2.3 Infection Control, Emergency Response, and Safety
Key Takeaways
Maryland pre-clinical CNA curriculum requires infection control and safety/emergency instruction (including the Heimlich maneuver) before direct client contact.
Standard Precautions apply to every resident; Contact, Droplet, and Airborne Precautions add transmission-specific PPE and room controls, and nursing homes use Enhanced Barrier Precautions for wounds, devices, and MDROs when Contact Precautions do not apply.
Hand hygiene is the single most effective infection-prevention measure; use soap and water for visibly soiled hands and for C. difficile.
Memory aids: RACE for fire response (Rescue, Alarm, Confine, Extinguish) and PASS for extinguisher use (Pull, Aim, Squeeze, Sweep).
Most Credentia skills end with the call signal within reach and hand washing, and many also return the bed to a low position.
Safety Is the Thread Through the Skills
Maryland regulations for nursing-assistant training (COMAR, the Code of Maryland Regulations) require pre-clinical instruction in infection control and safety and emergency procedures, including the Heimlich maneuver, before a trainee touches a client. On the 2024 NNAAP written outline, infection control and safety/prevention/emergency sit inside the 35% Basic Nursing Skills domain. On the Credentia skills evaluation, hand hygiene, personal protective equipment, call-signal placement, privacy, and safe positioning recur across the skill checklists because they prevent real harm.
The CNA safety role has two halves. First, prevent predictable harm using clean technique, good body mechanics, fall precautions, and correct equipment. Second, recognize danger and get help fast. Maryland standards direct the CNA to report changes, request assistance when unsure, and maintain a safe therapeutic environment under nurse supervision.
Standard Precautions treat the blood and body fluids of every resident as potentially infectious, regardless of diagnosis. Transmission-Based Precautions add to Standard Precautions when a specific organism is suspected or confirmed.
Precautions At A Glance
| Precaution | When it applies | CNA focus |
|---|---|---|
| Standard | Every resident, every shift | Hand hygiene, gloves for body fluids, safe linen and waste handling |
| Contact | Spread by touch or surfaces (e.g., C. difficile, scabies, or MRSA and other MDROs with drainage that cannot be covered or contained) | Gown and gloves on entry, dedicated or disinfected equipment |
| Enhanced Barrier (nursing homes) | A wound or indwelling device (infection or not), or an MDRO, when Contact Precautions do not apply | Gown and gloves for high-contact care (dressing, bathing, transfers, toileting, device and wound care); no room restriction |
| Droplet | Large respiratory droplets in close care (e.g., influenza) | Surgical mask on entry to the room, respiratory hygiene |
| Airborne | Tiny particles that stay suspended (e.g., tuberculosis, measles) | Negative-pressure room, fit-tested N95 respirator per policy |
Hand Hygiene and PPE Process
- Before clean care: clean hands before touching a resident or clean supplies.
- During care: move clean to dirty; change gloves when contaminated; gloves never replace hand hygiene.
- Donning PPE order: gown, then mask or respirator, then goggles, then gloves.
- Doffing PPE order: gloves first (the dirtiest), then goggles, then gown, then mask last; clean hands after removal. Use soap and water (not alcohol gel) for visibly soiled hands and for spore-forming C. difficile.
Emergency Pattern Recognition
On Credentia's test, glove removal in the PPE skill is a Critical Element Step, and if the evaluator has to remind you to put on or remove gloves, you get no credit for correcting that step. Build the habit in practice so it is automatic under test pressure. The same automaticity applies to emergencies, where the first action protects the resident, then summons the nurse.
| Emergency clue | First CNA priority | What NOT to do |
|---|---|---|
| Resident found on floor | Call for help, stay with resident, check responsiveness | Lift or move the resident before nurse assessment |
| Choking, cannot speak or cough | Call for help, then give 5 back blows followed by 5 abdominal thrusts, repeating until the object comes out or the resident becomes unresponsive | Give water or leave the resident |
| Fire or smoke | RACE: Rescue, Alarm, Confine, Extinguish/Evacuate | Open doors or windows, or fight a large fire |
| Seizure | Ease to the floor, turn onto one side, cushion the head, time it | Restrain the resident or put anything in the mouth |
| Chest pain or sudden dyspnea | Stay with the resident, raise the head, get the nurse now | Walk the resident or give any medication |
| Oxygen in use | Keep flames and smoking materials away, post signage | Use petroleum products near the resident or ignore signs |
RACE sequences fire response: Rescue anyone in immediate danger, sound the Alarm, Confine the fire by closing doors, then Extinguish a small fire or Evacuate. PASS governs extinguisher use: Pull the pin, Aim at the base of the flames, Squeeze the handle, Sweep side to side. Use an extinguisher only when trained, the fire is small and contained, and rescue or evacuation is not delayed.
Worked example: You see smoke from a trash can beside an awake resident. Apply RACE in order: first remove the resident from immediate danger, then pull the alarm. Opening the window feeds oxygen to the fire, and reaching for an extinguisher before moving the resident reverses the priority that the skills exam rewards.
Everyday Fall and Equipment Safety
Falls are prevented before any alarm sounds. Keep the bed in the lowest locked position when you leave, lock wheel brakes before every transfer, put non-skid footwear on a resident who will stand, keep the pathway clear and well lit, and place the call signal within reach. Use a gait belt (a transfer belt around the waist for support) or a mechanical lift only as the care plan and your training allow; a mechanical full-body lift generally requires two trained staff.
Report rather than improvise around hazards: frayed electrical cords, wet floors, broken bed rails, unlabeled spills, or a missing assistive device get secured and reported, never worked around. The safest written-test answer follows this order: protect the resident, report to the nurse, follow facility policy, document the facts, and stay within CNA scope. That sequence resolves questions about infection exposure, falls, fire, choking, abnormal vitals, suspected abuse, and unsafe equipment alike.
A CNA removes gloves after perineal care and is about to straighten the resident's clean blanket. What should happen first?
Put the used gloves back on until the bed is made.
Skip hand hygiene because gloves were worn.
Perform hand hygiene before touching the clean blanket.
Use sanitizer only if the resident asks.
A CNA sees smoke coming from a trash can in a resident's room. The resident is next to the smoke but awake. Which action comes first?
Use a fire extinguisher before moving the resident.
Open the window so smoke can leave the room.
Call the resident's family before taking action.
Remove the resident from immediate danger and activate the facility fire response.
Sections you finish are checked off in the contents.