Safety and

Infection
Control
Archer Review

Safety and Infection Control

▪ Standard Precautions / Transmission Based Precautions
▪ Use of Restraints / Seclusion / Safety Devices
▪ Handling Hazardous Materials
▪ Emergency Response Plan
▪ Home Safety
▪ Accident and Injury Prevention
▪ Error Prevention
▪ Ergonomic Principles
▪ Safe Use of Equipment
 Isolation
Precautions

Standard
● Perform hand hygiene
● Use PPE if you expect to be exposed to bodily fluids
● Disinfect patient equipment
● Follow safe injection practices
○ 1 needle, 1 syringe, 1 time
 Donning PPE
Gown
● Fully cover torso from neck to knees, arms to end of wrist,
and wrap around the back
● Fasten in back at neck and waist

Mask or Respirator
● Secure ties or elastic band at middle of head and neck
● Fit flexible band to nose bridge
● Fit snug to face and below chin
● Fit-check respirator

Goggles/Face Shield
● Put on face and adjust to fit

Gloves
● Use non-sterile for isolation
● Select according to hand size
● Extend to cover wrist of isolation gown
Gloves
Doffing PPE
● Grasp outside of glove with opposite gloved hand;
peel off
● Hold removed glove in gloved hand
● Slide fingers of ungloved hand under remaining glove
aat wrist
Goggles/Face Shield
● To remove, handle by “clean” headband Place in
designated receptacle for reprocessing or in waste
container
Gown
● Unfasten neck, then waist ties
● Remove gown using a peeling motion; pull gown from
each shoulder toward the same hand
● Gown will turn inside out
● Hold removed gown away from body, roll into a
bundle and discard into waste or linen receptacle
Mask or Respirator
● Front of mask/respirator is contaminated – DO NOT
TOUCH!
● Grasp ONLY bottom then top ties/elastics and remove
● Discard in waste container

NCLEX Question
You are working in an ICU caring for a 62 year old male who was prescribed
vancomycin for an infection. He develops persistent, watery diarrhea. Which of
the following precautions do you take? Select all that apply.

A. Sanitize your hands before and after entering the room

B. Place the patient is a negative pressure room
C. Wear an N95 and face shield when entering the room.
D. Use single use equipment and leave it inside of the room
Answer: D
A is incorrect. The nurse should suspect C. diff in the patient that develops watery diarrhea after an
antibiotic course. Sanitizing your hands before and after entering the room will not kill the C. diff spores.
The nurse will need to wash her hands with soap and water.

B is incorrect. Placing the patient is a negative pressure room is not necessary. The nurse suspects C. diff,
which requires special enteric precautions. A negative pressure room is indicated for airborne
precautions.

C is incorrect. Wear an N95 and face shield when entering the room. is not necessary. The nurse
suspects C. diff, which requires special enteric precautions. A N95 and face shield is indicated for
airborne precautions.

D is correct. Using single use equipment and leaving it inside of the room is important for special enteric
precautions. The nurse should take this precaution.

Restraints
When is it appropriate to use restraints?
● Is your patient a danger to themselves or others?
○ Patient trying to harm themself
○ Combative patient trying to harm team members
● Are they trying to pull out their IVs or airway?
● Delirious patients
○ Don’t know where they are
○ Are afraid and at risk for harming themself

Always, always, ALWAYS remove the restraints as soon as possible! Use other
methods when appropriate - redirection, orientation, sedation as ordered.

Types of restraints
● Physical
○ Physically restraining all limbs (4 nurses providing care)
○ Physically holding against their will
● Environmental
○ Seclusion
○ Secure unit
● Pharmacologic
○ Benzodiazepines
○ Antipsychotics
○ Sedatives
● Mechanical
○ Limb restraint, wrist restraint, vest, mitts
○ All four side rails raised
Mechanical restraints
Soft wrist restraint Mitts

Posey bed Vest

Things NOT considered a restraint
● Armboard for IV stabilization
● Immobilization during MRI, surgery, or procedure
● Orthopedic devices
● Bed rails during transport
● Crib for age appropriate children
● Helmets
● Handcuffs used by law-enforcement
 Non-Violent Violent
● HCP must see client ● HCP must see client within 1
hour
within 24 hours
● RN assessment - q15 minutes
● RN assessment - q1-2 ● Restraint order expires in:
hrs depending on unit ○ Adults: 4 hours
policy ○ 9-17 y.o: 2 hours
○ <9 y.o: 1 hour
● Restraint order expires
in 24 hours

Document, document, document!

