NCLEX-RN cheat sheet · Safety and infection control
Infection control and isolation
Standard and transmission-based precautions, hand hygiene, PPE order, sterile technique
AI-checkedChecked by AI against current guidelines, with spot-checks by a registered nurse.
Standard precautions are the minimum for every client, in every setting. Transmission-based precautions sit on top of them, never instead.
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At a glance
Contact, droplet or airborne
| Contact | Droplet | Airborne | |
|---|---|---|---|
| Spreads by | Touch: directly, or on surfaces and equipment | Large droplets from coughing, sneezing or talking; they fall within a few feet | Tiny particles that stay in the air and travel farther |
| Room | Single room if possible; or cohort the same organism; or beds more than 3 feet apart, curtain drawn | Single room if possible; or more than 3 feet apart, curtain drawn | Airborne infection isolation room: negative pressure to nearby areas, the right air exchanges, safe exhaust or HEPA filters. Door closed |
| You wear | Gown and gloves: on as you enter, off before you leave | Mask, on as you enter | Fit-tested N95 or higher-level respirator. A surgical mask isn't enough |
| Examples | C. difficile, norovirus, MRSA and other resistant organisms, RSV, scabies, lice | Influenza, pertussis, mumps, meningococcal disease | Tuberculosis, measles, chickenpox |
| How long | By the organism's guidance: norovirus, 48 hours after symptoms end | Meningococcal: 24 hours of effective therapy. Pertussis: 5 days of effective antibiotics | Confirmed TB: until the client improves on effective treatment and has 3 consecutive negative sputum smears, on separate days |
Plus standard precautions: Add eye and splash protection as standard precautions require, plus what the germ or procedure requires.
Chickenpox and shingles
| Client | Precautions |
|---|---|
| Chickenpox, or widespread shingles | Airborne plus contact, until lesions crust |
| Localized shingles, immunocompromised client | Airborne plus contact, until spread is ruled out |
| Localized shingles, healthy immune system | Standard precautions, with all lesions covered until dry and crusted |
Staffing: Staff who aren't immune to measles or chickenpox shouldn't care for those clients if immune staff are available.
Which hand hygiene?
| Situation | Use |
|---|---|
| Hands look clean | Alcohol rub: kills germs better, easier on the skin |
| Visibly soiled (blood, body fluids); before eating; after the restroom | Soap and water |
| C. difficile or norovirus | CDC: rub still preferred unless soiled. Many agencies require soap and water in outbreaks. Exam: soap and water |
| Technique | Rub until dry, about 20 seconds; scrub with soap at least 20 seconds. Most missed: thumbs, fingertips, between fingers |
When: Before client contact or a clean task, dirty to clean site, after contact or body fluids, right after removing gloves. Gloves never replace hand hygiene.
Putting on and taking off PPE
| Order | Get it right | |
|---|---|---|
| Put on | Hand hygiene → gown → mask or respirator → goggles or face shield → gloves last, over the gown's cuffs | Gown covers neck to knees, arms to wrists. Mask band shaped to the nose, snug under the chin. Fit-check a respirator every time |
| Remove | Gloves first → goggles or face shield → gown → mask or respirator → hand hygiene | The outsides are dirty. Goggles by the strap; gown touching only the inside, rolled away; mask by the ties, without touching the front |
| Where | Everything off at the doorway, except a respirator | The respirator comes off after you leave and close the door |
Follow policy: Dirtiest items first, mask last, because it sits on your face. Clean your hands between steps if they get contaminated. Agencies may teach another safe order, like gown and gloves together.
Chain of infection: break any link and it stops
| Infectious agent | Reservoir | Portal of exit | Mode of transmission | Portal of entry | Susceptible host | |
|---|---|---|---|---|---|---|
| Break | Treat the infection | Clean and disinfect | Cover coughs; dress wounds | Hand hygiene: germs travel most often on hands | Aseptic technique | Rest, nutrition, oral care, daily bathing |
Standard precautions: every client
- Gloves for expected contact with blood, body fluids, mucous membranes or broken skin. Never one pair for two clients; change from a dirty site to a clean one.
