NCLEX RN Safe and Effective Care: Safety and Infection Control FAQs

1. What are the key principles of infection control that nurses must follow in healthcare settings?

Infection control is critical to maintaining patient safety and preventing the spread of infectious diseases in healthcare settings. Nurses must adhere to the following key principles:

• Hand Hygiene: Hand hygiene is the most effective way to prevent the spread of infections. Nurses must perform proper handwashing or use alcohol-based hand sanitizers before and after patient contact, after touching surfaces, and after removing gloves.
  
• Personal Protective Equipment (PPE): Nurses should wear appropriate PPE, including gloves, masks, gowns, and eye protection, based on the patient’s infection status. For example, contact precautions require gloves and gowns, while airborne precautions require an N95 mask.
  
• Standard Precautions: Standard precautions must be applied to all patients regardless of their infection status. These include hand hygiene, appropriate use of PPE, safe handling of contaminated materials, and safe injection practices.
  
• Transmission-Based Precautions: Depending on the mode of transmission, additional precautions may be required. For droplet transmission, wear a mask, and for airborne transmission, use an N95 respirator. For contact transmission, ensure proper hand hygiene and use gloves and gowns.
  
• Environmental Cleaning: Nurses must ensure that the patient’s environment is regularly cleaned and disinfected, particularly high-touch surfaces like bed rails, doorknobs, and IV pumps. Environmental cleaning is vital for controlling the spread of hospital-acquired infections.

2. What are the different types of isolation precautions, and when are they used?

Isolation precautions are critical for preventing the spread of infections to other patients and healthcare workers. There are three main categories of isolation precautions:

• Standard Precautions: Used for all patients, regardless of their infection status. It includes hand hygiene, use of gloves, proper disposal of sharps, and safe injection practices. It also includes the use of PPE when necessary (e.g., gowns, masks).
  
• Contact Precautions: These are used when an infection is spread through direct or indirect contact with the patient or contaminated surfaces (e.g., MRSA, C. difficile). Healthcare workers should wear gloves and gowns when entering the patient’s room and limit the movement of the patient within the facility.
  
• Droplet Precautions: Used for infections transmitted through respiratory droplets (e.g., influenza, pertussis). Nurses should wear a mask when within three feet of the patient and ensure that the patient wears a mask if transported.
  
• Airborne Precautions: Used for infections spread through airborne particles (e.g., tuberculosis, varicella). Nurses should wear an N95 respirator and place the patient in an airborne infection isolation room (AIIR) with negative pressure.
  
• Protective (Reverse) Isolation: Used for immunocompromised patients to protect them from potential infections. It involves strict hygiene, proper PPE, and limiting visitors and healthcare staff to minimize exposure.

3. What are the best practices for safe medication administration in a healthcare environment?

Safe medication administration is critical for patient safety, and nurses must follow several best practices:

• The Five Rights: Nurses must ensure they follow the five rights of medication administration: Right patient, Right medication, Right dose, Right route, and Right time.
  
• Double-Check High-Risk Medications: For high-risk medications, such as insulin or anticoagulants, nurses should double-check doses, calculations, and patient identifiers before administration. It is often beneficial to have another nurse verify these medications.
  
• Proper Storage and Disposal: Medications should be stored in a safe environment, such as locked cabinets or fridges for temperature-sensitive medications. Nurses must also properly dispose of medications that are no longer needed (e.g., controlled substances) to prevent accidental exposure or misuse.
  
• Preventing Contamination: Nurses should always use clean techniques to administer medications, especially when preparing injections or IV medications. For example, never reuse syringes or needles, and use alcohol swabs to clean vial tops before drawing medication.
  
• Patient Education: Nurses should educate patients on the proper use of medications, including how to take them, potential side effects, and the importance of adhering to the prescribed regimen.

4. How can nurses prevent the spread of multi-drug resistant organisms (MDROs) in the healthcare environment?

Preventing the spread of MDROs is essential to protecting patients and healthcare workers. Nurses can implement the following strategies:

• Adherence to Precautions: Nurses should ensure that appropriate transmission-based precautions (contact, droplet, airborne) are implemented based on the organism. For MDROs, contact precautions are typically necessary.
  
• Hand Hygiene: Nurses should practice rigorous hand hygiene, especially when working with patients infected with MDROs. Hand sanitizers with at least 60% alcohol or soap and water are effective in removing contaminants.
  
• Environmental Cleaning: Regular cleaning and disinfection of the patient’s room and shared equipment are essential for preventing the spread of MDROs. High-touch surfaces should be cleaned more frequently, and dedicated equipment should be used when possible.
  
• Antibiotic Stewardship: Nurses should educate patients and healthcare staff on the importance of using antibiotics only when necessary. Reducing unnecessary antibiotic use helps prevent the development of MDROs.
  
• Surveillance and Isolation: Healthcare institutions should monitor for MDROs through surveillance systems and isolate patients who are infected or colonized with resistant organisms to prevent their spread.

5. What measures should nurses take to ensure a safe environment for patients at risk of falls or injury?

Ensuring patient safety, particularly for those at risk of falls, is a critical responsibility of nurses. Here are measures nurses can take:

• Fall Risk Assessment: Nurses should assess each patient’s fall risk using validated tools (e.g., Morse Fall Scale or Hendrich II Fall Risk Model) and document any identified risks. Fall risk factors include age, medication side effects (e.g., sedatives, antihypertensives), and mobility issues.
  
• Environment Safety: Nurses should ensure that the patient’s room is free of obstacles, clutter, or hazards like wet floors. Ensure that bed rails are up, call bells are within reach, and the bed is in the lowest position.
  
• Assistive Devices: Nurses should evaluate whether patients need assistive devices such as walkers, canes, or wheelchairs. They should be properly fitted and used in a safe manner.
  
• Patient Education: Educating patients on the importance of calling for assistance when getting out of bed, wearing non-slip footwear, and avoiding sudden movements can help reduce falls. Additionally, teaching patients how to safely use mobility aids is essential.
  
• Regular Monitoring: High-risk patients should be checked more frequently, especially those who are post-operative, sedated, or disoriented. Nurses should also ensure that patients are assisted with toileting needs to avoid accidents.