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Study guide · Safe and Effective Care Environment

Safety and Infection Prevention and Control

10 to 16% of the exam · 13 activity statements

Safety and Infection Prevention and Control covers how the practical nurse keeps clients, visitors and staff from harm: identifying clients, allergies, checking orders, catching errors, safe handling and equipment, restraints, security, emergencies, routine practices and additional precautions, and hazardous materials. On the REx-PN, items ask what the nurse does first to prevent harm, which precaution fits an organism, and when to stop, clarify or report. Answers follow Canadian guidance (routine practices and additional precautions, WHMIS) and the facility's policy, which the nurse follows in both British Columbia and Ontario.

A study feature written by ExamDragon, not part of the real exam. Each heading is one of the Related Activity Statements the Test Plan lists for this category (13 of them), in our words; the official wording is in the Test Plan.

At a glance

Safe and Effective Care Environment
10 to 16%

of the exam (the Test Plan's range)

Activity statements
13
Key terms
8

What this guide covers, statement by statement

  1. Confirm the client's identity correctly before giving care
  2. Assess for allergies or sensitivities and act on what you find
  3. Check that a prescriber's order is correct and suitable
  4. Spot errors and near misses in practice and act on them
  5. Teach clients and staff how to prevent and control infection
  6. Apply good body mechanics and safe handling while giving care
  7. Make sure equipment and its technology are used correctly and safely
  8. Meet the rules that govern restraint use
  9. Follow the facility's security procedures, for example for newborns or locked areas
  10. Teach the client how to stay safe and avoid injury, such as from falls
  11. Take part in planning for and responding to emergencies
  12. Use infection prevention and control principles, such as hand hygiene, aseptic technique and routine practices
  13. Handle hazardous and biohazardous materials by the set procedures

1Confirm the client's identity correctly before giving care

  • Confirm identity with at least two client-specific identifiers (full name, date of birth, health number, medical record number or a current photo) before every medication, treatment, specimen or procedure.
  • Ask open questions ("Please tell me your full name and date of birth") and compare the answers with the wristband, MAR or requisition.
  • A room number, bed location, diagnosis or a nod to a spoken name is never an identifier.
  • Label specimens at the bedside in the client's presence, never ahead of time.
  • When a band is missing or wrong, or two clients share a name, hold non-urgent care until identity is confirmed and the band replaced per policy.
  1. In practiceTwo residents named Singh share a long-term care hall. Before giving morning medications, the nurse compares the photo and date of birth on the MAR with the resident, rather than relying on the room or a familiar face.
  2. Where questions turnAccepting a yes to "Are you Mr. Singh?" or the room number as proof of identity.
Practise this activity

2Assess for allergies or sensitivities and act on what you find

  • Ask every client at every admission about drug, food, latex and environmental allergies, and what happened during each reaction.
  • Record the substance, the reaction, its severity and the date; flag the allergy per policy (band, MAR, electronic record).
  • Separate intolerances (nausea from codeine) from allergic reactions (hives, swelling, wheeze, anaphylaxis).
  • Check every new prescription against the allergy record, including drug classes; hold and clarify any conflict with the prescriber.
  • Hives with throat tightness, wheeze or low blood pressure is anaphylaxis: stay, call for help and start the facility's anaphylaxis protocol (intramuscular epinephrine first).
  1. In practiceA client with a recorded sulfa allergy has a new prescription for sulfamethoxazole-trimethoprim. The nurse holds the dose and contacts the prescriber for an alternative, then documents the clarification.
  2. Where questions turnGiving an antihistamine or rechecking vital signs later when the client has signs of anaphylaxis.
Practise this activity

3Check that a prescriber's order is correct and suitable

  • A complete prescription names the client, drug, dose, route, frequency, and for PRN orders the reason; anything missing is clarified before acting.
  • Check that the order fits the client: allergies, weight-based doses, a safe daily total, the client's condition and other orders (for example, NPO for surgery).
  • The nurse never changes, completes or guesses at an order; only the prescriber can, and the clarification is documented.
  • Take telephone or verbal orders only when policy allows: write it down, read it back in full and get confirmation.
  • Clarify do-not-use abbreviations (U, IU, QD, trailing zeros, missing leading zeros) rather than interpreting them.
  1. In practiceAn order reads acetaminophen 1,000 mg every 2 hours PRN. The nurse sees that this could exceed the safe daily maximum and calls the prescriber before giving any dose.
  2. Where questions turnFixing an unclear order on one's own, or giving it first and documenting a concern afterward.
Practise this activity

4Spot errors and near misses in practice and act on them

  • After an error, assess the client first, then notify the prescriber and the RN or charge nurse and follow any new orders.
  • Report errors and near misses (good catches) in the facility's safety reporting system; near misses show system problems before harm occurs.
  • Document in the health record only the facts of care (what was given, the assessment, who was notified); never mention the incident report there.
  • Stop an error that is about to happen (wrong diet, wrong client, unsafe transfer) before it reaches the client, then teach and report.
  • Controlled substance count discrepancies are never signed off; report them before either nurse leaves.
  1. In practicePharmacy sends warfarin 5 mg for a client prescribed 0.5 mg. The nurse does not give it, obtains the right strength and reports the near miss in the safety reporting system.
  2. Where questions turnCompleting paperwork before assessing the client who received the wrong drug.
Practise this activity

