Infection Control and Safety

✗ "Transmission-based precautions replace standard precautions once a patient is isolated."

✓ They are always ADDED to standard precautions, never substituted for them. Standard precautions apply to every patient at every encounter regardless of diagnosis or known infection status. Transmission-based precautions are a second layer on top, chosen by route: contact, droplet, or airborne.

✗ "Universal precautions and standard precautions are two names for the same thing."

✓ Universal precautions is the older, narrower OSHA concept: treat blood and certain body fluids as infectious. Standard precautions (CDC) is broader and came later: all blood, body fluids, secretions and excretions EXCEPT sweat, plus nonintact skin and mucous membranes. Standard precautions contain universal precautions, not the other way around.

✗ "Alcohol-based hand rub is always at least as good as washing."

✓ Alcohol rub is faster and preferred for routine hand hygiene on hands that are not visibly soiled. But it does not kill C. difficile spores, works poorly against norovirus, and does not remove visible soil. Soap and water is required for visibly soiled hands, blood or body fluid contact, C. difficile, norovirus, after the restroom, and before eating. Also: gloves are never a substitute — hand hygiene goes before donning and immediately after removal.

✗ "If it travels through the air, it needs an N95 and a negative-pressure room."

✓ Droplet organisms (influenza, pertussis, meningococcus, mumps, rubella, group A strep) travel short distances in large droplets that fall quickly: surgical mask, at least 3 feet of separation, single-patient room preferred. Airborne organisms stay suspended over distance: fit-tested NIOSH-approved N95 or higher plus an AIIR under negative pressure with the door closed. Second-order trap inside the same list: measles and pulmonary TB are airborne only, but varicella and disseminated zoster are airborne PLUS contact, so those two also require gown and gloves.

✗ "A strong enough disinfectant handles an instrument that still has dried blood on it."

✓ Cleaning comes first, always. Organic debris physically shields microorganisms from chemicals and from steam contact. The progression is sanitization (remove visible soil and debris), then disinfection, then sterilization. Sanitization only reduces counts; disinfection kills most pathogens, with high-level disinfection sparing only large numbers of bacterial spores; sterilization destroys all microorganisms, spores included.

✗ "Wearing clean gloves means I am using sterile technique."

✓ Medical asepsis (clean technique) reduces microbe numbers: hand hygiene, clean nonsterile gloves, disinfecting a counter. Surgical asepsis (sterile technique) eliminates all microorganisms and spores: sterile gloves and a sterile field, with the outer 1 inch of the field considered contaminated, everything kept above waist level and within sight, and no reaching across the field.

✗ "The autoclave tape turned dark, so the load is sterile."

✓ A chemical indicator only shows the pack was exposed to sterilizing conditions such as heat; it detects procedural and equipment errors, not sterility. Only a biological (spore) indicator proves the process killed spores — Geobacillus stearothermophilus for steam. CDC: run one at least weekly, and in every load that contains an implantable device, with a matching control from the same lot.

✗ "RACE and PASS describe the same fire procedure."

✓ RACE is what you do when a fire is discovered: Rescue anyone in immediate danger, Alarm (activate the alarm and call), Confine by closing doors and windows, then Extinguish or Evacuate. PASS is only how you operate the extinguisher: Pull the pin, Aim at the base of the fire, Squeeze the handle, Sweep side to side. RACE comes first; PASS is only the final E.

✗ "Anything that touched a patient goes in the red biohazard bag."

✓ OSHA regulated waste is limited to liquid or semi-liquid blood or other potentially infectious material, items that would release it in a liquid or semi-liquid state if compressed, items caked with dried blood capable of releasing it during handling, contaminated sharps, and pathological and microbiological waste. A lightly soiled bandage that will not release fluid, a used gown, or exam-table paper goes in regular trash. Over-segregating is a compliance and cost problem, not extra safety.

✗ "A patient asks whether her rash is contagious and whether she should be isolated — I should answer." (scope of practice)

✓ Answering is diagnosing, which is outside the scope of practice for an unlicensed assistive person. What the CCMA does do: follow the standing infection-control protocol — mask the patient per respiratory hygiene, place them in a private room, apply the precautions already ordered — and route the clinical question to the provider. Following a delegated protocol is in scope; assigning a diagnosis or deciding isolation status is not.

✗ "After a coworker's needlestick I can reassure her the source patient looks low risk, and skip the paperwork." (scope of practice)

✓ Risk assessment, source-patient testing, and any decision about post-exposure prophylaxis belong to a licensed provider and employee health under the employer's exposure control plan. The CCMA's role is first aid, immediate reporting, and accurate documentation. Reassuring someone out of an evaluation can cost them a treatment window that is time-sensitive.

✗ "A CLIA-waived rapid strep came back positive, so I can tell the patient she has strep and needs an antibiotic." (scope of practice)

✓ Running a CLIA-waived test and documenting the result is in scope. Telling the patient what the result means, naming the condition, or saying what treatment follows is interpreting and prescribing — both outside an unlicensed assistive person's scope. Report the value to the provider and let the provider deliver the result and the plan.