17.3 Infection Control & Standard Precautions
Key Takeaways
- Domain 4 Task 2 requires knowledge of infection control procedures and universal precautions for reducing transmission of contaminants, naming personal protective equipment, isolation precautions, and cleaning equipment.
- Standard precautions apply to EVERY client regardless of known diagnosis, because infectious status is frequently unknown at the time of care.
- Alcohol-based hand rub is the default for hand hygiene, but soap and water are required when hands are visibly soiled and when caring for a client with Clostridioides difficile, because alcohol does not kill spores.
- Contact precautions require gown and gloves, droplet precautions require a surgical mask in close proximity, and airborne precautions require a fit-tested N95 respirator and a negative-pressure room.
- Personal protective equipment is donned gown first and gloves last, and removed gloves first with hand hygiene performed after removal — the respirator is removed last, after leaving the room.
Infection Control & Standard Precautions
The blueprint requires infection control procedures and universal precautions for reducing transmission of contaminants, naming PPE, isolation precautions, and cleaning equipment as examples. Occupational therapists are unusually high-risk vectors: we move between rooms all day, carry shared equipment, and make prolonged hands-on contact during bathing, dressing, and transfers.
1. The Chain of Infection
Transmission requires six links, and infection control breaks any one of them:
| Link | Definition | Where We Break It |
|---|---|---|
| Infectious agent | The organism | Antimicrobials; disinfection |
| Reservoir | Where it lives (people, equipment, water, surfaces) | Cleaning; treating infection |
| Portal of exit | How it leaves (respiratory droplets, blood, stool, wound drainage) | Cover coughs; contain drainage |
| Mode of transmission | Contact, droplet, airborne, vehicle, vector | Hand hygiene, PPE, isolation — the therapist's main lever |
| Portal of entry | How it gets in (mucous membranes, broken skin, invasive lines) | Wound care; line care; eye protection |
| Susceptible host | Who is vulnerable | Vaccination; nutrition; glycemic control |
2. Standard Precautions — For Every Client, Every Time
Standard precautions assume that blood and all body fluids except sweat may be infectious, regardless of diagnosis. They apply universally because you frequently do not know a client's status.
Their components:
- Hand hygiene
- Personal protective equipment selected by anticipated exposure
- Respiratory hygiene and cough etiquette
- Safe injection practices
- Safe handling of potentially contaminated equipment and surfaces
- Environmental cleaning and disinfection
Hand Hygiene — the Highest-Yield Intervention in Health Care
| Situation | Method |
|---|---|
| Routine, hands not visibly soiled | Alcohol-based hand rub, rubbing all surfaces for about 20 to 30 seconds until dry |
| Hands visibly soiled | Soap and water, at least 20 seconds of friction |
| After contact with a client with Clostridioides difficile | Soap and water — mandatory. Alcohol does not kill C. difficile spores; mechanical removal is required |
| After removing gloves | Always — gloves are not a substitute for hand hygiene and can have unseen defects |
Perform hand hygiene before touching a client, before a clean or aseptic procedure, after body fluid exposure risk, after touching a client, and after touching the client's surroundings — including a wheelchair, bed rail, or call bell you never intended to touch.
Keep fingernails short, avoid artificial nails in direct-care roles, and remove rings and wristwatches that harbor organisms.
3. Transmission-Based Precautions
Applied in addition to standard precautions.
| Category | Representative Organisms | Personal Protective Equipment | Room and Equipment |
|---|---|---|---|
| Contact | MRSA, VRE, C. difficile, scabies, RSV, norovirus, draining wounds | Gown and gloves on room entry | Private room or cohorting; dedicated equipment; for C. difficile use a sporicidal (bleach-based) disinfectant and soap-and-water hand hygiene |
| Droplet | Influenza, pertussis, mumps, rubella, Neisseria meningitidis, group A streptococcus | Surgical mask when working within about 3 to 6 feet; eye protection if splash is likely | Private room preferred; client wears a mask when transported |
| Airborne | Tuberculosis, measles, varicella, disseminated zoster | Fit-tested N95 (or higher) respirator | Airborne infection isolation room with negative pressure, door closed; client wears a surgical mask when transported |
| Protective / neutropenic environment | Used for severely immunocompromised clients such as hematopoietic stem cell transplant recipients | Staff mask and meticulous hand hygiene; PPE per facility protocol | Positive-pressure room with HEPA filtration; no fresh flowers, potted plants, or raw produce; ill visitors excluded |
The distinction candidates miss most often: contact and droplet precautions use a surgical mask or none; only airborne precautions require a fit-tested respirator and a negative-pressure room. And note the pressure inversion — airborne isolation rooms are negative pressure to keep organisms in, while protective environments are positive pressure to keep organisms out.
