Infection Control Nursing Guide 2026: Precautions, PPE, and HAI Prevention

Part of the ICU Emergencies Hub — browse every related guide in one place.

This article was created with AI assistance.

Contents: Standard Precautions Transmission-Based Precautions PPE: Donning and Doffing Hand Hygiene MRSA, C. diff, VRE, MDRO HAI Prevention Bundles NCLEX High-Yield

Standard Precautions

Standard precautions apply to ALL patients, regardless of diagnosis or infection status, at ALL times. They are based on the principle that all blood, body fluids, secretions, excretions (except sweat), non-intact skin, and mucous membranes may contain transmissible infectious agents.

Hand hygiene (before and after every patient contact; before PPE don; after PPE doff)
Gloves for contact with blood, body fluids, secretions, mucous membranes, non-intact skin
Gown for splash/spray risk or contact with blood/body fluids
Mask and eye protection for splash/spray to face
Safe sharps handling (NEVER recap needles two-handed; use safety devices; sharps containers at point of care)
Safe injection practices (sterile single-use equipment for injections; no multi-dose vials for multiple patients)
Respiratory hygiene (cough etiquette — cover mouth/nose; provide masks to coughing patients)

Transmission-Based Precautions

Type	Mechanism	Diseases	PPE Required	Room
Contact Precautions	Direct or indirect contact with patient or environment (touching contaminated surfaces)	MRSA, VRE, C. diff, RSV, norovirus, scabies, wound infections with MDROs, C. diff, impetigo	Gown + gloves upon room entry; remove before leaving room	Private room preferred; cohort if unavailable
Droplet Precautions	Large respiratory droplets (>5 microns) — travel <3–6 feet; land on mucous membranes	Influenza, pertussis, meningococcal meningitis, mumps, rubella, Group A strep pharyngitis, COVID-19 (droplet + contact)	Surgical mask within 3 feet of patient; gloves + gown also recommended	Private room; keep door CLOSED (some facilities allow door open)
Airborne Precautions	Small droplet nuclei (<5 microns) — remain suspended in air; travel long distances; inhaled	Tuberculosis (TB), Measles, Varicella (chickenpox), Disseminated herpes zoster; also monkeypox (some guidelines)	N95 respirator (fit-tested) or PAPR; fit seal check before each use	NEGATIVE PRESSURE ROOM (air exhausted outside or HEPA filtered); door CLOSED at all times; minimum 6–12 air exchanges per hour

Airborne precautions require a NEGATIVE PRESSURE room with the door CLOSED. If a negative pressure room is unavailable, patient should be placed in a room with door closed and minimal traffic while transfer is arranged. An N95 respirator (NOT a surgical mask) is required — fit testing is mandatory before use.

PPE: Donning and Doffing Order

Donning Order (GOWN → MASK → GOGGLES → GLOVES)

Perform hand hygiene
Gown: Tie at neck and back; cover arms and torso completely
Mask or respirator: Surgical mask (ties at top/bottom) or N95 (pull-on elastic); mold to nose bridge; perform seal check for N95
Eye protection: Goggles or face shield over top of mask/respirator
Gloves: Don last; pull cuffs over gown sleeves

Doffing Order (GLOVES → GOGGLES → GOWN → MASK)

Doffing is the HIGHER RISK step — self-contamination most likely during removal:

Gloves first: Remove inside-out (grab outside of one glove and pull off; slide finger under inside of remaining glove and pull off); dispose
Perform hand hygiene
Goggles/face shield: Remove by grasping the back strap/earpieces (not the front which is contaminated); dispose or place in designated reprocessing container
Gown: Unfasten ties; pull forward and away, rolling it inside-out; avoid touching front; dispose
Perform hand hygiene
Mask: Remove by grasping ties/elastics at the back (not the front); dispose; do NOT touch mask surface
Perform hand hygiene

Hand Hygiene: The Single Most Effective Infection Control Intervention

Indications (WHO 5 Moments)

BEFORE touching a patient
BEFORE clean/aseptic procedures
AFTER body fluid exposure risk
AFTER touching a patient
AFTER touching patient surroundings

Soap vs Alcohol-Based Hand Rub (ABHR)

