11.Sterilization, 13.OR, 14.Surveillance Flashcards
Choose the correct answer:
a. Sterilization is destroying all microorganisms in but not on an object?
b. Disinfection is anything less than sterilization
c. Surgical instruments, catheters, and needles are “semi-critical” according to Spauldings classifications?
d. Manual cleaning of instruments is more efficacious than mechanical cleaners
B
destroying all microorganisms on but not in an object
c. Surgical instruments, catheters, and needles are “critical”
d. Manual cleaning of instruments is LESS efficacious than mechanical cleaners
Which of the following does NOT belong? Steam sterilization works by: • a. Temperature • b. Steam • c. Pressure • d. Time • e. Cavitation
E cavitation = ultrasonic cleaning for mechanical cleaning
What are the 4 components of steam sterilization?
Steam, pressure, temperature, and time
What is the process by which ultrasonic cleaning devices clean?
Cavitation – US waves create gas bubbles, which then implode and create a vacuum which removes particles and debris.
The typical recommendation for use of cold sterilization is? Stainless steel surgical equipment Wrapping material Endoscopic equipment Electrical cautery
C endoscopic equipment (think glutaraldehyde) although approval by different manufacturers varies
Which of the following is true? Ethylene oxide gas sterilizes by:
• Using electromagnetic energy to create a plasma phase from a vapor of hydrogen peroxide, oxygen, or peracetic acid/hydrogen peroxide mixture
• Using gamma irradiation
• Generation of ozone from oxygen and water
• Alkalyzation of proteins and nucleic acid
D Ethylene oxide gas sterilizes by:
• Alkalyzation of proteins and nucleic acid
Which of the following is false with ethylene oxide?
• Autoclaving small instruments can be stored for 96 weeks when packaged in double layer linen or plastic-paper envelopes
• Cloth wrapping materials will stay sterile for 3 months
• Paper wrapping material will stay sterile for 30-60 days
• Heat-sealed plastic wrapping will stay sterile for 1 year
B
• Cloth wrapping materials will stay sterile for 15-30 days with ethylene oxide gas
30-60 days paper wrapping
90-100 days plastic wrapping sealed with tape
1 year heat-selad plastic wrapping
Which of the following is false concerning chlorhexidine?
a. It is sporicidal at room temperature
b. Has variable efficacy against viruses and fungi
c. Is effective against MRSA
d. Can be neurotoxic and ototoxic
A is false
Which if the following is false concerning Triclosan?
a. It is a member of the phenol family
b. It has broad bacteriostatic properties
c. When combined with soaps, it looses it efficacy
d. It is less effective than chlorehexidine or iodine
C is false
What is true regarding hand preparation?
a. The area between fingers has the highest bacterial load
b. There is no evidence that iodine or chlorhexidine products are superior
c. Alcohol based scrubs of 1.5 minutes is as effective as traditional 3-5 minute scrubs
d. Recent studies have show that there is less bacterial load when rings are removed
C is correct
nail bed
(chlorhexidine superior in some studies)
(false, same bacterial load)
What is the incidence of single glove perforations is? • a. 0-11% • b. 5-17% • c. 12-31% • d. 13-33%
C 12-31%
What is the incidence of perforations of the inner glove when a double glove technique is used?
• a. 0-2%
• b. 3-13%
• c. 5-15%
• d. The premise if false, there is no difference between double and single gloving
B 3-13%
Floor bacteria has been reported to contribute up to what percent of airborne bacteria? • a. 5% • b. 10% • c. 15% • d. 20%
C 15%
How many air changes per hour should there be in an appropriately ventilated operating room? (with horizontal laminar flow) • a. 5 per hour • b. 10 per hour • c. 15 per hour • d. 20 per hour
C 15 per hr
Which of the following terms is NOT matched appropriately with the definition?
• Prevalence: number of instances of disease (new and old) in a known population at a designated time
• Incidence: the number of new cases of disease that occur in a known population over a designated period of time
• Epidemic: the background rate of disease, present as sporadic infections
• Syndrome: A clinical sign or group of clinical signs that characterize a disease
C is false
endemic, epidemic is occurence of disease in excess of endemic rate
Define the type of surveillance: passive
• Involves the analysis of certain clinical signs that may be indicators of an infectious disease. It is often used as a measure to identify outbreaks in complex populations that are not easy to monitor otherwise.
• Involves the use of data that are already available, such as medical record data, admission data, bacterial culture and susceptibility testing results, and other types of diagnostic testing data.
• Sampling of the hospital for surveillance of pathogens
• Usually involves screening of patients for infection or colonization with specific pathogens.
B is correct
Which is an example of passive surveillance?
