NCLEX-RN Safety and Infection Prevention and Control Summary

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.

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.

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.

Simple steps reduce falls:

• Bed in the lowest position, wheels locked
• Call light and personal items within reach
• A night light and a clear path to the bathroom
• Nonskid footwear
• Regular toileting rounds

These help the client move safely without adding new dangers.

Wrong choices

• "Keep all four side rails up": All four rails up can act as a restraint, and confused clients may climb over them and fall from a greater height.
• "Turn off all lights at night": Darkness increases the chance of tripping. A night light is safer.
• "Apply a vest restraint at night": Restraints are a last resort, need an order, and can cause injury. They do not prevent falls.

The goal when removing PPE is to avoid touching the dirtiest parts with clean hands and to protect the face as long as possible. One commonly used order from the CDC is:

1. Gloves
2. Goggles or face shield
3. Gown
4. Mask or respirator

The mask is removed last, touching only the ties or ear loops, and then hand hygiene is done right away.

(For putting PPE on, the order is gown, mask, goggles, then gloves.)

Wrong choices

• "Gloves": Gloves are the most contaminated item and are usually removed first (or together with the gown).
• "Gown": The gown comes off before the mask.
• "Goggles": Goggles come off before the gown and mask.

Restraints are tied to a part of the bed that does not move when the rails are lowered, which is the bed frame. A quick-release knot lets staff free the client fast in an emergency.

Other key points:

• Leave room for about two fingers under the restraint.
• Check the client often (skin, circulation, breathing, comfort) and release regularly for toileting, food, fluids, and movement, as required by policy and the order.

Wrong choices

• "Tie the restraints to the side rails": When the rail is lowered, it can pull on the client's arm and cause injury.
• "Check on the client only once each shift": Clients in restraints need frequent checks. Once a shift is unsafe.
• "Make the restraints tight enough that no finger fits": This can cut off blood flow and injure skin and nerves.

Droplet precautions protect against germs carried in larger drops from coughing, sneezing, or talking. These drops usually fall within a short distance. The nurse wears a surgical (face) mask when entering the room.

Standard precautions still apply as well (for example, gloves when touching body fluids). An N95 respirator is for airborne germs, or for special procedures that create fine sprays.

Wrong choices

• "An N95 respirator": An N95 is needed for airborne precautions, not routine droplet precautions.
• "A gown and gloves only": These alone do not protect the nose and mouth from droplets.
• "No protective equipment unless touching the client": Droplets can reach the nurse's face without any touch.

Hospitals use the memory aid RACE:

1. Rescue — move clients in immediate danger
2. Alarm — pull the alarm and call the emergency number
3. Contain — close doors and windows
4. Extinguish or Evacuate

To use a fire extinguisher, remember PASS: Pull the pin, Aim at the base, Squeeze the handle, Sweep side to side.

Wrong choices

• "Pull the fire alarm": This is the second step, after rescuing the client in danger.
• "Close the doors to the room": This is the third step (contain).
• "Use a fire extinguisher": This comes last, and only if the fire is small and it is safe to do so.

The medical record should contain the objective facts: what happened, what the nurse saw, the assessment, who was notified, and what care was given.

The incident report is a separate, internal document used to improve safety. It is not part of the medical record, so the nurse does not mention it in the chart or file a copy there.

Wrong choices

• "Write "incident report completed" in the medical record": The incident report is not mentioned in the client's chart.
• "Place a copy of the incident report in the chart": The incident report is kept separate from the medical record.
• "Complete an incident report only if the client is injured": Events and near misses are reported even without injury so the cause can be fixed.

Throw rugs are a common cause of tripping and falls at home. Removing them shows the client understood the teaching.

Other home safety tips: keep walkways clear, use night lights, install grab bars in the bathroom, wear nonskid, well-fitting shoes, and keep space heaters well away from beds and curtains.

Wrong choices

• "Put my space heater close to my bed": Heaters near bedding are a fire risk.
• "Keep the night lights off": Night lights help prevent falls when getting up at night.
• "Walk around ... in my socks": Socks can be slippery on smooth floors. Nonskid shoes or slippers are safer.