3.
BASIC INFECTION CONTROL
Needs more Very
A. STANDARD PRECAUTIONS Practice
Satisfactory
Satisfactory
1. Wear gloves (clean or sterile) prn for contact with
blood, all body fluids, non-intact skin, mucous
membranes.
2. Wash hands between patients, immediately after
gloves are removed, immediately after contact
with blood, any body fluid, secretion or excretion,
non-intact skin, or mucous membrane.
3. Wear masks and protective eyewear whenever
there is the possibility of splash of any type of
body fluid.
4. Wear moisture-proof apron or gown whenever
there is the potential of body fluid contact with
your clothing.
5. Dispose of equipment so that no patients or health
care workers are accidentally contaminated.
6. Handle soiled linens appropriately. Hold linen
away from uniform. Do not shake or toss linen.
Transport linen contaminated with blood or body
fluids in leakage-proof bags.
7. Clean contaminated articles and surfaces. Use an
appropriate disinfectant.
8. Use mouthpieces, resuscitation bags, or
ventilation devices for cardiopulmonary
resuscitation when possible.
9. Do not care for patients if you have open or
draining lesions.
Needs more
B. HANDWASHING Practice
Satisfactory Comments
1. Remove jewelries, including wrist watch and roll
sleeves above elbows.
2. Without touching the sink, turn on water. Adjust
temperature to warm prn.
3. Wet hands thoroughly by holding them under
water. Hold hands lower than elbows so that water
flows from arms to fingertips.
4. Dispense liquid or powdered soap and apply to
hands. If no dispenser, gather bar soap from soap
dish, rub it firmly between hands.
5. Drop soap on dish, if appropriate.
6. Use firm, rubbing, and circular movements to
wash the palm, back, and wrist of each hand.
Interlace the fingers and thumbs and move the
hands back and forth. Keep arms lower than
elbows. Continue this motion for 1 minute.
7. Clean Fingernails. Use orange stick if available.
8. Rinse thoroughly, keeping hands and forearms
lower than elbows.
9. Wash hands for a minimum of 2 minutes. For a
more thorough washing, extend the time for
wetting, washing, and rinsing.
10. Dry hands thoroughly from fingers to forearms
using paper towel or clean hand towel.
11. Turn off water with dry paper towel if faucet is
hand operated.
12. Use lotion as desired. .
Note: Hand Washing Before Sterile Techniques
1. Hold the hands higher than the elbows during this
hand wash. Wet the hands and forearms under
running water, letting it run from the fingertips to
the elbows so that the hands become cleaner than
the elbows.
2. Apply soap and wash as described earlier in step
5, maintaining hands uppermost.
3. After washing and rinsing, dry one hand after
another thoroughly in a rotating motion from the
fingers to the elbows.
Needs more
C. USING DISPOSABLE MASKS Practice
Satisfactory Comments
1. Ensure that the mask covers the mouth and the
nose because air moves into and out of both.
2. If mask has metal strip, adjust this firmly over
bridge of nose. A secure fit prevents both the
escape and the inhalation of microorganisms
around the edges of the mask and the fogging of
eyeglasses.
3. If glasses are worn, fit upper edge of mask under
glasses. Keeping edge of mask under glasses
helps prevent them from clouding.
4. Avoid unnecessary talking and if possible,
sneezing or coughing when caring for an at-risk
client. (e.g., when exposing an open wound).
5. Wear mask only once, and do not wear any mask
longer than the manufacturer recommends or
once it becomes wet.
6. When removing mask with strings, first untie the
lower strings of mask. This prevents the top part
of mask from falling onto the chest.
7. Discard a disposable mask in the waste container.
8. Wash hands if they were contaminated by
accidentally touching the soiled part of the mask.
D. GOWNING Needs more Satisfactory Comments
Practice
D. 1. DONNING A CLEAN GOWN
1. Pick up a clean gown, and allow it to unfold in
front of you without allowing the inside of
gown to touch any area visibly soiled with
body substances.
2. Fasten the ties at the neck to keep the gown
in place.
3. Overlap the gown at the back as much as
possible, and fasten the waist ties or belt.
Overlapping securely covers the uniform at
the back. Waist ties keep the gown from
falling away from the body and prevent
inadvertent soiling of uniform.
Needs more
D. 2. REMOVING A GROSSLY SOILED GOWN Satisfactory Comments
Practice
1. Avoid touching soiled parts on the outside of
the gown, if possible. The top part of gown
may be soiled, for example, if you have been
holding an infant with a respiratory infection.
2. Roll up the gown with the soiled part inside,
and discard it in the appropriate container.
E. DONNING AND REMOVING STERILE Needs more
Satisfactory Comments
GLOVES (OPEN METHOD) Practice
1. Wash hands thoroughly.
2. Wipe and dry hands with sterile towel.
3. Open the package of sterile gloves.
a. Place package of gloves on a clean, dry
surface.
b. Some gloves are packed in an inner and
outer package. Open outer package
without contaminating the gloves or inner
package.
c. Remove inner package from outer
package.
d. Open inner package without touching the
innder surfaces.
