Midwife Licensure Exam Fundamentals of Care & the Health-Care Process — Asepsis, Infection Control & Patient SafetyConcept Map

Concept

Chain of Infection

Sub Concepts

• Infectious Agent (bacteria, virus, fungi, parasite)
• Reservoir (human, animal, environment, equipment)
• Portal of Exit (respiratory, GI, GU, blood, skin)
• Mode of Transmission (contact, droplet, airborne, vehicle, vector)
• Portal of Entry (broken skin, mucous membranes, invasive lines)
• Susceptible Host (immunocompromised, very young/old, malnourished)

Relationship To Central

Foundation for understanding how infections spread; breaking any link prevents disease transmission

Concept

Stages of Infection

Sub Concepts

• Incubation (exposure to first symptoms)
• Prodromal (early, nonspecific symptoms; highly communicable)
• Acute Illness (specific signs/symptoms peak)
• Convalescence (recovery phase)

Relationship To Central

Identifies when patients are most communicable and symptomatic; guides nursing assessment and isolation timing

Concept

Body Defenses Against Infection

Sub Concepts

• Nonspecific (Innate) Immunity: skin, mucous membranes, normal flora, gastric acid, cilia, inflammatory response, phagocytosis
• Specific (Adaptive) Immunity: antibody-mediated (B cells), cell-mediated (T cells)

Relationship To Central

Understanding immunity guides assessment of patient susceptibility and intervention timing

Concept

Medical vs Surgical Asepsis

Sub Concepts

• Medical Asepsis (Clean Technique): reduces microorganism numbers, used for routine care, handwashing, clean gloves
• Surgical Asepsis (Sterile Technique): eliminates all microorganisms and spores, required for invasive procedures, surgery, catheterization

Relationship To Central

Core nursing competencies; medical asepsis for routine care; surgical asepsis for invasive procedures

Concept

Principles of Surgical Asepsis

Sub Concepts

• Sterile touches sterile only
• Sterile field created just before use; never left unattended
• 1-inch outer border is contaminated
• Anything below waist level or table edge is contaminated
• Moisture wicks microorganisms (strike-through contamination)
• Do not reach across or turn back on sterile field
• If in doubt, consider it contaminated

Relationship To Central

Essential knowledge for maintaining sterile fields during invasive procedures; high NLE frequency

Concept

Equipment Reprocessing (Spaulding Classification)

Sub Concepts

• Critical Items: sterilization required (steam autoclave, ethylene oxide, hydrogen peroxide plasma)
• Semi-Critical Items: high-level disinfection required
• Non-Critical Items: cleaning and low/intermediate-level disinfection

Relationship To Central

Determines appropriate cleaning, disinfection, or sterilization methods based on infection risk

Concept

Hand Hygiene

Sub Concepts

• WHO Five Moments: before patient contact, before aseptic procedure, after body-fluid exposure, after patient contact, after patient surroundings
• Alcohol-based hand rub: routine decontamination when hands not visibly soiled
• Soap and water: visibly soiled hands and for spore-forming organisms (C. difficile)
• Duration: at least 20 seconds; keep hands lower than elbows

Relationship To Central

Single most effective infection-control measure; breaks chain of infection at transmission point

Concept

Personal Protective Equipment (PPE)

Sub Concepts

• Donning Sequence: gown → mask/respirator → goggles/face shield → gloves
• Doffing Sequence: gloves → goggles/face shield → gown → mask/respirator
• Hand hygiene after removal
• Single-use gloves; change between patients and between dirty/clean tasks

Relationship To Central

Protects patient, nurse, and healthcare workers from pathogen exposure

Concept

Standard Precautions

Sub Concepts

• Treat all blood, body fluids, secretions, excretions (except sweat), non-intact skin, and mucous membranes as potentially infectious
• Hand hygiene
• PPE as needed
• Safe injection practices
• Respiratory hygiene and cough etiquette

Relationship To Central

Universal infection-control practices applied to ALL patients regardless of diagnosis

Concept

Transmission-Based Precautions (Isolation Precautions)

Sub Concepts

• Contact Precautions: MRSA, VRE, C. difficile, scabies; gown and gloves required; dedicated equipment; single room preferred
• Droplet Precautions: influenza, pertussis, mumps, N. meningitidis, rubella; surgical mask; private room or spatial separation
• Airborne Precautions (MTV): Measles, TB, Varicella; N95 respirator and negative-pressure (airborne infection isolation) room
• Protective (Reverse) Isolation: shields immunocompromised patients; positive-pressure room; no fresh flowers/standing water

Relationship To Central

Used in addition to standard precautions; tailored to specific organism transmission routes

Concept

Healthcare-Associated Infection (HAI) Prevention Bundles

Sub Concepts

• CAUTI Prevention: aseptic insertion, closed drainage system, keep bag below bladder level, remove catheter early
• CLABSI Prevention: hand hygiene, maximal sterile barriers, chlorhexidine skin prep, daily line necessity review
• VAP Prevention: head of bed 30-45 degrees, oral care, sedation/spontaneous breathing assessments
• SSI Prevention: perioperative antibiotics, glucose control, sterile technique, skin antisepsis
• Antimicrobial stewardship support

Relationship To Central

Evidence-based interventions to prevent common hospital-acquired infections

Concept

Sterile Gloving and Gowning

Sub Concepts

• Open (Closed Hand) Method: used for catheterization, dressing changes
• Closed Method: used in OR with sterile gown
• Handle glove cuff (inside) with bare hands; gloved hand touches only outside of second glove
• Keep gloved hands above waist and in view
• If glove tears or contaminated, change immediately

