Safety & Infection Prevention and ControlLesson 2.1
Standard Precautions and Transmission-Based Precautions
Break the chain of infection: clean hands, the right PPE, the right room, and a sterile field you can trust.
By the end you can
- Name each link in the chain of infection and the action that breaks it
- Pick airborne, droplet, or contact precautions and the PPE that goes with each
- Keep a sterile field sterile and protect a neutropenic client
Your case
Med-surg unit · two admissions within the hour
Mr. D, 52: three weeks of cough, night sweats, and weight loss. A sputum AFB smear is ordered. He is waiting in a semi-private room.
Ms. L, 34: acute leukemia, day 10 after chemotherapy. She calls you in because she feels chilled.
Mr. D AFB pendingMs. L ANC 300/mm³Ms. L temp 100.9 FOpen rooms 1 negative, 1 positive
Hold that thought
- Which room does each client need?
- What do you wear into Mr. D's room?
- Whose finding can't wait?
You will answer all three at the end of the lesson.
Concept 1 · Chain of infection
Six links. Break one and it stops
Build the chain in order
Pearl: in health care, the most common reservoir is people.
Concept 2 · Breaking the chain
Every intervention targets one link
Match the action to the link it breaks
Same mask, different link: on the infected client it blocks the portal of exit. On you, it protects your portal of entry.
Concept 3 · Modes of transmission
Touch, fall, or float
Contact: most common in health care
- Direct: skin to skin, hands to client
- Indirect: equipment, linens, surfaces, a shared stethoscope
- Broken by: hand hygiene, gloves, gowns, cleaning
Droplet: it falls
- Large particles (over 5 microns) that fall within 3 to 6 feet
- Made by coughing, sneezing, talking, suctioning
- Broken by: surgical mask, hand hygiene
Airborne: it floats
- Tiny particles (under 5 microns) that stay suspended and drift on air currents
- Anyone sharing the room's air can inhale them
- Broken by: N95 respirator, negative pressure room, HEPA filtration
The #1 trap: confusing airborne with droplet. If it floats, you need an N95 and a negative pressure room. If it falls, a surgical mask is enough.
Concept 4 · Standard precautions
Every client, every time
Assume infectious: blood, all body fluids, secretions, and excretions (except sweat), non-intact skin, and mucous membranes.
- Gloves
- Blood, fluids, mucous membranes, broken skin. Change between tasks and between clients
- Gown
- When clothing could be soiled. Off before you leave the room
- Mask, eye protection
- Splash or spray risk: suctioning, intubation, wound irrigation
- Never recap needles. Use safety-engineered devices
- Sharps container at the point of use, right away
- Single-dose vials: one client. Never reuse a needle or syringe
- Cough etiquette: tissues and masks for coughing clients in waiting areas
- Cleaning: high-touch surfaces regularly, terminal cleaning between clients
Quick check 1 of 4
A nurse is about to suction a client's tracheostomy. Which PPE do standard precautions call for?
Suctioning can spray secretions, so standard precautions add a mask and eye protection to gloves. Gloves alone leave the face exposed. An N95 is for airborne precautions, not routine splash risk.
Concept 5 · Hand hygiene
The single most effective measure
The 5 moments
- Before: touching the client, and any clean or aseptic procedure
- After: body fluid exposure, touching the client, and touching the client's surroundings
- Gloves never replace it. Clean hands before and after gloving
Soap and water or alcohol rub?
Tap a situation, then tap the box it belongs in.
Concept 6 · Airborne precautions
If it floats, wear an N95
- Room
- Airborne infection isolation room: negative pressure, air vented outside or HEPA filtered
- Door
- Closed at all times
- Staff
- Fit-tested N95 on before you enter, off after you leave and close the door. PAPR if you can't be fit-tested
- Transport
- Surgical mask on the client. Notify the receiving area first
My Chicken Hez TB: measles, chickenpox (varicella), disseminated herpes zoster, and tuberculosis. For the NCLEX, that is the airborne list.
- Negative pressure pulls air in so the pathogen cannot escape into the hall
- Positive pressure is the opposite: it protects a client with no immune defenses
Concept 7 · Droplet precautions
If it falls, a surgical mask will do
- Surgical mask on before you enter. Gloves and gown per standard precautions
- Room: private preferred, or share with a client who has the same organism
- No negative pressure needed. The door can stay open
- Transport: surgical mask on the client
- Think: influenza, pertussis, meningococcal meningitis, mumps, rubella, diphtheria, strep throat
Quick check 2 of 4
A client has bacterial meningitis caused by Neisseria meningitidis. Which precautions apply?
