Safety & Infection Control – NCLEX-RN Study Guide
Overview
Safety and Infection Control is a core domain of the NCLEX-RN, testing your ability to protect patients and healthcare workers from harm, infection, and environmental hazards. This guide covers standard and transmission-based precautions, fall prevention, restraint use, and hazardous materials safety. Mastering these concepts requires understanding not just what to do, but why and in what order to prioritize actions.
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Standard Precautions
Key Concepts
Standard precautions are the baseline level of infection control applied to every patient, every time, regardless of diagnosis or perceived infection risk. They treat all blood and body fluids as potentially infectious.
What Standard Precautions Cover
> ⚠️ Watch Out For: Sweat is the one exception — it is NOT considered potentially infectious under standard precautions. This is a common distractor on the NCLEX.
Hand Hygiene Rules
| Situation | Required Method |
|---|---|
| Hands visibly soiled | Soap and water |
| After C. diff patient care | Soap and water |
| Contact with spore-forming organisms | Soap and water |
| Routine care (hands not visibly soiled) | Alcohol-based hand rub acceptable |
> ⚠️ Watch Out For: Alcohol-based hand rub is not effective against spore-forming organisms like C. difficile. This distinction appears frequently on exams.
Needlestick Injury – Priority Action
1. Immediately wash the affected area with soap and water
2. Report the exposure to occupational health per facility protocol
3. Document the incident and initiate post-exposure prophylaxis (PEP) as indicated
> ⚠️ Watch Out For: The first action is always washing the wound — not reporting, not panicking. Apply the ABC/priority framework: address the immediate physical injury first.
Key Terms
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Transmission-Based Precautions
Key Concepts
Transmission-based precautions are used in addition to standard precautions when a patient has a known or suspected infection with a specific transmission route. There are three types: Airborne, Droplet, and Contact.
Quick Comparison Table
| Precaution Type | Transmission Route | Particle Size | Room Type | Required PPE |
|---|---|---|---|---|
| Airborne | Airborne droplet nuclei | <5 microns | Negative-pressure AIIR | Fit-tested N95 respirator |
| Droplet | Large respiratory droplets | >5 microns | Private room preferred | Surgical mask, gloves, gown |
| Contact | Direct contact / surfaces | N/A | Private room | Gloves and gown |
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Airborne Precautions
Diseases requiring airborne precautions (mnemonic: MTV — Measles, TB, Varicella):
Room requirements:
PPE required:
> ⚠️ Watch Out For: For TB, the nurse must wear an N95 respirator, not a surgical mask. The patient wears a surgical mask when being transported outside the room. This distinction is heavily tested.
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Droplet Precautions
Common diseases (mnemonic: SPIDERMAN):
PPE required:
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Contact Precautions
Common diseases:
PPE required:
C. diff Special Rule:
> ⚠️ Watch Out For: C. diff requires both contact precautions and soap-and-water hand hygiene. Students frequently forget that alcohol-based hand sanitizer is ineffective here.
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Combination Precautions
Some diseases require more than one type of precaution:
| Disease | Precautions Required |
|---|---|
| Varicella (chickenpox) | Airborne + Contact |
| Disseminated herpes zoster | Airborne + Contact |
| SARS/COVID-19 (per facility) | Airborne + Contact + Droplet |
> ⚠️ Watch Out For: Varicella requires both airborne AND contact precautions — a negative-pressure room is required, AND the nurse wears gloves and gown for contact with lesions.
Key Terms
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Fall Prevention
Key Concepts
Falls are a leading cause of patient injury in hospitals. The nurse's role includes risk assessment, environmental modification, patient education, and hourly rounding. Fall prevention is a National Patient Safety Goal (NPSG).
Morse Fall Scale
Morse Fall Scale factors assessed:
1. History of falling
2. Secondary diagnosis
3. Ambulatory aids used
4. IV/heparin lock present
5. Gait/transferring ability
6. Mental status
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Fall Prevention Interventions
Most evidence-based intervention: Hourly rounding addressing the 4 P's:
Additional interventions:
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Responding to a Falling Patient
Priority action: Guide the patient gently to the floor using your body to support them, protecting the head, to prevent injury from an uncontrolled fall.
> ⚠️ Watch Out For: Do NOT try to stop the fall completely — this can injure both the patient and the nurse. The priority is to control the descent and protect the head.
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Medication-Related Fall Risk
High-risk medications for falls include:
Patient education for patients on temazepam or similar medications:
> ⚠️ Watch Out For: Any medication causing sedation or orthostatic hypotension increases fall risk. Always include fall precaution teaching when discharging a patient on these medications.
Key Terms
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Restraint Use
Key Concepts
Restraints are a last resort intervention. The nurse must first try all less restrictive alternatives, obtain a physician's order, and continuously reassess the patient's need for restraints.
Types of Restraints
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Before Applying Restraints
Required steps (in order):
1. Attempt less restrictive alternatives first:
- Mittens (for patients pulling at lines)
- Distraction / reorientation
- Repositioning
- Family presence / sitter
- Addressing unmet needs (pain, toileting)
2. Document the alternatives tried and their failure
3. Obtain a physician's order (or obtain one within a specified time per facility policy)
4. Obtain informed consent when possible
5. Apply restraints using correct technique
> ⚠️ Watch Out For: Restraints are never applied without a physician's order except in an immediate safety emergency — and even then, an order must be obtained as soon as possible.
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Applying Restraints Safely
Vest (Posey) Restraint:
Key Safety Rules for ALL Restraints:
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Restraint Reassessment Requirements
Per Joint Commission standards:
> ⚠️ Watch Out For: The 2-hour reassessment interval is the most commonly tested restraint fact. Also know that restraint orders must be renewed within specific time frames (typically 24 hours for non-violent/non-self-destructive behavior).
Key Terms
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Hazardous Materials & Environmental Safety
Chemotherapy Safety (OSHA Guidelines)
Chemotherapy agents are hazardous drugs that require special handling to protect the nurse from exposure.
Required PPE for chemotherapy handling:
Additional safety measures:
> ⚠️ Watch Out For: Standard gloves are not sufficient for chemotherapy. Double chemotherapy-rated gloves are required. Know the correct waste disposal container color (yellow for chemo waste).
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Safety Data Sheets (SDS)
> ⚠️ Watch Out For: The SDS (or MSDS) is always the go-to resource for information about any chemical spill or hazardous substance. Know where to find it on your unit.
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Fire Safety – RACE and PASS
RACE (Fire Response Sequence):
| Letter | Action |
|---|---|
| R | Rescue – Remove patients from immediate danger |
| A | Activate – Pull the fire alarm |
| C | Confine – Close all doors and windows |
| E | Extinguish / Evacuate – Use extinguisher if safe; otherwise evacuate |
PASS (Fire Extinguisher Use):
| Letter | Action |
|---|---|
| P | Pull the pin |
| A | Aim the nozzle at the base of the fire |
| S | Squeeze the handle |
| S | Sweep from side to side |
> ⚠️ Watch Out For: RACE before PASS — you must first rescue patients and activate the alarm before attempting to extinguish a fire. Also note: aim at the base of the fire, not the flames.
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Tubing Safety – NPSG Labels
> ⚠️ Watch Out For: If you see a yellow label on a tubing connection, this is an enteral tube — do not connect IV medications to it. Wrong-route errors can be fatal.
Key Terms
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Quick Review Checklist
Use this checklist to confirm you understand the highest-yield concepts: