Safety and

Infection Control
Archer Review Crash Course

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 Isolation
Precautions

Standard
● Perform hand hygiene
● Use PPE if you expect to be exposed to bodily fluids
● Disinfect patient equipment
● Follow safe injection practices
○ 1 needle, 1 syringe, 1 time
Contact ● Infections requiring contact
● PPE to wear: precautions:
○ Gown ○ MRSA
○ Gloves ○ VRE
○ Noroviruses
● Patient dedicated equipment
○ Rotavirus
○ Disposable stethoscope
○ Conjunctivitis
○ BP cuff
○ Diphtheria (cutaneous)
○ Thermometer
○ Herpes Simplex virus
● Limit transport of patient ○ Human Metapneumovirus
● Appropriate patient placement ○ Pediculosis (lice)
○ Single patient room ○ Scabies
○ Same infections grouped together ○ Poliomyelitis
○ Staphylococcus aureus
C. diff
Hand sanitizer doesn’t kill C. diff spores!!

Follow contact precautions AND wash hands

with soap and water.
 Droplet ● Infections requiring droplet
precautions:
● PPE to wear: ○ Influenza
○ Mask ○ Pertussis
○ Eye cover ○ Mumps
■ Goggles or face shield ○ RSV
○ Rhinovirus
● Limit transport of patient
○ Adenovirus
○ When transporting, place mask on
○ Meningitis
patient.
○ Streptococcus Aureus
○ Teach patient to cough into elbow
○ Rubella
● Appropriate patient placement ○ Haemophilus influenzae type B
○ Single patient room ■ Epiglottitis
○ Same infections grouped together ○ Parvovirus
○ Diphtheria (pharyngeal)

Airborne
● PPE to wear: ● Infections requiring airborne
○ Respirator precautions:
■ N95 or PAPR
○ Tuberculosis
○ Gown** IF potential for bodily fluid exposure
○ Rubeola virus (Measles)
○ Gloves** IF potential for bodily fluid exposure
○ Varicella virus (Chickenpox)
● Airborne isolation room ○ Varicella zoster
○ Negative pressure when possible ○ SARS
○ DOOR MUST REMAIN CLOSED ○ Smallpox
○ Private room
● Appropriate healthcare personnel
○ Restrict susceptible personnel from entering
room.
○ Limit number of people needed to enter room.
● Limit transport of patient
○ Put mask on patient if they must leave the
room.
Airborne
● PPE to wear: ● Infections requiring airborne
○ Respirator precautions:
■ N95 or PAPR ○ Tuberculosis
○ Gown ○ Rubeola virus (Measles)
○ Gloves ○ Varicella virus (Chickenpox)
● Airborne isolation room ○ Varicella zoster
○ Positive pressure when possible ○ SARS
○ Private room ○ Smallpox
● Appropriate healthcare personnel
○ Restrict susceptible personnel from
entering room.
○ Limit number of people needed to
enter room.
● Limit transport of patient
○ Put mask on patient if they must leave
the room.

Donning PPE
Gown
● Fully cover torso from neck to knees, arms to end of wrist, and wrap around
the back
● Fasten in back at neck and waist

Mask or Respirator
● Secure ties or elastic band at middle of head and neck
● Fit flexible band to nose bridge
● Fit snug to face and below chin
● Fit-check respirator

Goggles/Face Shield
● Put on face and adjust to fit

Gloves
● Use non-sterile for isolation
● Select according to hand size
● Extend to cover wrist of isolation gown
 Doffing PPE
Gloves
● Outside of gloves are contaminated!
● Grasp outside of glove with opposite gloved hand; peel off
● Hold removed glove in gloved hand
● Slide fingers of ungloved hand under remaining glove at wrist
Goggles/Face Shield
● Outside of goggles or face shield are contaminated!
● To remove, handle by “clean” headband or ear pieces
● Place in designated receptacle for reprocessing or in waste container
Gown
● Gown front and sleeves are contaminated!
● Unfasten neck, then waist ties
● Remove gown using a peeling motion; pull gown from each shoulder
toward the same hand
● Gown will turn inside out
● Hold removed gown away from body, roll into a bundle and discard into
waste or linen receptacle
Mask or Respirator
● Front of mask/respirator is contaminated – DO NOT TOUCH!
● Grasp ONLY bottom then top ties/elastics and remove
● Discard in waste container
Hand Hygiene
Perform hand hygiene immediately after removing all PPE!

