← Infection Control – CNA Exam Flashcards

CNA Certified Nursing Assistant Exam Study Guide

Key concepts, definitions, and exam tips organized by topic.

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Infection Control – CNA Exam Study Guide


Overview

Infection control is a critical competency for CNAs, focusing on preventing the spread of pathogens in healthcare settings. This guide covers the chain of infection, hand hygiene, PPE use, isolation precautions, and aseptic technique. Mastery of these concepts protects both residents and healthcare workers from preventable infections.


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The Chain of Infection


Key Concept

Infection spreads through a predictable, six-link chain. Breaking any single link stops transmission.


The Six Links (In Order)

1. Infectious Agent – the pathogen (bacteria, virus, fungus, parasite)

2. Reservoir – where the pathogen lives and multiplies (human body, soil, water, equipment)

3. Portal of Exit – how the pathogen leaves the reservoir (coughing, wound drainage, feces)

4. Mode of Transmission – how the pathogen travels (contact, droplet, airborne, vehicle)

5. Portal of Entry – how the pathogen enters a new host (mouth, eyes, broken skin, respiratory tract)

6. Susceptible Host – a person who cannot resist the pathogen (elderly, immunocompromised)


Key Definitions

  • • Carrier – a person who harbors a pathogen but shows no signs or symptoms; can still transmit disease unknowingly
  • • Infectious disease – any disease caused by a pathogen
  • • Communicable disease – an infectious disease that can be transmitted from person to person or animal to person
  • • Reservoir – any environment (living or non-living) where pathogens survive and multiply

    • Which Link Does Each Action Break?

    | Action | Link Broken |

    |---|---|

    | Hand washing | Mode of transmission |

    | Gloves/gowns | Portal of entry / Portal of exit |

    | Isolating a patient | Mode of transmission |

    | Vaccination | Susceptible host |

    | Proper wound care | Portal of exit |


    ⚠️ Watch Out For

  • • Exam questions may ask which link a specific action breaks — hand washing most directly breaks the mode of transmission, not portal of entry
  • • Don't confuse carrier with a sick patient — carriers have no symptoms but are still contagious
  • • All reservoirs are not human — soil, water, and equipment also count

    • ---


    Hand Hygiene


    The Most Important Infection Control Practice

    Hand hygiene is the single most effective way to prevent the spread of infection.


    Soap and Water: Step-by-Step

    1. Wet hands with running water

    2. Apply soap

    3. Scrub all surfaces for at least 20 seconds

    4. Rinse thoroughly under running water

    5. Dry with a clean paper towel

    6. Use the paper towel to turn off the faucet


    When to Use Soap and Water vs. Hand Sanitizer

    | Use Soap and Water When… | Hand Sanitizer Is Acceptable When… |

    |---|---|

    | Hands are visibly soiled | Hands appear clean |

    | After using the restroom | Before/after routine patient contact |

    | Caring for C. difficile patients | After removing gloves (if no soil) |

    | After contact with spore-forming organisms | Between tasks with the same patient |


    Most Commonly Missed Areas

  • • Fingertips and thumbs — give these extra attention
  • • Backs of hands, between fingers, and under nails are also frequently missed

    • Key Terms

  • • Hand hygiene – any action to clean hands (soap/water or alcohol-based hand rub)
  • • Alcohol-based hand rub (ABHR) – effective against most pathogens but not C. difficile spores

    • ⚠️ Watch Out For

  • • After removing gloves, hand hygiene is still required — gloves are NOT a substitute
  • • C. difficile (C. diff) is a classic exam trap — alcohol-based sanitizer does NOT work; only soap and water kills the spores
  • • The paper towel used to dry hands is also used to turn off the faucet to avoid recontamination

    • ---


    Personal Protective Equipment (PPE)


    Donning Order (Putting ON)

    > "Gown, Mask, Goggles, Gloves"


    1. Gown (first — protects clothing before other PPE is applied)

    2. Mask or respirator

    3. Goggles or face shield

    4. Gloves (last — covers gown cuffs)


    Doffing Order (Taking OFF)

    > "Gloves, Goggles, Gown, Mask"


    1. Gloves (first — most contaminated item)

    2. Goggles or face shield

    3. Gown

    4. Mask or respirator (last — least contaminated)

    5. Perform hand hygiene after removing gloves AND again after all PPE is removed


    Why Gloves Come Off First

    Gloves are the most contaminated item. Removing them first prevents spreading pathogens to other PPE or bare skin during removal.


    PPE by Situation

    | Situation | PPE Required |

    |---|---|

    | Risk of blood/body fluid splash | Gloves + gown + mask + goggles |

    | Contact Precautions | Gloves + gown |

    | Droplet Precautions | Surgical mask + gloves + gown if contact likely |

    | Airborne Precautions | N95 respirator + gloves + gown |

    | Routine resident care | Gloves (minimum) |


    N95 vs. Surgical Mask

  • • N95 respirator – filters ≥95% of airborne particles; required for TB, measles, varicella
  • • Surgical mask – protects against droplets only; NOT sufficient for airborne pathogens

    • ⚠️ Watch Out For

  • • Donning and doffing order is a frequent exam question — memorize both sequences
  • • A surgical mask cannot substitute for an N95 with airborne precautions
  • • Perform hand hygiene twice during doffing — after gloves and after all PPE

    • ---


    Isolation Precautions


    Standard Precautions

  • • Applied to ALL patients, regardless of diagnosis or known infection status
  • • Treat all blood, body fluids, non-intact skin, and mucous membranes as potentially infectious
  • • Include hand hygiene, appropriate PPE, safe sharps handling, and respiratory hygiene

