Risk for Infection (Infection Control) Nursing Diagnosis & Care Plan

Risk for Infection is the diagnosis you carry on almost every patient. A surgical wound, a central line, a Foley, an immunosuppressed host: each one hands a pathogen a way in. Your job is to find the breach before it turns into a fever, and to break the chain of transmission at every point of contact. Most of what works is unglamorous (hand hygiene, asepsis, early detection), and most of it is on you.

What is Risk for Infection and Infection Control?

Infection happens when a patient's natural defenses cannot keep microorganisms out. Bacteria, viruses, fungi, and parasites invade through injuries, invasive lines, and broken barriers. The immune system is what stands in the way, and the organs and tissues that run it include the thymus, bone marrow, lymph nodes, spleen, appendix, tonsils, and Peyer's patches in the small intestine. When that system cannot clear an invading organism, infection sets in.

Any break in skin, mucous membranes, soft tissue, or organs such as the kidneys and lungs becomes a possible entry site after trauma, invasive procedures, or spread through the blood or lymphatics. Infection needs a full chain of events: a causative organism, a reservoir, a mode of transmission from reservoir to host, a portal of entry, and a susceptible host.

Infection is not the same as infectious disease. Infectious disease means the host has lost wellness because of the infection. A host can interact immunologically with an organism and stay symptom-free, which does not meet the definition.

Most infectious diseases spread by transferring organisms from one person to another, through contact, airborne routes, sexual contact, or shared IV drug equipment. Poverty, lack of knowledge, and malnutrition all raise a patient's risk.

Antimicrobials treat infections when the organism is susceptible, but some organisms (the human immunodeficiency virus, for one) have no effective antimicrobial. Immunization protects those at high risk. Handwashing remains the single best way to break the chain.

Infection control is the set of policies and procedures that limit the spread of infection in hospitals and other healthcare settings, with the goal of lowering infection rates. These programs grew out of surveillance of healthcare-associated infections (HAIs) and the epidemiology used to pin down their risk factors. Specific interventions depend on the nature and severity of the risk, and patients should be taught to recognize signs of infection and reduce their own exposure.

Signs and Symptoms of Infection

Subjective data

• Fatigue and malaise
• Pain or discomfort
• Decreased appetite

Objective data

• Elevated body temperature or fever
• Redness, swelling, or warmth at a site
• Purulent or unusual discharge
• Tachycardia
• Tachypnea
• Elevated white blood cell (WBC) count
• Positive culture results
• Inflammation or delayed wound healing
• Skin breakdown or lesions

Nursing Care Plans and Management

Care for infection risk runs on assessment, early detection, prompt treatment, and education for patients and staff. The aim is to cut healthcare-associated infections across every setting: hospitals, long-term care, clinics, and home care.

Nursing Problem Priorities

1. Infection control and prevention. Put prevention measures in place to stop infection from spreading.
2. Assessment and early detection. Catch infection early so treatment starts on time.
3. Isolation precautions. Place the patient in the right type of isolation for the mode of transmission and use the right barriers.
4. Surgical asepsis. Hold the line on surgical asepsis to prevent surgical site infections.
5. Patient and caregiver education. Teach prevention so patients and families can lower their own risk.

Nursing Assessment

Signs of infection vary with the type and site of infection and the patient's immune response.

• Fever. Often with chills and sweating.
• Pain or tenderness. Localized at the site of infection.
• Redness and swelling. Inflammation is the hallmark: redness, warmth, swelling.
• Tachycardia and tachypnea. Heart and respiratory rates climb as the body fights the pathogen.
• Malaise. A general sense of being unwell.
• Increased WBC count. The body produces more white cells in response to infection.

