Saftey and infection control

What precautions apply to every client regardless of diagnosis?

Standard precautions: hand hygiene; gloves for contact with blood/body fluids; gown, mask, and eye protection as exposure risk requires.

When should soap and water be used instead of alcohol-based hand rub?

When hands are visibly soiled and for C. difficile or other spore-forming organisms.

What is the usual PPE donning order?

Gown → mask/respirator → goggles/face shield → gloves.

What is a common PPE removal order?

Gloves → goggles/face shield → gown → mask/respirator; perform hand hygiene after removal.

What precautions are used for C. difficile?

Contact precautions, gown and gloves, dedicated equipment, and handwashing with soap and water.

What infections commonly require contact precautions?

C. difficile, MRSA, VRE, RSV, scabies, impetigo, draining wounds, and many multidrug-resistant organisms.

What infections commonly require droplet precautions?

Influenza, pertussis, mumps, rubella, diphtheria, and meningococcal meningitis.

What PPE is required for droplet precautions?

Surgical mask when entering/within close range of the client; add other PPE based on exposure risk.

What infections require airborne precautions?

Tuberculosis, measles, varicella, and disseminated herpes zoster.

What room and PPE are required for airborne precautions?

Negative-pressure room with the door closed and an N95 or higher-level respirator.

What is the difference between negative-pressure and positive-pressure rooms?

Negative pressure protects others from an infectious client; positive pressure protects an immunocompromised client from outside organisms.

What are key neutropenic precautions?

Strict hand hygiene, avoid sick visitors, avoid raw or undercooked foods, avoid fresh flowers/plants when indicated, and monitor closely for infection.

What are the six links in the chain of infection?

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

What is the difference between medical and surgical asepsis?

Medical asepsis reduces microorganisms; surgical asepsis maintains a sterile field free of microorganisms.

When is a sterile field considered contaminated?

If it becomes wet, falls below waist level, is out of sight, is touched by a nonsterile item, or the 1-inch outer border is touched.

How should a sterile package be opened?

Open the flap farthest away first, then the sides, then the flap nearest you.

What part of a sterile field is considered contaminated?

The outer 1-inch border.

What are key CAUTI prevention measures?

Avoid unnecessary catheters, use sterile insertion, maintain a closed system, keep the bag below the bladder, and remove the catheter as soon as possible.

What are key CLABSI prevention measures?

Hand hygiene, maximal sterile barrier during insertion, chlorhexidine skin prep, sterile dressing care, scrub the hub, and remove unnecessary lines.

What are key VAP prevention measures?

Head of bed 30–45°, regular oral care, suction as needed, assess readiness to extubate, and minimize unnecessary ventilation.

What should be done when transporting a client on isolation precautions?

Limit transport, cover infected areas, apply a mask to clients with respiratory infections when appropriate, and notify the receiving department.

What does RACE stand for in a fire?

Rescue → Alarm → Contain → Extinguish/Evacuate.

What does PASS stand for when using a fire extinguisher?

Pull → Aim → Squeeze → Sweep.

What is the first priority during a hospital fire?

Rescue anyone in immediate danger.

What is horizontal evacuation?

Moving clients beyond fire doors to a safe area on the same floor before vertical evacuation.

What are basic fall-prevention interventions?

Bed low and locked, call bell within reach, nonskid footwear, adequate lighting, clutter-free pathways, scheduled toileting, and assistance with mobility.

Who is at increased risk for falls?

Older adults, postoperative clients, clients with orthostatic hypotension, sedating medications, weakness, confusion, or impaired mobility.

What is the first principle of restraint use?

Use the least restrictive intervention only after alternatives have failed, except in an immediate emergency.

What are alternatives to restraints?

Reorientation, sitter/family presence, pain control, toileting, reduced stimulation, bed/chair alarms, and moving closer to the nurses’ station.

What ongoing care is required for a restrained client?

Assess circulation, skin, hydration, nutrition, elimination, range of motion, comfort, and continued need for restraint.

What should never be done during a seizure?

Do not restrain the client and do not place anything in the mouth.

What should the nurse do during a seizure?

Protect the head, remove hazards, turn to the side if possible, loosen restrictive clothing, time the seizure, and maintain airway safety.

What should be available for seizure precautions?

Suction and oxygen equipment; padded side rails if indicated.

What is the priority after a seizure ends?

Airway, breathing, neurologic assessment, vital signs, injury check, and postictal monitoring.

