Infection Control and Standard Precautions

Infection Control and Standard Precautions

Infection control sits inside Delaware Prometric Domain II: Promotion of Safety and also appears as critical steps in the clinical skills exam (especially handwashing and indirect care). Roughly 18% of the written exam addresses safety topics overall; many of those items ask how disease spreads and how CNAs stop it. You do not need to be a microbiologist—you need reliable habits that work on every shift in every resident room.

The Chain of Infection

Infections spread only when a complete chain is intact. Break any link and transmission stops.

Long-term care residents are often highly susceptible hosts: thinner skin, chronic disease, devices (catheters, feeding tubes), and close living quarters. That is why small lapses become outbreaks.

Modes of Transmission You Must Recognize

• Direct contact — Touching a resident’s secretions then your eye.
• Indirect contact — Contaminated blood pressure cuff, bedrail, or shared comb.
• Droplet — Large respiratory particles from coughs/sneezes (for example, influenza) that travel short distances.
• Airborne — Smaller particles that can remain suspended (for example, tuberculosis) requiring special airborne precautions beyond Standard Precautions alone.
• Common vehicle — Contaminated food, water, or medications (facility-level controls; still report unsafe food handling you observe).

Clean Environment Practices

A clean environment reduces reservoirs and indirect contact.

Daily Habits

• Keep overbed tables clear of used tissues, soiled briefs, and dirty basins.
• Clean reusable basins, urinals, and bedpans according to facility procedure; store dry.
• Change linens when wet or soiled; carry linen away from your uniform; never shake linens in the room (spreads particles).
• Dispose of trash and sharps only in correct containers; never recap needles if your role includes any exposure—follow facility sharps rules.
• Keep clean supplies separate from dirty utility areas; do not place clean linens on a dirty floor or chair seat.
• Wipe frequently touched surfaces when assigned (call lights, bed controls) with facility-approved disinfectant and correct wet contact time.

Personal Care Items

Label and keep personal items resident-specific: razors, toothbrushes, deodorant, lotions. Shared grooming tools are classic outbreak sources for skin infections.

Food and Hydration Safety (Within CNA Role)

Serve trays promptly; report trays left too long. Keep refrigerator items labeled per policy. Do not use the same gloves that provided perineal care to then handle a resident’s oral food without removing gloves and performing hand hygiene.

Signs and Symptoms of Infection

Report changes early. Older adults may show atypical signs—new confusion or falls—before a high fever appears.

Common signs to recognize and report:

• Fever or hypothermia (very low temperature can also signal serious infection in elders)
• Redness, warmth, swelling, pain, or red streaking near a wound or IV site (IVs are nursing-managed; still report what you see)
• Pus or increased wound drainage; foul odor
• Cloudy, foul-smelling, or burning urination; new incontinence; flank pain
• Productive cough, shortness of breath, new sputum color changes
• Diarrhea, vomiting, abdominal pain
• Skin rash or blistering suggestive of contagious illness
• Sudden behavioral change, lethargy, or loss of appetite in a previously stable resident

You do not diagnose “pneumonia” or “UTI.” You report objective findings: “Temperature 101.2°F, new productive cough, respiratory rate 28,” or “Resident more confused than baseline; urine cloudy with strong odor.”

Standard Precautions: The Baseline for Everyone

Standard Precautions are used for all residents, all the time—not only those with known diagnoses. They assume that blood and certain body fluids may contain bloodborne pathogens (HIV, hepatitis B, hepatitis C) and other infectious agents.

Core Elements

1. Hand hygiene before and after resident contact, before clean/aseptic tasks, after body fluid exposure risk, after touching resident surroundings, and after removing gloves.
2. Gloves when contact with blood, body fluids, mucous membranes, non-intact skin, or contaminated items is likely.
3. Gowns when clothing may be soiled by fluids or during close contact with infectious material.
4. Mask, eye protection, or face shield when splashes or sprays are reasonably anticipated (for example, some suctioning assist roles, wound irrigation assistance as assigned).
5. Safe injection and sharps handling per facility rules (CNAs typically do not inject, but may encounter sharps containers and must never reach into them).
6. Respiratory hygiene / cough etiquette — Cover coughs; offer masks to coughing residents when policy directs; perform hand hygiene after contact with respiratory secretions.
7. Clean and disinfect equipment between residents (shared vital-sign machines need cleaning per policy).

Standard Precautions are not optional “extra work.” Skipping gloves for “just a little urine” or failing hand hygiene after bedrails is how pathogens move unit-wide.

Hand Hygiene: Soap and Water Versus Alcohol-Based Rub

Prometric and skills evaluators watch hand hygiene closely. Know when each method is correct.

Use Soap and Water When

• Hands are visibly dirty or soiled with blood or body fluids
• Before eating and after using the restroom
• After caring for a resident with Clostridioides difficile (C. diff) or known/suspected infectious diarrhea as directed by facility policy (alcohol does not reliably kill C. diff spores)
• During norovirus outbreaks or when policy specifies soap and water for gastrointestinal pathogens
• After known exposure to spore-forming organisms when soap and water is required

Technique essentials (soap and water): Wet hands, apply facility soap, rub all surfaces (palms, backs, between fingers, under nails, thumbs, wrists) for the required time taught in your program (commonly at least 20 seconds of scrubbing), rinse fingertips down, dry with clean towel, and use towel to turn off faucet if required by procedure.

Alcohol-Based Hand Rub When

• Hands are not visibly soiled
• Moving between clean contacts on many routine care tasks
• Entering and leaving rooms under Standard Precautions when policy allows rubs

Apply enough product to cover all surfaces and rub until dry—do not wave wet hands dry incompletely. If hands feel gritty or product builds up, wash with soap and water.

Critical Timing Moments (Often Tested)

• Before touching a resident
• Before clean procedures (for example, oral care setup)
• After body fluid risk
• After touching the resident
• After touching the resident’s environment (bed controls, privacy curtains)
• After glove removal (gloves are not a substitute for hand hygiene)

Gloves and Glove Discipline

Gloves protect you and the resident only when used correctly:

• Perform hand hygiene before putting on gloves for care that needs clean hands.
• Change gloves when moving from a dirty body site to a clean site (for example, after peri care before touching a feeding tube site—follow skill sequence training).
• Never wash gloves and reuse them.
• Remove gloves before touching clean surfaces such as computer keyboards or your personal phone.
• Hand hygiene after removal every time.

Putting It Together on the Exam and on the Unit

When a question presents two good-sounding options, prefer the one that breaks transmission now: wash visibly soiled hands with soap and water, clean shared equipment between residents, report fever and new cough promptly, and use Standard Precautions even when the diagnosis is “unknown.” Delaware facilities expect these habits every day; Prometric Domain II expects the same judgment under time pressure.