Nursing Diagnosis

After assessment, frame the diagnoses around the specific breach in defenses. Use varies by setting and clinical judgment shapes the final plan. Common examples:

• Risk for Infection as evidenced by compromised skin and mucous membrane integrity (surgical wounds, chronic ulcers).
• Risk for Infection as evidenced by foreign bodies such as catheters, drains, and central lines that bypass natural barriers.
• Risk for Infection as evidenced by a break in skin integrity (eczema, psoriasis, severe burns) that opens a portal of entry.
• Risk for Infection related to decreased ciliary action and stasis of respiratory secretions in chronic respiratory disease.
• Risk for Infection as evidenced by a malnourished state that weakens the immune response.
• Risk for Infection as evidenced by immunocompromise (leukemia, HIV/AIDS, immunosuppressive therapy).

Nursing Goals

• The patient stays free of infection, shown by normal vital signs and no signs or symptoms.
• The patient maintains or restores defenses.
• Infection is recognized early enough for prompt treatment.
• The patient demonstrates a meticulous handwashing technique.

More specific outcomes:

• Within [specific timeframe], the patient shows no signs of infection (fever, redness, swelling, or drainage) and holds a temperature of 36.5°C to 37.2°C, a heart rate of 60 to 100 beats per minute, a respiratory rate of 12 to 18 breaths per minute, and a WBC count within normal limits.
• By [specific date], the patient shows stronger immune defenses through improvement or stabilization of relevant immunologic markers and verbalizes individualized strategies (nutrition, exercise, medication adherence) to support immune function.
• Within [specific timeframe], the patient catches potential infection early, reporting signs such as increased fatigue, localized heat, or unusual discharge so treatment can start fast.
• Within [specific timeframe], the patient performs meticulous handwashing, wetting hands, applying soap, scrubbing all surfaces including the backs of the hands, between the fingers, and under the nails for at least 20 seconds, then rinsing and drying, especially before meals, after the restroom, and after contact with contaminants.

Nursing Interventions and Actions

1. Performing Assessment and Early Detection

Catching infection early lets the team target the right antimicrobial against the specific pathogen.

1. Assess for the presence and history of common causes and risk factors for infection. These represent a break in the body's first line of defense. The organisms behind infection include bacteria, rickettsiae, viruses, protozoa, fungi, and helminths.

2. Assess for local infectious processes in the skin or mucous membranes. Watch for localized swelling, redness, pain or tenderness, loss of function, and palpable heat. A patient can be colonized with S. aureus on intact skin without any reaction, but once there is an incision, S. aureus can enter the wound and trigger local inflammation and white cell migration to the site.

3. Monitor and report signs and symptoms of infection. These vary by body area.

• 3.1. Redness, swelling, increasing pain, or purulent discharge from incisions, injuries, and the exit sites of IV tubing, drains, or catheters. These are the classic signs. Culture any suspicious drainage; antibiotic therapy follows the organisms identified. About 20% of patients are colonized at the moment of catheter insertion, since bacteria can ascend the catheter lumen from reflux of urine in contaminated bags or from the urethra.
• 3.2. Elevated temperature. Fever is often the first sign. A temperature up to 38°C (100.4°F) within 48 hours of surgery usually reflects surgical stress; beyond 48 hours it points more toward infection. A temperature above 37.7°C (99.8°F) may indicate infection, and a very high temperature with sweating and chills may indicate septicemia. In older adults, a tympanic temperature above 37.3°C (99.14°F) or a rectal temperature above 37.8°C (100.4°F) is a reliable marker of bacterial infection.
• 3.3. Color of respiratory secretions. Yellow or yellow-green sputum points to respiratory infection. Neutrophils carry a green pigment and are drawn to bacterial infection, so lower respiratory infections such as pneumonia can produce green sputum.
• 3.4. Appearance of urine. Cloudy, turbid, foul-smelling urine with visible sediment suggests urinary or bladder infection, but visual inspection alone is unreliable. Cloudiness is often protein or crystals, and odor can come from diet or medication, so obtain a urine culture.

4. Monitor WBC count. A rising count shows the body fighting pathogens. This leukocytosis is mostly neutrophils and usually signals an inflammatory response such as infection, though it also appears with parasitic infection or cancers such as leukemia. Reference ranges:

• Low: below 4,500
• Normal: 4,500 to 11,000
• High: above 11,000

A very low WBC count can signal severe infection risk. In older adults, infection may occur without a rise in WBC, and the differential may shift up or down in certain infections.

