Never use alcohol-based hand rub alone for C. difficile or other spore-forming organisms; wash with soap and water.
Before you read
Test yourself first: 5 questions
Question 1 of 5
The nurse is caring for a client with Clostridioides difficile (C. diff) infection. Which action is most important to prevent transmission?
Answer: B. C. diff spores are not killed by alcohol-based hand rub, so the nurse must wash hands with soap and water. Contact precautions are used, and the room should be cleaned with a sporicidal (bleach-based) agent. Relying on alcohol hand sanitizer or only an N95 would fail to interrupt fecal-oral spore transmission.
Question 2 of 5
A child is admitted with varicella (chickenpox). Which transmission-based precautions should the nurse implement?
Answer: C. Varicella is spread by both the airborne route and direct contact with vesicle fluid, so airborne and contact precautions are required. Droplet-only or standard precautions are insufficient to prevent transmission of varicella.
Question 3 of 5
A nurse is reviewing standard precautions with a new graduate. Which statement by the new graduate indicates correct understanding of standard precautions when caring for any client?
Answer: A. Standard precautions apply to all clients regardless of diagnosis and include hand hygiene and using gloves and other personal protective equipment whenever contact with blood or body fluids is anticipated. Gloves alone are not enough, precautions are not reserved only for clients with a known infection, and hand hygiene is required even when gloves are worn.
Question 4 of 5
The 'chain of infection' can be broken at the 'mode of transmission' link primarily by:
Answer: B. Hand hygiene and appropriate PPE break the mode of transmission. Other links: reservoir (cleaning), portal of exit/entry (covering wounds), and susceptible host (immunization).
Question 5 of 5
A child is hospitalized with respiratory syncytial virus (RSV) bronchiolitis. Which type of transmission-based precautions should the nurse initiate?
Answer: B. RSV spreads by large respiratory droplets and contaminated secretions, so contact and droplet precautions are used. Airborne (negative pressure) precautions are not required; standard precautions alone are insufficient.
Keep the streak going with more questions like these, each with a full rationale.
What is standard and transmission-based precautions?
Transmission-based precautions are added on top of standard precautions when a specific organism's spread route is known: contact, droplet, or airborne. Correct precautions and PPE protect the patient, staff, and other patients, and are a constant NCLEX safety theme. Remember the airborne mnemonic My Chicken Hez TB: Measles, Chickenpox (varicella), Herpes zoster disseminated, TB.
Key points to remember
- Standard precautions include hand hygiene, gloves when contacting body fluids, and gown/mask/eye protection when splash is likely, for all patients.
- Contact precautions (gown and gloves, private room or cohort) apply to C. difficile, MRSA, VRE, RSV, scabies, and draining wounds.
- Droplet precautions (surgical mask within ~3-6 feet, private room) apply to influenza, pertussis, meningococcal meningitis, mumps, and rubella.
- Airborne precautions (N95 respirator and negative-pressure room) apply to tuberculosis, measles, and varicella/disseminated zoster.
- C. difficile and other spore formers require soap-and-water handwashing because alcohol-based gel does not kill spores.
- PPE is removed in the order gloves, goggles/face shield, gown, then mask/respirator, with hand hygiene after; gown and gloves go on after the respirator when donning.
Nursing priorities
- Perform hand hygiene before and after every patient contact and after removing gloves.
- Apply the correct precaution type for the organism and post signage so all staff comply.
- Place airborne-precaution patients in a negative-pressure room and don an N95 (fit-tested) before entry.
- Don and doff PPE in the correct sequence to avoid self-contamination.
- Cohort or use a private room when a private room is unavailable, and dedicate equipment to that patient.
Patient teaching
- Family and visitors must perform hand hygiene and wear the same required PPE before entering the room.
- Cover coughs, dispose of tissues promptly, and limit movement out of the room while on precautions.
- Precautions protect you and others and are not a punishment; they end when the infection risk resolves.
Red flags: report now
- Never use alcohol-based hand rub alone for C. difficile or other spore-forming organisms; wash with soap and water.
- Never enter an airborne-isolation room without a fit-tested N95 or higher respirator.
- A breach in PPE or a needlestick exposure must be reported and followed up immediately.
- Do not transport an isolation patient without proper masking and notifying the receiving area.
References
Clinical references for this topic
