Asepsis, infection control, and fundamentals of care

Infection control and basic care items are guaranteed on the NLE. Most are recall questions with one twist: the exam pairs the concept with a scenario, so you must know which rule applies where.

Medical vs surgical asepsis

Medical asepsis (clean technique) reduces the number and spread of microorganisms: hand hygiene, routine cleaning, clean gloves for contact with body fluids. Surgical asepsis (sterile technique) eliminates all microorganisms and spores from an area: catheter insertion, sterile dressing changes, parenteral injections, the operating field.

Core sterile-field rules:

• Only sterile touches sterile; sterile below the waist or out of sight is contaminated.
• A 1-inch (2.5 cm) border around a sterile field is considered contaminated.
• Keep sterile objects above waist level; never reach across or turn your back on a sterile field.
• Moisture carries organisms: a wet sterile field on an unsterile surface is contaminated (strike-through).
• When in doubt, it is out.

Hand hygiene and precautions

Hand hygiene is the single most effective way to prevent infection transmission. Wash with soap and water for at least 20 seconds when hands are visibly soiled and after caring for clients with C. difficile (alcohol does not kill spores); otherwise alcohol-based rub is acceptable. Follow the WHO five moments: before client contact, before aseptic tasks, after body fluid exposure, after client contact, and after touching the client's surroundings.

Standard precautions apply to every client, every time: treat all blood and body fluids as infectious, wear gloves for contact with them, and never recap used needles.

Precaution	Key diseases	Main requirements
Airborne	Pulmonary TB, measles, varicella	Private negative-pressure room, N95 respirator, door closed
Droplet	Influenza, pertussis, mumps, meningococcal meningitis	Private room or cohort, surgical mask within 1 meter (3 feet)
Contact	MRSA, C. difficile, scabies, RSV	Gown and gloves, dedicated equipment, private room or cohort

Personal protective equipment: don gown, mask, goggles, gloves; doff gloves first, then goggles, gown, mask, with hand hygiene after.

Mobility and positioning

Immobility hazards include pressure injuries, contractures, orthostatic hypotension, venous thrombosis, constipation, and hypostatic pneumonia. Reposition dependent clients at least every 2 hours and keep heels off the bed. High-yield positions: semi-Fowler's (30 to 45 degrees) for dyspnea and tube feeding; high Fowler's (60 to 90 degrees) for severe respiratory distress and during meals for aspiration risk; side-lying (Sims') for unconscious clients to drain secretions and for enema administration (left Sims'); Trendelenburg is no longer routine for shock; supine with the head flat after lumbar puncture. Use a wide base of support and raise the bed to work height when moving clients; pivot, do not twist.

Nutrition, elimination, oxygenation basics

• Nasogastric feeding: verify placement (x-ray is the gold standard initially; pH of aspirate 4 or less suggests gastric placement), elevate the head at least 30 degrees during and 30 to 60 minutes after feeding, and check residuals per policy.
• Urinary elimination: normal output is at least 30 mL per hour; report less. For catheterized clients keep the drainage bag below bladder level and off the floor, and use a closed system.
• Bowel: for constipation increase fluids, fiber, and activity first; for an enema position the client left side-lying with the right knee flexed; stop if pain occurs.
• Oxygenation: nasal cannula delivers 1 to 6 liters per minute (24 to 44 percent oxygen); humidify at 4 liters or more. For COPD clients use the lowest effective flow and titrate to the prescribed saturation target. Oxygen supports combustion, so post "no smoking" signage.

Medication administration rights

The classic rights: right client (two identifiers), right drug, right dose, right route, right time, plus right documentation, right reason, right response, and the client's right to refuse. Check the label three times: when taking the container, when preparing, and when returning or discarding. Question illegible orders and unusual doses; the nurse who administers a wrong medication shares liability even with a valid order. Never document a medication before giving it, and never give a medication someone else prepared.

Key points

• Medical asepsis limits organisms; surgical asepsis eliminates them; when sterility is in doubt, discard.
• Hand hygiene is the number one infection control measure; soap and water for visible soil and C. difficile.
• Airborne = N95 and negative pressure; droplet = surgical mask; contact = gown and gloves.
• Reposition every 2 hours; elevate the head for feeding; left Sims' for enemas.
• Output below 30 mL per hour is reportable; keep urine bags below the bladder.
• Verify two client identifiers and perform three label checks for every medication.

Exam-day strategy

• Match the disease to the precaution first; the room and mask follow automatically.
• For sterile technique stems, scan for any action that breaks a rule (turning away, reaching over, wet field); that action is the answer.
• On medication error items, the safest answer usually verifies or questions before giving.