5. Assess nutritional status, weight, weight-loss history, and serum albumin. Poorly nourished patients may be anergic, unable to mount a cellular immune response, and so are more prone to infection. Micronutrient deficiency weakens immune function; vitamin D deficiency in particular raises the risk of respiratory infection.

6. Review medications and treatments that cause immunosuppression. Antineoplastics and corticosteroids suppress immune function. Corticosteroids and tumor necrosis factor inhibitors both raise the risk of fungal infection. Immunosuppressants are a class built to blunt the immune response.

7. Assess immunization status and history. Incomplete immunization leaves gaps in acquired immunity. Ask when the patient was last immunized, and weigh risks and benefits in terms of morbidity, mortality, and cost. Strong vaccine programs have driven down many infectious diseases.

8. Report any low-grade fever or new confusion in an older adult. A low-grade temperature rise in an older patient must be reported, since it can signal infection. Older adults often present with a nonspecific decline from baseline function, and cognitive impairment makes the picture even more atypical and harder to communicate. Fever can be absent in 30 to 50% of frail older adults even with serious infection.

9. Obtain a travel history. Travel history helps catch outbreaks and puts symptoms in context. As many as 43 to 79% of travelers to low- and middle-income countries develop a travel-associated health problem. Most post-travel infections surface soon after returning, but incubation periods vary and some present months to years later.

10. Determine specific travel exposures. Contaminated food or water, insect bites, and freshwater swimming all narrow the differential, and lodging and activities shift the risk. Travelers visiting friends and relatives face higher risk of malaria, typhoid fever, and other diseases, often because they stay longer, go to more remote places, have more contact with local water, and skip pre-travel advice.

11. In pregnant patients, assess the intactness of amniotic membranes. Prolonged rupture before delivery raises infection risk for mother and neonate. Many pregnant patients with infection are asymptomatic, so keep a high index of suspicion and screen adequately.

12. Screen pregnant patients at 35 to 37 weeks of gestation. Every pregnant patient should have a vaginal or rectal swab cultured at 35 to 37 weeks. The most specific site is the introitus, just inside the hymenal ring, and rectally beyond the sphincter. This identifies group B streptococcus, the most common cause of life-threatening infection in newborns.

13. Identify factors that reduce hand hygiene effectiveness. Skin cracks, dermatitis, or cuts trap bacteria. Rings and bracelets raise the microbial count on hands. When a bracelet cannot be removed for religious reasons, push it as high above the wrist as possible before hand hygiene.

14. Assess for latex allergy. Latex allergy is a reaction to proteins in natural rubber latex, including powdered latex gloves. Those at risk include healthcare workers who wear latex gloves often, patients with many prior surgeries, patients with frequent latex exposure, and patients with other allergies such as allergic rhinitis or certain food allergies.

15. Perform a blood and body fluid exposure risk assessment promptly after any incident. Complete it within 2 hours of the incident, in the emergency department or urgent care, with a healthcare provider assessing the risk of exposure and the risk of transmission from the source.

16. Monitor C-reactive protein (CRP). CRP is a marker of inflammation that rises about 6 hours after infection, peaks at 48 hours, and has a half-life of 19 hours. It is affected by immunosenescence but not by comorbidities, so it works for therapeutic monitoring.

17. Use validated biomarkers and tools to predict infection in older adults. The CURB-65 score (confusion, uremia, a respiratory rate of 30 breaths per minute, low blood pressure, and age 65 or older) is validated in older adults and helps predict mortality and the right care setting. The Pneumonia Severity Index (PSI) risk-stratifies community-acquired pneumonia to decide inpatient versus outpatient treatment.

2. Infection Control and Prevention

Infection control exists to prevent and reduce hospital-acquired infections through surveillance, isolation, outbreak management, environmental hygiene, education, and prevention policy.