Things change...Always refer to the CDC!!

Full list from the CDC regarding recommended precautions for each disease:
https://www.cdc.gov/infectioncontrol/guidelines/isolation/appendix/type-dura
tion-precautions.html
NCLEX Question
You are working in an ICU caring for a 62 year old male who was prescribed
vancomycin for an infection. He develops persistent, watery diarrhea. Which
of the following precautions do you take? Select all that apply.

A. Sanitize your hands before and after entering the room

B. Place the patient is a negative pressure room
C. Wear an N95 and face shield when entering the room.
D. Use single use equipment and leave it inside of the room

Answer: D
A is incorrect. The nurse should suspect C. diff in the patient that develops watery diarrhea after an
antibiotic course. Sanitizing your hands before and after entering the room will not kill the C. diff
spores. The nurse will need to wash her hands with soap and water.

B is incorrect. Placing the patient is a negative pressure room is not necessary. The nurse suspects C.
diff, which requires special enteric precautions. A negative pressure room is indicated for airborne
precautions.

C is incorrect. Wear an N95 and face shield when entering the room. is not necessary. The nurse
suspects C. diff, which requires special enteric precautions. A N95 and face shield is indicated for
airborne precautions.

D is correct. Using single use equipment and leaving it inside of the room is important for special
enteric precautions. The nurse should take this precaution.
 Restraints

When is it appropriate to use restraints?

● Is your patient a danger to themselves or others?
○ Patient trying to harm themself
○ Combative patient trying to harm team members
● Are they trying to pull out their IVs or airway?
● Delirious patients
○ Don’t know where they are
○ Are afraid and at risk for harming themself

Always, always, ALWAYS remove the restraints as soon as possible! Use other
methods when appropriate - redirection, orientation, sedation as ordered.
Different types of restraints
Soft wrist restraint Mitts

Different types of restraints

Posey bed Vest
Things NOT considered a restraint
● Armboard for IV stabilization
● Immobilization during MRI, surgery, or procedure
● Orthopedic devices
● Bed rails during transport
● Crib for age appropriate children
● Helmets
● Handcuffs used by law-enforcement

Non-Violent Violent
● HCP must see patient within 24
● HCP must see patient within 1 hour
hours
● RN assessment - q15 minutes
● RN assessment - q1-2 hrs
● Restraint order expires in:
depending on unit policy
○ Adults: 4 hours
● Restraint order expires in 24 hours
○ 9-17 y.o: 2 hours
○ <9 y.o: 1 hour
Document, document, document!
What MUST be documented when you have a patient in restraints:

● Reason restraints are indicated

● Start and stop times
● Plan of care
● Assessment
○ ESPECIALLY important to check for skin breakdown
○ Look at skin under all restraints, note any redness, and use preventative measures to
protect skin.
○ Required to release at least every 2 hours to fully assess

NCLEX Question
Which of the following situations represents an appropriate time to place your patient in restraints?
Select all that apply.

a. When they are trying to pull at their lines, tubes, and drains.
b. When their family member asks you to.
c. When you feel it is necessary.
d. When they are a danger to themselves.
Answer: A and D
A is correct. It is appropriate to place your patient in restraints, with an order from your healthcare provider, if
the patient is trying to pull out their lines, tubes, and drains. This makes them a danger to themselves and can
cause harm, so restraints may be appropriate.