• Collection of nasal and rectal swabs from all animals being admitted to a hospital, whether or not they have signs of infection, to screen for methicillin-resistant Staphylococcus aureus.
• After the stalls have been cleaned and disinfected, many equine hospitals perform routine cultures of stalls that have housed horses with diarrhea
• Monitoring work or school absences or over-the-counter drug prescriptions can be used as an indication that a disease outbreak might be present among people in a community
• Using records to review for incision infection monitoring.
A is active
B is environmental
C is (syndromic)
D is passive
What is NOT an indication for routine environmental surveillance?
• Testing stalls for Salmonella if they housed horses with diarrhea
• A quality control assessment to be used periodically high-level disinfection
• Routine testing of various surfaces in the hospital to detect potential multi drug resistant bacteria
• Biologic indicators for autoclave quality control
C(Routine testing is NOT helpful- a hospital will never be sterile. If there is an outbreak need to test specific areas with a predetermined action plan
D (THE BEST USE)
B (not the best use, but ok)
Which of the following is true?
• A infection control practitioner is a doctor that with advanced training in epidemiology.
• A successful surveillance program utilizes a written plan, with consistency over time, appropriate personnel resources and mandates, and is reviewed annually.
• Creating your own program for your individual hospital is a challenge because there are no resources for veterinarians
• Cost of surveillance is just offset by cost to the patients/owners
B is true
Infection control practitioner is typically a technician, and the most helpful person. Epidemiologist is a physician
(http://www.ccar-ccra.com/)
(also publicity, with the economic cost, and employee risks if zoonotic)
Which of the following is true?
A Mechanical cleaners are preferable and more efficacious than manual cleaning for all instruments
B Sterilization is an absolute term: process of destroying all microorganisms including bacteria, viruses, spores, fungi, and prions
C The Spaulding classification scheme breaks sterilization down into high-level, intermediate-level, and low-level
D It is unnecessary to clean all instruments prior to sterilization
B true
A manual cleaning is preferable for certain delicate instruments but is less efficacious than mechanical
C Spaulding = critical, semi-critical, and non-critical)
D clean that shit.
T/F Filtered medical-grade compressed air is the only approved method for drying instruments
True
True?
A Steam sterilization is by means of coagulation and denaturation of proteins by dry heat
B Steam sterilization operates by a direct proportion of steam, pressure, temperature and time
C The most common type of steam autoclave in veterinary medicine is the gravity-displacement sterilizer
D Dry heat is more effective than moist heat for sterilization, however it needs to occur at higher temperatures for a longer period of time
A steam = moist heat
B balance of steam, pressure, temp, and time - temp and time are interdependent
C true
D dry = LESS effective, and needs longer time and higher temp
Which is true in regards to ethylene oxide?
A Ethylene oxide is a medium temperature method of sterilization
B Ethylene oxide is a yellow, odorless, non-flammable gas with a boiling point of 15 degrees C
C Cycle time and ethylene oxide concentrations are inversely correlated, temperature and cycle time of directly correlated
D Ethylene oxide is safe with minimal hazards
A LOW temp
B colorless, odorless, flammable, with a boiling point of 10.5C
C true
D toxic, carcinogenic, mutagenic, as well as possibly neuro-hazardous
Which is true?
A Ozone sterilization is not suitable for wood or paper items
B Vaporized hydrogen peroxide sterilization can be used for metal, liquids, linens, powders, or cellulose materials.
C There is concern for oxidative damage to polyethylene implants sterilized with plasma sterilization and stored for prolonged periods.
D Ozone sterilization is toxic and has safety concerns related to mutagenesis, neurologic, and carcinogenic hazards.
A true
B Vaporized hydrogen peroxide CANNOT be used for liquids, linens, powders, or cellulose materials
C radiation sterilization - gamma rays may cause oxidative damage to polyethylene implants
D Ethylene oxide sterilization TOXIC- use will decrease over time
True or false? Another name for a class 2 sterilization indicator is a Bowie-dick test, and looks at air removal.
true
True/ False for sterilization indicators? Class 4 - react to all the parameters that are important to a given type of sterilization
False
Class 4 - react to more than one parameter
Class 5 - react to all the parameters that are important to a given type of sterilization
What are biologic indicators for and when?
