After completing the chapter, you will be able to accomplish the following:

1. Perform hand hygiene using an alcohol-based hand sanitizer.
2. Perform hand hygiene using soap and water (handwashing).
3. Put on and remove personal protective equipment safely.
4. Prepare a sterile field.
5. Add sterile items to a sterile field.
6. Put on sterile gloves and remove soiled gloves.

• Clinical Decision Making/Clinical Judgment
• Infection
• Inflammation
• Safety

• health care-associated infections (HAIs)
• medical asepsis
• pathogens
• personal protective equipment (PPE)
• standard precautions
• surgical asepsis
• transmission-based precautions

Nurses and other health care workers play a key role in preventing and controlling infection, minimizing complications, and reducing adverse outcomes for their patients. Prevention of health care-associated infections (HAIs) is a major challenge for health care providers. In the United States, more than a million HAIs occur every year, accounting for tens of thousands of deaths and billions of dollars in health care costs (Agency for Healthcare Research and Quality, 2019). Limiting the spread of microorganisms is accomplished by breaking the chain of infection. The practice of asepsis includes all activities to prevent infection or break the chain of infection. Medical asepsis, or clean technique, involves procedures and practices that reduce the number and transfer of pathogens (disease-producing microorganisms). Procedures incorporating medical asepsis include, for example, performing hand hygiene and wearing gloves. Refer to Fundamentals Review 1-1. Surgical asepsis, or sterile technique or aseptic technique, includes practices used to render and keep objects and areas free from microorganisms. Procedures incorporating surgical asepsis include, for example, inserting an indwelling urinary catheter or inserting an intravenous catheter. Refer to Fundamentals Review 1-2.

Hand hygiene is the most effective way to help reduce the spread of potentially infectious agents and reduce the risk of health care provider colonization or infection caused by germs from the patient (Centers for Disease Control and Prevention [CDC], 2019b). Hand hygiene means cleaning your hands by using either handwashing with soap and water, antiseptic hand wash, antiseptic handrub (alcohol-based hand sanitizer), or surgical hand antisepsis (CDC, 2019b). The Joint Commission has included a recommendation to use guidelines from the CDC or the World Health Organization (WHO) for hand hygiene as part of the 2020 Patient Safety Goal to “Prevent infection” (The Joint Commission, 2022). In addition, the WHO (2022) has identified the “My 5 Moments for Hand Hygiene” approach to define the key moments when health care workers should perform hand hygiene. These include:

• Moment 1: Before touching a patient
• Moment 2: Before a clean or aseptic procedure
• Moment 3: After body fluid exposure risk or risk of exposure
• Moment 4: After touching a patient
• Moment 5: After touching patient surroundings

Fundamentals Review 1-3 and 1-4 outline a summary of CDC-recommended practices for Standard and Transmission-Based Precautions, additional interventions that are an important part of protecting patients and health care providers and preventing the spread of infection.

This chapter focuses on nursing skills to assist in preventing the spread of infection. These skills include performing hand hygiene, using PPE, preparing a sterile field, adding sterile items to a sterile field, and putting on sterile gloves and removing after use.

1. You should call for or ask another staff member to obtain the bowl. Never walk away from or turn your back on a sterile field. This prevents possible contamination while the field is out of your view.
2. You should change gloves. Only a sterile object can touch another sterile object. Nonsterile touching sterile means contamination has occurred. Consider an object contaminated if you have any doubt about its sterility.
3. You should explain the rationale for transmission-based precautions, including specific information about airborne precautions. Airborne precautions are used for patients who have infections that spread through the air, such as tuberculosis, varicella (chicken pox), rubeola (measles), and possibly SARS. Place patient in a private room that has monitored negative air pressure in relation to surrounding areas, 6 to 12 air changes per hour, and appropriate discharge of air outside or monitored filtration if air is recirculated. Keep door closed and patient in room.