5Teach clients and staff how to prevent and control infection

  • Reinforce the four moments for hand hygiene with clients, families and UCPs: before initial client or environment contact, before an aseptic procedure, after body fluid exposure risk, after client or environment contact.
  • Alcohol-based rub is used unless hands are visibly soiled; soap and water are preferred for C. difficile when a sink is available.
  • Teach respiratory etiquette: cough into a tissue or the elbow, a mask for people with symptoms in waiting areas, 2 metres of separation.
  • Teach visitors the precautions on the door sign and how to put on and remove the equipment.
  • Gloves never replace hand hygiene; artificial nails are not worn by staff giving care.
  1. In practiceA family visiting a client with C. difficile asks whether the alcohol rub is enough. The nurse explains that soap and water at the sink remove the spores and shows them where to wash before leaving.
  2. Where questions turnTeaching that gloves or alcohol rub alone are enough for every organism.
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6Apply good body mechanics and safe handling while giving care

  • Assess the client's weight bearing, strength, cooperation and size before any transfer, and use the method and equipment the care plan names.
  • A client who cannot bear weight is moved with a full-body mechanical lift; a sit-to-stand lift needs partial weight bearing and the ability to follow directions.
  • Use slings of the type and size listed for the client and that lift model; never mix brands.
  • Work at waist height, keep a wide base, bend the knees, keep the load close, avoid twisting, and use friction-reducing sheets with enough helpers.
  • If a client starts to fall while walking, do not try to hold them up: use the gait belt to ease them to the floor.
  1. In practiceA 110 kg client after a stroke cannot stand. The nurse uses the full-body lift with a coworker, as the care plan states, rather than a pivot transfer.
  2. Where questions turnManually lifting a dependent client because the lift is down the hall.
Practise this activity

7Make sure equipment and its technology are used correctly and safely

  • Inspect equipment before use: cords, plugs, alarms and a current safety inspection label; take damaged items out of service, tag and report them.
  • Run quality control on point-of-care devices (glucose meters) as policy requires; a failed control means the device is not used.
  • Store oxygen cylinders upright and secured; check that the supply will last the trip (pressure minus residual, times the cylinder factor, divided by the flow).
  • When a reading does not match the client (a low oximeter value in a comfortable client), check the client first, then the device.
  • Use only equipment you are trained on, and keep bed alarms, call bells and bed brakes working and in use.
  1. In practiceA glucose meter fails its morning control test. The nurse removes it from use, labels it and reports it, then checks the client's glucose with a meter that passes.
  2. Where questions turnUsing a device that failed a check and adding a note that the result may be wrong.
Practise this activity

8Meet the rules that govern restraint use

  • Least restraint is the standard: assess the cause of the behaviour and try alternatives (toileting, pain relief, company, low bed, alarms, removing the irritant) first.
  • A restraint is any physical, chemical or environmental measure the client cannot remove at will, including four raised rails or a drug given to control behaviour.
  • Use a restraint only as a last resort to prevent serious harm, with consent from the client or substitute decision-maker (or under emergency rules) and per policy and any required order.
  • Tie to the bed frame with a quick-release tie, two fingers' space, call bell in reach; check circulation, skin, comfort and toileting and release as policy sets.
  • Document the behaviour, alternatives tried, the restraint, consent or authority, every check and removal; reassess the need often.
  1. In practiceA client with dementia keeps pulling at his catheter tubing. The nurse checks for pain and a full bag, secures and covers the tubing and asks whether the catheter is still needed, instead of applying wrist restraints.
  2. Where questions turnChoosing a restraint, a sedative or four raised rails before trying alternatives.
Practise this activity

9Follow the facility's security procedures, for example for newborns or locked areas

  • Newborn security: matching identification bands for infant and parent, infant security tags, controlled unit access and staff photo identification.
  • Teach parents to hand their baby only to staff wearing the unit's photo badge, never to leave the baby alone, and to report anyone suspicious.
  • Treat every infant security alarm as an abduction: call the facility's code and cover exits as assigned; observe and report rather than chase.
  • Controlled-access units (dementia, mental health, maternity) confirm a visitor's identity and permission before opening the door, and doors must latch behind visitors.
  • Medication rooms, carts and controlled substance cabinets stay locked; report any breach.
  1. In practiceThe infant tag alarm sounds at a stairwell. The nurse calls the infant abduction code at once and goes to the assigned exit, rather than resetting the alarm.
  2. Where questions turnAssuming a security alarm is false and resetting it.
Practise this activity

