Browse all questions

CDC handwashing guidance specifies at least 20 seconds of vigorous friction with soap on all hand surfaces, including between fingers, under nails, and wrists, then rinse and dry with a clean towel, turning off the faucet with the towel. Five seconds (a) is inadequate; rinse alone (c) does not remove organic soil and pathogens; air-drying (d) is slower and not standard in clinical care. Handwashing is the single most important infection-control measure.

CDC PPE donning sequence is hand hygiene → gown → mask/respirator → goggles or face shield → gloves (gloves pulled over gown cuffs). Doffing is in opposite order (gloves → goggles → gown → mask) with hand hygiene between steps and again at the end. Correct sequence prevents self-contamination and protects both worker and other residents under OSHA's Bloodborne Pathogen Standard (29 CFR §1910.1030). Practicing the order until it is automatic is essential before independent isolation care.

TB is transmitted by airborne droplet nuclei. CDC requires Airborne Infection Isolation Room (negative pressure with at least 6 air changes/hour, exhausted outdoors or through HEPA), N95 respirator (fit-tested) or PAPR for staff, and door kept closed. Standard (a), contact (b), or droplet precautions (d) are insufficient and risk staff and other-resident infection. The resident wears a surgical mask if transported.

C. difficile produces spores resistant to alcohol-based hand sanitizers; soap-and-water handwashing is mandatory after care. Contact Precautions (gown + gloves) apply. Environmental cleaning requires EPA-registered sporicidal agents (typically 1:10 bleach). Alcohol gel only (a), gloves only (b), or generic cleaner (c) allow spore transmission. C. difficile is a leading healthcare-associated infection with significant mortality in elders.

OSHA Bloodborne Pathogen Standard requires immediate post-exposure response: wash area with soap and water (or flush mucous membranes with water/saline), report to supervisor immediately, complete an incident report, and access post-exposure evaluation (source-patient testing, baseline labs, possible HIV/HBV prophylaxis per CDC guidance—within hours). Delay (a, c) reduces prophylaxis effectiveness; aggressive squeezing (d) is not recommended and may worsen tissue damage.

OSHA 29 CFR §1910.1030 requires sharps to be placed in closable, puncture-resistant, leakproof, labeled biohazard containers immediately at point of use; never recap, bend, or hand-pass. Regular trash (b), toilet (c), and linen hampers (d) all pose injury and infection risk to coworkers, housekeeping, and laundry staff who handle bags downstream. Sharps containers must not exceed 3/4 full and must be replaced promptly by a designated process to prevent overfill injuries.

RACE is the standard fire-response acronym: Rescue residents in immediate danger, sound the Alarm and call 9-1-1, Contain the fire by closing doors and windows, and Extinguish if small/safe or Evacuate per plan. CNAs work under nurse direction during evacuation; horizontal evacuation (through smoke doors to adjacent compartment) is usually preferred over vertical. PASS (Pull, Aim, Squeeze, Sweep) is the extinguisher acronym.

Falls prevention bundles include low beds, floor mats, accessible call lights, scheduled toileting (anticipating elimination needs), proper footwear (non-skid soles), bedside lighting, and rounding. Restraints (a) increase injury and death risk and are prohibited as routine prevention (CMS F-689, 42 CFR §483.12). Withholding the call light (b) is abuse; bed-confinement (c) causes deconditioning, pressure injury, and depression.

Standard Precautions, the foundation of infection control per CDC and OSHA Bloodborne Pathogen Standard, apply to ALL residents regardless of known infection status because exposures may occur before infection is known. They cover blood, all body fluids (sweat excepted), non-intact skin, and mucous membranes. Limiting to known cases (a, c) or visible blood (d) misses asymptomatic carriers and post-exposure scenarios; that thinking caused historic HIV/HBV transmission to staff.

OSHA ergonomic principles for safe patient handling: feet shoulder-width apart, bend knees and hips, keep back straight and load close, pivot rather than twist, use gait belt for controlled assist, and use mechanical lifts and two-person assist per the resident's mobility plan. Bending at waist with locked knees (b) and twisting (c) cause >50% of CNA back injuries; lifting alone (d) ignores the 35-lb safe-handling limit (NIOSH/ANA Safe Patient Handling).

