Infection Control in the Psychiatric Setting

Why Infection Control Matters in Psychiatric Settings

Psychiatric units present unique infection-control challenges. Patients may share common areas for meals, groups, and recreation. Cognitive symptoms, agitation, or medication side effects can make it difficult for some patients to follow hygiene instructions. Staff move rapidly between patients throughout a shift. These factors together create real risk for spreading pathogens if standard precautions are not consistently applied.

As a psychiatric technician, you are a front-line defense. Your consistent use of hand hygiene and personal protective equipment (PPE) protects patients, coworkers, and yourself.

Standard Precautions

Standard precautions apply to every patient, every time, regardless of diagnosis or known infection status. The CDC defines standard precautions as the minimum level of infection prevention that must be used in all patient care. They are based on the principle that blood, all body fluids, non-intact skin, and mucous membranes may carry infectious agents.

Key elements of standard precautions include:

• Hand hygiene — the single most effective measure to prevent healthcare-associated infections
• Gloves — when contact with blood, body fluids, mucous membranes, or non-intact skin is possible
• Gowns — when clothing or skin may be contaminated
• Masks and eye protection or face shields — when splashing or spraying of body fluids is possible
• Safe sharps handling — never recap needles by hand; dispose of sharps immediately in a puncture-resistant sharps container
• Proper handling of soiled linen and waste — contain at the point of use; do not carry soiled linen against your uniform

Hand Hygiene

The CDC recommends washing hands with soap and water when hands are visibly dirty or after known or suspected contact with spores (such as Clostridioides difficile). Alcohol-based hand rub (ABHR) is effective and preferred for most other situations because it kills a broad range of pathogens quickly.

CDC-recommended technique with soap and water (11 steps):

1. Wet hands with clean running water.

2. Apply enough soap to cover all hand surfaces.

3. Lather palms together.

4. Rub the back of each hand with the palm of the other hand, interlacing fingers.

5. Rub palms together with fingers interlaced.

6. Rub backs of fingers against opposing palms with fingers interlocked.

7. Rub each thumb in a rotational motion.

8. Rub fingertips of each hand in a circular motion against the opposite palm.

9. Rub each wrist.

10. Rinse hands thoroughly under running water.

11. Dry with a single-use towel; use the towel to turn off the faucet.

For ABHR, apply the product to one palm, rub hands together covering all surfaces using the same friction steps, and continue until hands are dry (approximately 20–30 seconds).

Transmission-Based Precautions

When a patient has a known or suspected infection that requires more than standard precautions, transmission-based precautions are added. There are three categories:

Contact Precautions

Used when pathogens spread by direct or indirect contact with the patient or the patient's environment. Examples: MRSA (methicillin-resistant Staphylococcus aureus), C. difficile, norovirus, scabies.

• Don gloves and gown before entering the room.
• Doff gloves and gown before leaving the room.
• Perform hand hygiene immediately after removing PPE.

Droplet Precautions

Used when pathogens are spread through large respiratory droplets produced by coughing, sneezing, or talking within approximately 3–6 feet. Example: influenza.

• Wear a surgical mask when within the recommended distance of the patient.

Airborne Precautions

Used when pathogens spread on small particles that remain suspended in the air over longer distances. Example: active tuberculosis (TB), measles, chickenpox.

• Place the patient in an airborne infection isolation room (negative pressure room).
• Wear a fit-tested N95 respirator (or higher) before entering the room.

Donning and Doffing PPE

The sequence matters. Putting on or taking off PPE incorrectly is a common cause of self-contamination.

Donning order: Gown → Mask or respirator → Eye protection/face shield → Gloves

Doffing order (most contaminated items removed first): Gloves → Eye protection/face shield → Gown → Mask or respirator → Hand hygiene after each removal step

Never touch the front of a gown or the outside of gloves during doffing. Roll gloves inside-out as you remove them.

Infection-Control Hazards in the Psychiatric Unit

During a contamination walk of a mock unit, common hazards include:

• Used sharps not in a sharps container — risk of needlestick injury
• Open food left at a patient's bedside — can harbor pathogens and attract pests
• Soiled linen dropped on the floor — spreads contamination; linen should be placed directly in a leak-proof bag
• Overflowing sharps containers — do not overfill; replace when three-quarters full
• ABHR dispensers that are empty or blocked — directly reduces hand-hygiene compliance

Scope of Practice and Safety Reminders

• Psychiatric technicians do not diagnose infections, but they must recognize signs of infection and report them promptly to the nurse or charge nurse.
• If you are uncertain whether a patient requires transmission-based precautions, apply standard precautions and ask your supervisor immediately.
• Fit testing for N95 respirators must be completed before you are assigned to care for a patient on airborne precautions; wearing an untested N95 does not guarantee protection.
• Document PPE use and any exposure incidents according to facility policy.