10Teach the client how to stay safe and avoid injury, such as from falls

  • Screen for fall risk with the facility's tool and put the matching prevention plan in place (low bed, non-slip footwear, call bell in reach, toileting rounds).
  • Home falls prevention: remove scatter rugs and clutter, add lighting and grab bars, keep items between waist and shoulder height, review medications that cause dizziness.
  • Prevent childhood poisoning: medicines, cannabis and chemicals locked up, out of sight and reach, in original containers; know the provincial poison centre number.
  • Electrical and fire safety at home: no frayed cords or overloaded outlets, working smoke alarms, no smoking or flames near oxygen and no petroleum products on the face with oxygen.
  • Child passenger safety (Transport Canada): rear-facing in the back seat as long as the seat allows, then forward-facing with a harness, then a booster until the belt fits (about 145 cm).
  1. In practiceA client going home on oxygen says she uses petroleum jelly on her nose. The nurse reinforces that petroleum products can burn in oxygen and suggests a water-based lubricant.
  2. Where questions turnAdvising high shelves to free counter space, or forward-facing car seats at a set birthday.
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11Take part in planning for and responding to emergencies

  • Know your role in the facility's emergency codes and report to the charge nurse or designated area when a plan is activated.
  • Fire: rescue anyone in immediate danger, raise the alarm, contain (close doors), then extinguish if small and safe or evacuate (RACE).
  • Fire extinguisher: pull the pin, aim at the base, squeeze, sweep (PASS); keep an exit behind you.
  • Evacuation usually moves those in immediate danger first, then ambulatory clients, then those needing help, then those bedridden.
  • In an external disaster, help identify stable clients who could be discharged; the primary health care provider and team decide, and media contact is left to designated staff.
  1. In practiceDuring a disaster plan, the charge nurse asks for possible early discharges. The nurse suggests a stable client with cellulitis on oral antibiotics, not a client with chest pain under investigation.
  2. Where questions turnLeaving the unit to help elsewhere without an assignment, or fighting a fire before moving the client away.
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12Use infection prevention and control principles, such as hand hygiene, aseptic technique and routine practices

  • Routine practices apply to every client: a point-of-care risk assessment before each interaction chooses gloves, gown, mask or eye protection for the expected exposure.
  • Contact precautions (MRSA, C. difficile): gown and gloves, dedicated equipment, a single room or dedicated toilet, sporicidal cleaning for C. difficile.
  • Droplet and contact precautions (influenza and many respiratory viruses): mask and eye protection within 2 metres, gown and gloves.
  • Airborne precautions (tuberculosis, measles, varicella with contact): negative pressure room, door closed, fit-tested N95 respirator; start on suspicion.
  • Remove PPE in the Canadian sequence: gloves, gown, hand hygiene, eye protection, mask, hand hygiene.
  • Surgical asepsis: the outer 2.5 cm of the field is unsterile, keep items above the waist and in view, moisture and doubt mean contamination, never reach across.
  1. In practiceA client on routine practices is coughing forcefully before oral suctioning. The nurse's risk assessment shows a splash risk, so the nurse adds a mask and eye protection to gloves.
  2. Where questions turnWaiting for a precaution order before choosing PPE, or wearing a surgical mask for tuberculosis.
Practise this activity

13Handle hazardous and biohazardous materials by the set procedures

  • Discard sharps uncapped at the point of use into a puncture-resistant container; never recap with two hands, bend or break needles; replace containers about three-quarters full.
  • After a needlestick or splash: let the wound bleed without squeezing, wash with soap and water (flush eyes or mucous membranes with water), report at once and follow the exposure protocol.
  • Cytotoxic drugs and the client's body fluids for about 48 hours after a dose: chemotherapy-rated gloves and gown, face protection if splashing, spill kit for spills.
  • WHMIS: every hazardous product has a supplier label and a safety data sheet describing hazards, PPE, storage, spill clean-up and first aid.
  • Clean blood spills with gloves: absorb, then disinfect with the facility's product or freshly made bleach dilution for the required contact time.
  1. In practiceA client took an oral chemotherapy drug last night. The nurse wears chemotherapy-rated gloves and a gown to empty the urinal and flushes the toilet with the lid closed.
  2. Where questions turnAssuming an oral cytotoxic drug needs no protection, or delaying the report of a needlestick to the end of the shift.
Practise this activity

Key terms

Routine practices
Canada's baseline infection prevention practices for every client, chosen through a point-of-care risk assessment.
Point-of-care risk assessment
The nurse's check before each interaction of the risk of exposure, which decides the PPE and other measures to use.
Additional precautions
Contact, droplet and airborne precautions added to routine practices for specific organisms.
Near miss
An event that could have harmed a client but was caught before it reached them; reported like an error.
Least restraint
The standard of trying every alternative and using a restraint only as a last resort, for the shortest time.
Chemical restraint
A drug given to control a client's movement or behaviour rather than to treat a condition.
WHMIS
Workplace Hazardous Materials Information System: Canada's system of hazard labels, safety data sheets and worker training.
RACE and PASS
Fire response (rescue, alarm, contain, extinguish or evacuate) and extinguisher use (pull, aim, squeeze, sweep).

After this guide: You can identify clients and allergies safely, clarify incomplete or unsafe orders, respond to errors and near misses, move clients and use equipment safely, apply least restraint, follow security and emergency plans, choose the right precautions and PPE sequence, and handle sharps, cytotoxic and hazardous materials.

Practise Safety and Infection Prevention and Control