Gloves do NOT replace hand hygiene; perform hand hygiene before donning and immediately after removal because microbes contaminate hands during glove use and removal. Gloves are changed between residents and between dirty and clean tasks on the same resident. Reusing across residents (b) spreads infection. Routine care uses clean (non-sterile) gloves; sterile gloves (d) are reserved for sterile procedures, outside CNA scope.

AHA Basic Life Support: recognize cardiac arrest, activate emergency response immediately ('Call a code blue / dial 9-1-1'), begin high-quality compressions, and apply AED when available. CNAs trained in BLS within scope start CPR unless a valid DNR/POLST directs otherwise. Delay (a), moving (b), or waiting for family (c) reduce survival; every minute without CPR cuts survival by ~10%. Always verify code status first.

Complete airway obstruction (universal choking sign, inability to speak/cough) requires immediate abdominal thrusts (Heimlich) for adults able to stand; chest thrusts for pregnant or obese individuals. If the resident loses consciousness, lower to floor, begin CPR, and look for object before each breath attempt. Offering water (a) worsens obstruction; isolated back-slaps without alternation are not the standard adult protocol (back-blows are part of infant/sometimes alternating adult sequences); waiting (d) wastes the 4-6 minute hypoxic window.

Oxygen accelerates combustion. Safety: no smoking or open flame within prescribed distance, no petroleum products (Vaseline) on face/lips—use water-based lubricant, post 'Oxygen in Use' signage, secure tanks upright in stable carrier away from heat sources, keep tubing free of kinks to ensure flow, and avoid synthetic fabrics or wool blankets that build static. Candles (b), Vaseline (c), and improper tank storage (d) are serious fire risks. NFPA 99 and facility policy must be followed at all times.

Elopement is a leading sentinel event for residents with dementia. The CNA approaches calmly from the front to avoid startling, uses simple cueing and redirection (familiar activity, snack, walking together to room), and notifies the nurse. Document the event; the team reviews wander-guard placement, door alarms, and care-plan interventions. Yelling (a) or grabbing (b) escalate distress and may be abuse; allowing elopement (d) endangers the resident.

OSHA Hazard Communication Standard (29 CFR §1910.1200) requires Safety Data Sheets (SDS) to be readily accessible to all employees. The SDS lists hazards, required PPE, dilution ratio, surface contact time, first aid, and disposal instructions. CNAs must consult the SDS and supervisor before first use of any product. Guessing (a) and mixing chemicals (b)—bleach plus ammonia produces toxic chloramine gas—are dangerous; unlabeled containers (c) violate Hazcom and risk poisoning of staff or residents.

MRSA spreads by contact. CDC Contact Precautions require gown and gloves donned before room entry and removed before exit, with hand hygiene immediately after removal. Dedicated equipment (BP cuff, stethoscope, thermometer) reduces cross-contamination. PPE applies to any room entry, even brief tasks (c). Gloves alone (a) leave clothing contaminated. N95 (d) is for airborne, not contact precautions.

Influenza is spread by respiratory droplets that travel about 3-6 feet. CDC Droplet Precautions: private room (or cohort), surgical mask within 6 feet, eye protection if splash risk; the resident wears a surgical mask if leaving the room. Airborne isolation/N95 (c) is reserved for TB, measles, COVID aerosol-generating procedures. Standard or contact alone (b, d) are insufficient for droplet transmission.

OSHA 29 CFR §1910.1030 requires items saturated with blood or other potentially infectious material to be placed in red biohazard-labeled bags for regulated medical-waste disposal. Regular trash (a) and recycling (d) are prohibited; the linen hamper (b) is for reusable linen, not disposables and not heavily saturated waste. Proper segregation protects housekeeping, custodial staff, and the community waste stream.

Least-restrictive interventions include low beds, floor mats, alarms, scheduled toileting, recliner positioning, activity engagement, and environmental modifications. Wrist ties (d) are physical restraints, not alternatives, and may only be used when less-restrictive interventions have failed and a documented medical symptom justifies restraint under 42 CFR §483.12(a)(2). 'Just in case' use is prohibited and may constitute false imprisonment and abuse.