1. Hold strict asepsis for dressing changes, wound care, IV therapy, and catheter handling. Aseptic technique cuts the chance of moving pathogens between patients and breaks the chain of infection. Insert urinary catheters with scrupulous aseptic technique, using a pre-assembled, sterile, closed drainage system and the smallest catheter that will work. Open wounds carry the same risk, so keep dressing changes and wound care aseptic.

2. Perform hand hygiene before patient contact, and teach the patient and family the "5 moments for hand hygiene":

• Before touching a patient
• Before a clean or aseptic procedure (wound dressing, starting an IV)
• After contact with body fluid
• After touching a patient
• After touching the patient's surroundings

Friction and running water remove organisms; washing between procedures stops transfer from one body area to another. Wash with antiseptic soap and water for at least 15 seconds, then use an alcohol-based hand rub. If hands are not visibly dirty and have not touched anything in the room, an alcohol-based hand rub rubbed in until dry is enough. Plain soap lowers bacterial counts, antimicrobial soap does better, and alcohol-based hand rubs do best.

3. Encourage protein-rich, calorie-rich food and a balanced diet. Good nutrition keeps the immune system responsive and helps the body maintain and rebuild tissue. In older adults, nutrition support can blunt the immune decline of aging; zinc, vitamin E, and vitamin D stand out.

4. Change soiled or wet dressings. Use aseptic technique. Surgical dressings are changed as ordered, usually on the second through fifth postoperative days, but change any visibly soiled dressing sooner after informing the provider.

5. Help the patient keep up skin hygiene. Frequent skin cleansing, especially of the hands, is a cheap, effective way to prevent self-inoculation by cutting viral transfer to the mucous membranes of the nose, mouth, and eyes.

6. Dispose of soiled linens properly. Linens contaminated with body fluids harbor bacteria, viruses, and fungi. Proper disposal protects both staff and patients.

7. Do not talk, cough, or sneeze over open wounds or sterile fields. Respiratory pathogens aerosolize easily and spread fast. Respiratory hygiene starts with recognizing symptoms and keeping clean habits around others.

8. Wear gloves when handling body fluids. Gloves barrier the hands against patient microflora. Wear them for contact with any secretions or excretions, discard after each patient contact, and wash afterward, since organisms on the hands multiply in the warm, moist glove environment.

9. Have patients perform hand hygiene when handling food or eating. The most common source of bacterial transmission in healthcare is spread by the hands of staff. Effective handwashing takes at least 15 seconds of vigorous scrubbing, with attention to the nail beds and between the fingers, where bacterial load is high.

10. Encourage increased fluid intake unless contraindicated (heart failure, kidney failure). Fluids dilute urine, empty the bladder more often, and reduce urinary stasis, lowering the risk of bladder and urinary tract infection. They also replace fluid lost to fever, thin secretions, and keep skin and tissue from drying and cracking into entry points for pathogens.

11. Encourage coughing, deep breathing, and frequent position changes. These reduce stasis of secretions in the lungs and bronchial tree, where stasis invites pneumonia. Chest physiotherapy (postural drainage, percussion, vibration, breathing retraining) clears secretions and improves ventilation.

12. Recommend soft-bristled toothbrushes and stool softeners to protect mucous membranes. Hard bristles damage the mucosa and open a portal of entry. Soft bristles are gentler on inflamed gums, which are more prone to infection.

13. Keep the patient's and your own fingernails short and clean. Rough edges and hangnails harbor organisms. Trim nails, clean the undersides with soap and water, and keep them short, since long nails hold more dirt and bacteria.

14. Encourage sleep and rest. Sleep modulates immune response. Short sleep weakens immunity and raises susceptibility, including to the common cold. A regular sleep routine supports effective immune function.

15. Teach stress-reducing techniques. Excess stress predisposes to infection. Meditation, deep breathing, and mindfulness lower stress hormones and steady the immune response.

16. Follow proper cleaning and disinfecting of the patient and environment. Keep soiled items off uniforms, do not shake linens or clothes, and dust with a damp cloth instead. Clean contaminated objects and sterilize or disinfect equipment per agency policy to control the source of microbial growth.

