5.2 Infection Control, Hand Hygiene, and Standard Precautions

Breaking the Chain of Infection

Infection control is a core part of Basic Nursing Skills because nurse aides move constantly between residents, rooms, linens, equipment, meals, and personal care. Microorganisms spread through direct contact, droplets, contaminated hands, soiled equipment, respiratory secretions, blood, stool, urine, and wound drainage. The aide cannot see most germs, so safe habits must happen every time, not only when a resident looks ill.

Hand hygiene is the single most important and most repeated infection control action. The CDC recognizes two methods. Use an alcohol-based hand rub when hands are not visibly soiled. Use soap and water when hands are visibly dirty, after using the restroom, and when caring for residents with Clostridioides difficile (C. diff) or other spore-forming organisms. This C. diff rule is heavily tested: alcohol-based rubs do not kill C. diff spores, so only the mechanical scrubbing action of soap and water reliably removes them from the hands. When in doubt with a soiled-care or diarrhea scenario, choose soap and water.

The Five Moments for Hand Hygiene

Hand hygiene is also required immediately after removing gloves, because glove removal can contaminate the hands. Gloves never replace hand hygiene. Proper technique with soap and water means wetting the hands, applying soap, and rubbing all surfaces (palms, backs, between fingers, fingertips, and thumbs) for at least 20 seconds, then rinsing with fingertips pointed down so water runs away from clean hands, and drying with a clean paper towel used to turn off the faucet.

Gloves carry their own rules. Wear gloves whenever contact with blood, body fluids, mucous membranes, non-intact skin, or contaminated items is likely, change them between tasks on the same resident when moving from a dirty to a clean site, and remove them before touching clean surfaces such as a doorknob, chart, or call light. Used gloves should never be washed and reused, and the same pair should never be worn from one resident to the next.

PPE: Selecting, Donning, and Doffing in Order

Personal protective equipment, or PPE, must match the expected exposure. Gloves may be enough for toileting help when splashing is not expected. A gown protects clothing when soiling is likely. A mask and eye protection are added when splashes or sprays could reach the face. A fitted respirator (such as an N95) is used for airborne precautions.

The order matters and is a frequent exam target. The CDC sequence is:

Donning (putting on):

1. Gown first, tied at the neck and waist.
2. Mask or respirator, secured snugly over the nose and chin.
3. Goggles or face shield.
4. Gloves last, pulled over the gown cuffs.

Doffing (removing):

1. Gloves first, because they are the most contaminated.
2. Goggles or face shield, handling by the headband.
3. Gown, touching only the inside, rolling it inward.
4. Mask or respirator last, by the ties or elastics, without touching the front.
5. Hand hygiene immediately after all PPE is off.

A memory aid: you put PPE on from the body outward and take it off worst-first. Doff at the doorway so contaminated equipment stays in the room, then perform hand hygiene before touching anything clean. Keep clean and dirty separate: do not place clean supplies on a soiled overbed table, carry clean linen against a soiled uniform, or return isolation-room items to the clean supply area unless policy specifically allows it.

Standard and Transmission-Based Precautions

Standard precautions apply to every resident, every time, regardless of diagnosis. The aide treats all blood, body fluids, secretions, non-intact skin, and mucous membranes as potentially infectious. You do not need to know a resident's diagnosis before protecting against body fluids.

Transmission-based precautions are layered on top of standard precautions when a specific infection is known or suspected, and the type is posted on the door:

• Contact precautions (e.g., C. diff, MRSA, VRE): gown and gloves for room entry; dedicated or disinfected equipment. C. diff specifically requires soap-and-water hand hygiene.
• Droplet precautions (e.g., influenza, pertussis): a surgical mask within about 6 feet of the resident.
• Airborne precautions (e.g., tuberculosis, measles): a fitted N95 respirator and a negative-pressure room with the door closed.

The aide follows the posted sign and care plan exactly and asks the nurse if the sign or supplies are unclear. Resident dignity still matters during isolation: explain care simply, keep the call light and personal items in reach, and support approved social contact so the resident does not feel punished. Finally, report signs that may suggest infection: fever, chills, new cough, shortness of breath, burning or cloudy urine, diarrhea, vomiting, wound drainage, redness, sudden weakness, new confusion, or poor intake. The aide does not diagnose infection; the aide notices, protects others from exposure, and reports facts promptly.