Key Takeaways
- Standard precautions apply to ALL patients regardless of diagnosis: hand hygiene, gloves, gown, mask/eye protection as needed
- Contact precautions: gown + gloves for MRSA, VRE, C. diff, scabies; dedicated equipment
- Droplet precautions: surgical mask within 3-6 feet for influenza, pertussis, meningococcal meningitis, COVID-19 (minimum)
- Airborne precautions: N95 respirator + negative pressure room for TB, measles, varicella, COVID-19 (ideal)
- VAP prevention bundle: HOB elevation 30-45 degrees, daily sedation vacation, DVT prophylaxis, stress ulcer prophylaxis, daily oral care with chlorhexidine, daily assessment of extubation readiness
- Hand hygiene is the single most effective measure to prevent healthcare-associated infections
- Alcohol-based hand rub (ABHR) is preferred for hand hygiene EXCEPT when hands are visibly soiled or C. diff is suspected (use soap and water)
- Ventilator circuit changes should NOT be done routinely; only change when visibly soiled or malfunctioning
Infection Control & Prevention
Infection control questions appear in the Troubleshooting & Infection Control domain (14% of the TMC exam). Respiratory therapists have extensive patient contact and handle equipment that is directly connected to patients' airways, making strict adherence to infection control practices essential.
Standard Precautions (Apply to ALL Patients)
Standard precautions are based on the principle that all blood, body fluids, secretions, excretions (except sweat), non-intact skin, and mucous membranes may be infectious. These apply to every patient encounter, regardless of known or suspected diagnosis.
| Measure | When to Use |
|---|---|
| Hand hygiene | Before and after every patient contact; before clean/aseptic procedures; after body fluid exposure; after touching patient surroundings |
| Gloves | Contact with blood, body fluids, mucous membranes, non-intact skin; handling contaminated equipment |
| Gown | When clothing may contact blood/body fluids; during procedures with splash potential |
| Mask + Eye protection | Procedures likely to generate splashes or sprays (suctioning, intubation, bronchoscopy) |
| Respiratory hygiene | Cover cough/sneeze; hand hygiene after contact with respiratory secretions |
| Safe injection practices | Single-use needles/syringes; single-dose vials preferred |
| Sharps disposal | Immediately into puncture-resistant container; never recap needles |
Transmission-Based Precautions
| Type | Protection | Room | Common Pathogens |
|---|---|---|---|
| Contact | Gown + gloves; dedicated equipment | Standard room; may cohort patients | MRSA, VRE, C. difficile, scabies, RSV, wound infections |
| Droplet | Surgical mask within 3-6 feet of patient | Standard room; door may remain open | Influenza, pertussis, meningococcal disease, mumps, COVID-19 (minimum) |
| Airborne | N95 respirator (fit-tested); negative pressure room | Airborne Infection Isolation Room (AIIR); 6-12 air changes/hour; negative pressure | Tuberculosis (TB), measles, varicella (chickenpox), COVID-19 (ideal) |
Hand Hygiene — The #1 Infection Prevention Measure
Alcohol-Based Hand Rub (ABHR):
- Preferred method for routine hand hygiene
- Effective against most bacteria and viruses
- Apply liberally, rub all surfaces for 20-30 seconds until dry
- NOT effective against: C. difficile spores, Norovirus (use soap and water instead)
Soap and Water:
- Required when hands are visibly soiled with blood or body fluids
- Required when C. difficile is known or suspected (spores resist alcohol)
- Wash for at least 20 seconds with friction
- Required before eating and after using the restroom
VAP Prevention Bundle
Ventilator-Associated Pneumonia (VAP) is a serious complication of mechanical ventilation. The VAP prevention bundle includes evidence-based practices that reduce VAP incidence:
| Intervention | Rationale |
|---|---|
| Head of bed (HOB) elevation 30-45 degrees | Reduces aspiration of gastric contents |
| Daily sedation vacation (SAT) | Facilitates earlier extubation; reduces ventilator days |
| Daily assessment of extubation readiness | Reduces duration of mechanical ventilation |
| DVT prophylaxis | Prevents venous thromboembolism (SCD boots, heparin) |
| Stress ulcer prophylaxis | Prevents GI bleeding (PPI or H2 blocker) |
| Oral care with chlorhexidine | Reduces oropharyngeal bacterial colonization |
| Subglottic secretion drainage | Removes pooled secretions above the ET cuff |
| Closed suction systems | Maintains circuit integrity; reduces contamination |
Equipment Sterilization and Disinfection
| Level | Process | Used For |
|---|---|---|
| Sterilization | Kills ALL microorganisms including spores (autoclave, ethylene oxide) | Surgical instruments, items entering sterile body areas |
| High-level disinfection | Kills all organisms except high numbers of spores (glutaraldehyde, OPA) | Bronchoscopes, reusable breathing circuits |
| Intermediate disinfection | Kills most bacteria, fungi, viruses, mycobacteria (alcohol, bleach) | Stethoscopes, ventilator surfaces |
| Low-level disinfection | Kills most bacteria, some viruses and fungi (quaternary ammonium compounds) | Non-critical surfaces, countertops |
Ventilator Circuit Management
- Do NOT routinely change ventilator circuits — change only when visibly soiled or malfunctioning
- Routine circuit changes increase (not decrease) the risk of VAP
- HMEs: Change every 48 hours or when visibly soiled/clogged
- Heated humidifier circuits: Drain condensation away from patient; avoid allowing condensate to reach the patient
A patient is admitted with suspected active pulmonary tuberculosis. Which type of precautions should be implemented?
When should alcohol-based hand rub (ABHR) NOT be used, requiring soap and water instead?
Which of the following is included in the VAP prevention bundle?
Match each pathogen to the appropriate transmission-based precaution level.
Match each item on the left with the correct item on the right
How often should ventilator circuits be routinely changed to prevent VAP?
A patient with MRSA pneumonia requires respiratory therapy treatment. Which precautions should the RT use?
Which level of disinfection is required for reprocessing a reusable bronchoscope?
Which of the following are components of the VAP prevention bundle? (Select all that apply)
Select all that apply