Infection Control, Home Safety and Emergencies

14% of the exam 5 min

Fourteen percent of the exam across two domains, each named on the federal subject list: preventing infection, keeping the home safe, and recognizing emergencies and knowing what to do.

Hand hygiene and standard precautions

Every infection follows a chain: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host. Hands are the most common mode of transmission, so hand hygiene is the single most important control. Wash with soap and water for at least 20 seconds, covering all surfaces, between the fingers and under the nails; rinse, dry with a clean towel, and turn off the faucet with a paper towel. An alcohol rub with at least 60% alcohol, rubbed until dry, works the rest of the time, but soap and water are needed when hands are visibly soiled, after using the restroom, before eating, and when a client has C. diff diarrhea, because alcohol does not kill its spores well. Standard precautions apply to every client every time: all blood, body fluids except sweat, broken skin and mucous membranes are treated as potentially infectious.

Check yourselfName three situations where soap and water must be used instead of alcohol rub.

Gloves, PPE and transmission-based precautions

Gloves are worn for contact with blood, body fluids, mucous membranes or broken skin. They do not replace hand hygiene: hands are cleaned after removing gloves every time, because gloves can have tiny holes and hands are contaminated during removal. Change gloves between tasks, when moving from a dirty area to a clean one on the same client, and whenever torn. CDC's order for putting on PPE is gown, mask or respirator, goggles or face shield, and gloves last so they cover the gown cuffs. Removal starts with the most contaminated item: gloves first, then goggles, gown, and the mask by its ties, followed by hand hygiene. Transmission-based precautions are always added to standard precautions, never substituted. Contact precautions (MRSA, C. diff) add a gown and gloves. Droplet precautions (influenza) add a surgical mask. Airborne precautions (tuberculosis, measles) require a fit-tested N95 respirator.

Check yourselfGive the order for putting PPE on and the first item to take off. Which mask does tuberculosis require?

Infection control in a home

A home has no supply room or housekeeping staff, so the aide carries the system with them. The supply bag goes on a clean, dry, hard surface, often on a paper barrier, never on the floor, a bed or near the toilet, and hands are cleaned before reaching into it. Soiled linen is handled with gloves, rolled with the dirty side in, held away from the uniform, never shaken, and washed promptly. Anything that touches the floor is considered dirty. Clean from the cleanest areas to the dirtiest, ending with the toilet. Clean a blood spill with gloves: absorb it, clean the area, then apply an EPA-registered disinfectant or freshly mixed bleach solution as the agency directs. A client's used needles go in a sharps container, or a heavy plastic bottle with a tight lid, labeled, as FDA guidance allows; never loose in the trash. If you are stuck by a used needle or lancet, wash with soap and water and report it immediately. Under OSHA, the employer offers the hepatitis B vaccine at no cost, and CDC recommends a flu shot every year.

Check yourselfA clean towel drops on the floor and a client's lancet sticks your finger. What happens to the towel, and what do you do about the stick?

A safe home: falls, fire and oxygen

Clear walkways, secured or removed throw rugs, night lights, grab bars, nonskid footwear and needed items within reach prevent falls. Set the water heater to 120°F or lower to prevent scalds. Unplug and report frayed cords, and never run cords under rugs. Test smoke alarms monthly. Never mix bleach with ammonia, which makes a toxic gas, and keep chemicals in their original labeled containers. In a fire, RACE puts Rescue first: get the client out, then sound the Alarm (call 911 from outside), Contain the fire by closing doors, and Extinguish only if it is small and safe. Do not open windows, which feeds the fire. To use an extinguisher, PASS: Pull the pin, Aim at the base, Squeeze the handle, Sweep side to side. Home oxygen makes fires start easily and burn hot: no smoking, candles, gas flames or sparks near it, and no petroleum jelly on the lips or nostrils; water-based products are used instead. The aide never changes the oxygen flow rate and reports shortness of breath instead.

Check yourselfA small kitchen fire starts while you are with a client in a wheelchair. What is first? And what are the four steps of PASS?

Emergencies: recognize, call, act

For most emergencies the first action is to call 911 or have someone call, then notify the agency. If a client cannot cough, speak or breathe, give abdominal thrusts; if they become unresponsive, lower them to the floor and begin CPR if you are trained. A client coughing forcefully is moving air, so let them cough. Stroke warning signs follow BE FAST: balance, eyes, face drooping, arm weakness, speech trouble, time to call 911. Note when symptoms started, because treatment depends on it. Chest pressure spreading to the arm, jaw or back, with sweating, nausea or breathlessness, means call 911, keep the client resting and stay with them. For low blood sugar (shaky, sweaty, confused) in a client who is awake and can swallow, give about 15 grams of fast sugar, such as 4 ounces of regular juice, per the care plan, and report it. An unresponsive client gets nothing by mouth. During a seizure, protect the head, move objects away and time it, without restraining or putting anything in the mouth, then turn the client on their side. Cool a burn under cool running water for 10 to 20 minutes. Stop bleeding with gloves and firm direct pressure. For poisoning, call Poison Help at 1-800-222-1222, or 911 if the client is unresponsive, not breathing or seizing.

Check yourselfA client with diabetes is sweaty, shaky and confused but awake. What do you give, if the plan allows? What changes if they cannot respond?

Where people lose points

✗ "Gloves mean hand hygiene can be skipped."

✓ Clean hands after removing gloves, every time.

✗ "Contact precautions replace standard precautions for a client with MRSA."

✓ They are added on top. Standard precautions never stop.

✗ "Grab the extinguisher first, then worry about the client."

✓ RACE: Rescue comes first.

✗ "Put petroleum jelly on dry lips for a client on oxygen."

✓ Petroleum products can ignite near oxygen. Use water-based products.

✗ "Put something between the teeth during a seizure so the tongue is not bitten."

✓ Nothing in the mouth, ever. It can break teeth or block the airway.

✗ "Diet soda works for low blood sugar because it is a drink."

✓ Diet soda has no sugar. Use regular juice or regular soda, per the care plan.

Numbers to memorize

Handwashing time	At least 20 seconds of scrubbing (CDC)
Alcohol rub strength	At least 60% alcohol, rub until dry
PPE on	Gown, mask, goggles, gloves
PPE off	Gloves first, mask last, then hand hygiene
Airborne (TB)	Fit-tested N95 respirator
Contact (MRSA, C. diff)	Gown and gloves
Hepatitis B vaccine	Offered at no cost to exposed employees (OSHA 1910.1030)
Water heater	120°F (49°C) or lower
Smoke alarms	Test monthly
RACE / PASS	Rescue, Alarm, Contain, Extinguish / Pull, Aim, Squeeze, Sweep
CPR compressions, adult	100-120 per minute, at least 2 inches deep (AHA)
Poison Help	1-800-222-1222

Test yourself

No answers here on purpose — retrieving them is the practice. Drill this domain if any of these stall you.

Name the six links in the chain of infection and the one hand hygiene breaks.
Give the PPE donning and doffing order, and explain why gloves come off first.
How do you dispose of a client's used insulin needles with no sharps container?
List five home oxygen safety rules.
What do the letters of BE FAST stand for, and why note the time?
Describe seizure first aid, including two things you must never do.

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