17. Do not eat or drink in patient or resident areas. Eating and drinking raises transmission risk between staff and patients. The mouth is a common portal of exit, so eat in a designated area away from infectious patients.

18. Avoid or remove artificial nails and nail extenders, and keep nails short. Artificial nails and extenders raise bacterial load up to nine times compared with natural nails, and are not recommended for healthcare workers. Keep nails to a maximum of 1/4 inch and no longer than the fingertip. Most hand microbes live under the nails, and long nails are harder to clean and puncture gloves more often.

19. Use warm water and proper products for hand hygiene. Warm water strips fewer protective oils than hot water, which damages skin. Dispense products from disposable pump containers that are never topped up, and use enough soap to dissolve fatty material that water alone cannot remove.

20. Carry an alcohol-based hand rub during patient care. These products contain 60 to 90% alcohol and are the preferred method for hand hygiene in healthcare, more effective than soap and water, faster to use, killing most germs and viruses, and available right at the point of care.

21. After exposure to potentially infectious blood or body fluids, wash the area thoroughly and follow agency exposure policy. Post-exposure management applies when percutaneous, permucosal, or non-intact skin is exposed; the exposure is to blood or potentially infectious fluid or tissue; the source is potentially infectious; and the exposed person is susceptible to HIV, hepatitis B, or hepatitis C. Wash the area with soap and water, or normal saline for mucous membranes. Do not promote bleeding of a percutaneous injury by cutting, scratching, or squeezing.

22. Provide micronutrient supplementation as appropriate. Micronutrients and omega-3 fatty acids are a safe, low-cost way to close nutritional gaps and support immune function.

• Vitamins and trace elements. A multivitamin and trace element supplement supplying vitamin A, B6, B12, folate, zinc, iron, selenium, magnesium, and copper can back a balanced diet.
• Vitamin C. Doses above 200 mg/day saturate the blood and reduce the risk, severity, and duration of upper and lower respiratory infection. Needs rise during infection, and sick patients may take 1 to 2 g/day.
• Vitamin D. Daily supplementation reduces acute respiratory infection risk; 2000 IU/day is recommended.
• Zinc. Marginal deficiency impairs immunity, and the deficient (children especially) face more diarrheal and respiratory illness. Recommended intake is 8 to 11 mg/day.
• Omega-3 fatty acids (EPA and DHA). These support immune function and help resolve inflammation; 250 mg/day is recommended.

23. Keep all staff current on vaccinations and the facility's physical exams. Encourage annual influenza vaccination and periodic latent tuberculosis testing to catch new exposure. Employee health should run proactive campaigns to keep staff well and prevent infection.

24. Run antimicrobial stewardship programs strictly. Stewardship controls antimicrobial resistance, improves outcomes, and reduces cost. Monitor susceptibility profiles to anticipate new resistance patterns and correlate them with the agents in use.

25. Collaborate on infection control policy and interventions. The infection control program develops, implements, and evaluates policy to minimize HAIs. Vertical interventions reduce risk from a single pathogen (surveillance cultures and isolation of MRSA-infected patients); horizontal interventions target multiple pathogens that share a transmission route (hand hygiene).

26. Promote oral hygiene. Poor oral care is linked to spread of infection, worse outcomes, and poor nutrition. Provide oral care in the morning, after meals, and before bed.

27. Encourage daily bathing. Daily bathing meaningfully lowers HAIs, and chlorhexidine gluconate wipes or solutions outperform plain soap and water. Wash basins have been shown to harbor pathogens.

28. Disinfect mobile phones and gadgets frequently. Cell phones and mobile devices carry more pathogens than a toilet seat or the bottom of a shoe, and patients, staff, and visitors bring them in constantly. Wipe devices with disinfectant and teach patients and caregivers to do the same.

3. Implementing Isolation Precautions

Specific precautions stop transmission, and the right ones depend on the organism.

