7.2 Infection Control & Standard Precautions

Standard Precautions: The Baseline for Everyone

Standard precautions are the minimum infection-prevention practices applied to every patient in every setting, whether or not an infection is suspected. They treat all blood, body fluids, secretions, non-intact skin, and mucous membranes as potentially infectious. On the NPTE-PTA, the wrong answers usually involve applying precautions selectively — the correct mindset is that the baseline never changes.

Core components: hand hygiene, gloves and other personal protective equipment (PPE) when exposure is possible, safe injection and sharps practices, respiratory hygiene/cough etiquette, and proper handling of contaminated equipment and linens.

Hand Hygiene Specifics

• Alcohol-based hand rub is preferred for routine hygiene when hands are not visibly soiled — it is faster and more effective against most bacteria and enveloped viruses. Apply enough to wet all surfaces and rub until dry (about 20 seconds).
• Soap and water (40–60 seconds) are mandatory when hands are visibly soiled and after caring for patients with Clostridioides difficile (C. diff) or norovirus. These pathogens form spores or are non-enveloped; alcohol does not kill them, so mechanical washing is required to physically remove them.
• Glove use never replaces hand hygiene — perform hand hygiene before donning and after removing gloves.

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Transmission-Based Precautions

These are layered on top of standard precautions when a specific organism is known or suspected.

Memory hook for airborne: My (measles) Chicken (varicella) Tea (TB) requires an N95. Some organisms need combined precautions — for example, varicella requires both airborne and contact.

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Donning and Doffing PPE (Tested Sequence)

The order matters because it minimizes self-contamination.

Donning (putting ON): gown → mask or respirator → eye protection (goggles/face shield) → gloves. Gloves go on last so they cover the gown cuffs.

Doffing (taking OFF): gloves → eye protection → gown → mask or respirator.

The principle: remove the most contaminated items first (gloves and gown front), and remove the mask last, after leaving the patient's room, because it protected your airway throughout. Perform hand hygiene whenever your hands may have been contaminated during removal, and again after the final step.

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Bloodborne Pathogen Exposure Protocol

If a PTA sustains a needlestick or mucous-membrane exposure to blood or body fluids, act in this order:

1. Wash the site immediately with soap and water; flush mucous membranes or eyes with water or saline. Do not squeeze or "milk" a puncture wound aggressively.
2. Report the exposure to a supervisor right away — do not wait until the end of the shift; prophylaxis is time-sensitive.
3. Seek post-exposure evaluation promptly so source testing and, if indicated, post-exposure prophylaxis (PEP) can begin within the effective window.
4. Document the incident per facility policy.

The Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard requires employers to make this evaluation, follow-up, and hepatitis B vaccination available to the employee at no cost.

Asepsis, Wounds, and Sterile Fields

The NPTE-PTA separates two cleanliness standards, and questions punish mixing them up:

• Medical asepsis (clean technique) reduces the number and spread of organisms — handwashing, gloves, disinfecting plinths and equipment between patients. Used for most PTA tasks, including routine wound care over intact granulation.
• Surgical asepsis (sterile technique) eliminates all microorganisms — used for sterile dressing changes, debridement assistance, and any procedure entering a sterile body cavity.

Sterile-field rules to memorize: a 1-inch border around a sterile field is considered contaminated; anything below waist level or out of your direct line of sight is contaminated; reaching across a sterile field, turning your back to it, or touching it with a non-sterile item breaks sterility. If any of these occur, the field is compromised and must be re-established.

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Multidrug-Resistant Organisms and Equipment

Shared therapy equipment (gait belts, theraband anchors, weights, mat tables) is a major transmission route. Disinfect between patients, and assign single-patient-use dedicated equipment for anyone on contact precautions. Linens and contaminated waste go in designated bags; sharps go directly into a rigid, puncture-resistant sharps container that is never overfilled.

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Worked Scenario and Common Traps

A PTA is scheduled to mobilize a patient newly diagnosed with active pulmonary tuberculosis. Before entering, the PTA dons a fit-tested N95 respirator (a surgical mask is insufficient) and confirms the patient is in a negative-pressure room with the door closed. The patient should wear a surgical mask if transported outside the room. After the session, the PTA doffs gloves and gown inside the room, exits, then removes the N95 last and performs hand hygiene.

Classic traps: (1) assuming a surgical mask protects against airborne TB — it does not; (2) using alcohol rub after C. diff care — it does not kill spores; (3) skipping hand hygiene because gloves were worn — gloves can have micro-perforations and contaminate hands during removal; (4) applying transmission-based precautions instead of standard precautions rather than on top of them. Standard precautions are always the foundation.