B is incorrect. A family member may request restraints, but this is not an appropriate reason to initiate
restraints. You should explain to the family member other options and what you are trying to do for their loved
one before initiating restraints.

C is incorrect. Just because you feel that restraints are necessary does not mean you may initiate them. You
must speak with your healthcare provider and explain why you think restraints are necessary to obtain an
order.

D is correct. If your patient is a danger to themselves, and other interventions are not keeping them safe, it is
appropriate to request an order for restraints from your healthcare provider.

NCSBN Client Need:

Topic: Effective, safe care environment Subtopic: Coordinated care

Reference: DeWit, S. C., Stromberg, H., & Dallred, C. (2016). Medical-surgical nursing: Concepts & practice. Elsevier Health Sciences.

Subject: Fundamentals
Lesson: Safety

CPR
Unconscious patient
1. Try to wake the patient, yell and shake them.
a. Sternal rub
2. Check their pulse
a. Adult - carotid; infant - brachial
b. NO LONGER than 10 seconds
3. Press the code bell & yell for help

Patient has no pulse

1. Start chest compressions
a. 100-120 beats/min
b. Depth: 2 inches
c. Allow full chest recoil
2. Have someone get the crash cart
CPR Cycles
● 30 compressions: 2 breaths
● 2 minutes
● At 2 minute mark; check rhythm and pulse
● If patient still pulseles, switch compressors
and resume compression
● NEVER stop compressions for more than
10 seconds.

Shock
● Allow AED to analyze rhythm
● Follow prompts
● If ‘shock advised’, resume
compressions while device charge
● Clear patient when AED advises
● Ensure patient completely clear, and
deliver shock
● IMMEDIATELY resume compressions
Infant CPR
● 2 rescuers: compression to breath ratio is 15:2
● Use two fingers for compressions
● Compress to a depth of ⅓ the AP diameter

NCLEX Question
You arrive at the bedside of a 51 year old patient who was found unconscious,
CPR is in progress. Which of the following actions if observed would require
you to intervene? Select all that apply.

A. Providing 15 compressions for every 2 breaths

B. Providing compressions with two fingers
C. Allowing for full chest recoil.
D. Checking for a pulse for 10 seconds.
Answer: A & B
A is correct. In a 51 year old patient, it would not be appropriate to provide
compressions and breaths in a 15:2 ratio. This is the correct ratio for infant
CPR.

B is correct. Providing compressions with two fingers is not appropriate in an

adult patient. The nurse should use both hands to compress to a depth of 2
inches. The 2 finger technique is appropriate only in infant CPR.

C is incorrect. Allowing for full chest recoil is an appropriate action. No

intervention is needed.

D is incorrect. Checking for a pulse for 10 seconds is an appropriate action. No

intervention is needed.

Fire Safety
Fire Prevention
● Always check your equipment at the beginning of your shift
● Keep electrical equipment away from water
● Never block doors in case of fire
● Know where the emergency shut off for oxygen is
○ Oxygen is flammable!
○ NO SMOKING!!!

If there is a fire: RACE

● R - Rescue

● A - Activate

● C - Contain

● E - Extinguish
To use a fire extinguisher: PASS
● P - Pull pin

● A - Aim

● S - Squeeze

● S - Sweep

NCLEX Question
A nurse is working on a busy medical surgical unit when a fire breaks out in
the trash can in a patient’s room. What is her priority nursing action?

A. Pull the fire alarm

B. Remove the patient from the room
C. Contain the fire
D. Get the fire extinguisher
Answer: B
To determine your priority nursing action in the event of a fire, use the
acronym RACE: rescue, activate, contain, and extinguish.

Of the choices offered, removing (rescuing) the patient from the room is the
priority.

Remember, the NCLEX is a public safety test. If there is an action YOU can take
to keep your patient SAFE, that’s the correct answer!!

Break! Back at...