    • The Three Transmission-Based Precautions

    | Type | How Disease Spreads | PPE Required | Room Requirement | Examples |

    |---|---|---|---|---|

    | Contact | Direct/indirect touch | Gloves + gown | Private room preferred | MRSA, C. diff, scabies, VRE |

    | Droplet | Respiratory droplets (>5 microns, <3 feet) | Surgical mask | Private room preferred | Influenza, COVID-19, meningitis, pertussis |

    | Airborne | Tiny particles suspended in air (long distance) | N95 respirator | Negative pressure room | TB, measles, chickenpox (varicella) |


    Negative Pressure Rooms

  • • Air pressure lower inside the room than in the hallway
  • • Prevents airborne pathogens from escaping into common areas
  • • Required for Airborne Precautions

    • Reverse (Protective) Isolation

  • • Protects a highly immunocompromised patient from outside pathogens
  • • Used for patients receiving bone marrow transplants or chemotherapy
  • • Direction of protection is reversed — staff protect the patient, not just themselves

    • Key Terms

  • • MRSA – Methicillin-resistant Staphylococcus aureus; Contact Precautions required
  • • C. difficile (C. diff) – spore-forming bacteria; Contact Precautions + soap and water required
  • • TB (Tuberculosis) – Airborne Precautions + N95 + negative pressure room

    • ⚠️ Watch Out For

  • • Standard Precautions apply to everyone — not just known infectious patients
  • • MRSA = Contact Precautions (not airborne or droplet)
  • • TB always requires a negative pressure room AND an N95 — not just a mask
  • • Droplet precautions require a surgical mask upon entering the room — not just during close contact

    • ---


    Medical vs. Surgical Asepsis & Sterilization


    Asepsis: Clean vs. Sterile


    | | Medical Asepsis (Clean Technique) | Surgical Asepsis (Sterile Technique) |

    |---|---|---|

    | Goal | Reduce and prevent spread of pathogens | Eliminate ALL microorganisms, including spores |

    | Used For | Routine patient care, hand hygiene | Wound care, catheter insertion, surgery |

    | Example | Hand washing, wearing gloves | Setting up a sterile field, inserting a Foley catheter |


    Disinfection vs. Sterilization


    | | Disinfection | Sterilization |

    |---|---|---|

    | What it destroys | Most pathogens; not all spores | ALL microorganisms, including spores |

    | Used for | Patient care equipment, surfaces | Items entering sterile body sites |

    | Example | Cleaning a blood pressure cuff | Sterilizing surgical instruments |


    Contamination

    An object is contaminated when it has been in contact with pathogens or potentially infectious material. It must be cleaned, disinfected, or sterilized before safe reuse.


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    Sharps, Biohazard Waste & Exposure Control


    Safe Sharps Handling

  • • Discard immediately into a puncture-resistant, leak-proof sharps container
  • • Never recap, bend, or break used needles
  • • Never place sharps in regular trash or linen bags
  • • Sharps containers should be replaced when ¾ full

    • Biohazard Waste Disposal

  • • Red or orange biohazard bags – for waste contaminated with blood or body fluids
  • • Indicates infectious material requiring special disposal procedures

    • Blood/Body Fluid Exposure Response

    If exposed to blood or body fluids (e.g., needlestick, splash to eyes):

    1. Flush immediately with large amounts of water or saline for at least 15 minutes

    2. Report immediately to a supervisor

    3. Follow the facility's exposure control plan

    4. Document the incident


    Key Terms

  • • OSHA – Occupational Safety and Health Administration; sets and enforces workplace safety standards including the Bloodborne Pathogens Standard
  • • Bloodborne Pathogens Standard – OSHA regulation protecting healthcare workers from exposure to HIV, hepatitis B, hepatitis C, and other bloodborne pathogens
  • • Nosocomial infection / HAI – Healthcare-associated infection; acquired in a healthcare setting

    • - Common examples: CAUTI (catheter-associated UTI), MRSA, C. diff, VAP (ventilator-associated pneumonia)

  • • Exposure control plan – facility's written plan for managing occupational exposure to infectious material

    • ⚠️ Watch Out For

  • • Never recap a needle — this is a leading cause of needlestick injuries
  • • Eye flush must be at least 15 minutes — not a quick rinse
  • • HAIs are preventable — the exam may emphasize that proper technique significantly reduces their occurrence
  • • OSHA protects workers — CDC guidelines protect patients; know the difference

    • ---


    Quick Review Checklist


    Use this before your exam to confirm you can answer each point confidently:


  • • [ ] Name all six links of the chain of infection in order
  • • [ ] Explain what a carrier is and why they are a risk
  • • [ ] State the 20-second rule for hand washing and describe proper technique
  • • [ ] Know when to use soap and water vs. hand sanitizer (especially C. diff)
  • • [ ] Recite the correct donning order: Gown → Mask → Goggles → Gloves
  • • [ ] Recite the correct doffing order: Gloves → Goggles → Gown → Mask
  • • [ ] Know that Standard Precautions apply to ALL patients
  • • [ ] Match each disease to the correct precaution type (MRSA = Contact, TB = Airborne, Flu = Droplet)
  • • [ ] Explain why Airborne Precautions require a negative pressure room and an N95
  • • [ ] Distinguish medical asepsis from surgical asepsis
  • • [ ] Distinguish disinfection from sterilization
  • • [ ] Describe proper sharps disposal (puncture-resistant container, never recap)
  • • [ ] Identify the correct response to a blood or body fluid exposure (flush 15 min, report)
  • • [ ] Define OSHA and its role in protecting healthcare workers
  • • [ ] Define nosocomial/HAI and give at least two examples

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    💡 Final Tip: The CNA exam frequently tests application, not just memorization. Practice asking yourself "what would I do if…" for each scenario. When in doubt, always prioritize hand hygiene and appropriate PPE.

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