CNA · Basic Nursing Skills · 6 min read
Isolation Precautions, Bed Making, Linens and Biohazard Waste
- Differentiate between contact, droplet, and airborne transmission-based precautions, including proper personal protective equipment sequences and room requirements.
- Apply safe infection control practices for handling clean and soiled linens and disposing of biohazard waste and sharps within the nurse aide role.
- Demonstrate proper bed making procedures for closed, open, surgical, and occupied beds while maintaining resident safety, comfort, and skin integrity.
Transmission-Based Precautions and PPE Sequences
In healthcare settings, standard precautions are used for everyone, but transmission-based precautions are used in addition to standard precautions for residents with known or suspected contagious infections. These precautions are categorized based on how specific pathogens travel from person to person. The three categories of transmission-based precautions are contact precautions, droplet precautions, and airborne precautions. Following the specific rules for each category protects other residents, visitors, and the nursing team from the spread of infectious illnesses.
Contact precautions are used for infections spread by direct or indirect contact with a resident or contaminated surfaces or equipment, such as Clostridioides difficile and MRSA. When caring for a resident on contact precautions, the nurse aide must put on a clean gown and gloves before entering the resident's room. Equipment also requires special consideration: the nurse aide should use dedicated resident-care equipment for a resident on contact precautions when possible, and any shared equipment must be cleaned and disinfected before use with another resident. Hand hygiene methods depend on the specific pathogen. For example, when caring for a resident with Clostridioides difficile, the nurse aide must wash hands with soap and water because alcohol rubs do not kill spores.
Droplet precautions are used for diseases transmitted through large respiratory droplets from coughing or sneezing, such as influenza. For droplet precautions, the nurse aide must put on a surgical mask before entering the resident's room. If transport outside the room is necessary, a resident on droplet precautions should wear a surgical mask if tolerated. Airborne precautions are used for pathogens that remain infectious suspended in the air over long distances, such as tuberculosis. Airborne precautions require the nurse aide to wear a fit-tested N95 or higher-level respirator mask before entering the room. Residents requiring airborne precautions are placed in a specialized airborne infection isolation room with negative air pressure, and the nurse aide must keep the door to an airborne infection isolation room closed except when entering or leaving.
Putting on and taking off personal protective equipment, known as PPE, must always follow a specific order to prevent contaminating clean clothing or skin. The recommended sequence for donning personal protective equipment is gown first, then mask or respirator, goggles or face shield, and gloves last. When leaving the care area, one recommended sequence for removing personal protective equipment is gloves, goggles or face shield, gown, then mask or respirator. A respirator must be removed after leaving the room. The nurse aide must perform hand hygiene immediately after removing personal protective equipment.
| Precaution Category | Example Pathogen / Disease | Required PPE for Nurse Aide | Key Environmental or Care Practice |
|---|---|---|---|
| Contact Precautions | Clostridioides difficile, MRSA | Clean gown and gloves before entering room | Wash hands with soap and water for C. difficile; use dedicated equipment when possible or clean/disinfect shared equipment |
| Droplet Precautions | Influenza | Surgical mask before entering the room | Resident wears surgical mask during transport outside room if tolerated |
| Airborne Precautions | Tuberculosis | Fit-tested N95 or higher-level respirator mask before entering room | Specialized airborne infection isolation room with negative air pressure; keep door closed except when entering or leaving |
Common mistakes
- Returning unused clean sheets to the clean linen cart after bringing them into a resident's room, rather than treating them as contaminated.
- Using alcohol-based hand rub instead of washing with soap and water after caring for a resident with Clostridioides difficile.
- Placing soiled or damp linens on the floor, overbed table, or resident chair instead of rolling them inward and placing them directly into a designated laundry bag or hamper.
- Trying to push or force trash into an overfilled sharps container rather than stopping use at the fill line and reporting it to the nurse.
Key points
- Transmission-based precautions (contact, droplet, and airborne) are used in addition to standard precautions for residents with known or suspected contagious infections.
- Contact precautions require a gown and gloves, droplet precautions require a surgical mask, and airborne precautions require a fit-tested N95 or higher-level respirator mask and a negative pressure room with the door kept closed.
- Clean linens must be held away from the uniform and never returned to the clean cart once taken into a room, while soiled linens must be rolled inward without shaking and placed directly into laundry bags.
- Disposable non-sharp items saturated with blood or potentially infectious materials go into red or labeled biohazard containers, while sharps go directly into puncture-resistant sharps containers without recapping or bending.
- Beds must be raised to waist height with wheels locked during bed making, and returned to the lowest position with the call light in reach before leaving.
- Bottom linens must be pulled tight and wrinkle-free to prevent skin friction and pressure injuries, while a toe pleat relieves pressure on the resident's feet.
- Any skin tears, reddened areas, or breakdown observed during bed making, as well as any sharps injuries, must be reported to the nurse immediately.
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