CDC guidance: alcohol-based hand rub (60-95% alcohol) is preferred for most clinical encounters because it is fast and more effective than handwashing for non-spore organisms. However, soap-and-water handwashing is required when hands are visibly soiled, after caring for C. difficile or norovirus (spores survive alcohol), before eating, and after using the restroom. Other situations (b, c, d) are appropriate for alcohol rub.

Safe transfer preparation: explain procedure, ensure non-skid footwear, lock all wheels, raise HOB so resident can sit upright, position wheelchair at 45° on resident's strongest side, apply gait belt low on torso, count '1-2-3 stand,' lift with legs. Neck-holds (c) risk CNA cervical injury and resident falls; dragging on a sheet (d) causes shearing skin injury. Omitting explanation (a) violates the resident's right to know.

Per updated CDC/CDPH SNF guidance, COVID-19 care requires N95 respirator (or PAPR) for staff entering the room because aerosol generation can occur, plus eye protection, gown, and gloves. Surgical mask (a) is insufficient; gown/gloves alone (b) miss airborne protection; standard precautions (d) are inadequate during active infection. Doff in order without contaminating self; perform hand hygiene multiple times.

Side rails may function as restraints when they restrict freedom of movement; CMS treats them under restraint rules requiring least-restrictive analysis, informed consent, medical justification, and ongoing monitoring. FDA has documented deaths from entrapment and publishes seven entrapment zones with dimensional limits. Routine bilateral use (a, b) violates federal regulation. Alternatives include low beds, transfer-aid handles, mat near bed.

CDC and WHO 'Five Moments' require hand hygiene immediately after glove removal because microbes contaminate hands during use and doffing through micro-tears and during the removal process. Reuse (b) cross-contaminates; delaying hygiene (c) spreads pathogens; pocketing (d) contaminates uniform. This single step prevents many healthcare-associated infections, the leading preventable cause of harm in long-term care.

PASS is the universal fire-extinguisher operation acronym: Pull the pin to break the seal, Aim at the base of the flames (not the flames themselves), Squeeze the handle to release the agent, and Sweep side to side until the fire is out. Stand 6-8 feet back. Only attempt extinguishment on a small contained fire after the Rescue, Alarm, and Contain steps of RACE, and only if you have a clear escape path behind you. Evacuate immediately if uncertain or if smoke is heavy. NFPA 10 governs extinguisher use.

OSHA 29 CFR §1910.1030 requires soiled linen to be bagged at point of use in leak-resistant bags (red biohazard if dripping/saturated), handled minimally with gloves, never sorted at bedside, and never held against the uniform. Carrying loose (a) contaminates body and floor; sink rinsing (b) creates aerosol and contamination; standard cart (d) without leak protection risks exposure of laundry staff.

CNAs work within scope: assist with compressions if BLS-trained, retrieve crash cart/AED, time intervals, document compressions, support family in a separate space, and perform support tasks at the direction of the RN/MD code leader. Diagnosis (b), clinical updates by phone (c), and medication documentation (d) are licensed-staff responsibilities. Clear scope adherence keeps the code organized and protects the CNA license.

Norovirus is highly contagious via fecal-oral and aerosolized vomit. CDC/CDPH outbreak response: soap-and-water handwashing (alcohol rub less effective on non-enveloped norovirus), contact precautions, cohort ill residents, dedicate staff if possible, clean with EPA-list G norovirus disinfectant (bleach), exclude symptomatic staff until 48-72 hours symptom-free, restrict admissions/visitors as advised by Public Health. Wrong answers (a, b, c) would worsen the outbreak.

Isolation signage must clearly indicate type and required PPE. Missing or incorrect signage is a system failure requiring immediate correction—verify with the nurse, restock signage and PPE, and document. Entering without proper PPE (a, c) exposes the CNA and other residents; asking the resident (d) is unreliable and breaches privacy norms. CDPH licensure standards require accurate visible signage at the entry.