4. Donning and Doffing
Donning (putting on) — clean to dirty:
- Hand hygiene
- Gown
- Mask or respirator (perform a seal check on an N95)
- Goggles or face shield
- Gloves last, pulled over the gown cuffs
Doffing (taking off) — most contaminated first:
- Gloves — peel off without touching the outside; hand hygiene
- Goggles or face shield — handle by the headband
- Gown — untie, pull away from the neck and shoulders, roll inward, discard; hand hygiene
- Leave the room
- Mask or respirator — handle by the ties or straps, never by the front
- Hand hygiene
The respirator comes off after leaving an airborne isolation room, because the air in the room is the hazard.
5. Bloodborne Pathogens and Exposure Response
Under the OSHA Bloodborne Pathogens Standard, employers must supply PPE, hepatitis B vaccination, an exposure control plan, sharps containers, and post-exposure follow-up. The pathogens of concern are hepatitis B, hepatitis C, and HIV.
Immediate response to a needlestick, sharps injury, or mucous membrane splash:
- Wash the site with soap and water; flush mucous membranes and eyes with water or saline for an extended period.
- Report immediately — post-exposure prophylaxis for HIV is time-critical and loses effectiveness with delay.
- Follow the exposure control plan: source testing, baseline testing, prophylaxis, and follow-up.
- Complete the incident report.
Never recap needles, dispose of sharps at the point of use, and never reach blindly into a container or a client's belongings.
6. Equipment Cleaning — Occupational Therapy Specifics
- Non-critical items that touch intact skin — gait belts, goniometers, dynamometers, wheelchairs, therapy tables, tub benches — require cleaning and low-level disinfection between clients. Follow the contact time printed on the disinfectant; wiping and immediately drying does not disinfect.
- Single-client items: therapy putty, splinting material, elastic bandages, and slings are not shared and are labeled and stored individually.
- Porous and hard-to-clean items — cloth gait belts, fabric slings, foam positioning wedges, plush toys — are the ones most often skipped. Use wipeable alternatives or assign them to a single client.
- Pediatric toys require a defined cleaning protocol; mouthed toys are removed for cleaning immediately after use.
- Isolation rooms: use dedicated equipment where possible, and disinfect any shared item before it leaves the room.
- Aquatic and hydrotherapy equipment follows a facility-specific protocol including water chemistry.
7. Practical Rules for the Therapy Session
- Take in only what you need. Every item that crosses the threshold must be cleaned or discarded.
- Plan the sequence: treat clients on isolation precautions last when scheduling permits, and never carry a shared clipboard, phone, or pen from an isolation room to the next client without disinfecting it.
- Move clean to dirty within a task — bathe the face before the perineum, and change gloves in between.
- Model respiratory hygiene: cover coughs, provide tissues and a hands-free receptacle, offer a mask to a coughing client.
- Protect the client too. Precautions run in both directions, particularly for immunocompromised clients; a therapist who comes to work with an acute respiratory infection is a hazard.
- Vaccination and screening — hepatitis B, influenza, and tuberculosis screening — are part of the practitioner's own risk management obligation.
An occupational therapist has just completed a bathing session with a client on contact precautions for Clostridioides difficile infection. After removing gown and gloves, what hand hygiene method is required?
An occupational therapist is assigned to evaluate a client admitted with suspected active pulmonary tuberculosis. Which combination of precautions is required?
An occupational therapist is leaving the room of a client on contact and droplet precautions. What is the correct sequence for removing personal protective equipment?