 Radiation

Reduce Exposure
● When possible, keep your distance
● Never touch an implanted radiation device
● Minimize the time spent in the room
○ Cluster care
● Minimize the staff going into the room
Personal Protective Equipment
● Double gloves
● Goggles
● Shoe covers
● N95 or higher level respirator
● Dosimeter
○ Device worn by staff to measure their exposure
○ Can indicate when staff members have reached the limit and should be re-assigned

Patient Care
● Immediately discard any bodily fluids in hazardous waste
○ Urinal
○ Waste from blood draw
○ Towels used to clean up fluids
● Cluster care
● Leave trash and linen in the room for proper disposal
NCLEX Question
The nurse is caring for a patient with an implanted radiation device to deliver
internal radiation. Which of the following precautions should she take to keep
herself and others safe? Select all that apply.

A. Keep the patient in a single room

B. Dispose of the patients trash in a medical waste bin
C. Place a sign on the door with the patient's diagnosis and treatment plan
D. Wear a dosimeter to track radiation exposure

Answer: A and D
A is correct. Keeping the patient in a single room will prevent other patients from
unnecessary radiation exposure.

B is incorrect. Radiation waste requires special handling. Disposing of the patients

trash in a medical waste bin would pose a danger to staff. Medical waste includes
things like paper, tissues, used utensil, and other non hazardous waste.

C is incorrect. It is not appropriate to place a sign on the door with the patient's
diagnosis and treatment plan. This would violate HIPPA. Istead, the nurse should
place a caution sign on the door warning of radiation, but without the patient’s
diagnosis and treatment plan.

D is correct. Wearing a dosimeter to track radiation exposure is an appropriate

safety measure to ensure there is not excessive exposure to any one staff
member.
 Waste

Medical waste
● Any non-hazardous trash
● Paper
● Leftover food
● Used utensils
● Tissues
● No special requirements for disposal
● Use regular trash can
Infectious waste
● Medical waste that is or COULD be infectious
● Used sharps
● Bodily fluids
● Swabs
● Wound dressings
● Dispose per facility protocol
○ Sharps container

Hazardous waste
● Waste that poses a potential danger to staff
● Not necessarily infectious
● Clean sharps
● Hazardous medications
○ Chemo
○ ‘Blue bin drugs’
● Dispose per facility protocol
○ Blue bin
Radioactive waste
● Anything involved with radiation
○ Medications
○ Implants
○ Tubing
○ Syringes
○ Bodily fluids
○ Towels
○ PPE used while caring for the patient
● Certified team members dispose of waste
● Special containers

NCLEX Question
The nurse just administered IM toradol to a 15 year old female. What is the
correct way for her to dispose of the needle?

A. Cap the needle and place it in the sharps container.

B. Place the needle in a biohazard bag
C. Place the uncapped needle in the sharps container immediately
D. Cap the needle and dispose of it in the regular trash.
Answer: C
A is incorrect: Capping the needle and placing it in the sharps container is not
appropriate. Needles should never be recapped due to the increased risk of
injury to staff.

B is incorrect: Used sharps should not be placed in a biohazard bag. This is

unsafe and improper disposal of potentially infectious waste.

C is correct: It is appropriate to place the uncapped needle in the sharps

container immediately. Not recapping the needle decreases risk of a
needlestick injury, and the sharps container is an appropriate location for
potentially infectious waste such as used sharps.

D is incorrect: It is not appropriate to either cap the needle or dispose of it in

the regular trash.

Fall Prevention
Fall risk
● Geriatric patients
● LOC
● Altered mental status
● Equipment cluttering room

Fall prevention
● Ensure call light is in reach
● Remove unnecessary equipment
● Fall socks
○ Yellow
○ Non-slip
● Bed alarm
● Ensure room is well lit
● Offer help to bathroom frequently
● ‘Call don’t fall’
Fall bundle
● Yellow is the universal ‘Fall Risk’ color
● Yellow socks
● Yellow wristband
● Yellow sign on door

Door sign
Assistive devices to prevent falls
● Walker
● Cane
● Wheelchair
● Crutches