What measures reduce aspiration risk in dysphagia?

Sit upright, use small bites and sips, use prescribed texture/thickened liquids, follow swallowing strategies, and obtain swallow evaluation when indicated.

What position is used during tube feeding?

Head of bed at least 30–45° during feeding and for a period afterward according to policy.

What should be done if aspiration is suspected during tube feeding?

Stop the feeding, position the client appropriately, assess airway and respiratory status, and suction as needed.

What oxygen-safety teaching is essential?

No smoking/open flames, avoid petroleum-based products near oxygen, secure cylinders upright, and keep oxygen away from heat sources.

What are the three main radiation-safety principles?

Time, distance, and shielding.

How should care be organized for a client with a radioactive implant?

Cluster care to limit exposure time, maximize distance, use shielding as required, and follow visitor restrictions.

Who should generally avoid visiting clients with internal radiation sources?

Pregnant people and young children according to radiation-safety guidelines.

What PPE is used when handling chemotherapy or contaminated body fluids?

Chemotherapy-rated gloves and protective gown; add eye/face protection if splash risk exists.

What should the nurse do for chemotherapy extravasation?

Stop the infusion immediately, leave the catheter in place if needed for aspiration or antidote, follow drug-specific protocol, and notify the provider.

Which medications are common high-alert medications?

Insulin, heparin, opioids, chemotherapy, and concentrated electrolytes.

What safety practice is commonly used with high-alert medications?

Independent double-checks according to facility policy.

What are key medication-administration safety principles?

Verify client identity, allergies, medication/order, dose, route, time, indication, required assessments, and documentation.

What IV solution is compatible with blood products?

0.9% normal saline.

What should be checked before starting a blood transfusion?

Correct client using two identifiers, correct blood product, compatibility, IV patency, and baseline vital signs.

When is the highest risk for an acute transfusion reaction?

During the first 15 minutes of the transfusion.

What is the first action for a suspected transfusion reaction?

STOP the transfusion.

What should be done after stopping a transfusion for a reaction?

Keep the IV open with new tubing and normal saline, assess the client, notify the provider and blood bank, recheck identification, and follow facility protocol.

What are common signs of an acute transfusion reaction?

Fever, chills, dyspnea, flushing, back/chest pain, hypotension, tachycardia, hives, or anxiety.

What are acceptable client identifiers?

Examples include full name and date of birth or medical record number; room number is not acceptable.

When should two client identifiers be used?

Before medications, blood products, procedures, specimen collection, and other treatments.

What is the Universal Protocol?

Confirm correct client, correct procedure, and correct site, mark the site when applicable, and perform a final time-out.

What happens during a surgical time-out?

The team verbally confirms the correct client, procedure, site/side, allergies, and other critical safety information.

What are major safe-sleep rules for infants?

Place infant supine on a firm flat sleep surface with no loose blankets, pillows, bumpers, or toys.

What is the safest car-seat position for infants and young children?

Rear-facing as long as allowed by the car-seat manufacturer’s height and weight limits.

What are important newborn security measures in the hospital?

Match identification bands, verify staff identification, use security systems, and never leave the newborn unattended.

What is the priority when suicide risk is high?

Maintain immediate safety with the required level of observation and remove dangerous or ligature-risk objects.

Can a suicidal client be left alone if they promise not to harm themselves?

No. Follow the prescribed observation level and suicide precautions.

What is the first approach to an escalating or aggressive client?

Use calm verbal de-escalation, maintain personal space, keep access to an exit, reduce stimulation, and use the least restrictive intervention.

Where should the nurse position themself with a potentially violent client?

Maintain safe distance and keep access to the exit; do not allow the client to block the nurse in.

What should be done after a needlestick or blood/body-fluid exposure?

Wash the exposed area immediately, flush mucous membranes if involved, report the exposure promptly, and follow post-exposure testing/prophylaxis protocol.

Should used needles be recapped?

No. Activate the safety device and dispose of the needle immediately in a sharps container.

What should the nurse do if electrical equipment malfunctions?

Stop using it, disconnect it if safe, remove it from service, label/report it, and obtain functioning equipment.

What is the safest approach if medical equipment is alarming?

Assess the CLIENT first, then assess the equipment and cause of the alarm.

What principle applies to ventilator or monitor alarms?

Never silence or disable an alarm without first assessing the client and determining the cause.