4. Put the first glove on the dominant hand.
a. If the gloves are packaged so that they lie
side by side, grasp the glove for the
dominant hand by its cuff (on the palmar
side) with thumb and first finger on non-
dominant hand. Touch only the inside of
cuff.
b. Insert the dominant hand into the glove
and pull the glove on. Keep thumb of
inserted hand against the palm of hand
during insertion.
c. Leave the cuff turned down.
5. Put the second glove on the non-dominant hand.
a. Pick up the other glove with the sterile
gloved hand, inserting the gloved fingers
under cuff and holding gloved thumb close
to gloved palm.
b. Pull on the second glove carefully. Hold
thumb of gloved first hand as far as
possible from the palm.
c. Adjust each glove so that it fits smoothly,
and carefully pull the cuffs up by sliding
the fingers under the cuffs.
6. Remove and dispose the used gloves.
a. If the used gloves are soiled with
secretions, remove them by turning them
inside out.
F. ESTABLISHING AND MAINTAINING A Needs more Satisfactory Comments
STERILE FIELD Practice
1. Confirm the sterility of the package
a. Ensure the sterile pack is clean and dry; if
moist, it is considered contaminated and
must be discarded.
b. Check the sterilization expiration dates,
and look for indications that it has been
previously opened.
c. Follow agency practice about disposal of
possibly contaminated packs.
2. Open the package
2. A. To Open a Wrapped Package on a Surface
a. Place a package in the center of work area
so that top flap of wrapper opens away
from you.
b. Reaching around the package (not over it)
pinch the first flap on the outside of
wrapper between thumb and index finger.
With some folded packages, it may be
necessary to grasp the uppermost flap at
each corner. Pull the flap open, laying it
flat on the far surface.
c. Repeat for the side flaps, opening top one
first. Use right hand, for right flap, and left
hand for left flap to avoid reaching over
the sterile contents.
d. Pull the fourth flap towards you by
grasping the corner that is turned down.
Make sure the flap does not touch your
uniform.
2. B. To Open a Wrapped Package While Holding It
a. Hold package in one hand with the top
flap opening away from you.
b. Using the other hand, open the package
as described above, pulling the corners of
the flaps well back.
2. C. To Open Commercially Prepared Packages
a. If the flap of the package has an unsealed
corner, hold the container in one hand,
and pull back on the flap with the other
hand.
b. If the package has a partially sealed edge,
grasp both sides of the edge, one with
each hand, and pull apart gently.
c. Commercially prepared sterile packages
and containers usually have
manufacturer’s directions for opening.
3. Rewrap the sterile package as required (e.g., for
transport to the bedside).
a. Rewrap the reverse order to unwrapping.
Close the proximal flap first to prevent
reaching across the sterile field, the side
flaps next, and the distal flap last.
4. Establish a sterile field by using a drape.
a. Open the package containing the drape as
described above.
b. With one hand, pluck the corner of the
drape that is folded back on the top.
c. Lift the drape out of the cover, and allow it
to open freely without touching any
object. If the drape touches outside of
package, it is considered contaminated.
d. Discard the cover.
e. With the other hand, carefully pick up
another corner of the drape, holding it well
away from yourself.
f. Lay the drape on a clean and dry surface,
placing the bottom (i.e., the freely hanging
side) farthest from you. This will avoid
leaning over the sterile field and
contaminating it.
5. Add necessary sterile supplies.
5. A. To Add Wrapped Supplies in a Sterile Field
a. Open each wrapped package as described
in the preceding steps.
b. With the free hand, grasp the corners of
the wrapper, and hold them against the
wrist of the other hand. The sterile hand is
now covered by the sterile wrapper.
c. Place the sterile bowl, drape, or other
supply on the sterile field by approaching
from an angle rather than holding the arm
over the field.
d. Discard the wrapper.
5. B. To Add Commercially Packaged Supplies to a
Sterile Field
a. Open each package (e.g., gauze) as
described above.
b. Hold the package 15 cm (6”) above the
field, and allow the contents to drop on
the field. Keep in mind that 2.5 cm (1 inch)
around the edge of the field is considered
contaminated.
5. C. To Add Sterile Solution to a Sterile Bowl
a. Before pouring any liquid, read label 3 X to
make sure you have the correct solution
and its strength.
b. Remove lid or cap from bottle, and invert
lid before placing it on a surface that is not
sterile.
c. Hold bottle so that label is uppermost.
d. Hold bottle of fluid at a height of 10-15 cm
(4-6”) over bowl and to side of sterile field
so that as little of the bottle as possible is
over the field.
e. Pour solution gently, avoid splashing the
liquid.
f. Replace lid securely on the bottle if you
plan to use it again, provide date and time
of opening.
6. Use sterile forceps to handle sterile supplies.
a. Keep the tips of wet forceps lower that the
wrist at all times, unless sterile gloves are
donned.
b. Hold sterile forceps above waist level.
c. Hold sterile forceps within sight.
d. When using forceps to lift sterile supplies
out of a commercially prepared package,
be sure that the forceps do not touch the
edges or outside of wrapper.
e. When placing forceps whose handles were
in contact with bare hand, position the
handles outside sterile area.
f. Deposit a sterile item on a sterile field
without permitting moist forceps to touch
the sterile field when the surface under
the absorbent sterile field is unsterile and
a barrier drape is not used.