Infection Control & Standard Precautions

Quick Answer: Use Standard Precautions for all residents; add Contact/Droplet/Airborne precautions per transmission type. Hand hygiene before and after every resident contact is non-negotiable on the NY five-skill exam.

Why Infection Control Dominates the NY Exam

Basic Nursing Skills is 35% of the written blueprint, and infection control threads through every clinical skill. Prometric evaluates hand hygiene throughout all five assigned skills—not as a standalone optional step. A missed handwash at a critical moment fails the entire skill.

NY nursing homes are surveyed by NYSDOH on infection prevention. CNAs are the front line for breaking the chain of infection in shared dining rooms, therapy gyms, and multi-bed units.

Chain of Infection

Breaking any link prevents spread. Hand hygiene breaks the mode of transmission link most often.

Standard Precautions

Apply to every resident, every time:

Sweat is excluded from Standard Precautions body-fluid list—a common exam trap.

Hand Hygiene Technique

Soap and water (20+ seconds friction):

1. Wet hands with running water
2. Apply soap; rub palms, backs, fingers, nails
3. Rinse thoroughly
4. Dry with clean towel; use towel to turn off faucet

Alcohol-based rub: apply to dry hands; rub until dry—use when hands not visibly soiled.

Transmission-Based Precautions

C. difficile: soap-and-water handwashing preferred over alcohol rub because spores resist alcohol.

NY Nursing Home Application

Isolation signage on resident doors tells you which precautions to add. Never remove signs or share equipment between isolation rooms without cleaning per policy. Report torn gloves or PPE shortages before providing care that requires protection.

PPE Donning and Doffing

Don (put on): gown → mask → goggles/face shield → gloves

Doff (remove): gloves → goggles → gown → mask → hand hygiene

Doffing order prevents contaminating clean areas. Exam questions love reversed sequences.

Cleaning and Linen

• Place soiled linen in leak-proof bag at point of use—do not shake
• Hold linen away from uniform
• Clean dirtiest to cleanest surfaces; top to bottom
• Disinfect per facility policy after blood/body fluid spills

Waste Disposal

Soiled dressings and contaminated supplies go in red biohazard bags per facility color coding. Needles and sharps never go in regular trash—use puncture-resistant sharps containers only.

Bloodborne Pathogens

Treat all sharps and blood as infectious (HIV, HBV, HCV). Never recap needles; dispose in puncture-resistant container. Report needlestick immediately per facility exposure protocol.

Post-Exposure Steps

1. Wash exposure site with soap and water (eyes: flush with water)
2. Report to supervisor immediately
3. Complete incident report
4. Follow occupational health bloodwork protocol

Worked Scenario

Stem: "You finish perineal care on a Contact Precautions resident. What is the correct sequence?"

Remove gloves → perform hand hygiene → don new gown and gloves before touching the environment or next task. Skipping hand hygiene between glove changes is a skills-test critical failure.

NY Skills Exam Connection

Indirect-care steps on every NNAAP skill include hand hygiene at entry, before/after glove use, and before leaving. Practice until automatic so you preserve the 30-minute budget for skill performance.

Cough Etiquette and Respiratory Hygiene

Cover coughs with tissue or elbow; dispose of tissues; perform hand hygiene. Residents with respiratory symptoms may need droplet precautions—report new cough or fever before continuing group activities.

Common Exam Traps

• Alcohol rub after C. diff contact (wrong—use soap and water)
• Shaking soiled linen (spreads pathogens)
• Removing gown before gloves (contaminates hands)
• Skipping hand hygiene because gloves were worn
• Reusing gloves between residents without hand hygiene between

NYSDOH Infection Control Survey Focus

Infection control citations are among the most common NY nursing home survey findings. CNAs directly affect hand hygiene compliance rates observed by surveyors.

Multi-Drug Resistant Organisms (MDRO)

Dedicated equipment stays in isolation room when possible. Clean shared equipment between residents.

Influenza and Respiratory Season

During flu season, NY facilities may restrict visitors and enforce droplet precautions for symptomatic residents. CNAs wear masks per policy; report own fever or cough before working—do not bring infection to vulnerable residents.

Food Service Infection Control

Wash hands before dining room setup and feeding assistance. Residents with contagious GI illness may eat in room on contact precautions—follow tray delivery protocol.

Personal Protective Equipment Stock

Report low PPE supply before starting care that requires gloves or gowns. Do not reuse disposable gloves between residents. Gown front is contaminated after contact precautions care.

Environmental Cleaning Responsibilities

CNAs may clean resident-specific items (overbed table, call light) with approved disinfectant. Blood spills require trained response—report and contain per exposure control plan.