Training Module — New Hire 04: Infection Control & PPE

Policy Reference: NC-10 — Infection Prevention and Control

Learning Objectives

By the end of this module, you will be able to:

1. Perform correct hand hygiene using the WHO 5 Moments technique.
2. Select and use appropriate PPE for different care situations.
3. Correctly don and doff PPE without self-contamination.
4. Describe the correct response to a bloodborne pathogen exposure.
5. Identify when to exclude yourself from patient care due to illness.

Key Points

Standard Precautions — The Foundation
Treat every patient as if they could be infectious — even if they appear healthy. Standard Precautions apply to blood, all body fluids, non-intact skin, and mucous membranes. This is not about judgment of patients; it's about consistently protecting everyone.

Hand Hygiene — The Single Most Important Infection Control Measure

Use the WHO 5 Moments:

1. Before touching a patient
2. Before a clean/aseptic procedure
3. After body fluid exposure risk
4. After touching a patient
5. After touching a patient's environment

Soap and water is required (not hand sanitizer) when hands are visibly dirty, after using the restroom, and when C. difficile is suspected or confirmed (alcohol-based products do not kill C. diff spores).

Hand sanitizer technique: Apply to palm, rub hands together covering all surfaces for 20–30 seconds until dry.

Soap technique: Wet hands, apply soap, scrub all surfaces for at least 20 seconds (sing Happy Birthday twice), rinse thoroughly, dry with clean paper towel, use paper towel to turn off faucet.

PPE Selection Guide

Donning (Putting On) Sequence:

1. Gown (if needed)
2. Mask/respirator
3. Eye protection
4. Gloves last

Doffing (Removing) Sequence — Most Important Part:

1. Gloves first (peel inside-out, avoid touching outer surface)
2. Eye protection
3. Gown (roll inward away from body)
4. Mask last
5. Hand hygiene immediately after every removal step

Bloodborne Pathogen Exposure
If you have a needlestick, cut with a contaminated sharp, or splash of blood/body fluids to eyes, mouth, or broken skin:

1. Immediately wash the wound with soap and water (15 minutes for eyes — flush with water).
2. Call your supervisor within 1 hour.
3. An incident report must be completed.
4. You will be referred for medical evaluation and possible post-exposure prophylaxis (PEP) — PEP for HIV must begin within 72 hours, ideally within 2 hours.

TB Screening Requirements
All Noble Care employees must complete tuberculosis screening:

• At hire: Baseline TB screening using either a tuberculin skin test (TST) or an Interferon-Gamma Release Assay (IGRA) blood test. Results must be documented before any patient contact.
• Annually: Repeat TB screening is required each year thereafter.
• Positive result: If your TST or IGRA is positive, a chest X-ray is required before any patient contact. You will be referred for medical evaluation and may need additional follow-up as directed by the physician.

Hepatitis B (HBV) Vaccination
Noble Care offers the Hepatitis B vaccine series to all employees at no cost:

• The vaccine must be offered within 10 working days of your hire date.
• You are strongly encouraged to accept vaccination — HBV is a serious occupational risk for caregivers who may be exposed to blood or body fluids.
• If you decline, you must sign a written declination form. You may change your mind and request the vaccine at any time during your employment.

When to Stay Home
Do not report to a patient's home if you have: fever ≥100°F, vomiting, diarrhea, new rash, productive cough, conjunctivitis (pink eye), or suspected COVID-19. Call your supervisor immediately. Do not leave a patient without care — always call the office first so coverage can be arranged.

Real-World Scenario

Rosa is providing morning care for Mrs. D, who has a known history of MRSA. Rosa arrives, dons gloves and a gown as per the care plan. During bed bath, Rosa's glove tears. She quickly replaces the glove but does not remove the gown. She finishes care and removes the gown and gloves before leaving the room, then proceeds to the kitchen to prepare breakfast without washing her hands first.

What went wrong:

1. Rosa should have performed hand hygiene after removing the torn glove before putting on a new one.
2. After removing PPE, hand hygiene must be performed before touching anything else — including food preparation surfaces.

The risk: MRSA can be transmitted to food preparation areas and to subsequent patients Rosa visits that day if hand hygiene is not performed.