Meningococcal disease spreads by respiratory droplets at close range, so it is droplet, not airborne. It is contagious: close contacts need prophylactic antibiotics such as rifampin or ciprofloxacin. Students often pick airborne for frightening infections, but this one is droplet.
Concept 8 · Contact precautions
Gown and gloves before you touch anything
- Spread by touching the client, or surfaces and equipment the client touched
- Gown and gloves on entry. Off before you leave, then hand hygiene right away
- Room: private, or share with a client who has the same organism
- Dedicated equipment: the stethoscope, BP cuff, and thermometer stay in the room
- Think: MRSA, VRE, C. diff, RSV, scabies, lice, impetigo, norovirus, rotavirus
C. diff adds two rules: soap and water for hand hygiene, and a sporicidal agent such as bleach for the room.
Concept 9 · Pick the precaution
Name the route, pick the room
Tap a disease, then tap the precaution it needs.
Two bins at once: varicella and disseminated herpes zoster need airborne and contact precautions. Fluid from the lesions spreads it too.
Concept 10 · PPE on and off
Clean hands first, gloves last
Put it on in order
- Taking it off
- Gloves (dirtiest), goggles or face shield, gown, mask, then hand hygiene
- Airborne
- Take the N95 off after you leave the room and close the door
Concept 11 · Sterile technique
Sterile only inside the border
Sterile
- The inside of the sterile package
- The drape inside its 1-inch border
- Gloved hands above the waist, in sight
Contaminated
- The outer 1-inch border
- Anything below the waist or out of sight
- A wet drape, or any item you are unsure of
Quick check 3 of 4
A nurse sets up a sterile field for urinary catheter insertion. Which action contaminates the field?
Your arm and sleeve are not sterile, so reaching across contaminates the field. Pass items around it instead. The other three are correct technique: only the outer 1-inch border counts as contaminated.
Concept 12 · Sterile rules
If in doubt, it is contaminated
- Never turn your back on the field. Out of sight is contaminated
- Never reach across it. Pass items around the field
- Wet is contaminated: moisture wicks germs up from below (strike-through). Start over
- Unsure? Discard and replace. A new kit costs less than an infection
- Open packages with the first flap away from you, sides next, last flap toward you
- Pour from 4 to 6 inches, label in your palm, after a small lip pour
Open the package with clean hands. With your nondominant hand, lift the dominant-hand glove by its folded cuff, touching only the inside, and slide your hand in. Then slip your gloved fingers under the cuff of the second glove, touching only its sterile outside, and pull it on.
Concept 13 · Protective isolation
This isolation protects the client
- Who: ANC under 500/mm³, bone marrow transplant, high-dose chemo, aplastic anemia
- Room: private, positive pressure, HEPA filtered, door closed
- Keep out: sick visitors, fresh flowers and plants, raw fruits and vegetables
- Staff: meticulous hand hygiene. Staff with an active infection stay away
Fever may be the only sign. No pus, no redness, no WBC rise. A fever in a neutropenic client is an emergency.
Quick check 4 of 4
A client with leukemia has an ANC of 200/mm³. The spouse arrives with garden flowers and a fresh fruit salad. What does the nurse do?
Fresh flowers carry mold spores such as Aspergillus, and raw fruit carries bacteria the client cannot fight. Both stay out. Hand hygiene does not make them safe, so honor the spouse's intent with a safer way to help.
Concept 14 · Disease reporting
Report it, then trace it
- Your role: spot it, tell the infection preventionist or charge nurse, make sure public health gets it
- Reportable: TB, measles, mumps, rubella, pertussis, hepatitis, HIV, meningococcal disease
- Also: gonorrhea, syphilis, chlamydia, salmonella, E. coli O157:H7
- Still confidential: it goes to public health, never to employers, schools, or the public
| Disease | Close contacts get |
|---|---|
| TB | A PPD skin test or IGRA blood test |
| Meningococcal disease | Prophylactic antibiotics |
| STIs | Confidential partner notification |
Decide it
Two rooms, two directions
Back to Mr. D and Ms. L · one negative, one positive room open
Mr. D is coughing in the semi-private room. Ms. L is shivering under two blankets.
Who goes where?
Backwards. Positive pressure would push his TB into the hall, and negative pressure would pull hallway air in on her.
Right. Negative pressure keeps his TB contained. Positive pressure keeps germs away from her.
Airborne precautions start on suspicion. Cough, night sweats, and weight loss are enough.
You are about to enter Mr. D's new room. What do you put on?
A surgical mask does not filter particles this small. That is the mask he wears for transport.
That is contact precautions. TB spreads through the air.
Right. It comes off after you leave and close the door, and the door stays closed.