- Gown if your clothes could be soiled: off before you leave the room, never reused.
- Splashes or sprays likely? Protect your eyes, nose and mouth.
- Used needles aren't recapped, bent or removed: safety device, then straight into the sharps container. Recapping unavoidable? One-handed scoop or a device.
- One needle, one syringe, one client. Single-dose vials: one client only.
- Coughing clients and visitors get a mask; at least 3 feet of space when respiratory infections are going around.
Sterile technique
- Only sterile items on a sterile field. Check packages for moisture, tears, the expiry date and the indicator.
- The outer inch, and anything below the table edge, counts as contaminated.
- Keep sterile items between waist and shoulders, in sight. Turn away and the field is no longer sterile.
- First flap away from you, last toward you, so you never reach over the field.
- Drop items from about 6 inches; pour from the side. Moisture wicks germs through.
- In doubt, it's contaminated. Discard the field and set up a new one.
Priority and safety calls
- ★ Start precautions when you suspect the infection. Don't wait for the lab to confirm it.
- ★ Airborne: keep the door closed except to go in and out. A client with TB never shares a room: airborne isolation room, or transfer to a facility that has one.
- Clients leave the room only when medically necessary. On droplet or airborne precautions, the client wears a surgical mask, lesions are covered, and you tell the receiving department first.
- Contact: use the client's own equipment, like a stethoscope and blood pressure cuff. Shared equipment is cleaned and disinfected before the next client.
- Not enough single rooms? Contact precautions: first to drainage that can't be contained, or stool incontinence.
- Nursing homes: enhanced barrier precautions for a resistant organism, a wound or an indwelling device like a catheter, when contact precautions don't otherwise apply. Gown and gloves only for high-contact care; no room restriction. A resistant organism with uncontained drainage or acute diarrhea needs contact precautions.
- Isolation never means less care: visit, check in, keep the call light in reach. Explain why it's needed and how long it may last.
How the NCLEX tests it
- Contact: gown and gloves. Droplet: a mask. Airborne: a negative-pressure isolation room and a fit-tested N95 or higher respirator.
- Traps: a surgical mask for TB, an open door on airborne precautions, and taking a respirator off in the room.
- Removing PPE, gloves come off first: they're the most contaminated.
- Clients with the same organism can share a room (cohorting). Draining MRSA shouldn't room with an immunocompromised client.
- Gloves don't replace hand hygiene. With C. difficile on the exam, choose soap and water.
- Probably sterile isn't sterile: in doubt, discard the field and start again.
- Localized shingles in a healthy host: standard precautions, with all lesions covered until dry and crusted.
Practice it next
This sheet comes from Standard precautions, hand hygiene and asepsis and Transmission-based precautions and PPE in our NCLEX-RN course. Try free practice questions, or see the lessons it was written from.
Quick self-quiz
- TB, measles and chickenpox need ___ precautions.
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airborne - An airborne isolation room is at ___ pressure to the areas around it.
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negative - Pertussis needs droplet precautions until ___ days of effective antibiotics.
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5 - Taking off PPE, the ___ come off first.
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gloves - Hands visibly soiled with blood need ___.
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soap and water - Rooming clients with the same organism together is called ___.
Show answer
cohorting
Sources
- CDC/HICPAC, Guideline for Isolation Precautions (full guideline, PDF)
- CDC/HICPAC, 2007 Guideline for Isolation Precautions, Appendix A: Type and Duration of Precautions
- CDC, Sequence for Putting On and Removing PPE
- CDC, Hand Hygiene for Healthcare Workers
- CDC, Standard Precautions for All Patient Care
- CDC, Implementation of PPE in Nursing Homes (Enhanced Barrier Precautions)
- Open RN, Nursing Skills 2e, 4.4 Sterile Fields
More safety and infection control cheat sheets
Educational use only. This sheet is a study aid for the NCLEX-RN, not a substitute for clinical judgment, your facility’s policy or the provider’s orders. Where practice varies, follow facility policy and state law. NCLEX® and NCLEX-RN® are registered trademarks of NCSBN, which does not endorse these materials.