Standard Precautions and Transmission-Based Precautions

Must-know rules

Every intervention breaks a link. Hand hygiene breaks transmission. Masks break portals. Sterile technique protects portals of entry. Immunizations strengthen the host.
Standard precautions = every client, every time. Hand hygiene, gloves, gown, mask/eye protection for splash risk, sharps safety, respiratory hygiene.
C. diff and norovirus = soap and water ONLY. Alcohol-based rub does not kill spores.
My Chicken Hez TB = airborne. N95 + negative pressure room. Everything else = droplet (surgical mask) or contact (gloves + gown).
Varicella and disseminated zoster = airborne + contact. Dual precautions: both routes of transmission.
Sterile field rules are absolute. Never turn your back, never reach across, wet = contaminated, when in doubt = contaminated.
Negative pressure = protect others. Positive pressure = protect the client. TB gets negative. Neutropenic gets positive.
Fever in a neutropenic client = emergency. It may be the only sign of infection. Notify immediately. Antibiotics within the hour.

CHAIN OF INFECTION & MODES OF TRANSMISSION

DOJO RULE

Every nursing infection control intervention breaks a link. Hand hygiene breaks mode of transmission.

MODES OF TRANSMISSION: THE BIG THREE

Contact: (most common in healthcare): Direct: skin-to-skin, hands to client.
Droplet: Large respiratory particles (>5 microns) that travel ≤3–6 feet then fall.
Airborne: Tiny particles (<5 microns) that remain suspended in air and travel long distances via air...

STANDARD PRECAUTIONS & HAND HYGIENE

THE STANDARD PRECAUTIONS BUNDLE

Hand hygiene: the single most effective infection prevention measure.
Gloves: when touching blood, body fluids, mucous membranes, non-intact skin, or contaminated surfaces.
Gown: when clothing may contact blood or body fluids. Remove before leaving the client's room.
Mask / eye protection / face shield: when procedures may generate splashes or sprays of blood or body...
Sharps safety: never recap needles. Use safety-engineered devices.
Respiratory hygiene / cough etiquette: cover coughs, provide tissues

C. DIFF & NOROVIRUS EXCEPTION

Alcohol-based hand rub does NOT kill C. difficile spores or norovirus. For these organisms, soap and water with friction is required

TRANSMISSION-BASED PRECAUTIONS:AIRBORNE, DROPLET & CONTACT

Disease	Airborne	Droplet	Contact
Tuberculosis (pulmonary)
Measles (rubeola)
Varicella (chickenpox)
Disseminated herpes zoster
Influenza
Pertussis
Meningococcal meningitis
Mumps

DOJO RULE

Airborne = N95 + negative pressure room. Droplet = surgical mask + private room. Contact = gloves + gown + dedicated equipment. The NCLEX's #1 infection control trap is confusing...

MNEMONIC: "MY CHICKEN HEZ TB"

Airborne diseases: Measles, Chicken pox (varicella), Herpes zoster (disseminated), TB. Everything else is droplet or contact. If it's not on this list, it's not airborne.

IMMUNOCOMPROMISED PRECAUTIONS & COMMUNICABLE DISEASE REPORTING

NEUTROPENIC / PROTECTIVE PRECAUTIONS

Who needs it: Clients with ANC (absolute neutrophil count) <500/mm³, bone marrow transplant recipients
Room: Private room with positive pressure (pushes air out, preventing unfiltered air from entering).
Visitors: No sick visitors. No fresh flowers or plants (harbor bacteria and mold).
Staff: Meticulous hand hygiene before entry. Mask if the nurse has any signs of URI.
Monitoring: Assess for infection constantly.

DOJO RULE

Negative pressure protects others FROM the client: (airborne isolation: pulls air in and filters it).

FINAL DOJO RULE

Infection prevention is not passive: it's every action you take and every action you don't skip. The nurse who washes their hands, dons the right PPE

Memory hooks

My Chicken Hez TB My Measles (rubeola) · Chicken Chickenpox (varicella) · Hez Herpes zoster · TB Tuberculosis

SPIDERMAN S Strep pharyngitis · P Pertussis · I Influenza · D Diphtheria (pharyngeal) · E Epiglottitis (H. influenzae type · R Rubella · M Mumps · A Adenovirus · N Neisseria meningitidis

MRS WEE M Multidrug-resistant organisms · R RSV · S Skin · W Wound infections · E Enteric · E Eye