3.2 Infection Prevention & Control

Breaking the Chain of Infection

Infection control is a major exam domain and a graded critical step in every KCTCS skill — you begin and end nearly every procedure with hand hygiene. To understand why, learn the chain of infection, a six-link model. Break any one link and the infection cannot spread.

Handwashing most directly breaks the mode of transmission — it physically removes pathogens from your hands before they reach the next person. That is why hand hygiene is called the single most important infection-control measure an SRNA performs.

Hand Hygiene: The Number-One Skill

Perform hand hygiene before and after every resident contact, before gloving, after glove removal, after touching contaminated surfaces, and after using the restroom. Two methods exist. Soap-and-water washing is required when hands are visibly soiled and after caring for a resident with Clostridioides difficile (C. diff) or another spore-forming organism, because alcohol does not kill spores — only the mechanical friction and rinsing of washing removes them. Scrub all surfaces (backs of hands, between fingers, under nails) for at least 20 seconds with warm water, keeping hands lower than the elbows so dirty water drains into the sink, and use a clean paper towel to turn off the faucet. Alcohol-based hand rub (ABHR) is faster and acceptable when hands are not visibly soiled — rub until dry.

Standard Precautions and PPE

Standard precautions apply to all residents at all times, regardless of diagnosis, because you cannot always know who is infectious. Treat every person's blood and body fluids as potentially infectious. Wear gloves whenever you anticipate contact with blood, any body fluid (urine, stool, saliva, sputum), mucous membranes, non-intact skin, or contaminated surfaces. Add a gown when splashing of body fluids is possible, and a mask and eye protection when spraying or splashing to the face is possible. The correct donning (putting on) order protects you as you approach the resident, and the doffing (taking off) order removes the dirtiest item first.

• Donning: 1) Gown, 2) Mask or N95 respirator (seal-checked), 3) Goggles or face shield, 4) Gloves last (pulled over the gown cuffs).
• Doffing: 1) Gloves first (the most contaminated), 2) Goggles/face shield, 3) Gown, 4) Mask/respirator last (remove after leaving the room), then perform hand hygiene.

Transmission-Based (Isolation) Precautions

When a specific pathogen is known, the facility adds transmission-based precautions on top of standard precautions. There are three categories:

Memorize the classic traps: MRSA in a wound = contact precautions; active TB = airborne precautions with a user-seal-checked N95; C. diff = contact precautions plus soap-and-water handwashing. COVID-19 typically requires droplet and contact precautions, escalating to airborne (N95) during aerosol-generating procedures.

Medical Asepsis, Linens, and Waste

Medical asepsis means practices that reduce the number and spread of microorganisms — the everyday 'clean technique' of the SRNA. Always work from clean to dirty. When handling linens, hold them away from your uniform, never shake them (shaking sends microorganisms into the air), roll soiled linens with the dirty side inward, and place them in the hamper at the point of use — never on the floor or overbed table. Biohazardous waste (used dressings, soiled gloves, anything saturated with blood or body fluid) goes in a labeled red biohazard bag. Sharps (needles, lancets) go directly into a puncture-resistant sharps container and are never recapped — recapping causes most needlesticks.

Glove Use and Common Mistakes

Gloves protect both you and the resident, but only when used correctly. Change gloves and perform hand hygiene between residents, and even for the same resident when moving from a dirty task to a clean task — for example, after perineal care before touching the resident's face or feeding them. Gloves are single-use: never wash and reuse them, and never wear the same pair down the hall to a second resident, because contaminated gloves spread pathogens just as bare hands do. Remove gloves by peeling from the wrist so they turn inside out, and wash your hands afterward — the friction of donning and doffing, plus tiny unseen defects, means clean hands after glove removal are essential. On contact precautions, facilities also use dedicated equipment (a thermometer, blood pressure cuff, and gait belt that stay in the room) or cohorting (grouping residents with the same infection) to keep pathogens from traveling.

Bloodborne Pathogens and OSHA

The federal OSHA Bloodborne Pathogen Standard protects workers from HIV, hepatitis B (HBV), and hepatitis C (HCV), which spread through blood and certain body fluids. Facilities must provide a written exposure-control plan, free HBV vaccination, PPE, and immediate post-exposure follow-up. If you suffer a needlestick or other blood exposure, the first action is to wash the site immediately with soap and water for at least 60 seconds (do not squeeze the wound — that can force pathogens deeper — and do not apply caustic agents like bleach), then report to your supervisor at once and seek medical evaluation per facility protocol. Prompt reporting starts baseline testing and any needed prophylaxis; delaying can cost the window for treatment. These rules, together with hand hygiene and standard precautions, form the everyday safety net that keeps both residents and SRNAs from becoming links in the chain of infection.