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Infection Control and Workplace Safety

Infection control questions reward exact sequences: the order you put PPE on, the order you take it off, which precaution matches which organism, and what belongs in a red bag versus regular trash. Everything in this domain rests on two pillars, the CDC infection control guidance and the OSHA Bloodborne Pathogens Standard.

The chain of infection and standard precautions

Infection spreads through a predictable six-link chain, and infection control is simply the practice of breaking any one of those links. Standard precautions are the baseline set of practices applied to every patient at every encounter, regardless of diagnosis or suspected infection status. They exist because you cannot tell by looking who is carrying a bloodborne or respiratory pathogen.

The six links
The chain runs from the infectious agent to the reservoir, the portal of exit, the mode of transmission, the portal of entry, and finally the susceptible host. Breaking any single link stops the infection.
CDC
Standard precautions apply to everyone
Treat blood, all body fluids, secretions, excretions except sweat, non-intact skin, and mucous membranes as potentially infectious for every patient, in every setting, every time.
CDC
What standard precautions include
Hand hygiene, personal protective equipment based on anticipated exposure, respiratory hygiene and cough etiquette, safe injection practices, safe handling of contaminated equipment and surfaces, and sharps safety.
CDC
Respiratory hygiene and cough etiquette
Offer a mask to coughing patients, provide tissues and no-touch waste containers, encourage hand hygiene after contact with secretions, and seat symptomatic patients at least three to six feet from others when possible.
CDC
Safe injection practices
Use one needle, one syringe, one time, for one patient. Never reuse a syringe to re-enter a vial, and treat single-dose vials as single-patient use even if medication remains.
CDC
Environmental cleaning
Clean and disinfect frequently touched surfaces and shared equipment between patients with an EPA-registered hospital disinfectant, observing the wet contact time printed on the product label.

Transmission-based precautions

Transmission-based precautions are added on top of standard precautions, never used in place of them, whenever a patient is known or suspected to be infected with an organism that spreads by a specific route. The three categories are contact, droplet, and airborne, and each has its own PPE and room requirements. Matching organism to category is one of the most heavily tested items in this domain.

Contact precautions
Wear a gown and gloves for all interactions involving the patient or their environment. Typical indications include MRSA, VRE, Clostridioides difficile, scabies, lice, and respiratory syncytial virus.
CDC
Droplet precautions
Wear a surgical mask when within about six feet of the patient, because large respiratory droplets do not travel far. Typical indications include influenza, pertussis, mumps, rubella, and Neisseria meningitidis.
CDC
Airborne precautions
Wear a fit-tested N95 respirator or higher and place the patient in an airborne infection isolation room with negative pressure. Typical indications include tuberculosis, measles, varicella, and disseminated herpes zoster.
CDC
Spores need soap and water
Alcohol-based hand rub does not kill Clostridioides difficile spores or norovirus. After caring for these patients, wash with soap and running water and disinfect surfaces with a bleach-based or other sporicidal product.
CDC
Precautions are layered, not substituted
A patient on contact precautions still requires hand hygiene, eye protection when splashing is likely, and every other element of standard precautions.
Patient transport
Limit transport of patients on transmission-based precautions, and when transport is necessary, have the patient wear a mask for droplet or airborne organisms and cover infected skin lesions for contact organisms.
CDC

Hand hygiene and PPE donning and doffing

Hand hygiene is the single most effective measure for preventing the spread of infection in health care, and PPE only works if it is put on and taken off in the correct sequence. The doffing order exists to keep the most contaminated items away from your face and clothing. Perform hand hygiene before donning, and again immediately after doffing.

