Infection prevention and safety
Healthcare-associated infections and preventable harm are major risks. Simple, consistent practices prevent much of it. For study only, not clinical guidance: always follow your programme, current local protocols, and supervising clinicians.
Hand hygiene
Hand hygiene is the single most important measure to prevent infections. The WHO's 'five moments' are: before touching a patient, before a clean or aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching patient surroundings. Alcohol-based hand rub is preferred unless hands are visibly soiled or after caring for patients with C. difficile, when soap and water are needed.
The chain of infection
Infection spreads through a chain: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. Breaking any link stops transmission: hand hygiene and cleaning interrupt transmission; vaccination reduces host susceptibility.
Standard precautions
Standard precautions apply to all patients: hand hygiene, gloves and other personal protective equipment (PPE) when exposure to blood or body fluids is possible, safe injection practices, respiratory hygiene, and safe handling of sharps and equipment. They assume any patient may carry an infection.
Transmission-based precautions
Additional precautions apply for specific infections. Contact precautions (gown and gloves) for organisms such as MRSA and C. difficile; droplet precautions (surgical mask) for influenza and pertussis; airborne precautions (N95 respirator and negative-pressure room) for tuberculosis, measles, and chickenpox.
Donning and doffing PPE
PPE must be put on and removed in the correct order to avoid contamination. A common CDC sequence for putting on is gown, mask or respirator, goggles or face shield, then gloves; removal typically starts with gloves (the most contaminated), then goggles, gown, and mask, with hand hygiene after removal.
Preventing falls
Falls are a leading cause of injury in hospitals. Prevention includes fall risk assessment, keeping the bed low and locked, call bells within reach, non-slip footwear, clear paths, scheduled toileting, and reviewing medications that cause dizziness. Restraints are a last resort and require orders and monitoring.
Patient identification and safety goals
Use at least two identifiers (such as name and date of birth) before giving medications, blood, or treatments, as required by The Joint Commission's National Patient Safety Goals. Other goals include improving communication of critical results, safe medication use, and preventing infection.
Worked example
A nurse caring for a patient with C. difficile diarrhoea uses contact precautions: gown and gloves on entering the room. After care, she removes PPE in the correct order and washes her hands with soap and water, because alcohol rub does not reliably kill C. difficile spores.
Key takeaways
Hand hygiene is the most important infection-prevention measure; use soap and water for C. difficile. The chain of infection can be broken at any link. Standard precautions apply to all patients; contact, droplet, and airborne precautions add protection for specific infections. Don and doff PPE in the correct order. Prevent falls with risk assessment and environmental measures. Use two patient identifiers.
Flashcard
Most important infection prevention measure
Check your understanding
A patient has suspected tuberculosis. Which precautions are needed?