NCLEX-RN · Safe and Effective Care Environment
NCLEX-RN: Safety and Infection Prevention and Control Concepts
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Overview
This chapter is about keeping clients and staff safe. You will learn how germs spread and which precautions stop them, how to identify clients correctly, and how to prevent falls and use restraints safely. Emergency steps, such as what to do in a fire, also belong here.
Standard precautions apply to every client, every time: clean your hands and use gloves and other protection when you may touch body fluids. Transmission-based precautions are added for certain germs. Airborne precautions need a fitted respirator and a special room, droplet precautions need a mask when close to the client, and contact precautions need a gown and gloves.
Before any medicine, test or treatment, check two client identifiers, such as name and date of birth, and never use the room number. Restraints are a last resort, need a provider order, and must be checked often. For a fire, remember RACE for the steps and PASS for using an extinguisher.
Key concepts
Standard precautions
Basic infection control used with every client. Clean your hands before and after care, and wear gloves, a gown, a mask or eye protection when you may touch blood or body fluids.
Memory tipTreat all body fluids as if they could spread infection, no matter the diagnosis.
Airborne precautions
Used for germs that float in the air for a long time, such as tuberculosis, measles and chickenpox. The client stays in a negative-pressure room with the door closed, and staff wear a fitted N95 respirator.
Memory tip'My Chicken Hez TB': Measles, Chickenpox (varicella), Herpes zoster spread through the body, TB.
Droplet precautions
Used for germs spread by large droplets from coughing or sneezing, such as influenza, pertussis (whooping cough) and some types of meningitis. Staff wear a surgical mask when close to the client.
Memory tipDroplets fall quickly, so a regular mask is enough. A private room is preferred.
Contact precautions
Used for germs spread by touch, such as MRSA and C. difficile. Staff wear a gown and gloves, and equipment such as a stethoscope stays in the room.
Memory tipFor C. difficile, wash hands with soap and water. Alcohol hand rub does not kill its spores.
Two client identifiers
Before giving medicine or care, confirm the client with two identifiers, such as full name and date of birth. The room or bed number is never an identifier.
Memory tipAsk the client to state their name and birth date; do not just ask 'Are you Mr. Lee?'
Source: The Joint Commission (National Performance Goals) · as of 2026
Restraint safety
Restraints are used only when other ways have failed and the client may harm self or others. They need a provider order, must be tied to the bed frame with a quick-release knot, and the client is checked often for skin, circulation and needs.
Memory tipNever tie restraints to the side rail. Try less restrictive options first, such as a sitter or moving the client near the station.
RACE and PASS
RACE is the order of actions in a fire: Rescue clients in danger, Alarm, Contain the fire by closing doors, Extinguish or Evacuate. PASS is how to use an extinguisher: Pull the pin, Aim at the base, Squeeze the handle, Sweep side to side.
Memory tipRescue comes first. Aim at the base of the fire, not the flames.
Often tested
- Match each disease to the right precaution: TB and measles airborne, influenza droplet, MRSA and C. difficile contact.
- Use soap and water, not alcohol rub, for C. difficile.
- A room number is never a client identifier.
- Tie restraints to the bed frame, not the side rail, and try less restrictive options first.
- In a fire, rescue clients in immediate danger before anything else.
- Never recap a used needle; put it straight into a sharps container.
Easy to confuse: Transmission-based precautions
| Type | Examples | Main protection |
|---|---|---|
| Airborne | TB, measles, chickenpox | N95 respirator, negative-pressure room |
| Droplet | Influenza, pertussis | Surgical mask when close |
| Contact | MRSA, C. difficile | Gown and gloves |
3 sample questions
Verified practice questions from this unit.
Question 1. A nurse is leaving the room of a client with Clostridioides difficile (C. diff) infection. Which hand hygiene method should the nurse use?
- ① Washing with soap and water
- ② Removing gloves without any hand hygiene
- ③ Alcohol-based hand rub
- ④ Wiping hands with a disinfectant wipe for equipment
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Answer: ① Washing with soap and water
Key point: C. diff spores: wash hands with soap and water
C. diff forms spores (a tough, protected form of the germ). Alcohol does not kill these spores well. Washing with soap and running water physically rubs and rinses them off the hands.
So for C. diff, the nurse wears gloves and a gown (contact precautions) and then washes hands with soap and water after care.
Wrong choices
- "Alcohol-based hand rub": Alcohol rub is fine for most germs but does not work well against C. diff spores.
- "Removing gloves without any hand hygiene": Hand hygiene is always needed after removing gloves; gloves can have tiny holes or contaminate hands while being removed.
- "Wiping hands with a disinfectant wipe for equipment": Equipment wipes are not made for skin and can harm it.
Question 2. Which client requires airborne precautions?
- ① A client with a MRSA wound infection
- ② A client with pertussis (whooping cough)
- ③ A client with influenza
- ④ A client with pulmonary tuberculosis
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Answer: ④ A client with pulmonary tuberculosis
Key point: Airborne: TB, measles, chickenpox (varicella)
Airborne precautions are for germs that float in tiny particles and travel far in the air. Common examples are tuberculosis (TB), measles, and chickenpox (varicella).
The client stays in an airborne infection isolation room (negative pressure, door closed), and staff wear a fit-tested N95 respirator or higher.
Wrong choices
- "A client with influenza": Influenza is spread mainly by droplets. It needs droplet precautions.
- "A client with a MRSA wound infection": MRSA in a wound spreads by touch. It needs contact precautions.
- "A client with pertussis": Pertussis is spread by droplets. It needs droplet precautions.
Question 3. Before giving a medication, which is the correct way for the nurse to identify the client?
- ① Check the room number and ask the client's name
- ② Check the bed number and the client's diagnosis
- ③ Use two identifiers, such as the client's full name and date of birth
- ④ Ask, "Are you Mr. Brown?"
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Answer: ③ Use two identifiers, such as the client's full name and date of birth
Key point: Use two client identifiers; never the room number
Before giving medications, blood, or treatments, the nurse uses at least two client identifiers, such as the client's full name and date of birth, and checks them against the ID band and the order.
The client should be asked to state the information, not just agree with it.
Wrong choices
- "Check the room number": Clients change rooms. A room or bed number is never used as an identifier.
- "Check the bed number and the client's diagnosis": Neither is a reliable way to identify a person.
- "Ask, "Are you Mr. Brown?"": A confused or hard-of-hearing client may just say yes. Ask the client to say their name.