Safety and Infection Prevention and Control

Sweat. Standard precautions treat blood, all other body fluids, secretions and excretions, nonintact skin, and mucous membranes as potentially infectious for every client regardless of diagnosis, using hand hygiene and PPE based on anticipated exposure.

Tuberculosis, measles (rubeola), and varicella (chickenpox; also disseminated zoster). These spread on small droplet nuclei that stay suspended in air, so the client is placed in a negative-pressure airborne infection isolation room and staff wear a fit-tested N95 respirator; a surgical mask is not adequate.

A surgical (procedure) mask, put on when entering the room. Droplet precautions are used for large respiratory droplets that travel only a short distance: influenza, pertussis, mumps, rubella, and Neisseria meningitidis infection. A private room is preferred; a negative-pressure room is not required.

A gown and gloves, put on at entry for all interactions with the client or environment. Contact precautions are used for organisms spread by direct or indirect contact, such as MRSA, VRE, C. difficile, scabies, and RSV; dedicated or disposable equipment (stethoscope, BP cuff) is used for that client.

Soap and water must be used for C. difficile because alcohol-based sanitizer does not kill the spores. Mechanical washing physically removes them.

Donning: gown, mask or respirator, goggles or face shield, then gloves. Doffing: gloves (most contaminated) first, then goggles or face shield, gown, and mask or respirator last (a respirator is removed after leaving the room), followed by hand hygiene.