What MUST be documented when you have a patient in restraints:

● Reason restraints are indicated

● Start and stop times
● Plan of care
● Assessment
○ ESPECIALLY important to check for skin breakdown
○ Look at skin under all restraints, note any redness, and use preventative measures to protect
skin.
○ Required to release at least every 2 hours to fully assess
NCLEX Question
Which of the following situations represents an appropriate time to place your patient in restraints?
Select all that apply.

a. When they are trying to pull at their lines, tubes, and drains.
b. When their family member asks you to.
c. When you feel it is necessary.
d. When they are a danger to themselves.

Answer: A and D
A is correct. It is appropriate to place your patient in restraints, with an order from your healthcare provider, if the
patient is trying to pull out their lines, tubes, and drains. This makes them a danger to themselves and can cause
harm, so restraints may be appropriate.

B is incorrect. A family member may request restraints, but this is not an appropriate reason to initiate restraints.
You should explain to the family member other options and what you are trying to do for their loved one before
initiating restraints.

C is incorrect. Just because you feel that restraints are necessary does not mean you may initiate them. You must
speak with your healthcare provider and explain why you think restraints are necessary to obtain an order.

D is correct. If your patient is a danger to themselves, and other interventions are not keeping them safe, it is
appropriate to request an order for restraints from your healthcare provider.

NCSBN Client Need:

Topic: Effective, safe care environment Subtopic: Coordinated care

Reference: DeWit, S. C., Stromberg, H., & Dallred, C. (2016). Medical-surgical nursing: Concepts & practice. Elsevier Health Sciences.

Subject: Fundamentals
Lesson: Safety
 Handling Hazardous Materials

Medical waste
● Any non-hazardous trash
● Paper
● Leftover food
● Used utensils
● Tissues
● No special requirements for disposal
● Use regular trash can
Infectious waste
● Medical waste that is or COULD be infectious
● Used sharps
● Bodily fluids
● Swabs
● Wound dressings
● Dispose per facility protocol
○ Sharps container

Hazardous waste
● Waste that poses a potential danger to staff
● Not necessarily infectious
● Clean sharps
● Hazardous medications
○ Chemo
○ ‘Blue bin drugs’
● Dispose per facility protocol
○ Blue bin
Radioactive waste
● Anything involved with radiation
○ Medications
○ Implants
○ Tubing
○ Syringes
○ Bodily fluids
○ Towels
○ PPE used while caring for the patient
● Certified team members dispose of waste
● Special containers

NCLEX Question
The nurse just administered IM toradol to a 15 year old female. What is the
correct way for her to dispose of the needle?

A. Cap the needle and place it in the sharps container.

B. Place the needle in a biohazard bag
C. Place the uncapped needle in the sharps container immediately
D. Cap the needle and dispose of it in the regular trash.
Answer: C
A is incorrect: Capping the needle and placing it in the sharps container is not
appropriate. Needles should never be recapped due to the increased risk of injury
to staff.

B is incorrect: Used sharps should not be placed in a biohazard bag. This is

unsafe and improper disposal of potentially infectious waste.

C is correct: It is appropriate to place the uncapped needle in the sharps container

immediately. Not recapping the needle decreases risk of a needlestick injury, and
the sharps container is an appropriate location for potentially infectious waste
such as used sharps.

D is incorrect: It is not appropriate to either cap the needle or dispose of it in the

regular trash.

Radiation
Reduce Exposure
● When possible, keep your distance
● Never touch an implanted radiation device
● Minimize the time spent in the room
○ Cluster care
● Minimize the staff going into the room

Personal Protective Equipment

● Double gloves
● Goggles
● Shoe covers
● N95 or higher level respirator
● Dosimeter
○ Device worn by staff to measure their exposure
○ Can indicate when staff members have reached the limit and should be re-assigned
Patient Care
● Immediately discard any bodily fluids in hazardous waste
○ Urinal
○ Waste from blood draw
○ Towels used to clean up fluids
● Cluster care
● Leave trash and linen in the room for proper disposal

NCLEX Question
The nurse is caring for a patient with an implanted radiation device to deliver
internal radiation. Which of the following precautions should she take to keep
herself and others safe? Select all that apply.

A. Keep the patient in a single room

B. Dispose of the patients trash in a medical waste bin
C. Place a sign on the door with the patient's diagnosis and treatment plan
D. Wear a dosimeter to track radiation exposure
Answer: A and D
A is correct. Keeping the patient in a single room will prevent other patients from
unnecessary radiation exposure.