Walker
● Stand in the center of the walker
● Slide walker forward 6-8 inches
● Keep all 4 feet of walker on ground
● Step forward with affected side
○ Keep weight on the walker and unaffected leg
● Bring unaffected leg up to walker
Crutches: Fit
● Don’t rest on armpits
● Use shoulders and arms for strength
● Slight bend through the elbows
Three-Point Gait
● For partial weight bearing
● Crutches are advanced with the affected leg
● Unaffected leg brought forward
Swing-Through Gait
● For non-weight bearing patients
● Stand on the unaffected leg
● Move both crutches forward about a foot
● Brace the hand grips for support
● Swing both legs through the crutches
Crutches up the stairs

Crutches down the stairs

Cane
● Cane goes on the unaffected side
● Slight bend at the elbow
● Cane moves forward 6-10 inches
● Affected leg moves forward with cane
● Unaffected leg then moves past the cane
NCLEX Question
You are the bedside nurse on a medical surgical floor caring for each of the
following patients. In which order would the nurse categorize their fall risk
from greatest to least risk?

A. 25 year old female with a broken hand

B. 87 year old male, history of fall, Parkinson’s disease
C. 45 year old male taking acetaminophen for abdominal pain
D. 52 year old female, blind, post op day 1

Answer: B, D, C, A
The patient with the highest fall risk is B: 87 year old male, history of fall,
Parkinson’s disease. This patient has a total of 3 risk factors: age, history of
fall, and balance issues due to parkinson’s disease.

The patient with the second highest fall risk is D: 52 year old female, blind,
post op day 1. This patient has a total of 2 risk factors: visual impairment and
recent surgery.

The patient with the third highest fall risk is C: 45 year old male taking
morphine for abdominal pain. This patient has a total of 1 risk factor: opioid
pain medication.

The patient with the least fall risk is A: 25 year old female with a broken hand.
This patient has no risk factors.
 Wrap up
questions
NCLEX Question
A nurse is caring for a patient diagnosed with meningococcal meningitis.
Which of the following isolations precautions should the nurse initiate?

A. Droplet
B. Contact
C. Airborne
D. Special enteric
Answer: A
Meningococcal meningitis is a type of bacterial infection in the brain and
spinal cord. It is very dangerous and highly contagious. The nurse will need to
implement droplet precautions immediately to prevent transmission of the
meningococcal meningitis.

NCLEX Question
While working in the emergency department, a fire breaks out in the waiting
room. The charge nurse tells you to get the fire extinguisher. Place the
following steps in order for correctly using the fire extinguisher.

A. Aim the fire extinguisher

B. Sweep the area of the fire
C. Pull the pin
D. Squeeze the handle
Answer: C, A, D, B
To remember how to use a fire extinguisher, use the acronym PASS: first pull
the pin, next aim the fire extinguisher at the fire, next squeeze the handle to
start dispensing the contents of the fire extinguisher, and last sweep the
nozzle over the area of the fire to completely extinguish the fire.

NCLEX Question
An 82 year old female lives in an assisted living facility and using a cane to
ambulate independently. Which of the following observations would require
intervention? Select all that apply.

A. Holding the cane on the unaffected side

B. Elbows are straight
C. Moves her affected leg forward with cane
D. Moves her unaffected leg forward with the cane
Answer: B and D
A is incorrect. Holding the cane on the unaffected side is an appropriate action
and does not require intervention.

B is correct. The elbows should not be straight, but should have a slight bend
in them.

C is incorrect. Moving her affected leg forward with the cane is an appropriate
action and does not require intervention.

D is correct. Moving her unaffected leg forward with the cane is not correct
and requires intervention. She should be moving her affected, or weak, leg
forward with the cane.

But….How do I study?!?!
Answer: The Sure Pass Program

If you follow the Sure Pass

Program and fail the NCLEX,
Archer will give you a 100% money
back refund for ALL PRODUCTS!
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