NCLEX Review: Precautions

NCLEX Review: Precautions

Introduction to Precautions

  • Purpose: To protect healthcare providers and other patients from potential infectious diseases.

  • Types of Precautions:

    • Standard Precautions: Applied to every patient at all times regardless of known or suspected infection status, as we may not be aware of all potential contagions.

    • Transmission-Based Precautions: Added on top of standard precautions when a patient is known or suspected to have an infectious disease. These are specific to how a disease is transmitted (airborne, droplet, or contact).

Standard Precautions

  • Definition: Basic infection control practices used with all patients to protect oneself and others.

  • Components:

    • Performing hand hygiene.

    • Wearing appropriate personal protective equipment (PPE) as needed.

    • Safe handling of patient equipment.

    • Safe injection practices.

    • Environmental cleaning.

    • Respiratory hygiene/cough etiquette.

    • Safe handling of laundry.

    • Appropriate patient room placement.

Hand Hygiene

  • When to Perform:

    • Before and after patient contact.

    • After removing gloves.

    • After touching any surfaces in a patient's room that could be contaminated.

  • Methods:

    • Soap and water.

    • Alcohol-based hand sanitizing gel.

  • When Only Soap and Water Must Be Used:

    • When hands are visibly soiled.

    • Before eating or touching food.

    • After using the bathroom.

    • If the patient has a diarrheal illness caused by:

      • C. Diff (Clostridioides difficile)

      • Norovirus

      • Rotavirus

Personal Protective Equipment (PPE)

  • Purpose: To protect skin, clothing, or mucous membranes from potential splashes of body fluids.

  • Types of PPE:

    • Gloves:

      • Needed when coming into contact with any types of fluids (e.g., vomit, stool, urine, mucus, blood).

    • Gowns:

      • Needed if there is potential for fluids or blood to get onto scrubs or clothing.

    • Goggles, Face Mask, or Face Shield:

      • Needed if there is potential for fluids or blood to make contact, especially with mucous membranes of the eyes, nose, or mouth (e.g., patient coughing or vomiting during suctioning or mouth care).

Transmission-Based Precautions

These precautions are implemented in addition to standard precautions based on the specific mode of disease transmission.

Airborne Precautions

  • Transmission Mechanism:

    • Occurs when a patient coughs or sneezes, releasing respiratory droplets containing germs.

    • Unlike droplet diseases, the germs in airborne droplets survive the drying process, forming tiny residue particles called droplet nuclei.

    • These droplet nuclei are very small, float in the air, and remain suspended for extended periods, waiting to be inhaled.

    • Infection: Occurs through inhalation into the respiratory tract.

    • Distinction from Droplet: Airborne particles are much smaller and remain suspended; droplet particles are larger and fall faster.

  • Diseases Included:

    • Chickenpox (Varicella)

    • Disseminated Herpes Zoster (Widespread Shingles)

    • Measles

    • Tuberculosis (TB)

    • Note: Patients with Chickenpox and Disseminated Herpes Zoster also require Contact Precautions in addition to Airborne Precautions.

  • Mnemonic for Airborne Diseases and PPE: Airborne Chicken Number 95 dissected her tubby mealworm.

    • Airborne: Indicates Airborne Precautions.

    • Chicken: Chickenpox.

    • Number 95: N95 mask (required at all times).

    • dissected her: Disseminated Herpes Zoster.

    • tubby: Tuberculosis (TB).

    • mealworm: Measles.

  • Required PPE: N95 mask must be worn at all times. Other PPE (gloves, gown, eye protection) should be selected as needed based on the task in the patient's room (following standard precautions).

  • Special Room Requirements:

    • Airborne Infection Isolation Room (AIIR), also known as a Negative Pressure Room.

    • Maintains lower pressure inside the patient's room compared to outside, preventing airborne particles from escaping.

    • Performs 6 to 12 air changes per hour (ACPH) to clean the air and reduce droplet nuclei.

    • The door must be kept closed at all times.

  • Patient Transport: Limited to essential purposes. If transport is necessary, the patient must wear a surgical mask to contain respiratory secretions.

Droplet Precautions

  • Transmission Mechanism:

    • Transmitted when a person coughs, sneezes, or talks, producing respiratory droplets.

    • These droplets are larger than airborne particles.

    • They travel a shorter distance (typically fall within approximately 3 feet).

    • Infection: Occurs when droplets enter the eyes, nose, or mouth (mucous membranes) of another individual.

  • Diseases Included:

    • Diphtheria (pharyngeal type)

    • Epiglottitis

    • Influenza (Flu)

    • Meningococcal disease (sepsis, pneumonia, or meningitis)

    • Mumps

    • Pneumonia

    • Mycoplasma pneumonia

    • Parvovirus B19 (Fifth disease)

    • Pneumonic plague

    • Adenovirus

    • Streptococcal pharyngitis

    • Whooping cough (Pertussis)

    • Rhinovirus

    • Scarlet fever

    • German measles (Rubella)

    • Note: Patients with Influenza (Flu) and Adenovirus also require Contact Precautions in addition to Droplet Precautions.

  • Mnemonic for Droplet Diseases and PPE: Whose adjustable droplet mask stops scary pneumatic parasites plaguing distinguished German men. My epic moms, Rhonda.

    • Whose: Whooping cough (Pertussis).

    • adjustable: Adenovirus.

    • droplet: Indicates Droplet Precautions.

    • mask: Surgical mask (required at all times).

    • stops: Streptococcal pharyngitis.

    • scary: Scarlet fever.

    • Pneumatic: Pneumonia.

    • Fluid (implied from