Module 04

Infection Control
& PPE

Standard Precautions, Hand Hygiene & Personal Protective Equipment

What You'll Learn

Learning Objectives

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

The Foundation

Standard
Precautions

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 — the patient and you.

The Single Most Important Measure

Hand Hygiene — WHO 5 Moments

Hand hygiene is the single most effective way to prevent the spread of infection. Use the WHO 5 Moments framework every time.

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

Technique Matters

Soap vs. Sanitizer

Soap & Water Required

Hands are visibly dirty or soiled
After using the restroom
When C. difficile is suspected or confirmed
Before preparing food for a patient

Technique: Wet hands, apply soap, scrub all surfaces for at least 20 seconds, rinse thoroughly, dry with clean paper towel, use towel to turn off faucet

Alcohol-Based Sanitizer OK

Hands are not visibly soiled
Between tasks during a visit
When soap and water not immediately available
Routine hand hygiene moments

Technique: Apply to palm, rub hands together covering all surfaces for 20-30 seconds until completely dry

Alcohol-based products do NOT kill C. diff spores. When in doubt, use soap and water.

Remember This

Clean Hands
Save Lives

Hand hygiene is not a suggestion or a shortcut. It is the single most important thing you do to protect your patients and yourself.

Know What to Wear

PPE Selection Guide

Situation	Minimum PPE Required
Personal care with exposure risk	Gloves
Splash/spray risk (wound care, bathing, oral care)	Gloves + Mask + Eye Protection
Contact precautions (MRSA, VRE, C. diff)	Gloves + Gown
Droplet precautions (flu, COVID-19)	Gloves + Surgical Mask
Airborne precautions (TB, chickenpox)	Gloves + N95 Respirator + Gown

Always check the patient's Care Plan for specific precaution requirements. When in doubt, call the office.

Putting On PPE

Donning Sequence

Always don PPE in the correct order. Putting on gloves last ensures they cover the gown cuffs and remain the outermost barrier.

1

Gown

Tie at neck and waist. Cover torso completely.

2

Mask / Respirator

Secure ties/straps. Fit snugly over nose and mouth.

3

Eye Protection

Goggles or face shield. Position securely.

4

Gloves Last

Extend over gown cuffs. Most contaminated = last on.

The Most Critical Step

Doffing Sequence — Removing PPE

Improper removal is where most contamination occurs. The order is reversed from donning.

Gloves FIRST — peel inside-out, avoid touching outer surface. Hand hygiene.
Eye protection — remove by headband or earpieces only. Hand hygiene.
Gown — unfasten ties, roll inward away from body. Hand hygiene.
Mask LAST — remove by ties/straps only. Do not touch the front. Hand hygiene.

Hand hygiene AFTER EVERY removal step — not just at the end.

Common Mistakes

Glove Use — Do It Right

✓ Correct Glove Practices

Change gloves between tasks (e.g., toileting and meal prep)
Change gloves if they tear during use
Hand hygiene before putting on new gloves
Select correct size — too loose or tight reduces protection
Remove by peeling inside-out from the cuff

✗ Common Mistakes

Using the same gloves for multiple tasks
Washing and reusing disposable gloves
Touching your face, phone, or doorknobs with gloves on
Skipping hand hygiene after glove removal
Snapping gloves off — this can fling contaminants

Emergency Protocol

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:

Immediately wash the wound with soap and water. For eyes: flush with water for 15 minutes.
Call your supervisor within 1 hour — (740) 262-9845
An incident report must be completed — document everything
Medical evaluation and possible PEP — you will be referred immediately

Time is critical: Post-exposure prophylaxis (PEP) for HIV must begin within 72 hours, ideally within 2 hours. Do not delay reporting.

Protect Your Patients

When to Stay Home

Do not report to a patient's home if you have any of the following symptoms. Call your supervisor immediately — do not leave a patient without care.

