Key Takeaways
- Standard precautions apply to ALL patients regardless of diagnosis: hand hygiene, gloves for contact with blood/body fluids, proper PPE, sharps disposal
- Transmission-based precautions: contact (gown + gloves, e.g., MRSA, C. diff), droplet (surgical mask, e.g., influenza, COVID), airborne (N95 respirator, negative pressure room, e.g., TB, measles)
- Patient safety during transfers: lock wheelchair brakes, use gait belt, ensure proper footwear, clear pathway, use proper body mechanics
- Fall prevention in clinical settings: identify fall risk factors, use bed alarms, ensure call light access, proper lighting, non-slip surfaces
- Body mechanics for therapists: wide base of support, keep load close to body, lift with legs, avoid twisting, use momentum and leverage
- Emergency procedures: know location of emergency equipment, AED use, CPR protocols, emergency action plans
- Environmental modifications for home safety: remove throw rugs, improve lighting, install grab bars, widen doorways for wheelchair access
- Vital sign parameters for stopping exercise: SBP >250 or <80 mmHg, SBP drop >10 mmHg with increasing workload, HR >220-age, SpO2 <88%, new chest pain or ECG changes
Safety & Protection
Patient and therapist safety is paramount in all physical therapy settings. The NPTE tests your knowledge of infection control, safe patient handling, emergency procedures, and clinical decision-making to prevent adverse events.
Infection Control
Standard Precautions (Apply to ALL Patients)
Standard precautions are the minimum infection prevention practices that apply to all patients in all healthcare settings, regardless of suspected or confirmed infection status:
- Hand hygiene: Before and after every patient contact; soap and water for visible soiling or C. difficile; alcohol-based sanitizer for routine decontamination
- Gloves: When touching blood, body fluids, mucous membranes, non-intact skin, or contaminated equipment
- Gown: When contact with blood or body fluids is anticipated
- Face protection: Mask and eye protection during procedures likely to generate splashes or sprays
- Sharps safety: Use safety devices; dispose in puncture-resistant containers
- Respiratory hygiene/cough etiquette: Cover cough, offer masks to patients with respiratory symptoms
Transmission-Based Precautions
| Type | When Used | PPE Required | Room Requirements | Examples |
|---|---|---|---|---|
| Contact | Spread by direct or indirect contact | Gown + gloves; dedicated equipment | Private room preferred | MRSA, VRE, C. difficile, scabies |
| Droplet | Spread by large droplets (>5 microns), travel <6 feet | Surgical mask within 6 feet | Private room preferred | Influenza, pertussis, COVID-19, meningococcal |
| Airborne | Spread by small droplet nuclei (<5 microns), remain suspended in air | N95 respirator or PAPR | Negative-pressure room (AIIR) | Tuberculosis, measles, varicella (chickenpox) |
Safe Patient Handling
Transfer Safety Checklist
Before any transfer:
- Lock wheelchair brakes and remove armrests/footrests as needed
- Apply gait belt around the patient's waist (snug, 2 fingers' width slack)
- Ensure proper footwear (non-skid shoes; no socks on bare floors)
- Clear the pathway of obstacles, cords, and clutter
- Position wheelchair at 45-degree angle to the surface
- Communicate the plan to the patient and any assistants
- Use proper body mechanics with a wide base of support
Level of Assistance Scale
| Level | Description |
|---|---|
| Independent | Patient performs safely without any assistance or cueing |
| Modified Independent | Patient uses assistive device or takes extra time but needs no helper |
| Supervision/Standby | Therapist present for safety but provides no physical assistance |
| Contact Guard Assist (CGA) | Therapist maintains hand contact for safety/balance |
| Minimal Assist | Patient performs 75%+ of the effort |
| Moderate Assist | Patient performs 50-74% of the effort |
| Maximum Assist | Patient performs 25-49% of the effort |
| Dependent | Patient performs less than 25% of the effort |
Fall Prevention in Clinical Settings
Risk Factors for Falls
| Intrinsic (Patient) Factors | Extrinsic (Environmental) Factors |
|---|---|
| Age >65 | Wet or slippery floors |
| History of falls | Poor lighting |
| Impaired balance/gait | Loose rugs or cords |
| Muscle weakness | Lack of grab bars |
| Cognitive impairment | Unfamiliar environment |
| Visual impairment | Inappropriate footwear |
| Polypharmacy (5+ medications) | Bed height too high |
| Orthostatic hypotension | Clutter in pathways |
Orthostatic Hypotension Criteria
Orthostatic hypotension is defined as:
- SBP drop of ≥20 mmHg, OR
- DBP drop of ≥10 mmHg, OR
- Symptoms (dizziness, lightheadedness, visual changes) within 3 minutes of standing from supine or sitting
Management: Have the patient sit at the edge of the bed before standing, use compression stockings, perform ankle pumps, ensure adequate hydration, and progress position changes gradually.
Body Mechanics for Therapists
| Principle | Application |
|---|---|
| Wide base of support | Feet shoulder-width apart, staggered stance |
| Keep load close to body | Reduces torque on the spine |
| Lift with the legs | Bend at hips and knees, not the back |
| Avoid twisting | Turn with feet; pivot, do not rotate the trunk |
| Use momentum and gravity | Let the patient's movement work with you |
| Communicate | Count "1-2-3" for coordinated effort |
| Get help | Use two-person assist or mechanical lift when needed |
Home Safety Modifications
Common home modifications for patients with mobility limitations:
- Remove throw rugs and secure loose cords
- Install grab bars in bathroom (toilet, shower)
- Improve lighting especially at stairs and nighttime paths
- Add ramp for wheelchair/walker access (1:12 slope ratio — 1 inch rise per 12 inches of ramp)
- Widen doorways to 32+ inches for wheelchair clearance
- Raised toilet seat for patients with limited hip flexion (THA precautions)
- Shower bench/transfer tub bench for seated bathing
- Non-slip mats in bathroom and kitchen
A patient with active pulmonary tuberculosis requires which type of transmission-based precautions?
Orthostatic hypotension is defined as a systolic blood pressure drop of at least:
When positioning a wheelchair for a transfer, it should be placed at what angle to the surface?
A patient performs approximately 40% of the effort during a transfer while the therapist provides the remaining 60%. This is documented as:
The recommended ramp slope ratio for wheelchair accessibility is 1:_____, meaning 1 inch of rise for every specified inches of ramp length.
Type your answer below
MRSA (Methicillin-resistant Staphylococcus aureus) requires which type of transmission-based precautions?
A patient stands from sitting and reports dizziness. Their BP drops from 130/80 sitting to 105/72 standing. This patient has:
Before performing a standing pivot transfer, which of the following is the FIRST safety step?