4.2 Standard Precautions, Hand Hygiene & Personal Protective Equipment (PPE)
Key Takeaways
Standard Precautions apply to all residents; select barriers for the expected contact with blood, body fluids other than sweat, mucosa, or non-intact skin.
Use hand hygiene before and after care and after glove removal; soap and water is required for visible soil and specified outbreak situations.
One CDC PPE sequence removes gloves, eye protection, gown, and mask; airborne respirators are removed after room exit and door closure.
Report needlestick or mucosal exposure immediately after first aid and obtain urgent occupational-health evaluation.
4.2 Standard Precautions, Hand Hygiene & Personal Protective Equipment (PPE)
In healthcare facilities, certified nursing assistants must treat infectious agents as ubiquitous and often undetectable. Residents may harbor multidrug-resistant pathogens or bloodborne viruses without showing overt symptoms. To prevent horizontal pathogen spread between residents, staff, and visitors, regulatory bodies—including the CDC, OSHA, and the South Dakota Board of Nursing—enforce infection control mandates anchored in Standard Precautions, rigorous hand hygiene, and proper personal protective equipment (PPE).
Standard Precautions: The Universal Foundation
Standard Precautions represent the primary, universal tier of infection prevention applied in the care of all residents at all times, regardless of diagnosis or presumed infection status. Under Standard Precautions, healthcare personnel must treat all human blood, body fluids, secretions, excretions (except sweat), non-intact skin, and mucous membranes as potentially infectious.
Core elements of Standard Precautions include:
- Hand Hygiene: Decontaminating hands before and after resident contact and immediately following glove removal.
- PPE Selection: Donning appropriate barriers based on the anticipated risk of exposure to blood or body fluids.
- Respiratory Hygiene & Cough Etiquette: Covering coughs, using disposable tissues, and offering masks to coughing individuals.
- Sharps Safety: Preventing percutaneous injuries through engineering controls and safe disposal containers.
- Environmental & Linen Sanitation: Disinfecting equipment and handling soiled textiles safely.
Hand Hygiene: Protocols & Mandatory Indications
Hand hygiene is universally recognized as the single most effective clinical intervention for halting the transmission of healthcare-associated infections. Contaminated caregiver hands are the primary vehicle for pathogen cross-contamination in nursing facilities.
Alcohol-Based Hand Rub (ABHR) vs. Soap and Water
For routine decontamination when hands are not visibly soiled, the CDC recommends alcohol-based hand rub (ABHR) containing 60% to 95% alcohol. ABHR provides rapid bactericidal action, saves time, and preserves skin integrity. The CNA dispenses the manufacturer-recommended amount into cupped hands and rubs vigorously across all surfaces—palms, dorsum, between fingers, knuckles, thumbs, fingernails, and wrists—until completely dry (usually about 20 seconds; use the product directions).
Mandatory Indications for Soap and Water Handwashing
Use soap and water in the following situations, and follow the facility infection-prevention protocol:
- Visibly Soiled Hands: Hands contaminated with blood, feces, urine, wound drainage, or dirt.
- Outbreak Precautions: During C. difficile and norovirus outbreaks, use soap and water as directed after care. C. difficile forms spores; norovirus is a virus and does not form spores. ABHR does not reliably inactivate C. difficile spores, but CDC still generally prefers ABHR in routine care when hands are not visibly soiled; gloves and correct removal are essential. Follow more protective facility instructions.
- After Using the Restroom: Following personal elimination or assisting a resident with toileting.
- Before Meal Service: Prior to handling, preparing, or serving resident meal trays.
Standard 20-Second Handwashing Protocol
Handwashing is taught and practiced in the approved program. The Board's assigned skills forms control evaluation requirements; Headmaster administers the knowledge exam. The following is a general safe-care sequence:
- Stand back from the sink so uniform never touches the contaminated basin or counter.
- Turn on warm water; adjust flow to prevent splashing onto clothing.
- Wet hands and wrists thoroughly under running water, keeping hands pointed downward below elbows throughout the procedure to prevent contaminated water from running back up forearms.
- Apply soap and generate a copious lather.
- Rub hands together vigorously, applying continuous friction for at least 20 seconds. Scrub interlaced fingers, palms, backs of hands, knuckles, thumbs, wrists, and subungual areas (under fingernails) against opposite palms.
- Rinse thoroughly under running water with fingertips pointed downward.
- Dry thoroughly from clean fingertips upward to wrists with clean, disposable paper towels, discarding them immediately.
- Turn off faucet handles using a fresh, dry paper towel barrier; discard paper towel.
