Certified Nursing Assistant (CNA) Exam Infection Control Summary

Hands carry germs from person to person and from surfaces to people. Hand hygiene, either washing with soap and water or using an alcohol-based hand rub, is the most important way to stop the spread of infection.

Wrong choices

• Opening the windows: Fresh air does not remove germs from hands and surfaces.
• Giving antibiotics: Nurse aides do not give antibiotics, and antibiotics do not stop the spread of germs between people.
• Wearing a mask all day: Masks help in some situations, but hand hygiene prevents the most spread.

Alcohol-based hand rub works for most routine hand hygiene, but when hands are visibly soiled you must wash with soap and water. Soap and running water remove dirt and body fluids that hand rub cannot.

Wrong choices

• Wipe your hands on your uniform: This spreads germs to your uniform and does not clean your hands.
• Put on gloves over the dirt: Gloves do not clean hands, and germs stay on the skin.
• Use alcohol-based hand rub: Hand rub is not enough when hands are visibly dirty.

Standard precautions treat all blood, body fluids (except sweat), broken skin, and mucous membranes as possibly infectious. They are used with every resident, every time, because you cannot tell who carries germs.

Wrong choices

• Only when a doctor writes an order: Standard precautions are used every time, without an order.
• Only residents in isolation rooms: Isolation residents need extra precautions on top of standard precautions.
• Only residents with a known infection: Many people carry germs without signs, so precautions are needed for everyone.

Gloves do not replace hand hygiene. Germs can pass through tiny holes or get on the hands while removing gloves. Always clean your hands right after taking gloves off.

Wrong choices

• Nothing, because the gloves kept the hands clean: Gloves can have tiny holes, and hands can get dirty while taking them off.
• Rinse the gloves and keep them for the next resident: Disposable gloves are used once and thrown away.
• Put on new gloves without cleaning the hands: Hands must be cleaned before putting on new gloves.

Roll soiled linen with the dirty side in, hold it away from your uniform, and put it straight into the laundry bag or hamper. Never shake linens or put them on the floor.

Wrong choices

• Held against the chest: Holding linens against the uniform moves germs onto your clothes.
• Put on the floor until the bed is made: The floor is dirty and spreads germs to other surfaces.
• Shaken out first to remove crumbs: Shaking linens spreads germs into the air.

Signs of infection include redness, swelling, warmth, pain, pus or drainage, fever, and new confusion in older adults. Report these signs to the nurse right away.

Wrong choices

• Dry skin on the elbows: Dry skin is common in older adults and is not a sign of infection.
• A pulse of 76 beats per minute: This is a normal adult pulse.
• Sleeping after lunch: A nap is normal.

Always work from clean to dirty. This keeps germs from the dirtiest areas from spreading to areas that are already clean.

Wrong choices

• From the bottom up to the top every time: The rule is clean to dirty, not a fixed body direction.
• From the dirtiest area toward the cleanest area: This spreads germs onto clean areas.
• In any direction, as long as soap is used: Direction matters even with soap.

A common order for putting on PPE is gown, mask, goggles or face shield, then gloves. Gloves go on last so they cover the cuffs of the gown and stay as clean as possible.

Wrong choices

• Mask: The mask goes on before eye protection and gloves.
• Goggles or face shield: Eye protection goes on before the gloves.
• Gown: The gown goes on first so the gloves can cover its cuffs.

Contact precautions are for germs that spread by touching the resident or items in the room, such as some drug-resistant bacteria. Wear a gown and gloves, and keep equipment such as a blood pressure cuff in the room when possible.

Wrong choices

• A mask only: A mask alone does not protect against germs spread by touch.
• No protective equipment: Contact precautions require protective equipment.
• A fitted N95 respirator only: A respirator is for airborne precautions.

TB germs float in tiny particles in the air for a long time. Airborne precautions use a special room with the door kept closed and a fitted respirator such as an N95 for staff.

Wrong choices

• Standard precautions only: TB needs extra precautions on top of standard precautions.
• Contact precautions: Contact precautions are for germs spread by touch.
• Droplet precautions: Droplet precautions are for germs in larger drops that travel only a short distance, such as the flu.