	Soap and Water	Alcohol-Based Hand Rub
Preferred for	Visibly soiled hands; Clostridioides difficile (C. diff); Norovirus; after removing gloves (some guidelines)	Most routine hand hygiene; faster; less skin damage with frequent use
Technique	Wet hands; apply soap; rub ALL surfaces for ≥20 seconds; rinse; dry with paper towel; use towel to turn off faucet	Apply to palm; rub all surfaces (palm, back, between fingers, thumbs, fingertips, wrists) until dry (~20–30 seconds)
Key point	ABHR does NOT kill C. diff spores or norovirus — MUST use soap and water for these	Highly effective for most organisms; preferred over soap for routine use per CDC

Key MDROs and Infection Control Requirements

Organism	Precautions	Key Nursing Points
MRSA (Methicillin-Resistant S. aureus)	Contact precautions	Most common in nose, axillae, groin, wounds; decolonization with mupirocin nasal ointment + CHG bathing may be ordered; vancomycin for systemic treatment; screen high-risk patients (ICU admissions, recent hospitalizations)
VRE (Vancomycin-Resistant Enterococcus)	Contact precautions	GI colonization common; linezolid or daptomycin for systemic treatment; survives on environmental surfaces for weeks — rigorous environmental cleaning; dedicate patient equipment (stethoscope, BP cuff)
C. difficile (C. diff)	Contact precautions; soap and water ONLY (ABHR not effective for spores)	Antibiotic use disrupts gut flora → C. diff overgrowth; diagnosis by GDH + toxin or PCR; treatment: fidaxomicin (preferred), vancomycin PO, or metronidazole (mild cases); severe: colectomy may be needed; hyperchlorinated bleach for environmental cleaning (kills spores); probiotics may help prevent recurrence
CRE (Carbapenem-Resistant Enterobacteriaceae)	Contact precautions; often enhanced contact (gown + gloves for all contact, not just direct)	Extremely limited treatment options; colistin or ceftazidime-avibactam; strict hand hygiene paramount; screening of high-risk patients in outbreak settings; highest mortality of all MDROs
TB (Mycobacterium tuberculosis)	Airborne precautions	Negative pressure room; N95; 3 consecutive negative sputum AFB smears before removing precautions; notify public health; rule out TB in patients with chronic cough, night sweats, weight loss, hemoptysis, recent travel to endemic area

HAI Prevention Bundles

HAI Type	Key Prevention Bundle Elements
CLABSI (Central Line-Associated Bloodstream Infection)	Maximum sterile barrier during insertion; hand hygiene; CHG skin antisepsis; subclavian preferred over femoral; remove ASAP; daily necessity assessment; CHG-impregnated dressing; hub scrubbing ("scrub the hub" x 15 sec)
CAUTI (Catheter-Associated UTI)	Only insert when indicated; sterile insertion; closed drainage system; drainage bag below bladder; daily removal assessment; pericare with soap and water
VAP (Ventilator-Associated Pneumonia)	HOB 30–45 degrees; daily SAT + SBT; analgesia-first sedation; daily oral care with CHG; subglottic secretion drainage; avoid unnecessary intubation
SSI (Surgical Site Infection)	Pre-op CHG shower; appropriate antibiotic timing (within 60 min of incision); hair removal only if necessary (clipper, not razor); normothermia maintenance; glucose control; minimize OR traffic

NCLEX High-Yield Points

Airborne = TB, Measles, Varicella, disseminated Zoster; requires N95 + NEGATIVE PRESSURE room
Droplet = flu, meningococcal, pertussis, mumps; surgical mask + private room + door closed
Contact = MRSA, VRE, C. diff, RSV, scabies, norovirus; gown + gloves upon room entry
C. diff: SOAP AND WATER only — ABHR does NOT kill spores; bleach for environmental cleaning
PPE donning order: Gown → Mask → Goggles → Gloves. Doffing: Gloves → Goggles → Gown → Mask
WHO 5 Moments: before touching patient, before clean procedure, after body fluid exposure, after touching patient, after touching patient surroundings
MRSA treatment: vancomycin IV (systemic); mupirocin intranasal for decolonization
Negative pressure room: air flows IN from hallway; exhaust goes OUT or is HEPA filtered; for airborne precautions
Highest risk moment for self-contamination: DOFFING — most infections from improper removal of contaminated PPE

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