Personal Protective Equipment (PPE): Donning & Doffing Sequences
Personal protective equipment creates a physical barrier protecting healthcare workers from infectious pathogens. Equipment is chosen based on anticipated clinical exposure:
- Gloves: Protect hands from blood, body fluids, and non-intact skin; single-use only; change between contaminated and clean tasks on the same resident.
- Gowns: Protect skin and clothing from splashes, sprays, or gross contact contamination.
- Surgical Masks: Protect mouth and nose against large respiratory droplets and fluid splashes.
- Respiratory Protection: N95 filters at least 95% of the specified test aerosol; this is not a sharp particle-size cutoff. Tight-fitting respirators require fit testing and a user seal check each use. Loose-fitting hood PAPRs do not require fit testing; use the device approved by the respiratory-protection program.
- Goggles / Face Shields: Provide dedicated eye and facial mucous membrane protection from fluid sprays.
Exact CDC Donning Sequence (Putting On PPE)
- Gown: Fasten securely at both neck and waist ties.
- Mask or Respirator: Fit snugly over nose bridge and chin; adjust metal band.
- Goggles or Face Shield: Adjust headband or earpieces over eyes and face.
- Gloves: Extend cuffs completely over the wrist cuffs of the isolation gown.
One CDC Doffing Sequence (Taking Off PPE)
The outside front surfaces of PPE are contaminated; inside surfaces and rear straps are less likely to be contaminated; handle cautiously:
- Gloves: Remove using glove-to-glove, skin-to-skin peel technique, turning inside out; discard.
- Goggles or Face Shield: Lift from rear headband without touching the front; discard or place in reprocessing.
- Gown: Untie neck and waist; peel away from shoulders touching inside only; roll inside out into a bundle; discard.
- Mask or Respirator: Handle by ties/bands without touching the front. Remove an airborne-precaution respirator only after leaving the room and closing the door. Follow the specific device and facility sequence.
- Hand Hygiene: Perform immediately after removal, and during the sequence whenever hands become contaminated. Other approved sequences remove gown and gloves together.
OSHA Bloodborne Pathogens Standard & Exposure Protocols
The OSHA Bloodborne Pathogens Standard protects healthcare personnel against Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), and Hepatitis C Virus (HCV). Key requirements include:
- Hepatitis B Vaccination: Employers must offer the full HBV vaccine series free of charge within 10 working days of initial assignment involving occupational exposure, after required training, unless an exception applies.
- Safe Sharps Disposal: Needles must never be bent, broken, or manually recapped. Immediately discard into rigid, puncture-resistant, leak-proof biohazard sharps containers. Replace containers before overfilling, according to their marked fill line and instructions. Do not reach into a container or handle an exposed discarded needle.
- Accidental Needlestick/Splash Protocol: Immediately wash punctures with soap and water (or irrigate exposed eyes/mucous membranes with water or saline); report immediately and obtain urgent occupational-health evaluation. HIV prophylaxis, when indicated, must begin as soon as possible; do not wait for symptoms or delay referral to satisfy paperwork. The clinician determines testing, prophylaxis, and follow-up.
Sources checked October 16, 2026
CDC clinical hand hygiene; CDC nursing-home Enhanced Barrier Precautions; OSHA bloodborne pathogens.
After fecal incontinence care during a C. difficile outbreak, the aide's hands are visibly soiled. Which hand hygiene method is required?
Applying a high-potency foam alcohol-based rub and rubbing hands for 15 seconds
Wiping hands thoroughly with a quaternary ammonium surface disinfectant towelette
Rinsing hands under cold water without soap and drying with a clean paper towel
Washing hands thoroughly with soap and warm running water applying friction for at least 20 seconds
According to the Centers for Disease Control and Prevention (CDC), what is the correct procedural order for donning personal protective equipment (PPE)?
Gown, mask or respirator, goggles or face shield, gloves
Gloves, gown, goggles or face shield, mask or respirator
Mask or respirator, gown, gloves, goggles or face shield
Goggles or face shield, gloves, gown, mask or respirator
While assisting a licensed nurse with morning care, a certified nursing assistant sustains an accidental puncture wound from an uncapped syringe needle discarded in bed linens. What is the CNA's immediate first action?
Complete an administrative employee incident report form before leaving the room
Wash the puncture wound immediately with soap and running water, then notify the charge nurse
Squeeze the puncture wound firmly to express all remaining blood and apply household bleach
Apply a clean adhesive bandage to the wound and resume resident care duties until shift end
Sections you finish are checked off in the contents.