1. Tell the patient not to share personal care items (toothbrushes, towels, razors, combs, makeup). These harbor bacteria, viruses, and fungi, and razors can transmit bloodborne pathogens if they nick the skin. Not sharing cuts the spread.

2. Limit visitors and reinforce reporting of infection signs. Restricting visits reduces transmission. The best way to avoid spread is to keep symptomatic people away from others until they are asymptomatic or noncontagious.

3. Provide surgical masks to coughing visitors and explain why. Teach visitors to cover the mouth and nose with the elbow when coughing or sneezing, contain secretions with tissues disposed of in a no-touch receptacle, and perform hand hygiene afterward. Masks should cover the mouth and nose during any time with the patient, each room should have protective barriers changed between patients, and garbage receptacles should be readily available.

4. Place high-risk patients in protective isolation. Protective (reverse) isolation is set when the WBC shows neutropenia. Neutropenic patients go in a single room with adequate ventilation when possible.

Initiate specific precautions for suspected agents as determined by CDC protocol.

Standard Precautions

Standard precautions assume every patient may be colonized or infected, symptoms or not, so a uniform level of caution applies to all. Elements include hand hygiene, PPE, proper handling of equipment and linen, environmental control, prevention of sharps injury, and appropriate room assignment.

• Hand hygiene. Decontaminate hands frequently. When visibly dirty or contaminated with biological material, wash with soap and water. When not visibly soiled, use alcohol-based waterless antiseptic for routine decontamination.
• Glove use. Wear gloves for contact with any patient secretions or excretions, and discard after each patient contact.
• Needlestick prevention. Take extreme care with needles, scalpels, and other sharps. Do not recap used needles; place them straight into puncture-resistant containers near the point of use. If a needle must be recapped, use a one-handed approach.
• Avoidance of splash and spray. When body fluids may be sprayed or splashed, use goggles, a facemask, or a cover gown.

Airborne Precautions

Airborne precautions are required for presumed or proven pulmonary TB, varicella, measles, or other airborne pathogens. Hospitalized patients go in airborne infection isolation rooms engineered for negative pressure, rapid air turnover, and air that is highly filtered or exhausted directly outside. PPE includes a fit-tested N95 respirator. Keep the door closed at all times, restrict staff to non-susceptible persons, and post a sign outside the room.

Droplet Precautions

Droplet precautions are used for organisms such as influenza or meningococcus spread by close contact with respiratory or pharyngeal secretions. Wear a facemask within 3 to 6 feet of the patient. PPE includes masks and goggles or face shields.

Contact Precautions

Contact precautions are used for organisms spread by skin-to-skin contact, such as antibiotic-resistant organisms or C. difficile. Wash with soap and water rather than alcohol or waterless products, since spores resist them. Bleach-containing cleaners are best because bleach kills spores, so clean frequently touched equipment daily or whenever soiled. PPE includes gloves and gowns, with dedicated equipment for the patient. Use only soap and water for hand hygiene with C. difficile.

Proper Wearing of PPE

• Gloves. Wear them for direct care and perform hand hygiene after disposing of them. Double-gloving supports infection prevention in surgical procedures.
• Masks. Use masks, goggles, and face shields to protect the eyes, mouth, and nose during procedures and direct care (such as suctioning) that may splash blood, fluids, secretions, or excretions. Loosely woven cloth masks give the least protection; NIOSH-approved respirators give the most.
• Gowns. Wear a gown for direct contact with uncontained secretions or excretions, then remove it and perform hand hygiene before leaving the room. Never reuse a gown, even for the same patient. USP 800 sets gown standards for handling hazardous drugs.

Limit patient transport. Transport only for essential purposes such as diagnostic or therapeutic procedures that cannot be done in the room. Use appropriate barriers on the patient for the route and risk of transmission, and notify the receiving area of the arrival and the precautions needed.

Institute enteric precautions as indicated. Use these for known or suspected GI pathogens such as Clostridium difficile or norovirus, which live in feces. Wear a gown in the room to prevent fecal contamination of clothing, use only soap and water for hand hygiene (sanitizer does not work against C. difficile), and run a special disinfecting process after discharge, including the mattress.

