes FIRST?

CLIENT FIRST.

1. Assess client

2. Stabilize/protect

3. Notify provider

4. Notify appropriate supervisor

5. Follow reporting procedure

6. Monitor

7. Document care objectively

Never incident report before assessing client.

What do I need to know about incident reports and near misses?

Incident report:

• Quality improvement/risk management

• Separate from medical record

Chart:

• What happened objectively

• Assessment

• Interventions

• Response

🚨 Do NOT chart:

“Incident report completed.”

Near miss: error caught before reaching client; may still need reporting.

What if another healthcare worker is doing something unsafe?

If harm is imminent:

STOP/PROTECT CLIENT FIRST.

Then report/escalate.

If worker appears impaired:

• Protect clients

• Report observed unsafe behavior

• Use chain of command

You do NOT need to diagnose them or privately investigate first.

What is the master restraint rule?

LAST RESORT + LEAST RESTRICTIVE

First ask:

WHY is the client behaving this way?

Try:

• Reorientation

• Toileting

• Pain control

• Correct hypoxia

• Treat delirium

• Sitter

• Family

• Reduce stimulation

• Bed alarm

Never use restraints for:

• Convenience

• Punishment

• Confusion alone

What restraint rules are highly testable?

• Least restrictive

• Frequent reassessment

• Monitor skin/circulation

• Meet food/fluid/toileting needs

• Remove ASAP

• Follow order/legal requirements

• No indefinite PRN restraint orders

• Don't attach restraint to movable side rail

Also:

Four side rails ≠ automatically safer.

They may function as a restraint or increase fall injury.

What are the main fall-prevention interventions?

Individualize to the cause.

• Bed low + locked

• Call bell/items within reach

• Clear pathway

• Good lighting

• Nonskid footwear

• Assistive device

• Toileting assistance

• Review meds

• Assist with mobility

Don't rely solely on:

• Signs

• Alarms

• Side rails

Fix WHY they're falling.

A client has fallen. What do I do FIRST?

STAY + ASSESS.

• Stay with client

• ABCs

• Assess injury

• Neuro assessment if appropriate

• Get assistance

🚨 Do NOT automatically pick them up.

Then notify, monitor, document and complete appropriate reporting.

What are seizure safety precautions?

Before:

• Bed low

• Protect rails appropriately

• Suction available

• Oxygen available

• Remove hazards

During:

• Protect head

• Side position

• Time seizure

• Don't restrain

• Nothing in mouth

After:

AIRWAY + BREATHING FIRST.

What is the major aspiration rule after stroke?

If dysphagia is possible:

NPO UNTIL SWALLOWING SAFETY IS ESTABLISHED.

No:

• Food

• Drinks

• Oral meds

Aspiration-risk clients:

• Stroke

• ↓ LOC

• Dysphagia

• Neurologic disease

• Tube feeding

• Sedation

Watch for:

• Coughing

• Wet voice

• Respiratory distress

How do I reduce aspiration with tube feedings?

• Verify tube placement per policy

• Elevate HOB appropriately

• Monitor tolerance

• Maintain elevation afterward as appropriate

Sudden:

• Cough

• Hypoxia

• Respiratory distress

→ suspect aspiration.

What are RACE and PASS?

RACE = FIRE RESPONSE

R — Rescue
A — Alarm
C — Contain
E — Extinguish/Evacuate

PASS = EXTINGUISHER

P — Pull
A — Aim at base
S — Squeeze
S — Sweep

🚨 If client is in immediate fire danger:

RESCUE FIRST.

What are the major oxygen safety rules?

Oxygen supports combustion.

• No smoking

• No open flames

• Away from ignition sources

• Secure cylinders

• Ensure equipment works

• Avoid unsafe petroleum products

• Use approved water-based lubricant when needed

What if medical equipment malfunctions or alarms?

TREAT THE CLIENT, NOT THE MACHINE.

If malfunction:

1. Protect client

2. Stop defective equipment

3. Get functioning replacement

4. Remove defective equipment from service

5. Label/report

Never blindly silence alarms.

Monitor says VF but client is awake → assess client/electrodes.

Client pulseless/unresponsive → treat emergency.

What are the key CAUTI prevention rules?

• Catheter only when indicated

• Aseptic insertion

• Closed drainage system

• Unobstructed flow

• Bag BELOW bladder

• Bag off floor

• Proper hygiene

• Sample through designated port

BIGGEST prevention:

Remove unnecessary catheter ASAP.

What are the key CLABSI prevention rules?

• Hand hygiene

• Strict aseptic technique

• Skin antisepsis

• Sterile dressing care

• Scrub/disinfect access points

• Monitor site

• Remove line when no longer necessary

Possible infection:

• Fever/chills

• Redness

• Tenderness

• Drainage

What findings suggest IV phlebitis?

• Red

• Warm

• Tender/painful

• Palpable venous cord

Usually:

DISCONTINUE IV + manage per policy.

Don't just slow the infusion and ignore it.

How do I prevent cross-contamination?

• Dedicated equipment when needed

• Clean/disinfect shared equipment

• Change gloves between dirty/clean tasks

• Hand hygiene

• Handle linen appropriately

CLEAN → DIRTY

Never dirty → clean with same contaminated gloves/equipment.

Don't shake contaminated linen.

What are the key newborn security rules?

• Verify infant ID bands

• Match parent/infant ID

• Verify staff identification

• Transport infant in bassinet

• Never leave infant unattended

If identification doesn't match:

STOP.

Do NOT transfer newborn until identity is confirmed.

What are the three radiation safety principles?

TIME — DISTANCE — SHIELDING

• Minimize TIME

• Maximize DISTANCE

• Use SHIELDING

Follow special restrictions for radioactive implants/treatments.

What are the highest-yield pediatric safety risks?

INFANTS

• Suffocation

• Aspiration

• Falls

• Burns

• Unsafe sleep

TODDLERS

• Poisoning

• Falls

• Burns

• Drowning

• Choking

Keep meds/chemicals/small objects/hot objects inaccessible.

🚨 Never call medicine “candy.”

How is mass-casualty priority DIFFERENT from normal NCLEX priority?

Normal hospital:

SICKEST/UNSTABLE FIRST

Mass casualty:

GREATEST GOOD FOR GREATEST NUMBER

Prioritize seriously injured clients who are likely to survive with rapid treatment.

What do disaster triage colors mean?

🔴 RED = IMMEDIATE
Life-threatening but survivable with rapid treatment.

🟡 YELLOW = DELAYED
Serious but can safely wait.

🟢 GREEN = MINOR
Walking wounded.

⚫ BLACK = EXPECTANT/DECEASED
Dead or unlikely to survive given available resources.

What Safety & Infection patterns should I recognize instantly?

• TB → Airborne → N95 + negative pressure

• Measles → Airborne

• Varicella → Airborne + Contact

• Influenza → Droplet

• Pertussis → Droplet

• Meningococcal meningitis → Droplet

• C. diff → Contact + gown/gloves + spore-control cleaning

• Scabies → Contact

• Airborne client transported → client wears surgical mask

• Negative pressure → protects people outside

• Positive pressure → protects vulnerable client

• Sterility questionable → contaminated

• Used syringe → contaminated even with new needle

• Single-dose vial → one patient

• Insulin pen → one patient

• Needlestick → wash + report

• Serious allergy conflict → hold + clarify

• Med error reached client → assess client

• Unsafe coworker → protect first → report second

• Fall → stay + assess before moving

• Restraint → least restrictive/last resort

• Defective equipment → stop using

• Fire → RACE

• Extinguisher → PASS

• Mass casualty → greatest good for greatest number