Editing Infection Control and Safety – RN Flashcards

Rapid-review flashcards for [[Infection Control and Safety]] at NCLEX-RN depth. Cover the answer, recall it, then check. Terms in the answer that appear on the exam are bolded.

== Chain of Infection and Epidemiology ==

;Name the six links in the chain of infection.
:Infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. Breaking '''any one''' link prevents infection.
;What is the most common mode of transmission of healthcare-associated infections?
:'''Indirect contact''' by way of the contaminated hands of healthcare personnel. This is why hand hygiene is the single most effective control measure.
;Define a healthcare-associated infection.
:An infection acquired during the course of receiving care that was '''not present or incubating on admission'''. The four most commonly targeted are '''CAUTI, CLABSI, VAP, and SSI'''.
;What are the four stages of the infectious process?
:'''Incubation''' (exposure to first symptoms, often contagious), '''prodromal''' (vague symptoms, communicability frequently highest), '''illness''' (specific signs and symptoms), and '''convalescence''' (recovery).
;How does infection often present in an older adult?
:Atypically. '''New-onset confusion, falls, functional decline, anorexia, incontinence, or hypotension may occur without fever.''' A normal temperature does not rule out infection.
;What laboratory pattern suggests acute bacterial infection?
:Leukocytosis with an increase in immature neutrophils ('''bands''', a left shift), with supporting elevation of C-reactive protein or procalcitonin. Lymphocytosis suggests a viral cause and eosinophilia suggests parasites or allergy.
;Define neutropenic fever and state the priority action.
:A single temperature of '''100.4 degrees Fahrenheit (38 degrees Celsius) or higher''' in a client with an absolute neutrophil count generally below 500 cells per microliter. It is an emergency: obtain '''blood cultures and administer broad-spectrum antibiotics without delay''', typically within one hour.

== Precautions ==

;To whom do standard precautions apply?
:'''Every client, every time, regardless of diagnosis.''' All blood, body fluids, secretions and excretions '''except sweat''', non-intact skin, and mucous membranes are treated as infectious.
;List the elements of standard precautions.
:Hand hygiene; PPE by anticipated exposure; respiratory hygiene and cough etiquette; safe injection practices; safe handling of equipment, linens, and the environment; sharps safety; sterile technique for spinal and epidural procedures; and risk-based patient placement.
;When are transmission-based precautions initiated?
:'''On clinical suspicion, not on culture confirmation.''' They are used '''in addition to''' standard precautions.
;PPE and placement for contact precautions?
:'''Gown and gloves''' on entry, single room preferred, cohorting permitted for the same organism, and '''dedicated or single-use equipment'''. Disinfect anything shared before it leaves the room.
;PPE and placement for droplet precautions?
:'''Surgical mask''' on entry, single room preferred with at least three to six feet between cohorted beds, and the door may remain open. The '''client''' wears a surgical mask during transport.
;PPE and placement for airborne precautions?
:'''Fit-tested N95 or higher respirator''' plus an '''airborne infection isolation room''': negative pressure, at least 6 air changes per hour in existing construction and 12 in new or renovated, exhausted outdoors or HEPA filtered, '''door closed''', pressure monitored daily.
;Which conditions require airborne precautions, and which require airborne plus contact?
:Airborne: '''tuberculosis (pulmonary or laryngeal) and measles'''. Airborne plus contact: '''varicella and disseminated herpes zoster''' (and smallpox). Localized zoster in an immunocompetent client needs only standard precautions with lesions covered.
;Which organisms require soap-and-water hand hygiene rather than alcohol rub?
:'''''Clostridioides difficile'', norovirus, and ''Bacillus anthracis''''', and any time hands are visibly soiled. Alcohol does not kill spores.
;How long are precautions maintained for meningococcal disease and for pertussis?
:Meningococcal disease: droplet until '''24 hours''' of effective antibiotic therapy. Pertussis: droplet until '''5 days''' of effective therapy.
;What is a protective environment and who needs one?
:A '''positive-pressure''', HEPA-filtered room with at least 12 air changes per hour and sealed construction for severely immunocompromised clients, classically '''allogeneic hematopoietic stem cell transplant''' recipients. It protects the client from the environment. No fresh flowers, potted plants, standing water, or construction dust.
;A transplant client develops varicella. What room is required?
:An '''airborne infection isolation room with an anteroom''' so that both positive-pressure protection for the client and negative-pressure containment of the pathogen can be met.
;After an infectious client leaves an airborne infection isolation room, how soon may an unprotected person enter?
:After enough time for adequate air exchanges, roughly '''one hour at 6 air changes per hour''' and about 35 minutes at 12. Facility policy governs.

