Infection Control and Standard Precautions in Clinical Practice

Why Infection Control Matters in Clinical Practice

Healthcare-associated infections (HAIs) are a leading patient safety concern in the United States. As a practical nurse, you are often the person closest to the patient, which means your technique directly determines whether pathogens are contained or spread. Standard precautions are the foundation of infection control: they treat every patient's blood, body fluids, non-intact skin, and mucous membranes as potentially infectious, regardless of diagnosis. Mastering personal protective equipment (PPE) and hand hygiene is not optional—it is a core competency you must perform correctly every single time.

Standard Precautions: The Baseline

The CDC requires that standard precautions be applied to the care of all patients in all healthcare settings. Standard precautions include:

• Hand hygiene before and after every patient contact
• PPE selected based on the anticipated exposure
• Safe handling and disposal of sharps
• Respiratory hygiene and cough etiquette
• Safe injection practices
• Proper handling of potentially contaminated equipment and surfaces

Transmission-based precautions are layered on top of standard precautions when a patient has a known or suspected infection spread by contact, droplet, or airborne routes.

Transmission-Based Precautions: Choosing the Right PPE

Contact precautions are used for pathogens spread by direct or indirect contact with the patient or the patient's environment (e.g., MRSA, C. difficile, VRE). Required PPE: gloves and gown upon room entry.

Droplet precautions are used for pathogens transmitted via respiratory droplets that travel short distances—generally within about three feet of the patient (e.g., influenza, pertussis). Required PPE: gloves, gown, and a surgical mask upon room entry; a face shield or goggles if splash is anticipated.

Airborne precautions are used for pathogens that remain infectious over longer distances in small particles suspended in the air (e.g., tuberculosis, measles, varicella). Required PPE: gloves, gown, and a fit-tested N95 respirator (or higher-level respirator) upon room entry; place patient in an airborne infection isolation room (AIIR) with negative air pressure.

Always consult your facility's isolation precautions reference cards and policy when there is any doubt about which tier applies.

Hand Hygiene: The CDC Five Moments

The CDC and World Health Organization identify five critical moments for hand hygiene:

1. Before touching a patient

2. Before a clean or aseptic procedure

3. After body-fluid exposure or risk

4. After touching a patient

5. After touching the patient's surroundings

Alcohol-based hand rub (ABHR) is the preferred method when hands are not visibly soiled. Apply enough product to cover all surfaces of both hands; rub together until completely dry—this typically takes 20–30 seconds.

Soap and water is required when hands are visibly soiled, after caring for a patient with known or suspected C. difficile (spores are not reliably killed by ABHR), and when there is potential norovirus exposure. Wet hands, apply soap, lather all surfaces for at least 20 seconds using friction, rinse under running water, and dry with a single-use paper towel. Use the towel to turn off the faucet.

Donning PPE: The Correct Sequence

Put on PPE before entering the patient's room in this order:

1. Gown — Tie securely at neck and waist so the gown covers your clothing and skin.

2. Mask or respirator — For an N95, perform a user seal check every time.

3. Face shield or goggles — Position to protect eyes, nose, and mouth.

4. Gloves — Pull cuffs over the gown sleeves.

Doffing PPE: The Critical Step

Doffing (removing) PPE is where contamination most often occurs. The outside surfaces of your PPE are considered contaminated; the inside surfaces are considered clean. Remove PPE outside the patient room or in the anteroom if available, and perform hand hygiene after each step.

1. Gloves — Grasp the outside of one glove and peel it off, turning it inside out. Hold it in the gloved hand. Slide fingers of the bare hand under the remaining glove at the wrist; peel it off inside out so the first glove is contained inside. Discard. Hand hygiene immediately.

2. Face shield or goggles — Handle by the headband or earpieces only; never touch the front. Discard or place in designated reprocessing container.

3. Gown — Unfasten ties. Pull gown away from neck and shoulders by touching only the inside. Roll the gown inside out, away from the body. Discard. Hand hygiene.

4. Mask or respirator — Handle by the ties or ear loops only; never touch the front. Discard. Hand hygiene.

Critical safety rule: Do not touch your face, hair, or clothing at any point during doffing.

Setting Up and Breaking Down an Isolation Room

Before entering: gather all supplies you anticipate needing so trips in and out are minimized. Post the appropriate precaution sign. Place a PPE station (cart or table) outside the door with the correct equipment for the designated precaution level.

When leaving: doff PPE in the correct sequence, dispose of waste in appropriate receptacles, and perform hand hygiene before moving to any other patient care area. Reusable equipment (e.g., stethoscope) must be cleaned and disinfected per facility policy before removal from the room.

Safety Reminders for Clinical Practice

• Never reuse single-use PPE.
• An ill-fitting N95 provides no reliable protection; fit testing is required before clinical use.
• Report PPE shortages or equipment defects to your supervisor immediately—never improvise substitutes without authorization.
• Document any exposure incidents per facility policy and notify the charge nurse promptly.
• Your scope of practice as an LPN includes implementing, but not independently modifying, isolation precaution orders.