Standard precautions are the foundation
Standard precautions apply to every client, every time, regardless of diagnosis or presumed infection status. They cover hand hygiene, gloves whenever contact with blood, body fluids, secretions, excretions, non-intact skin or mucous membranes is anticipated, and additional barriers such as gown, mask and eye protection when splashing is likely.
Hand hygiene is the single most commonly tested infection control action, and it is the correct answer more often than candidates expect. Alcohol-based hand rub is appropriate for most situations, but soap and water is required when hands are visibly soiled and when caring for a client with Clostridioides difficile or other spore-forming organisms, because alcohol does not destroy spores.
Sharps safety belongs here too: never recap needles, dispose in a puncture-resistant container at the point of use, and never overfill a sharps container. These appear as straightforward knowledge items and as embedded errors in scenario stems where you must identify what the nurse did wrong.
- •Hand hygiene before and after every client contact, and after glove removal
- •Soap and water for visibly soiled hands and for C. difficile
- •Gloves for anticipated contact with any body fluid or non-intact skin
- •Never recap needles; dispose at point of use
The three transmission-based categories
Transmission-based precautions are layered on top of standard precautions, never instead of them. Contact precautions require a gown and gloves on room entry and dedicated equipment where possible. Droplet precautions require a surgical mask when within about six feet of the client, and a private room or cohorting. Airborne precautions require a negative-pressure room, an N95 respirator or higher, and a surgical mask on the client during transport.
The exam rarely asks you to define a category; it asks you to apply one. A stem describes a client with suspected pulmonary tuberculosis and asks which room to assign, which PPE to don, or what to do first. The answer depends entirely on you having memorised the disease-to-category mapping, so build that mapping early and rehearse it weekly.
Transport is a recurring sub-topic. When a client on airborne precautions must leave the room, the client wears the surgical mask; staff PPE requirements do not simply transfer to corridor use. When a client on contact precautions is transported, cover the affected area and change gown and gloves before leaving.
| Precaution | PPE | Room | Key diseases |
|---|---|---|---|
| Contact | Gown and gloves on entry | Private or cohort | C. difficile, MRSA, VRE, scabies, RSV, impetigo |
| Droplet | Surgical mask within 6 feet | Private or cohort | Influenza, pertussis, meningococcal meningitis, mumps, rubella, group A strep |
| Airborne | N95 respirator | Negative pressure, door closed | Tuberculosis, measles, varicella, disseminated zoster |
| Protective (neutropenic) | Standard plus source control | Positive pressure, HEPA filtered | Severe neutropenia, transplant recipients |
Donning, doffing and neutropenic care
Donning order is gown, mask or respirator, goggles or face shield, then gloves. Doffing is where contamination happens, so the order matters more: gloves, goggles or face shield, gown, then mask or respirator, performing hand hygiene between steps and immediately after. Remember that the mask comes off last because the room air is the hazard until you have left.
Protective or neutropenic precautions reverse the logic: instead of containing an organism, you are protecting a vulnerable client from the environment. That means a positive-pressure room, no fresh flowers or standing water, no raw or undercooked foods depending on institutional policy, restricting visitors with any infectious symptoms, and meticulous hand hygiene from everyone who enters.
Watch for the classic exam trap where a neutropenic client's only sign of serious infection is a low-grade fever, because the inflammatory response is blunted. In a neutropenic client, a fever is an emergency and requires prompt reporting, blood cultures and antibiotics, not watchful waiting.
- •Don: gown, mask, eye protection, gloves
- •Doff: gloves, eye protection, gown, mask — hand hygiene throughout
- •Neutropenic clients need positive-pressure rooms and no fresh flowers or standing water
- •Fever in a neutropenic client is an emergency, not a routine finding
How to drill this content efficiently
Infection control is the highest ratio of marks to study hours on the whole exam because the content is finite and the questions are direct. Spend one focused hour building the disease-to-precaution table from memory, then test yourself on it twice a week for a month. Recall practice, not rereading, is what makes it automatic.
Then practise it in context. Infection control frequently hides inside management of care items about room assignment and inside fundamentals items about technique. A question asking which client can share a room with whom is really a precautions question wearing a different hat.
Our fundamentals and management of care question sets embed precautions inside realistic assignment scenarios, which is the format most likely to appear on your exam. Work a set, review every rationale, and rewrite any precaution you missed onto your table before your next session.