B is incorrect. Radiation waste requires special handling. Disposing of the patients

trash in a medical waste bin would pose a danger to staff. Medical waste includes
things like paper, tissues, used utensil, and other non hazardous waste.

C is incorrect. It is not appropriate to place a sign on the door with the patient's
diagnosis and treatment plan. This would violate HIPPA. Istead, the nurse should
place a caution sign on the door warning of radiation, but without the patient’s
diagnosis and treatment plan.

D is correct. Wearing a dosimeter to track radiation exposure is an appropriate safety

measure to ensure there is not excessive exposure to any one staff member.

Emergency Response: CPR

Unconscious patient
1. Try to wake the patient, yell and shake them.
a. Sternal rub
2. Check their pulse
a. Adult - carotid; infant - brachial
b. NO LONGER than 10 seconds
3. Press the code bell & yell for help

Patient has no pulse

1. Start chest compressions
a. 100-120 beats/min
b. Depth: 2 inches
c. Allow full chest recoil
2. Have someone get the crash cart
CPR Cycles
● 30 compressions: 2 breaths
● 2 minutes
● At 2 minute mark; check rhythm and pulse
● If patient still pulseles, switch compressors
and resume compression
● NEVER stop compressions for more than 10
seconds.

Shock
● Allow AED to analyze rhythm
● Follow prompts
● If ‘shock advised’, resume compressions
while device charge
● Clear patient when AED advises
● Ensure patient completely clear, and
deliver shock
● IMMEDIATELY resume compressions
Infant CPR
● 2 rescuers: compression to breath ratio is 15:2
● Use two fingers for compressions
● Compress to a depth of ⅓ the AP diameter

NCLEX Question
You arrive at the bedside of a 51 year old patient who was found unconscious,
CPR is in progress. Which of the following actions if observed would require you
to intervene? Select all that apply.

A. Providing 15 compressions for every 2 breaths

B. Providing compressions with two fingers
C. Allowing for full chest recoil.
D. Checking for a pulse for 10 seconds.
Answer: A & B
A is correct. In a 51 year old patient, it would not be appropriate to provide
compressions and breaths in a 15:2 ratio. This is the correct ratio for infant CPR.

B is correct. Providing compressions with two fingers is not appropriate in an

adult patient. The nurse should use both hands to compress to a depth of 2
inches. The 2 finger technique is appropriate only in infant CPR.

C is incorrect. Allowing for full chest recoil is an appropriate action. No

intervention is needed.

D is incorrect. Checking for a pulse for 10 seconds is an appropriate action. No

intervention is needed.

Home Safety
Assess the home environment
● Adequate lighting?
● Stairs required to get to bedroom/bathroom?
● Cords?
● Throw rugs?
● Fire hazards?
● Are there….
○ Fire alarms
○ Fire extinguishers
○ Carbon monoxide detectors
● Can the client get out in the event of an emergency?

If the client is at risk for falls

● Remove throw rugs
● Ensure there are no cords or wires where the client walks
● Nightlights should be installed
● Encourage installation of assistive hardware when appropriate
○ Grab bars
○ Raised toilet seats
○ Handrails
● Encourage a fall alert system
 Error, Injury, and Accident
Prevention

Ways to prevent errors and injuries

● Client identification
● Verifying orders
● Allergies
● Infant and child car seats
● Fire prevention
● Seizure precautions
● Fall precautions
● Aspiration precautions
● Neutropenic precautions
Client Identification
● Use TWO patient identifiers
○ Name
○ Date of birth (DOB)
○ Medical Record Number (MRN)
○ Do NOT use the room number…. Patients can change rooms!
● Assess for any allergies at first contact
○ Note in medical record
○ Place allergy alert band on client
● Verify orders and treatments
○ Double-check medications

Car Seats
● Rear facing car seat until 2 years old.
● Forward facing car seat after 2 years old.
● ALWAYS place in the back seat of the car.
● NO puffy jackets, coats, etc. on the child while
in the car seat.
● Chest clip at the breast bone
Fire Prevention
● Always check your equipment at the beginning of your shift
● Keep electrical equipment away from water
● Never block doors in case of fire
● Know where the emergency shut off for oxygen is
○ Oxygen is flammable!
○ NO SMOKING!!!

