Infection Control and Safety – LPN Flashcards

Rapid-review flashcards for Infection Control and Safety at NCLEX-PN depth. The focus is on doing the task correctly, spotting hazards, and knowing what to report to the registered nurse. Cover the answer, recall it, then check.

Basics of Infection

What are the six links in the chain of infection?

Infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. Breaking one link stops the infection.

What is the single most effective way to prevent the spread of infection?

Hand hygiene. On an exam, look hard at hand hygiene before choosing any other option.

Name the signs of a localized infection.

Redness, warmth, swelling, pain, and purulent drainage at one site, sometimes with loss of function.

Name the signs of a systemic infection.

Fever, chills, increased heart rate and respiratory rate, malaise, and an elevated white blood cell count. Report these to the registered nurse.

How might infection look in an older adult?

It may show up as new confusion, a fall, poor appetite, new incontinence, or unusual sleepiness with little or no fever. Report any of these to the registered nurse.

Which clients are most at risk for infection?

The very young and very old, and clients who are immunosuppressed, malnourished, diabetic, postoperative, or have any invasive device such as an intravenous line, urinary catheter, drain, or breathing tube.

Hand Hygiene

When should hand hygiene be performed?

Before touching a client, before a clean or sterile task, after any exposure to body fluids, after touching a client, after touching the client's surroundings, before putting on gloves and right after taking them off, before handling medications or food, and after using the restroom.

When must soap and water be used instead of alcohol-based hand rub?

When the hands are visibly soiled, after caring for a client with Clostridioides difficile or norovirus, after using the restroom, and before eating. Alcohol does not kill spores.

How long should hands be scrubbed with soap and water, and how is the alcohol rub used?

Lather all surfaces for at least 20 seconds, rinse with fingertips pointing down, dry with a paper towel, and use the towel to turn off the faucet. For alcohol rub, apply enough to cover all surfaces and rub until completely dry, roughly 20 to 30 seconds. Do not fan or wipe hands dry.

Do gloves replace hand hygiene?

No. Gloves can have unseen defects and hands become contaminated during removal. Perform hand hygiene before donning and immediately after removing gloves, and change gloves between clients and between a dirty and a clean site on the same client.

Precautions

Who gets standard precautions?

Every client, every time, no matter the diagnosis. Treat all blood, body fluids, secretions and excretions except sweat, non-intact skin, and mucous membranes as infectious.

What PPE is required for contact precautions, and give three examples of conditions.

Gown and gloves on entry. Examples: MRSA, VRE, C. difficile, norovirus, scabies, lice, RSV, and draining wounds that a dressing cannot contain. Use dedicated equipment in the room.

What PPE is required for droplet precautions, and give three examples of conditions.

A surgical mask on entry, plus eye protection if splashing is likely. Examples: influenza, pertussis, mumps, rubella, meningococcal meningitis, and group A streptococcal infection.

What PPE and room are required for airborne precautions, and which conditions?

A fit-tested N95 respirator and a negative-pressure airborne infection isolation room with the door kept closed. Conditions: tuberculosis, measles, chickenpox (varicella), and disseminated shingles (the last two also need contact precautions).

What does the client wear when leaving the room on droplet or airborne precautions?

A surgical mask, never an N95. The mask on the client keeps the client's droplets contained. Cover any skin lesions, and notify the receiving department before transport.

Which precautions are used for a client with C. difficile, and what else is different?

Contact precautions, soap-and-water hand hygiene, a private room with dedicated equipment, and cleaning with a bleach or other sporicidal disinfectant. Report ongoing diarrhea, abdominal distention, or signs of dehydration to the registered nurse.

Which precaution level does a client with neutropenia need?

A protective environment: a positive-pressure, filtered room that keeps organisms away from the client. No fresh flowers, potted plants, standing water, or ill visitors. This protects the client rather than others.

PPE and Sterile Technique

What is the order for putting on PPE?

Hand hygiene, then gown, mask or respirator, goggles or face shield, gloves last, pulling the gloves over the gown cuffs.

What is the order for taking off PPE?

Gloves, goggles or face shield, gown, mask or respirator, then hand hygiene. Remove everything before leaving the room except the respirator, which comes off after you exit.

How are gloves removed safely?

Grasp the outside of one glove at the palm and peel it off, hold it in the gloved hand, slide ungloved fingers under the cuff of the second glove, and peel it off over the first. Discard and perform hand hygiene.