Post signage on isolation room doors. State the type of precaution on the door or at the foot of the bed. A private room, or cohorting patients with the same infection, is acceptable, and private bathrooms are preferred.

Don PPE just before patient interaction and remove it right after, followed by hand hygiene.

Donning of PPE

1. Remove rings, bracelets, and watches, then perform hand hygiene.
2. Apply a waterproof long-sleeved gown and tie the neck and waist strings to prevent cross-contamination of the forearms and body.
3. Apply a surgical or N95 mask with a secure fit and no air leaks, since a poor fit is the leading reason for exposure.
4. Apply goggles or a face shield to protect the eyes, nose, and mouth. Goggles can sit over eyeglasses.
5. Apply non-sterile gloves over the gown cuff for complete skin coverage during care.

Doffing of PPE

1. Remove gloves first: grasp the outer edge at the wrist and peel away, then reach under the second glove with the bare hand and peel it off. Perform hand hygiene.
2. Remove the gown without contaminating clothing: from the neck ties, pull the outer part forward, turn it inward, roll it into a ball, and discard it. Perform hand hygiene.
3. Remove eye protection by the sides (the arms and headband are clean; the front is contaminated).
4. Remove the mask or N95 by the ties, ear loops, or straps (these are clean). If tied, remove the bottom tie first, then the top, and lean forward to let the mask drop off. Perform hand hygiene.

4. Promoting Surgical Asepsis

The surgical environment runs on strict asepsis and tight environmental control: staff health, room cleanliness, sterility of equipment and surfaces, and set processes for scrubbing, gowning, gloving, and attire.

Perform a thorough surgical scrub before the procedure. Surgeons, assistants, and nurses scrub the hands and arms with antiseptic soap and water. Alcohol-based or scrubless products are used in some institutions but only work when no gross contaminants are present.

Wear the appropriate PPE. Surgical team members wear long-sleeved sterile gowns and gloves, cover the head and hair with a cap, and wear a mask over the nose and mouth to keep upper respiratory bacteria out of the wound. Only those who have scrubbed, gloved, and gowned touch sterile objects.

Prepare the surgical site meticulously. Cleanse an area of skin larger than the exposure and apply an antiseptic solution. If hair removal is needed and was not done before the patient reached the OR, do it just before the procedure with electric clippers to minimize infection risk.

Sterilize or disinfect all articles before use. Every surgical supply, instrument, needle, suture, dressing, glove, cover, and solution that may contact the wound or exposed tissue must be sterilized first. Only scrubbed, gloved, gowned personnel touch sterile objects.

Keep sterile objects from touching anything non-sterile. Sterile objects may be touched only by sterile equipment or sterile gloves. When sterility is in doubt, treat the object as non-sterile. Keep forceps tips down during a sterile procedure so fluid does not travel up the instrument and contaminate the field.

Keep all sterile items above waist level. Anything below the waist, or held below the waist, is considered non-sterile.

Keep the sterile field in sight. A sterile field must stay in view the whole procedure. Never turn your back on it, and keep at least 1 foot of distance to prevent contamination.

Avoid contamination when opening sterile equipment. Dispense items to the field in a way that preserves sterility. Once a package is opened, the edges are non-sterile. Deliver supplies and solutions so the sterility of the object or fluid stays intact.

Do not use sterile equipment with any puncture, moisture, or tear. A breached sterile barrier is contaminated. A tear or puncture that exposes an unsterile surface underneath renders the area unsterile, and the equipment must be replaced.

Avoid the border of a sterile field. The 1-inch border at the edge of a sterile drape is non-sterile. Keep all objects inside the field and away from that border.

Monitor every sterile field constantly. Items of doubtful sterility are unsterile. Prepare fields as close to the time of use as possible.

Keep movement around the field from contaminating it. Do not sneeze, cough, laugh, or talk over the field, never reach over it, and keep a margin between sterile and non-sterile areas. When pouring sterile solutions, only the lip and inner cap of the container are sterile, so the container must not touch the field, and avoid splashes.