If there is a fire: RACE

● R - Rescue

● A - Activate

● C - Contain

● E - Extinguish
To use a fire extinguisher: PASS
● P - Pull pin

● A - Aim

● S - Squeeze

● S - Sweep

NCLEX Question
A nurse is working on a busy medical surgical unit when a fire breaks out in the
trash can in a patient’s room. What is her priority nursing action?

A. Pull the fire alarm

B. Remove the patient from the room
C. Contain the fire
D. Get the fire extinguisher
Answer: B
To determine your priority nursing action in the event of a fire, use the acronym
RACE: rescue, activate, contain, and extinguish.

Of the choices offered, removing (rescuing) the patient from the room is the
priority.

Remember, the NCLEX is a public safety test. If there is an action YOU can take to
keep your patient SAFE, that’s the correct answer!!
Aspiration precautions
● Identify at risk clients
● Observe at risk clients during meals
● During meals:
○ Do not rush
○ Small bites to side of mouth
○ Alternate solids and liquids
○ Sit upright
● Diet: thickened liquids
● Oral care after meals
● Remain upright for 30-60 minutes after meals

Neutropenic precautions
Fall Precautions
● At risk clients:
○ Geriatric patients
○ LOC
○ Altered mental status
○ Equipment cluttering room

Fall prevention
● Ensure call light is in reach
● Remove unnecessary equipment
● Fall socks
○ Yellow
○ Non-slip
● Bed alarm
● Ensure room is well lit
● Offer help to bathroom frequently
● ‘Call don’t fall’
Fall bundle
● Yellow is the universal ‘Fall Risk’ color
● Yellow socks
● Yellow wristband
● Yellow sign on door

Door sign
NCLEX Question
You are the bedside nurse on a medical surgical floor caring for each of the
following patients. In which order would the nurse categorize their fall risk from
greatest to least risk?

A. 25 year old female with a broken hand

B. 87 year old male, history of fall, Parkinson’s disease
C. 45 year old male taking morphine for abdominal pain
D. 52 year old female, blind, post op day 1

Answer: B, D, C, A
The patient with the highest fall risk is B: 87 year old male, history of fall,
Parkinson’s disease. This patient has a total of 3 risk factors: age, history of fall,
and balance issues due to parkinson’s disease.

The patient with the second highest fall risk is D: 52 year old female, blind, post
op day 1. This patient has a total of 2 risk factors: visual impairment and recent
surgery.

The patient with the third highest fall risk is C: 45 year old male taking morphine
for abdominal pain. This patient has a total of 1 risk factor: opioid pain
medication.

The patient with the least fall risk is A: 25 year old female with a broken hand.
This patient has no risk factors.
 Wrap up
questions

NCLEX Question
A nurse is caring for a patient diagnosed with meningococcal meningitis. Which
of the following isolations precautions should the nurse initiate?

A. Droplet
B. Contact
C. Airborne
D. Special enteric
Answer: A
Meningococcal meningitis is a type of bacterial infection in the brain and spinal
cord. It is very dangerous and highly contagious. The nurse will need to
implement droplet precautions immediately to prevent transmission of the
meningococcal meningitis.

NCLEX Question
While working in the emergency department, a fire breaks out in the waiting
room. The charge nurse tells you to get the fire extinguisher. Place the following
steps in order for correctly using the fire extinguisher.

A. Aim the fire extinguisher

B. Sweep the area of the fire
C. Pull the pin
D. Squeeze the handle
Answer: C, A, D, B
To remember how to use a fire extinguisher, use the acronym PASS: first pull the
pin, next aim the fire extinguisher at the fire, next squeeze the handle to start
dispensing the contents of the fire extinguisher, and last sweep the nozzle over
the area of the fire to completely extinguish the fire.

NCLEX Question
An 82 year old female lives in an assisted living facility and using a cane to
ambulate independently. Which of the following observations would require
intervention? Select all that apply.

A. Holding the cane on the unaffected side

B. Elbows are straight
C. Moves her affected leg forward with cane
D. Moves her unaffected leg forward with the cane
Answer: B and D
A is incorrect. Holding the cane on the unaffected side is an appropriate action
and does not require intervention.

B is correct. The elbows should not be straight, but should have a slight bend in
them.

C is incorrect. Moving her affected leg forward with the cane is an appropriate
action and does not require intervention.

D is correct. Moving her unaffected leg forward with the cane is not correct and
requires intervention. She should be moving her affected, or weak, leg forward
with the cane.