Before every patient interaction, the nurse must perform hand hygiene and consider the use of additional personal protective equipment, introduce themselves, and identify the patient using two different identifiers. It is also important to provide a culturally safe space for interaction and to consider the developmental stage of the patient.

Hand Hygiene and Infection Prevention

Before initiating care with a patient, hand hygiene is required, and a risk assessment should be performed to determine the need for personal protective equipment (PPE). This is important for protection of both patient and nurse.

Hand Hygiene

Hand hygiene is a simple but effective way to prevent infection when performed correctly and at the appropriate times when providing patient care. See Figure 1.3.^[1] for an image about hand hygiene from the Centers for Disease Control (CDC).^[2] Use the information below to learn more and watch a video about effective handwashing.

Key points from the CDC about hand hygiene include the following^[3]:

• In general, hand sanitizers are as effective as washing with soap and water and are less drying to the skin. When using hand sanitizer, use enough gel to cover both hands and rub for approximately 20 seconds, coating all surfaces of both hands until your hands feel dry. Go directly to the patient without putting your hands into pockets or touching anything else.^[4]
• Be sure to wash with soap and water if your hands are visibly soiled or the patient has diarrhea from suspected or confirmed C. Difficile (C-diff).
• Clean all areas of the hands, including the front and back, the fingertips, the thumbs, and between fingers.
• Gloves are not a substitute for cleaning your hands. Wash your hands after removing gloves.
• Hand hygiene should be performed at these times:
  • Immediately before touching a patient
  • Before performing an aseptic task (e.g., placing an indwelling device) or handling invasive medical devices
  • Before moving from working on a soiled body site to a clean body site on the same patient
  • After contact with blood, body fluids, or contaminated surfaces
  • Before donning gloves and immediately after glove removal
  • When leaving the area after touching a patient or their immediate environment

Checklists for performing handwashing and using hand sanitizer are located in Appendix A.

Personal Protective Equipment (PPE)

Medical asepsis is a term used to describe measures to prevent the spread of infection in health care agencies. Performing hand hygiene at appropriate times during patient care and applying gloves when there is potential risk for exposure to body fluids are examples of using medical asepsis. Additional precautions are implemented by health care team members when a patient has, or is suspected of having, an infectious disease. These additional precautions are called personal protective equipment (PPE) and are based on how an infection is transmitted, such as by contact, droplet, or airborne routes. Personal protective equipment (PPE) includes gowns, eyewear or goggles, face shields, gloves, and masks. PPE is used along with environmental controls, such as surface cleaning and disinfecting to prevent the transmission of infection.^[8] See Figure 1.4^[9] for an image of health care team members applying PPE. These precautions are further discussed in the “Aseptic Technique” chapter. For the purpose of this chapter, be sure to perform a general risk assessment before entering a patient’s room and apply the appropriate PPE as needed. This risk assessment includes the following:

• Is there signage posted on the patient’s door that contact, droplet, enhanced barrier, or airborne precautions are in place? If so, follow the instructions provided.
• Does this patient have a confirmed or suspected infection or communicable disease?
• Will your face, hands, skin, mucous membranes, or clothing be potentially exposed to blood or body fluids by spray, coughing, or sneezing?

Introducing Oneself

When initiating care with patients, it is essential to first provide privacy, and then introduce yourself and explain what will be occurring. Providing privacy means taking actions such as talking with the patient privately in a room with the door shut or privacy curtain drawn around the bed. A common framework used to communicate with patients is AIDET, a mnemonic for Acknowledge, Introduce, Duration, Explanation, and Thank You.^[10]

• Acknowledge: Greet the patient by the name documented in their medical record. Make eye contact, smile, and acknowledge any family or friends in the room. Ask the patient their preferred way of being addressed (for example, “Mr. Doe,” “Jonathon,” or “Johnny”) and their preferred pronouns (i.e., he/him, she/her, or they/them), as appropriate.
• Introduce: Introduce yourself by your name and role. For example, “I’m John Doe and I am a nursing student working with your nurse to take care of you today.”
• Duration: Estimate a timeline for how long it will take to complete the task you are doing. For example, “I am here to obtain your blood pressure, heart rate, and oxygen saturation levels. This should take about 5 minutes.”
• Explanation: Explain step by step what to expect next and answer questions. For example, “I will be putting this blood pressure cuff on your arm and inflating it. It will feel as if it is squeezing your arm for a few moments.”
• Thank You: At the end of the encounter, thank the patient and ask if anything is needed before you leave. In an acute or long-term care setting, ensure the call light is within reach and the patient knows how to use it. If family members are present, thank them for being there to support the patient as appropriate. For example, “Thank you for taking time to talk with me today. Is there anything I can get for you before I leave the room? Here is the call light (Place within reach). Press the red button if you would like to call the nurse.”

Patient Identification

Use at least two patient identifiers before performing assessments, obtaining vital signs, or providing care.

Use two patient identifiers:

• Ask the patient to state their name and date of birth. If they have an armband, compare the information they are stating to the information on the armband and verify they match. See Figure 1.5^[11] for an image of an armband.
• If the patient doesn’t have an armband, confirm the information they are stating to information provided in the chart.
• If the patient is unable to state their name and date of birth, scan their armband or ask another staff member or family member to identify them.

Confirm “two identifiers” with a second source:

• Scan the wristband.
• Compare the name and date of birth to the patient’s chart.
• Ask staff to verify the patient in a long-term care setting.
• Compare the picture on the medication administration record (MAR) to the patient.
• If present, ask a family member to confirm the patient’s name.

Cultural Safety

When initiating patient interaction, it is important to establish cultural safety. Cultural safety refers to the creation of safe spaces for patients to interact with health professionals without judgment or discrimination. See Figure 1.6^[12] for an image representing cultural safety. Recognizing that you and all patients bring a cultural context to interactions in a health care setting is helpful when creating cultural safe spaces. If you discover you need more information about a patient’s cultural beliefs to tailor your care, use an open-ended question that allows the patient to share what they believe to be important. For example, you may ask, “I am interested in your cultural background as it relates to your health. Can you share with me what is important about your cultural background that will help me care for you?”^[13]

Adapting to Variations Across the Life Span

It is important to adapt your interactions with patients in accordance with their developmental stage. Developmentalists break the life span into nine stages^[14]:

• Prenatal Development
• Infancy and Toddlerhood
• Early Childhood
• Middle Childhood
• Adolescence
• Early Adulthood
• Middle Adulthood
• Late Adulthood
• Death and Dying

A brief overview of the characteristics of each stage of human development is provided in Table 1.2. When caring for infants, toddlers, children, and adolescents, parents or guardians are an important source of information, and family dynamics should be included as part of the general survey assessment. When caring for older adults or those who are dying, other family members may be important to include in the general survey assessment. See Figure 1.7^[15] for an image representing patients in various developmental stages of life.

Table 1.2 Variations Across the Life Span