Infection control including hand hygiene, aseptic technique, and procedures for donning and doffing personal protective equipment (PPE)

Overview

Infection control practice centres on hand hygiene (the single most effective intervention for preventing healthcare-associated infection transmission) and correct use of personal protective equipment (PPE) - donning and doffing sequence matters, since incorrect technique (particularly during doffing) is a recognised route of self-contamination
A core, everyday clinical skill applied across every patient interaction, with particular intensity of application in outbreak settings (e.g. highly transmissible respiratory pathogens) where breaches in technique have caused documented healthcare worker infections

The "5 moments for hand hygiene" (before patient contact, before an aseptic procedure, after body fluid exposure risk, after patient contact, after contact with patient surroundings) structures when hand hygiene is required, reflecting the different transmission risk points in a typical patient encounter

Doffing PPE is the higher-risk step (removing contaminated equipment without transferring contamination to skin/clothing) compared with donning, and requires a specific, deliberate sequence (typically gloves, then gown, then hand hygiene, then eye protection, then mask, then final hand hygiene) - order matters and should follow institutional protocol precisely rather than being improvised

Alcohol-based hand rub is preferred over soap and water for most clinical hand hygiene moments given superior efficacy and skin tolerance with frequent use, except when hands are visibly soiled or after contact with spore-forming organisms (e.g. Clostridioides difficile), where soap and water is required given alcohol's limited activity against spores
Transmission-based precautions (contact, droplet, airborne) are added to standard precautions based on the specific pathogen's transmission route

Clostridioides difficile (soap and water required, not alcohol rub, given spore resistance), airborne precaution pathogens (e.g. tuberculosis, requiring N95/P2 respirator and negative-pressure room where available), healthcare worker self-contamination during PPE doffing
Alcohol-based hand rub is ineffective against Clostridioides difficile spores - soap and water (mechanical removal) is required specifically for suspected or confirmed C. difficile, which is a frequently tested exception to the general preference for alcohol rub in most other clinical hand hygiene scenarios

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