Module 15 of 15 · 50 minutes
Standard 15: Infection prevention and control
By the end of this module you will be able to
- Apply standard infection control precautions consistently
- Perform hand hygiene to the correct technique at the correct moments
- Use personal protective equipment correctly, including donning and doffing order
- Explain the chain of infection and where each link can be broken
Work through it
2 interactives for this module, built on the WAJD Teach engine. Nothing moves until you ask it to, and every one has a written version if you would rather read it.
Amara Infection control is the training everybody has sat through most often. What do people still get wrong?
Nadia Gloves, mostly. But before the rules, let me give you the reason behind them, because rules without reasons get skipped at half past six on a bad shift.
Amara Go ahead.
Nadia Infection needs six links in a chain. An infectious agent. A reservoir where it lives. A portal of exit. A mode of transmission. A portal of entry. And a susceptible host. Break any one link and the infection does not happen.
Amara So every rule is breaking a link.
Nadia Exactly. Hand hygiene breaks transmission. Isolation breaks transmission. Catheter care protects a portal of entry. Good nutrition and vaccination reduce host susceptibility. Safe waste disposal removes the reservoir. Once you can see which link you are breaking, the rule stops being arbitrary.
Amara Hand hygiene. Everybody knows this one.
Nadia Everybody knows it and compliance in audits is routinely well under a hundred per cent. The World Health Organization Five Moments are: before touching a patient, before a clean or aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching their surroundings.
Amara That last one, surroundings. People miss that.
Nadia Constantly. You straighten a bed rail, you touch a table, you go to the next person. That is transmission.
Amara Gel or soap?
Nadia Soap and water whenever hands are visibly soiled, and always after caring for anybody with diarrhoea and vomiting. Alcohol gel does not reliably kill Clostridioides difficile spores or norovirus. In an outbreak, gel alone gives you false confidence.
Amara How long?
Nadia At least twenty seconds, all steps of the technique, and then dry thoroughly. Drying is not the optional bit at the end. Damp hands transfer organisms far more readily than dry ones.
Amara Bare below the elbows. Is that real or is it a uniform preference?
Nadia Real. No wrist watch, no stoned rings, no long nails, no gel nails. Cuts covered with a waterproof dressing. All of those harbour organisms and all of them stop you washing properly.
Amara Right. Gloves. You said this is the big one.
Nadia The commonest error in every service I have ever audited is the same glove worn for more than one task, or more than one person. Gloves worn continuously are not a barrier. They are a transport system.
Amara That is a horrible image and I will remember it.
Nadia Good. And gloves are never a substitute for hand hygiene. Clean your hands before you put them on and after you take them off, every time.
Amara What is the order for putting PPE on and taking it off?
Nadia On: apron, then mask if needed, then eye protection if needed, then gloves. Off: gloves first, then apron, then eye protection, then mask, cleaning your hands between the steps and at the end. And take it off in the room, not in the corridor.
Amara Why does the doffing order matter?
Nadia Because you are removing the most contaminated thing first, and working towards your own face last. Do it backwards and you wipe a contaminated glove across your own eyes.
Amara Isolation. Anything beyond follow the sign?
Nadia Yes, and it is a point of principle. An isolated person is at real risk of loneliness, low mood and physical deterioration. So isolation must be reviewed and it must end when it is no longer needed. I have seen signs left on doors for weeks because nobody owned taking them down.
Amara And outbreaks?
Nadia Two or more linked cases and you report, so the health protection team can act. For diarrhoea and vomiting the forty eight hour rule generally applies before returning to work or ending isolation.
Amara You mentioned antibiotic resistance. What can a care worker actually do about that?
Nadia More than you would think. Report accurate symptoms rather than conclusions. Cloudy or strong smelling urine on its own is not a urinary tract infection. Asymptomatic bacteriuria is very common in older adults, and treating it causes harm without benefit. So describe what you actually observed, and let the clinician decide.
The written material
The chain of infection
Infection needs six links: an infectious agent, a reservoir where it lives, a portal of exit, a mode of transmission, a portal of entry, and a susceptible host. Break any link and the infection does not happen.
Almost everything you do in infection control is breaking one of those links, and knowing which one turns a rule into a reason. Hand hygiene breaks transmission. Isolation breaks transmission. Catheter care protects a portal of entry. Nutrition and vaccination reduce host susceptibility. Safe waste disposal removes the reservoir.
Hand hygiene, done properly
Hand hygiene is the single most effective measure and the most commonly skipped. The World Health Organization Five Moments are: before touching a patient, before a clean or aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching patient surroundings.
Soap and water is required rather than alcohol gel when hands are visibly soiled, and after caring for anyone with diarrhoea and vomiting, because alcohol gel does not kill Clostridioides difficile spores or norovirus reliably. Wash for at least 20 seconds using all steps of the technique, and dry thoroughly, because wet hands transfer organisms far more readily than dry ones.
- Bare below the elbows: no wrist watch, no stoned rings, no long or gel nails
- Cover cuts with a waterproof dressing
- Alcohol gel is not effective against C. difficile spores or norovirus, use soap and water
- Dry thoroughly; damp hands spread organisms
PPE, and the order that matters
PPE is selected by the task and the risk, not by habit. Gloves are for anticipated contact with blood, body fluids, mucous membranes or broken skin. Gloves are not a substitute for hand hygiene, and hands must be cleaned before and after their use.
Donning order: apron, then mask if needed, then eye protection if needed, then gloves. Doffing order is the reverse of contamination risk: gloves, then apron, then eye protection, then mask, with hand hygiene between steps and at the end. Remove PPE in the room, not the corridor, and dispose of it as clinical waste.
Isolation, outbreaks and antimicrobial resistance
Where an infection is transmissible, source isolation protects others. Follow the signage, use dedicated equipment, and remember the dignity cost: an isolated person is at real risk of loneliness and deterioration, so isolation must be reviewed and never left to run on out of habit.
Two or more linked cases may indicate an outbreak and must be reported so the health protection team can act. In diarrhoea and vomiting, the 48 hour rule generally applies before returning to work or ending isolation.
Antimicrobial resistance is driven partly by unnecessary prescribing. Reporting accurate symptoms rather than assuming a urinary tract infection from cloudy urine alone is a real contribution: asymptomatic bacteriuria is common in older adults and treating it causes harm.
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