Infection Prevention and Control Flashcards

A practical nurse is caring for a patient with pulmonary tuberculosis (TB) who requires transport to radiology for a chest X-ray. The patient is currently on airborne precautions. Which sequence of actions is correct before transporting this patient?

Answer: Place a surgical mask on the patient, notify receiving department, and ensure the transport route minimizes exposure to others

When transporting a TB patient, a surgical mask is placed on the patient (not an N95 — the mask on the patient reduces source emission). The receiving department must be notified so they can prepare and minimize dwell time in common areas. The transport route should minimize exposure. The nurse does not need to wear an N95 during transport outdoors in a corridor if the patient is masked; however, notification and route planning are essential. Placing an N95 on the patient is incorrect — surgical masks contain the patient's respiratory droplets sufficiently for transport.

A practical nurse notes that a patient with Clostridioides difficile (C. diff) infection has had three liquid stools in 24 hours and the diarrhea has now resolved for 48 hours. The patient asks when contact precautions can be discontinued. What is the most accurate response based on current evidence?

Answer: Contact precautions should be maintained for at least 72 hours after resolution of diarrhea, and some guidelines recommend continuation for the entire hospitalization

C. diff spores can persist in the environment and on the patient's skin long after symptoms resolve. While some older guidelines stated 48 hours after symptom resolution, current evidence and many Canadian infection control guidelines recommend extending contact precautions for at least 72 hours post-resolution or for the entire hospitalization, particularly in endemic settings. The C. diff organism continues to be shed even after clinical improvement, making premature discontinuation a significant transmission risk.

During a surgical dressing change using sterile technique, a practical nurse accidentally touches the sterile field with the outside of the sterile glove packaging. Which statement about the sterile field is correct?

Answer: The sterile field is considered contaminated because the outer packaging is not sterile

In sterile technique, the outside of sterile packaging is NOT considered sterile — only the inner contents are sterile. Any contact between the sterile field and the non-sterile outer packaging contaminates the field. This is a fundamental principle: a sterile field is contaminated when it contacts any non-sterile surface, even briefly. The entire sterile field must be re-established. The '2.5 cm border' rule applies to the edges of sterile drapes (considered non-sterile), not to contacts with packaging.

A practical nurse is preparing to insert a peripheral IV catheter. The nurse cleans the site with chlorhexidine gluconate (CHG) and immediately proceeds to insert the catheter. The charge nurse observes this and intervenes. What is the primary reason for the intervention?

Answer: The nurse did not allow adequate contact time for CHG to achieve antisepsis before proceeding with insertion

Chlorhexidine gluconate requires adequate drying and contact time (approximately 30 seconds of friction scrub followed by 30 seconds of drying time, or per manufacturer instructions) to be bactericidal. Proceeding with insertion before CHG has dried means the antiseptic has not achieved its full effect, increasing infection risk. CHG is indeed the recommended agent for IV site preparation per most Canadian guidelines. The direction of cleaning for IV sites is back-and-forth or circular from center outward — but the contact time error is the critical issue here.

A practical nurse working on a medical unit is assigned to care for four patients: a patient in airborne precautions for measles, a patient in droplet precautions for influenza, an immunocompromised post-chemotherapy patient in protective isolation, and a patient with a MRSA wound infection in contact precautions. In what order should the nurse see these patients to minimize infection transmission risk?

Answer: Immunocompromised protective isolation patient → influenza droplet patient → MRSA contact patient → measles airborne patient

The immunocompromised patient in protective (reverse) isolation should be seen first, as this patient is most vulnerable to acquiring infections from the nurse. The influenza patient (droplet) poses less transmission risk via indirect contact than the MRSA patient (contact — direct touch of infected surfaces/wound). The MRSA wound patient is seen before the measles patient because, while both require extra precautions, the measles patient poses the highest environmental contamination risk through airborne spread. Saving the highest-risk transmitter for last minimizes carry-over risk to subsequent patients.

A practical nurse is reviewing the hand hygiene practices on the unit. Which clinical scenario represents an indication for handwashing with soap and water rather than alcohol-based hand rub (ABHR)?

Answer: After providing perineal care to a patient with Clostridioides difficile infection

Soap and water handwashing is specifically indicated over ABHR when caring for patients with C. difficile infection. C. diff produces spores that are NOT killed by alcohol-based hand rubs — physical removal by friction and water is required to mechanically remove spores from the hands. This is one of the critical exceptions to the general preference for ABHR. MRSA, blood pressure assessments, medication administration, and catheter insertions are all appropriate contexts for ABHR unless hands are visibly soiled.