Microorganisms move on air currents. Because of this movement, avoid shaking or tossing linens, which can create air currents on which microorganisms can be transported. To reduce the speed of microorganisms, most hospitals are built in such a way that the ventilation system does not circulate air from one section to another. Be sure that all doors leading to rooms used for circulatory isolation are kept closed to stop air currents.

Rooms designed to be used for patients with airborne infections, such as tuberculosis, have air systems that create negative pressure in the room. When the door is opened, air from the corridor moves into the room, and potentially contaminated air from the room does not move outward. In operating rooms, the air systems are designed to provide positive pressure. When the door is opened, potentially contaminated air does not move into the operating room. Instead, air from the extra clean environment tends to move out into the corridor.

Microorganisms are transferred from one surface to another whenever objects touch. Both clean and dirty items are present in a hospital. Even among ostensibly clean items, some are more clean than others. When a clean item touches a less clean item, it becomes “dirty,” because microorganisms are transferred to it. Therefore, keep your hands away from your own hair and face, keep linens away from your uniform, and always keep clean items separate from dirty ones. If you drop anything on the floor, consider it dirty.

Microorganisms are transferred by gravity when one item is held above another. Avoid passing dirty items over clean items or areas because it is possible for microorganisms to drop off onto a clean item or area. When storing items in a bedside stand, place clean items on upper shelves and potentially dirty items, such as bedpans, on lower shelves.

Microorganisms are released into the air on droplet nuclei whenever a person breathes or speaks. Coughing or sneezing dramatically increases the number of microorganisms released from the mouth and nose. Avoid having a patient breathe directly into your face, and avoid breathing directly into a patient’s face. If the patient has a cough, wear a mask when giving care.

Whenever you cough or sneeze, cover your nose and mouth with a tissue, and discard it immediately. Whenever you have coughed, sneezed, or blown your nose, wash your hands before you touch anything else. Teach the patient to handle coughing and sneezing in the same way. If you handle tissues that the patient has used when coughing or sneezing, always wash your hands thoroughly.

Microorganisms move slowly on dry surfaces but quickly through moisture. For this reason, use a dry paper towel when you turn off faucets, and a dry bath basin before you return it to a bedside stand for storage. Proper handwashing removes many of the microorganisms that can be transferred by the hands from one item to another. Wash your hands not only when they are obviously soiled, but whenever you move from one patient to another or from patient contact to contact with the general environment or vice versa.

Blood-borne infections may be spread to another person through contact between blood and body substances that contain the blood-borne organism and open wounds, sores, or mucous membranes and through penetrating injuries with contaminated items. Healthcare workers can protect themselves from these blood-borne infections by using precautions that prevent contact with blood and body fluids that transmit blood-borne pathogens.