== PPE, Asepsis, and Exposure ==

;State the donning and doffing sequences.
:Donning: hand hygiene, '''gown, mask or respirator, goggles or face shield, gloves'''. Doffing: '''gloves, goggles or face shield, gown, mask or respirator''', then hand hygiene. Remove all PPE before leaving the room except the '''respirator, which is removed after exiting'''.
;Contrast medical and surgical asepsis.
:'''Medical asepsis (clean technique) reduces''' the number of organisms; '''surgical asepsis (sterile technique) eliminates all organisms including spores'''. Sterile technique is required for surgery, central line and urinary catheter insertion, tracheostomy care, and fresh surgical wound and burn dressings.
;State five rules of a sterile field.
:The outer '''1-inch border''' is contaminated; keep sterile items '''above waist level and in sight'''; never turn your back or reach across the field; '''moisture causes strike-through contamination'''; and open the first wrapper flap away from the body. Never leave a sterile field unattended.
;Priority actions after a needlestick with a hollow-bore device.
:Wash the site with soap and water immediately, '''report to employee health at once''', test source and worker per protocol, and start '''HIV post-exposure prophylaxis as soon as possible, ideally within hours'''. Hepatitis B management depends on vaccine and antibody status; there is '''no prophylaxis for hepatitis C''', so serial testing is used.
;Where does PPE fall in the hierarchy of controls?
:'''Last.''' Elimination, substitution, engineering controls (ventilation, safety-engineered sharps, closed suction), and administrative controls (policy, staffing, vaccination, screening) come before PPE.

