Study Notes: Transmission Precautions, PPE, and Pulse Points

Pulse Points and Alternate Routes

  • Overview: Pulse points are used to assess circulation; sometimes due to injury or patient condition we cannot access the main three pulse points that were named earlier (as referenced in class). We may need to locate an alternate route for assessment.

  • Dorsal pedal (pedal/dorsal pedis) pulse: located on the foot; commonly discussed as a pulse point in the lower extremity.

  • Anticubital (AC) fossa: another anatomical site referenced for assessment or IV considerations; used as context for choosing alternate sites.

  • Practical point: if an IV line is near a pulse point, avoid taking a pulse there to prevent interference with IV site or medication administration; select an alternative location.

  • Takeaway: understanding multiple pulse points is important for patient assessment and for adapting to injuries or IV sites.

PPE: Purpose, Standard Precautions, and Donning/Doffing

  • Purpose of PPE: to protect you (the health care provider) and to protect patients; reduces cross-contamination and spread.

  • Terminology: Standard precautions are the modern term for what used to be called universal precautions.

  • Key component: Hand hygiene is the #1 way to stop the spread of infection (hand washing or hand sanitizer).

  • PPE components:

    • Gloves: protect hands.

    • Gowns: protect skin and clothing.

    • Masks: protect respiratory pathways; can be surgical masks or respirators (e.g., N95) when indicated.

    • Eye protection: goggles or face shields; glasses alone do not count as PPE.

    • Face shields: some shields come with a built-in mask; can be worn over glasses.

  • Fogging issue and fix:

    • Breathing into masks with eye protection can cause humidity buildup that fogs goggles/face shields.

    • Fix: pinch the mask tight at the bridge of the nose; use a strip of clear tape (transport tape) across the bridge to reduce fogging.

  • Donning and doffing order (general, not surgical asepsis):

    • Donning (putting PPE on): hand hygiene → gown → mask → eye protection (goggles/face shield) → gloves.

    • Doffing (removing PPE): gloves → gown → eye protection → mask → hand hygiene.

  • Special note on orders:

    • The PPE order for everyday general use differs from the order used in aseptic technique or surgical settings; do not confuse the two.

  • Important caveat:

    • If you hear different orders in different contexts (exam vs. bedside), follow the context-specific guidance provided (this is not the same as sterile technique).

  • Practical tips:

    • If you only use a mask with a built-in face shield, you may skip separate goggles but ensure eye protection is in place.

    • Eye protection must be worn even if you wear glasses.

  • Exam readiness:

    • Donning and doffing PPE correctly is a common skills checklist item on tests and bedside assessments.

Transmission Precautions: Airborne, Droplet, and Contact

  • Core idea: Transmission precautions dictate the PPE and protocols based on how a disease is spread.

  • Airborne precautions:

    • Droplets can stay suspended in the air for some time; specific diseases require airborne precautions.

    • Mandatory PPE: a respirator mask (e.g., N95) for entry into the room.

    • Common airborne diseases discussed: Measles (medical term: rubeola), Varicella (chickenpox), and Tuberculosis (TB).

    • Mnemonic sometimes used: MTV (Measles, TB, Varicella) to recall key airborne diseases; some sources add others.

    • COVID-19 and SARS: may be listed as airborne or in some contexts both airborne and droplet depending on guidelines; be prepared for variability in classifications.

    • Reminder: chickenpox etymology; the medical term you should know is Varicella.

  • Droplet precautions:

    • Large droplets that travel short distances and may require face protection.

    • Example disease mentioned: Pertussis (medical term for whooping cough).

    • PPE: mask (surgical mask or higher as indicated) plus eye protection (goggles or face shield) when entering a room with a droplet-spreading illness.

    • COVID and SARS: sometimes categorized as droplet in some guidelines, though classifications can vary.

  • Contact precautions:

    • Direct contact or contact with contaminated surfaces; high risk for transmission via hands, surfaces, and equipment.

    • Common examples mentioned: MRSA, Clostridioides difficile (C. diff), pink eye (conjunctivitis), and head lice.

    • Procedure: patients with contact precautions are typically placed in a single room; a dedicated cart with PPE is placed outside the door.

    • Entry restrictions for students: high school students observing in hospital settings are often not permitted to enter contact isolation rooms; inform staff if you are not allowed to enter.

  • Operational details:

    • PPE should be donned before entering rooms with isolation precautions.

    • Rooms may have signage indicating the isolation type and the PPE cart outside the door.

    • Rarely, two patients with the same infection may share a room, but this is uncommon and depends on infection control policy.

  • Additional examples of contagious conditions within the contact category include head lice; emphasis on avoiding spread in communal spaces.

Fomite and Vector Concepts

  • Fomite:

    • A nonliving object that can spread disease.

    • Examples: keyboards, money, phones, door handles, etc.

    • Rationale: pathogens can be transferred from contaminated surfaces to hands and then to mucous membranes.

  • Vector:

    • A living organism that transmits disease (e.g., mosquitoes, ticks).

    • Distinct from fomites in being a living carrier.

Everyday Practices, Exam Relevance, and Practical Tips

  • Hand hygiene discipline:

    • Wash hands at the beginning of a shift, the end of a shift, and in between tasks.

    • Wash or sanitize before meals; do not eat or apply makeup at the nurse’s station while interacting with patients.

  • Equipment disinfection:

    • Disinfect or clean equipment between uses on different patients (e.g., BP cuffs, stethoscopes, carts).

  • PPE and exam readiness:

    • PPE donning/doffing is a common exam skill; there can be differences between everyday PPE and aseptic technique orders.

    • Some questions on EKG-related scenarios may test knowledge of transmission precautions or PPE requirements.

  • Practical lab/test prep:

    • Flashcard drills and hands-on practice with vital signs and standing scales are planned activities.

  • General spirit:

    • The goal of these precautions is to prevent the spread of infection while caring for sick patients and protecting yourself from exposure.

Quick Reference: Key Mnemonics and Concepts

  • Airborne: Measles, Varicella, TB (Measles, Varicella, TB) — mnemonic aids vary (MTV or other variants).

  • Droplet: Pertussis, and sometimes SARS/COVID depending on guidelines; emphasize face protection and eye protection.

  • Contact: MRSA, C. diff, pink eye, head lice; room isolation and PPE outside the door.

  • Fomite: Nonliving objects that harbor and spread pathogens.

  • Vector: Living organisms that transmit disease (e.g., mosquitoes).

  • Donning order (non-surgical): Hand hygiene → Gown → Mask → Eye protection → Gloves.

  • Doffing order (non-surgical): Gloves → Gown → Eye protection → Mask → Hand hygiene.

  • Fogging mitigation: Tighten seal at the nose bridge and use tape to prevent fogging of goggles/shields.

  • Alternate pulse point consideration: If IV near pulse sites (e.g., AC fossa), avoid taking a pulse there and select an alternate site.