Relationship To Central

Procedural competencies for maintaining surgical asepsis during invasive procedures

Concept

Patient Identification and Safety Verification

Sub Concepts

• Verify with at least two identifiers (name and birthdate/hospital number)
• Never use room number alone
• Applies to all medications, procedures, and treatments

Relationship To Central

Prevents medication errors, wrong-site procedures, and harmful events

Concept

Fall Prevention

Sub Concepts

• Assess fall risk on admission (Morse Fall Scale or similar)
• Bed in lowest position with brakes locked
• Side rails per policy (four raised rails = restraint)
• Call light, personal items, water, glasses within reach
• Adequate lighting, dry non-slip floors, clear pathways, non-slip footwear
• Assist high-risk patients with ambulation and toileting
• Use fall-risk identifier (color-coded band)
• Manage orthostatic hypotension (rise slowly)

Relationship To Central

Leading cause of injury, especially in elderly; requires comprehensive prevention strategy

Concept

Restraints

Sub Concepts

• Require physician order (time-limited)
• Use least-restrictive type
• Never tie to side rails
• Use quick-release knot to movable bed part
• Frequent monitoring: skin integrity, circulation, toileting, range of motion

Relationship To Central

Last-resort safety intervention with significant ethical and legal implications per RA 9173

Concept

Environmental and Waste Safety

Sub Concepts

• Yellow bags: infectious waste
• Black bags: non-infectious waste
• Puncture-proof sharps containers for needles and sharps
• Never recap needles (or use one-handed scoop technique)
• Dispose at point of use
• Needlestick/sharps injury management: wash, report, post-exposure prophylaxis assessment

Relationship To Central

Protects healthcare workers and environmental safety; aligns with DOH Health Care Waste Management guidelines

Concept

Surgical Safety and Communication

Sub Concepts

• WHO Surgical Safety Checklist
• Site marking protocols
• SBAR structured handoff (Situation, Background, Assessment, Recommendation)
• High-alert medication double checks

Relationship To Central

Prevents wrong-site surgery, wrong procedures, and communication failures

To

Hand Hygiene

From

Chain of Infection

Strength

strong

Relationship

Hand hygiene breaks the chain at the transmission point, preventing pathogen movement from reservoir to next host

To

Transmission-Based Precautions

From

Chain of Infection

Strength

strong

Relationship

Understanding transmission routes (contact, droplet, airborne) determines which precautions are required

To

Transmission-Based Precautions

From

Stages of Infection

Strength

strong

Relationship

Prodromal and acute stages require isolation implementation; timing of precautions based on stage progression

To

Susceptible Host

From

Body Defenses Against Infection

Strength

strong

Relationship

Immunocompromised patients have impaired body defenses; understanding defenses guides identification of at-risk populations

To

Principles of Surgical Asepsis

From

Medical vs Surgical Asepsis

Strength

strong

Relationship

Surgical asepsis principles are the practical application of sterile technique rules

To

Sterile Gloving and Gowning

From

Principles of Surgical Asepsis

Strength

strong

Relationship

Sterile gloving and gowning are specific procedures that apply surgical asepsis principles

To

Medical vs Surgical Asepsis

From

Equipment Reprocessing

Strength

moderate

Relationship

Spaulding classification determines whether cleaning, disinfection, or sterilization is used based on equipment contact level

To

Standard Precautions

From

Hand Hygiene

Strength

strong

Relationship

Hand hygiene is a core component of standard precautions applied to all patients

To

Transmission-Based Precautions

From

PPE Management

Strength

strong

Relationship

Different precautions require different PPE combinations; donning and doffing sequences prevent self-contamination

To

Transmission-Based Precautions

From

Standard Precautions

Strength

strong

Relationship

Transmission-based precautions are used in addition to, not instead of, standard precautions

To

Chain of Infection

From

HAI Prevention Bundles

Strength

moderate

Relationship

HAI prevention bundles work by breaking the chain of infection through targeted interventions at specific links

To

Patient Safety

From

Fall Prevention

Strength

strong

Relationship

Fall prevention is a key patient safety intervention addressing a leading cause of hospital injury

To

Patient Safety

From

Patient Identification

Strength

strong

Relationship

Proper identification is fundamental to preventing wrong-patient, wrong-medication, and wrong-procedure errors

To

Patient Safety

From

Restraints

Strength

moderate

Relationship

Restraint use is a safety measure of last resort that carries ethical and legal implications per RA 9173

To

Hand Hygiene

From

Environmental and Waste Safety

Strength

moderate

Relationship

Proper waste disposal and sharps management prevent occupational exposure injuries and need for hand hygiene after exposure

To

Patient Safety

From

Surgical Safety and Communication

Strength

strong

Relationship

WHO Surgical Safety Checklist and SBAR communication prevent wrong-site surgery and communication failures

To

HAI Prevention Bundles

From

Medical vs Surgical Asepsis

Strength

moderate

Relationship

HAI bundles apply asepsis principles; CAUTI uses aseptic insertion and closed systems; CLABSI uses sterile barriers

To

Transmission-Based Precautions

From

Infectious Agent

Strength

strong

Relationship

Type of infectious agent determines transmission route and therefore the appropriate isolation precautions

To

PPE Management

From

Portal of Entry

Strength

moderate

Relationship

Understanding portals of entry guides selection of appropriate PPE to block pathogen access

To

Medical vs Surgical Asepsis

From

Cleaning, Disinfection, and Sterilization

Strength

strong

Relationship

Sterilization achieves surgical asepsis; disinfection and cleaning achieve medical asepsis at different levels