Ms. L's temp is 100.9 F with chills. Her ANC is 300/mm³. What do you do?
Right. Febrile neutropenia can turn septic fast. Blood cultures, then broad-spectrum antibiotics within the hour.
That masks the only sign of infection she can show, and it wastes the hour that matters.
Waiting delays antibiotics. Her ANC already tells you she cannot fight this.
How it ends
- Ms. L gets blood cultures and antibiotics within the hour. Her fever breaks by morning
- Mr. D's AFB smear is positive. Precautions were already in place
- The health department is notified, and his close contacts get TB testing
Lock it in
Three hooks to carry into the exam
Two more
- Floats or falls: airborne particles float and need an N95. Droplets fall within 3 to 6 feet and need a surgical mask
- Negative keeps it in, positive keeps it out: TB gets negative pressure, a neutropenic client gets positive
Rapid fire
Standard precautions apply to every client, whatever the diagnosis.
Every client, every time. Transmission-based precautions are added on top.
Alcohol-based hand rub is the best choice after caring for a client with norovirus.
Soap and water with friction, the same as for C. diff.
A wet sterile drape is contaminated.
Moisture wicks germs up from the surface below. Start over.
Under standard precautions, sweat is treated as infectious.
Sweat is the one exception. Other body fluids, secretions, and excretions count.
You need an N95 to care for a client with influenza.
Influenza is droplet. A surgical mask is enough.
NCLEX traps
What the exam will try to trick you with
Droplet. Meningococcal meningitis needs a surgical mask and a private room, not an N95.
False. Alcohol does not kill the spores. Soap and water with friction, every time.
Surgical mask. The N95 protects the wearer. The client's mask contains their own particles.
Never. Gloves can have defects and hands get contaminated taking them off. Clean hands before and after.
Never recap. The sharps container belongs at the point of use.
Cheat card
The whole lesson on one card
Standard
- Break any link, stop the infection
- Every client, every time
- Splash risk: mask and eye protection
- Never recap needles
Hand hygiene
- Most effective single measure
- 5 moments, before and after
- C. diff, norovirus: soap and water
- Gloves never replace it
Isolation
- Airborne: N95, negative pressure
- Droplet: surgical mask
- Contact: gown and gloves on entry
- Varicella: airborne plus contact
Sterile and protective
- Never turn your back or reach across
- Wet or in doubt: contaminated
- Neutropenic: positive pressure
- Neutropenic fever: call now
The printable version is in the Cheat Sheets library.
Lesson quiz · 1 of 5
A nurse is caring for a client with C. diff. Which hand hygiene is best after removing gloves?
C. diff spores resist alcohol, and only soap and water with friction physically removes them. "Either" is wrong because alcohol rub does not work here. The same rule applies to norovirus.
Lesson quiz · 2 of 5
Which new admission needs a negative pressure room?
A positive AFB smear with a cough means active pulmonary TB: airborne precautions in a negative pressure room. The neutropenic client needs the opposite, positive pressure. MRSA is contact and influenza is droplet, and neither needs special airflow.
Lesson quiz · 3 of 5
A client in airborne precautions for suspected TB needs a chest x-ray in radiology. Which action is correct?
The client wears a surgical mask to contain their own particles, and radiology prepares to limit exposure. The N95 is for staff protecting themselves. Clients can leave for needed tests when these steps are followed.
Lesson quiz · 4 of 5
A client is diagnosed with varicella (chickenpox). Which precautions apply?
Varicella spreads through the air and through fluid from the lesions, so it needs both: N95 and a negative pressure room, plus gown and gloves. Disseminated herpes zoster gets the same pair. Droplet or contact alone misses a route.
Lesson quiz · 5 of 5
A nurse is about to enter the room of a client on contact precautions for MRSA. Which order is correct?
Clean hands first, then the gown, then gloves so the cuffs cover the gown sleeves. Removal starts with the gloves (the dirtiest), then the gown, then hand hygiene. Gowning before hand hygiene puts the gown on with contaminated hands.
Wrap-up
0 / 5
Quiz score
Back to Mr. D and Ms. L · two admissions
Which room does each client need? Mr. D, with suspected TB, gets the negative pressure airborne isolation room with the door closed. Ms. L, with an ANC of 300, gets the positive pressure room for protective isolation.
What do you wear into Mr. D's room? A fit-tested N95, on before you enter and off after you leave and close the door. Precautions start on suspicion, not on the AFB result.
Whose finding can't wait? Ms. L's. A fever of 100.9 F with an ANC of 300 is febrile neutropenia, an emergency. Call now: cultures, then antibiotics within the hour.
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