Infection Control & Standard Precautions

Infection Control & Standard Precautions

Infection prevention and control is one of the most critical responsibilities of a Nursing Assistant (CNA). Long-term care residents are especially vulnerable to healthcare-associated infections (HAIs) due to advanced age, chronic illnesses, compromised immune systems, invasive devices (such as urinary catheters), and communal living environments. Understanding how pathogens spread and adhering strictly to infection control protocols protects residents, staff, and visitors alike.

The Chain of Infection

Infection occurs when a disease-causing microorganism (pathogen) enters the body and multiplies. For an infection to spread from one person or environment to another, a specific sequence of six events known as the Chain of Infection must occur. If any single link in the chain is broken, the spread of infection is successfully stopped.

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Hand Hygiene Protocols

Hand hygiene is universally recognized as the single most important practice to prevent the spread of infection in healthcare settings. Nursing assistants must perform hand hygiene before and after every resident contact, after handling contaminated materials or removing gloves, and before performing clean or aseptic procedures.

Soap and Water Hand Washing Technique

Hand washing with soap and running water is required whenever hands are visibly soiled, after using the restroom, before handling food, and when caring for residents with spore-forming infections.

1. Turn on warm water at the sink and wet hands and wrists thoroughly. (Avoid hot water, which dries and cracks skin).
2. Apply 3 to 5 mL of liquid soap to hands. Keep hands lower than elbows throughout the procedure so contaminated water does not flow backward onto arms.
3. Rub hands together vigorously for a minimum of 20 seconds, generating strong mechanical friction.
4. Clean all hand surfaces thoroughly: palms, backs of hands, between fingers, web spaces, knuckles, wrists, and underneath fingernails (rubbing fingertips against the opposite palm).
5. Rinse hands under warm running water from wrists down to fingertips.
6. Use a clean, dry paper towel to pat hands completely dry from fingertips up to wrists.
7. Use a separate, dry paper towel to turn off the water faucet to prevent recontaminating clean hands. Throw paper towels into the waste receptacle.

Alcohol-Based Hand Rubs (ABHR)

Alcohol-based hand rubs (containing 60% to 95% alcohol) are the preferred method for routine hand hygiene when hands are not visibly soiled. ABHR is faster, more accessible, and less drying to the skin than frequent soap-and-water washing.

• Apply the manufacturer-recommended amount of hand rub into a cupped hand.
• Rub hands together vigorously, covering all surfaces of hands and fingers.
• Continue rubbing for 15 to 20 seconds until hands are completely dry. Do not wipe off excess product with paper towels.

⚠️ CRITICAL EXAM WARNING: C. diff and Norovirus Exceptions Alcohol-based hand sanitizers DO NOT kill bacterial spores such as Clostridioides difficile (C. diff) or non-enveloped viruses like Norovirus. When caring for a resident with suspected or confirmed C. diff or Norovirus, the Nursing Assistant MUST perform hand hygiene using soap and water with vigorous mechanical friction for at least 20 seconds to physically wash the spores down the drain.

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Standard Precautions

Standard Precautions are a set of infection prevention practices designed to apply to ALL residents, regardless of their suspected or confirmed infection status, in any healthcare setting. Standard Precautions are based on the core principle that all blood, body fluids, secretions, excretions (except sweat), non-intact skin, and mucous membranes are potentially infectious.

Components of Standard Precautions

• Hand Hygiene: Performed before and after resident care, after touching body fluids or contaminated equipment, and immediately after glove removal.
• Personal Protective Equipment (PPE): Worn whenever exposure to blood or body fluids is anticipated.
• Respiratory Hygiene / Cough Etiquette: Covering coughs with tissues or inner elbow; providing masks to coughing residents; maintaining physical distance when feasible.
• Safe Injection and Needle Practices: Using safety-engineered sharps; disposing of used needles immediately in rigid, puncture-resistant biohazard sharps containers (never recap needles!).
• Environmental Cleaning & Decontamination: Cleaning and disinfecting frequently touched surfaces (bed rails, call buttons, tray tables) with agency-approved germicidal wipes.
• Handling Soiled Linen: Rolling soiled linens inward (dirty side in) away from uniform; placing directly into designated linen bags; never shaking soiled linens or placing them on floor/furniture.