What is the difference between clean technique and sterile technique?

Clean (medical asepsis) reduces the number of organisms; sterile (surgical asepsis) removes all organisms including spores. Sterile technique is used for urinary catheter insertion, tracheostomy care, and fresh surgical wound dressings.

Name four rules for keeping a sterile field sterile.

The outer 1-inch border is contaminated; keep sterile items above the waist and in view; never turn your back or reach across the field; and any wetness contaminates the field. Open the first flap of a package away from you and never leave the field unattended.

Safety in the Environment

List five actions that reduce a client's risk of falling.

Bed in the lowest position with wheels locked, call light and belongings within reach, nonskid footwear, adequate lighting and a clear path to the bathroom, and scheduled toileting with assistance for the first time up after surgery or sedation.

When are side rails considered a restraint?

When they keep the client from getting out of bed voluntarily, classically all four rails up. This raises the risk of entrapment and of a worse injury from climbing over the rail.

What is the first action if a client is found on the floor?

Assess the client before moving them: check responsiveness, vital signs, pain, and for obvious injury such as a shortened, externally rotated leg. Call for help, notify the registered nurse and provider, and document objectively what was found and done.

What must be checked on a client in restraints, and how often is the restraint released?

Check circulation, sensation, movement, skin, and correct placement, typically every 2 hours for nonviolent restraint and every 15 minutes with continuous observation for violent restraint. Release at least every 2 hours for range of motion, repositioning, toileting, fluids, and skin care.

How and where are restraints tied?

To the movable bed frame with a quick-release knot, never to a side rail, applied over clothing or padding with room for two fingers underneath. Keep scissors accessible, and never restrain a client face down.

Is a PRN restraint order acceptable?

No. PRN and standing restraint orders are prohibited. A restraint requires a current provider order, and it may be discontinued at any time without a new order.

What does RACE stand for?

Rescue anyone in danger, Activate the alarm, Confine the fire by closing doors and shutting off oxygen, Extinguish only if the fire is small and you have a clear exit.

What does PASS stand for, and which extinguisher is used in most hospital areas?

Pull the pin, Aim at the base of the fire, Squeeze the handle, Sweep side to side. An ABC multipurpose extinguisher is used for most healthcare fires. Never use water on an electrical or grease fire.

Who is evacuated first, and which route is never used?

Ambulatory clients first, then those needing assistance, then bedbound clients. Move horizontally past smoke barrier doors first. Never use an elevator.

List four oxygen safety measures.

Post "oxygen in use" signage, prohibit smoking and open flames, avoid spark-producing devices such as electric razors and heating pads and petroleum- or alcohol-based products near the face, use cotton rather than wool or synthetic fabrics, and secure cylinders upright so they cannot fall.

What should the nurse do with a frayed electrical cord or damaged equipment?

Unplug it, remove it from service, tag it, and report it immediately. Never tape or repair it, and never keep using it. Grasp the plug rather than the cord when unplugging, and keep cords out of walkways.

How are used needles handled?

Never recap, bend, or break a needle. Activate the safety device and drop the whole assembly into a puncture-resistant sharps container at the point of use. Replace the container when it is about three-quarters full.

How is soiled linen handled?

Hold it away from your uniform, never shake it, never place it on the floor or a clean surface, and bag it in the client's room.

Reporting and Scope

What findings must the LPN or LVN report promptly to the registered nurse?

New or rising fever, chills, new confusion, increasing wound redness or purulent drainage, foul-smelling or cloudy urine, new shortness of breath or falling oxygen saturation, a suspected exposure or break in precautions, and any client whose condition is worsening.

What may the LPN or LVN do independently in this subject, and what belongs to the RN?

The LPN or LVN applies standard and transmission-based precautions, performs sterile procedures within state scope, monitors stable clients, applies and monitors restraints per policy, reinforces teaching, and documents. The registered nurse performs the initial assessment, creates and evaluates the plan of care, and provides initial teaching. The state nurse practice act governs scope.

What may unlicensed assistive personnel do?

Hand hygiene, applying PPE, transporting, positioning, ambulating, hygiene, and taking and reporting vital signs. They may not assess, teach, or decide precautions.

What is done with an incident or occurrence report?

It is completed as an internal quality improvement document. Document the client's condition and care factually in the medical record, but do not chart that an incident report was filed and do not place a copy in the chart.

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