Chain of Infection

Common Errors

Common nursing assistant errors with chain of infection:

• Not applying proper body mechanics: use mechanical lifts for residents who cannot bear weight; wide base of support with feet shoulder-width apart, one foot slightly forward; bend at the knees and hips, not at the waist
• Forgetting to identify the resident before providing care
• Not reporting changes in condition promptly to the nurse
• Performing tasks outside the CNA scope of practice

Documentation

CNAs document chain of infection findings by reporting to the nurse and recording in the medical record. Key observations to document:

• Behavioral changes: new confusion, agitation, refusing meals, sleep pattern changes
• Skin observations: color changes, redness over bony prominences, bruising, open areas, edema
• Fall risk factors: history of falls, medications (sedatives, diuretics), mobility impairment, cognitive decline

Exam Focus Areas

On the Cna Nnaap, Cst Surgical Tech, Medical Assistant exam(s), questions about chain of infection typically test:

1. Proper procedure for activities of daily living (ADLs)
2. Resident rights and appropriate responses to violations
3. Observations that must be reported to the nurse immediately
4. Body mechanics and safe transfer techniques

Safety Considerations

Safe practice of chain of infection requires proper body mechanics and fall prevention:

• Get help for residents over 35 lbs or who are combative
• Push rather than pull when moving objects or residents
• Use mechanical lifts for residents who cannot bear weight
• Raise bed to working height to avoid bending

Workplace Applications

Applying chain of infection in daily practice as a nursing assistant:

• Right to voice grievances without fear of retaliation or discharge
• Right to participate in care planning and be informed about condition and treatment changes
• Right to privacy for personal care, mail, phone conversations, medical information
• Therapeutic silence: allow time for the resident to process and respond
• For hearing-impaired: face the resident, speak clearly (not louder), reduce background noise
• Cultural sensitivity: respect food preferences, spiritual practices, family dynamics