Fever

Temperature of 100°F (37.8°C) or higher

GI Symptoms

Vomiting or diarrhea

Respiratory

Productive cough or suspected COVID-19

Skin / Eyes

New rash or conjunctivitis (pink eye)

Always call the office first so coverage can be arranged: (740) 262-9845

Environmental Safety

Infection Control in the Home

Cleaning & Disinfection

Clean frequently touched surfaces during each visit
Use patient-provided cleaning supplies when available
Clean before disinfecting — cleaning removes debris
Allow disinfectant to air dry for full effectiveness

Waste & Laundry

Bag soiled linens immediately — don't carry against your body
Dispose of gloves and single-use items in a lined waste container
Sharps go in a sharps container — never in regular trash
Wash hands after handling any waste

Cross-Contamination Prevention

Between Patients

If you visit multiple patients in a day, you are a potential vector for transmitting infections between homes. These steps prevent that.

Remove all PPE before leaving the patient's home — never wear PPE between homes
Hand hygiene before getting into your car
Clean your supplies — stethoscope, blood pressure cuff, bag handles
Change scrubs if visibly soiled — carry a spare set in your car
Hand hygiene again upon entering the next patient's home

Beyond Standard Precautions

Transmission-Based Precautions

Contact Precautions

MRSA, VRE, C. difficile — Gloves + gown for all contact. Dedicate equipment when possible.

Droplet Precautions

Influenza, COVID-19, pertussis — Surgical mask within 6 feet of patient. Gloves for direct contact.

Airborne Precautions

TB, chickenpox, measles — N95 respirator required (must be fit-tested). Gloves + gown. Contact office before entering home.

Always check the Care Plan for specific precaution orders. If unsure, call the office before providing care.

Be Prepared

Your PPE Kit

NobleCare provides all required PPE. You are responsible for carrying adequate supplies and notifying the office when you need more — before you run out.

Always Carry

Disposable gloves (multiple sizes)
Surgical masks
Hand sanitizer (60%+ alcohol)
Disposable gowns (2-3 minimum)
Trash bags for soiled items

Running Low?

Request supplies from the office before you run out
Never reuse single-use PPE
Never skip PPE because you don't have supplies
If out of PPE, call the office before starting care

What Would You Do?

Scenario

Situation

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

A) Rosa handled it correctly — she replaced the torn glove promptly
B) Rosa should have removed the gown too when the glove tore
C) Rosa failed to perform hand hygiene after removing the torn glove AND after removing all PPE
D) Rosa should not have been doing the bed bath at all with MRSA

✓ Correct Answer: C

Hand Hygiene After Every PPE Change

What Rosa Did Wrong

Failed to perform hand hygiene after removing the torn glove — before putting on a new one
After removing all PPE, went straight to food preparation without washing hands
MRSA could have been transmitted to kitchen surfaces and food

Correct Steps

Remove torn glove carefully
Hand hygiene immediately
Put on new glove
Complete care
Remove all PPE in correct doffing order
Hand hygiene before touching anything else

What Would You Do?

Scenario

Situation

You wake up on a scheduled workday with a 101°F fever and a productive cough. You have two patients today and don't want to leave them without care.

A) Go to work and wear a mask to protect patients
B) Call your supervisor immediately before your shift starts so coverage can be arranged
C) Work the morning shift then go home if you feel worse
D) Only stay home if you have a positive COVID test

✓ Correct Answer: B

Call Your Supervisor — Never Leave Patients Uncovered

Why the Others Are Wrong

A — A mask alone is not sufficient. You are infectious and should not provide direct care with a fever.
C — Working "half a day" exposes patients to infection and worsens your condition.
D — Multiple symptoms require exclusion regardless of COVID status. Fever + cough = stay home.

The Right Approach

Call your supervisor before your shift
The office will arrange replacement coverage
Never leave a patient without care by no-showing
Return to work only when symptom-free for 24 hours

Review

Knowledge Check

1. When should you perform hand hygiene during personal care?

Before touching the patient and after touching the patient (WHO 5 Moments)

2. When is soap and water required instead of hand sanitizer?

When caring for a patient with suspected C. difficile (alcohol doesn't kill C. diff spores)

3. What is the correct order for removing (doffing) PPE?

Gloves first, then eye protection, then gown, then mask last

4. You experience a needlestick. What is your immediate first action?

Immediately wash the wound with soap and water, then call your supervisor

5. You wake up with a 101°F fever and productive cough. What do you do?

Call your supervisor immediately before your shift so coverage can be arranged

Module 04 Complete