Donning order
Put on the gown first, then the mask or respirator, then goggles or a face shield, and finally gloves, pulling the glove cuffs over the gown sleeves.
CDC
Doffing order
Remove gloves first, then goggles or face shield, then the gown, and remove the mask or respirator last after leaving the patient room. Perform hand hygiene immediately afterward.
CDC
Alcohol-based hand rub
Use a product containing 60 to 95 percent alcohol, apply enough to cover all surfaces, and rub hands together until completely dry, which takes about 20 seconds.
CDC
When soap and water is required
Wash with soap and running water for at least 20 seconds when hands are visibly soiled, after using the restroom, before eating, and after caring for patients with C. difficile or norovirus.
CDC
Gloves do not replace hand hygiene
Perform hand hygiene before putting gloves on and after taking them off, change gloves between patients and between dirty and clean tasks on the same patient, and never wash and reuse disposable gloves.
CDC
Respirator fit testing
Employees required to wear a tight-fitting respirator must be medically evaluated, fit tested before first use and at least annually, and must perform a user seal check each time they put it on.
OSHA 29 CFR 1910.134

OSHA bloodborne pathogens and exposure control

The OSHA Bloodborne Pathogens Standard is the federal rule that governs occupational exposure to blood and other potentially infectious materials, with hepatitis B, hepatitis C, and HIV as the primary concerns. It creates specific employer duties that are frequently tested: a written plan, free vaccination, engineering controls, training, and post-exposure follow-up. Knowing who pays and how quickly is often the key to the question.

The governing standard
Occupational exposure to blood and other potentially infectious materials is regulated by the Bloodborne Pathogens Standard, which applies to any employee who can reasonably anticipate contact with blood as part of their duties.
OSHA 29 CFR 1910.1030
Written Exposure Control Plan
The employer must maintain a written Exposure Control Plan, review and update it at least annually and whenever new tasks or devices change exposure risk, and make it accessible to employees.
OSHA 29 CFR 1910.1030
Hepatitis B vaccination
The employer must offer the hepatitis B vaccine series at no cost within 10 working days of initial assignment to a job with occupational exposure. An employee who declines must sign a declination form and may request the vaccine later at any time.
OSHA 29 CFR 1910.1030
Engineering and work practice controls
Employers must provide sharps with engineered injury protection and puncture-resistant containers, and must prohibit eating, drinking, smoking, applying cosmetics, and handling contact lenses in areas of occupational exposure.
OSHA 29 CFR 1910.1030
Post-exposure evaluation
After a needlestick or other exposure, wash the area with soap and water or flush mucous membranes with water, report the incident immediately, and receive a confidential medical evaluation, source testing where permitted, and follow-up at no cost to you.
OSHA 29 CFR 1910.1030
Hazard communication
Employees must have access to safety data sheets for hazardous chemicals used in the workplace, containers must carry standardized GHS labels with pictograms, and training must be provided before first use.
OSHA 29 CFR 1910.1200

Asepsis, sharps, and biohazard waste

Medical asepsis reduces the number of microorganisms while surgical asepsis eliminates them entirely, and each procedure requires one or the other. Waste handling follows the same logic: what is contaminated with regulated blood or body fluid gets treated as biohazard, and what is not goes in ordinary trash. Over-labeling everything as biohazard is expensive and is not the correct answer.

Medical asepsis, or clean technique
Medical asepsis reduces the number and spread of microorganisms through hand hygiene, gloves, disinfection of surfaces, and proper waste handling. It is used for injections of routine vaccines, vital signs, and most exam room tasks.
Surgical asepsis, or sterile technique
Surgical asepsis destroys all microorganisms and their spores and is required for minor surgery, urinary catheterization, sterile dressing changes, and any procedure entering a normally sterile body area.
Rules of the sterile field
The outer one inch is contaminated, anything below waist level or out of your direct sight is contaminated, never reach across the field or turn your back on it, and any moisture that soaks through the drape contaminates it.
Sharps containers
Containers must be closable, puncture-resistant, leak-proof on sides and bottom, and labeled with the biohazard symbol or color-coded red. Replace them when they reach roughly two-thirds to three-quarters full and never force items in.
OSHA 29 CFR 1910.1030
Regulated waste versus ordinary trash
Regulated waste includes liquid or semi-liquid blood, items caked with dried blood that could release it if compressed, contaminated sharps, and pathological waste, and it goes in a labeled red biohazard bag. A gauze pad with a small dried spot of blood generally does not.
OSHA 29 CFR 1910.1030
Blood spill cleanup
Put on gloves and other appropriate PPE, absorb the spill with disposable material, clean the area, then disinfect with an EPA-registered disinfectant effective against bloodborne pathogens or a freshly prepared one-to-ten bleach solution.
CDC
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Last updated: July 2026

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