== Safety, Restraints, and Environment ==

;Name two validated fall risk screening tools and the strongest single predictor of a fall.
:The '''Morse Fall Scale''' and the '''Hendrich II Fall Risk Model'''. The strongest single predictor is a '''history of a previous fall'''.
;Which medication classes most increase fall risk, and which increase fall harm?
:Risk: '''benzodiazepines and sedative-hypnotics, opioids, antipsychotics, antidepressants, anticholinergics, antihypertensives, diuretics, insulin and sulfonylureas''', and polypharmacy generally. Harm: '''anticoagulants and antiplatelets''', which raise the risk of serious bleeding after a fall.
;First action after an unwitnessed fall?
:'''Assess before moving the client''': level of consciousness, vital signs, pain, deformity or leg shortening and external rotation, and head injury. Perform neurologic checks if the head was struck, the fall was unwitnessed, or the client is anticoagulated. Then notify the provider and family, and complete the '''incident report as an internal document that is not referenced in the chart'''.
;When do side rails become a restraint?
:When they prevent the client from leaving the bed voluntarily, classically '''all four rails raised'''. They also create '''entrapment risk''' and increase injury from climbing over.
;State the CMS time limits and face-to-face requirement for violent or self-destructive restraint.
:A '''face-to-face evaluation within 1 hour''' by a physician, other licensed independent practitioner, or trained registered nurse. Order limits: '''4 hours for adults 18 and older, 2 hours for ages 9 through 17, and 1 hour for children under 9''', renewable within these limits up to 24 hours before a new in-person evaluation.
;What is the order requirement for restraint, and what is never allowed?
:An order from a physician or other licensed independent practitioner is required; in an emergency a trained RN may apply and obtain the order as soon as possible, generally within one hour. '''PRN and standing restraint orders are never permitted.''' Nonviolent medical or surgical restraint orders are renewed at least once each calendar day.
;State the safe application and monitoring rules for restraints.
:Least restrictive device, applied over padding, '''two fingers''' fitting underneath, tied to the '''movable bed frame''' with a '''quick-release knot''', never to side rails. Release at least '''every 2 hours''' for range of motion, repositioning, toileting, hydration, and skin care. Monitor every 2 hours for nonviolent and every 15 minutes with continuous observation for violent restraint. Never restrain prone or in any way that impairs breathing.
;What do RACE and PASS stand for?
:'''R'''escue, '''A'''larm, '''C'''onfine, '''E'''xtinguish. '''P'''ull the pin, '''A'''im at the base of the fire, '''S'''queeze the handle, '''S'''weep side to side. An '''ABC''' extinguisher is the multipurpose choice in healthcare.
;State the evacuation priority and route rules.
:Ambulatory clients first, then those needing assistance, then nonambulatory and bedbound. Evacuate '''horizontally past smoke barrier doors first, vertically only if needed, and never by elevator'''.
;List key oxygen safety measures.
:No smoking or open flame, no spark-producing devices such as electric razors, avoid petroleum-based and alcohol-based products near the face, use '''cotton''' rather than wool or synthetic bedding, post signage, and secure cylinders '''upright in a holder or chained''' away from heat.
;What is microshock and who is at risk?
:Injury from a very small leakage current reaching the myocardium through a conductive path such as a '''pacing wire or central catheter'''. Minimize bedside electrical devices, use grounded hospital-grade equipment, and never defeat the ground pin.
;PPE and handling for hazardous antineoplastic drugs.
:'''Double chemotherapy-rated gloves''', a closed-front impermeable gown, eye protection, a closed system transfer device, and preparation in a '''biological safety cabinet'''. Handle excreta with PPE for at least 48 hours after administration per policy and use a spill kit for spills.
;Radiation safety principles for a client with a sealed internal implant.
:'''Time, distance, and shielding.''' Limit time in the room, maximize distance, wear a lead apron and dosimeter, keep '''long-handled forceps and a lead container''' in the room, '''never touch a dislodged implant with bare hands''', and restrict pregnant staff, pregnant visitors, and children.

== Program, Outbreak, and Delegation ==

;What are the first steps when a cluster of infections is identified on a unit?
:Confirm cases and define a case, '''notify infection prevention and public health when required''', institute appropriate precautions immediately, '''cohort clients and staff''', build a line list and epidemic curve to find the common exposure by person, place, and time, intensify cleaning with an effective agent, exclude ill staff, and evaluate the effect on the case rate.
;Why is antimicrobial stewardship an infection control intervention?
:Antibiotic exposure is the dominant modifiable risk factor for '''''C. difficile''''' and for the emergence of multidrug-resistant organisms. Reducing unnecessary and overly broad therapy attacks the '''infectious agent''' link.
;How is a device-associated infection rate expressed?
:'''Infections per 1,000 device days''', which adjusts for how much the device was used and allows comparison over time and across units.
;What is the reference standard for measuring hand hygiene compliance?
:'''Direct observation of hand hygiene opportunities''', ideally trended alongside infection outcomes. Product volume is an indirect proxy and self-report overestimates compliance.
;What may the RN never delegate in this subject?
:'''Assessment, initial teaching, evaluation of outcomes, and nursing judgment about an unstable client''', including the decision to initiate precautions and the required assessments surrounding restraint use. Tasks such as transport, hygiene, vital signs, and applying PPE may be delegated with clear instruction.

[[Category:Infection Control and Safety]]
[[Category:Registered Nurse (NCLEX-RN)]]
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