Infection prevention technique

Infection-prevention technique questions reward the nurse who keeps a sterile field honest, takes dirty PPE off in a safe order, and washes a needlestick before doing anything else. Isolation categories live next door; this chapter owns the skill stack that stops microbes from crossing the chain.

Standard precautions and hand hygiene

Hand hygiene, gloves for blood and body fluids, sharps safety, and cough etiquette are baseline for every client. Known diagnosis only adds transmission-based layers; it never subtracts the baseline. Health care–associated infections travel on hands and shared equipment more often than on dramatic airborne dramas, so the ordinary soap-and-water or alcohol moment is the highest-yield prevention move on the exam.

Alcohol-based rub is the default when hands are not visibly soiled and spore formers are not the concern. Soap and water win when hands are dirty, after toileting, and after caring for clients with *C. difficile* or norovirus, because spores shrug off foam. Dry thoroughly; wet hands pick up organisms again. Gloves do not replace hand hygiene - clean before gloving and after gloves come off.

• Clean (medical) asepsis: reduce organisms for most routine care (bathing, oral meds, nonsterile dressings).
• Sterile (surgical) asepsis: required for invasive procedures and sterile dressing changes when ordered.
• Cough etiquette and safe injection practices are part of standard precautions, not “extra” for known infection only.

Medical vs surgical asepsis

Medical asepsis is clean technique: you lower the count of organisms without promising a sterile field. Surgical asepsis aims for absence of microorganisms in a defined field - central lines, urinary catheter insertion, sterile wound packing. Mixing the two is a classic fail: opening a sterile kit then wiping the same field with a used washcloth, or treating a sterile Foley insertion like a quick clean catheterization without sterile gloves and a sterile field.

Disinfection reduces pathogens on surfaces and reusable gear; sterilization destroys all microbial life including spores (autoclave, approved sterilants). Critical items that enter sterile tissue or the vascular system need sterilization. Semi-critical items that touch mucous membranes need high-level disinfection at minimum. Do not invent “rinse and reuse” for a sterile-critical device on an exam stem.

Sterile field rules that fail people on purpose

A sterile field stays sterile only while every rule is kept. Gravity, moisture, and out-of-sight motion are the usual betrayers. Hands or instruments that drop below the waist leave your visual control and are treated as contaminated. Moisture that soaks through a drape wicks organisms from the table up into the field - that is strike-through, and the field is gone.

Pouring sterile solutions: lip the bottle if policy requires, hold the label in your palm so drips do not ruin the label, pour from a height that does not splash, and do not touch the bottle lip to the sterile container. Once opened, many solutions have a time limit - follow the stem or policy rather than using yesterday’s open bottle as “still fine.” If contamination happens, stop and rebuild. Continuing “because you are almost done” is how surgical sites get infected on the exam and in real life.

• Open sterile packages away from you first so the wrapper does not drag over the field.
• Add sterile items by dropping them onto the field without reaching across.
• Sterile gloves: skin never touches the outer glove surface; if a tear appears, replace both gloves and reassess the field.

PPE and sharps: technique without self-contamination

Contact, droplet, and airborne categories - and the don/doff order that matches them - live in Transmission-based precautions. This chapter stays on sterile-field honesty, hand hygiene, and exposure first aid. One technique overlap: when airborne PPE was used, the respirator usually leaves last and after you exit the room so you are not bare-faced in contaminated air.

Sharps never go in a regular trash bag. Engage safety devices when the device has one, do not recap used needles by two-handed scooping against policy, and drop the sharp into a puncture-resistant container at the point of use. Overfilled sharps boxes cause sticks when people force one more syringe through the lid - replace the container when it hits the fill line.

Needlestick exposure order

A hollow-bore stick can push bloodborne pathogens under the skin in one motion. The first job is to clean the puncture with soap and water so you reduce what sits at the entry site before you leave the sink. Reporting and occupational-health evaluation matter, but they come after the wash - not instead of it.

1. Wash the site with soap and water immediately.
2. Report the injury to the charge/occupational health pathway without delay.
3. Seek evaluation for post-exposure prophylaxis and baseline labs as directed.
4. Complete the occurrence report. Charting waits behind first aid and reporting.

Why wash before you run to employee health: every minute at the sink is first aid you control. Squeezing the site hard as the “treatment” is not the plan - it adds trauma and is not a substitute for soap-and-water cleansing. Alcohol swab alone, “I’ll finish this med pass first,” or charting the incident before washing are the distractors that look responsible and still leave the puncture dirty.

After the wash, report and follow the occupational-health pathway for source risk assessment, baseline labs, and whether post-exposure prophylaxis is indicated. Exact drug regimens are ordered and timed by that protocol - do not invent them from memory on the exam. Edge case: if the client’s blood is still on your hands or the device, keep yourself and others safe (sharps container, gloves off carefully) without delaying the soap-and-water wash as the first personal action. Mucous-membrane splash (eyes, mouth) gets immediate flush with water or saline per protocol, then the same report pathway.

Priority map