Select sterile or clean gloves based on what you will touch. Clean gloves are used whenever there is risk of contact with body fluids or contaminated surfaces. Sterile gloves meet FDA sterilization requirements and are used for invasive procedures or contact with a sterile site, tissue, or body cavity.

5. Providing Patient and Caregiver Education

Teach proper hygiene, respiratory etiquette, wound care, and the importance of completing prescribed treatment. Support and counseling matter too, since infection can carry real anxiety and stigma.

Teach the patient and caregivers about the infectious process. Educate the patient and, when needed, report the case to public health for contact tracing and followup. Infectious disease can feel mysterious and stigmatizing, so teach with empathy.

Have caregivers obtain accurate temperature readings. Fever signals infection severity and whether antibiotics are working, so outpatients with fever should learn to take accurate readings. Families often note warm skin without taking a temperature, and that number helps adjust therapy or reconsider a diagnosis.

Teach proper cleaning, disinfecting, and sterilizing. Cleaning with soap or detergent lowers the number of germs on surfaces. Sanitizing reduces what remains after cleaning, and disinfecting kills harmful germs left behind. Clean surfaces first, since dirt makes it harder for sanitizing or disinfecting chemicals to reach and kill germs.

Teach the patient to avoid people with infections or colds, and to keep physical distance. Infections spread to susceptible patients (immunocompromised especially) through direct contact, contaminated objects, or air. During COVID-19, avoiding contact with people carrying the virus, symptomatic or not, lowered the risk of catching it.

Demonstrate and have the patient return-demonstrate all high-risk procedures they will do after discharge, such as dressing changes and peripheral or central IV site care. Patients and families need to master these skills, and return demonstration before discharge confirms they can do them correctly.

Teach the purpose and technique of maintaining isolation. Understanding isolation helps patients and families cooperate with precautions. Nurses model hygiene in every part of care and have countless chances to either spread or stop organisms.

If infection occurs, teach the patient to take anti-infectives as prescribed and to finish the full antibiotic course even when symptoms improve. Antibiotics work best at a constant blood level. Stopping early breeds resistance and lets symptoms return. Hospitals increasingly run antimicrobial stewardship programs to control resistance, improve outcomes, and reduce cost.

Tell patients and caregivers to remind staff who skip infection control steps. Watch others' hand hygiene and call out lapses, and help patients and families feel comfortable reminding staff to perform hand hygiene before contact.

Provide information on vaccines and vaccination programs. Vaccination prevents specific infectious diseases across a population. An annual influenza vaccine is recommended for everyone 6 months or older unless contraindicated. Immunosuppressed adults should be vaccinated against pneumococcus and meningococcus, and healthcare workers should be immune to measles, mumps, rubella, pertussis, tetanus, hepatitis B, and varicella.

Teach patients to report problems after vaccination. Ask adult recipients about any problems after vaccination. As required by law, a Vaccine Adverse Event Reporting System (VAERS) form must be completed and can be submitted online.

Tell caregivers to disinfect all equipment and the patient's surroundings and use aseptic technique. Catheter-related sepsis should be suspected in any patient with unexplained fever, redness, swelling, or drainage around a vascular catheter site, and reported promptly.

Teach the family how to reduce their own risk of infection. Reasonable barriers to transmission in the household are part of home care. If the patient has active pulmonary TB, contact the public health department for family screening and treatment. Physical separation matters for immunosuppressed patients and their families when varicella is present.

Teach sharps safety if the patient has a bloodborne infection. Family members helping care for a patient with HIV or hepatitis C can prevent transmission by careful handling of any sharp contaminated with blood, with caution when shaving the patient, changing dressings, or giving IV, intramuscular, or subcutaneous medication. Use containers designed for sharps disposal.

Encourage time outdoors and better ventilation. Improved ventilation and filtration keep virus particles from building up in indoor air, which helps protect the patient from catching and spreading the virus that causes COVID-19. Spending time outside instead of inside helps too.