Determine if sterilization process is sound
Ideally perform weekly
True/False Geobacillus stearothermophilus
is a biologic indicator for steam, plasma and ozone sterilizers
True
Bacillus atrophaeus is a biologic indicator for which sterilization method?
ethylene oxide
True/false: Alcohol works by… Cause protein denaturation, lysis, and metabolic interruption of cells
true
True/false: Iodine works by causing Disrupt cell membrane
FALSE
iodine = Oxidation and substitution of intracellular molecules
chlorhex = Disrupt cell membrane
True/false: Chlorhexidine works Oxidation and substitution of intracellular molecules
FALSE iodine = Oxidation and substitution of intracellur molecules
chlorhex = Disrupt cell membrane
Which antiseptic Does not penetrate organic material, and Nontoxic to skin?
alcohol
Use with caution around wounds: lethal to fibroblast; Ototoxic; Effect is not fast, but it has long residual effect; Neurotoxic… antiseptic =….
chlorhexidine
Use with caution around wounds: toxic to fibroblast; Inactivated in blood and organic debris
iodine
Which of the following is true regarding hand preparation?
A 5 liters of water per hand is used on average when prepping with medicated soaps
B Combination of first scrub with medicated soaps followed by alcohol rub has shown an increase in reduction of microbiota
C It takes greater than 6 hours for bacterial regrowth to baseline while wearing gloves following the usage of alcohol-based hand rubs
D High concentrations of alcohol has been shown to have similar antibiotic efficacy to those with medicated soaps
A 20L
B has NOT been shown
C true
D alcohol surpasses significantly the antibiotic effects
Which of the following is true?
A Bacteria can penetrate all types of woven reusable fabric gowns within 20 minutes while nonwoven disposable are impermeable
B Moylan et al reports bacterial transmission of 55% within 3-3.5 hours of surgery with reusable gowns
C Moylan et al reports bacterial transmission of 75.5% for surgeries that exceed 6 hours with reusable gowns
D Disposable gowns have been shown to be more economical as well as decrease the surgical infection rate
A penetrate in 30 min
B (46.6%) within 3 hrs sx with reusable gowns
C 4 hours = 75.5% transmission
D true
Which statement is true regarding incidence of glove perforation?
A Perforation of single glove technique: 11.5-44%
B Perforation of double glove technique for outer glove 12.7-31%
C Perforation of inner glove for double glove technique 3.8-13%
D Contamination is greater after 90 minutes despite which technique is used
A Perforation of single glove technique: 11.5-44% (12.7-31%)
B Perforation of double glove technique for outer glove 12.7-31% (11.5-44)
C True
D Contamination is greater after 90 minutes despite which technique is used (60)
T/f: There is significant difference noted in contamination between skullcaps and bouffant caps
(false, they’re the same)
t/f: Hairspray has been shown to reduce bacterial contamination
true
t/f:Publications have failed to demonstrate the efficacy of face masks in reducing contamination
true
These are all due to the laminar airflow of the ORS
t/f: Bacteria from footwear has been shown to contribute up to 10% to the airborne contamination levels of the OR
(false, up to 15%)
Which is true? A Iodophors exert their bactericidal effects by denaturing proteins, a process that occurs more readily in the presence of water B The most effective concentration of alcohol is 40% C Iodophors are iodine-containing compounds in which the iodine is complexed to a low-molecular-weight carrier D Iodide (I− ) has no antimicrobial value
A alcohol
B alcohol 60-70%…loses efficacy below 50%)
C HIGH molecular weight!
D TRUE (Iodine is found in various forms in aqueous solutions, but its antimicrobial efficacy is largely due to molecular iodine (I2) and hypoiodic acid)
Which is false?
Iodine can be used freely on open wounds
Iodine, in its active forms, has rapid efficacy in killing bacteria, spores, viruses, and fungi.
Iodine efficacy against spores is dependent on prolonged contact time, but is still better than that of many other agents
Iodine’s activity is decreased in the presence of organic debris and blood
A caution around open wounds because iodine toxicity can result from absorption of iodine
Which is true?
A Glutaraldehyde is a derivative of hydroxydiphenylether, which is a member of the phenol family. The primary mechanism of action is cell wall destruction
B 0.05%, chlorhexidine is lethal to canine embryonic fibroblasts
C Triclosan is more effective than chlorhexidine or povidone-iodine in terms of antibacterial activity and is intermediate in its residual effect
D Chlorhexidine has no residual toxicity
A Triclosan = from phenol derivative; cell wall destruction B true C triclosan is less effective D chlorhex (Does have residual toxicity)
Which is false?
A Clipping of hair at various intervals before surgery has been associated with higher rates of infection compared with clipping immediately preceding the procedure
B Approximately 30% of the skin flora remains protected in deeper layers and follicles, no matter which protocol is chosen
C It has been observed in human beings that resident flora may vary according to age, with children having a higher percentage of spore-forming bacteria
D Contact times can vary from as little as 30 seconds with some chlorhexidine-alcohol preparations to 2 minutes with povidone-iodine
B false
The usual or expected background rate of disease, present as sporadic infections = ?
endemic
An occurrence of disease in excess of the anticipated (endemic) rate= ?
epidemic
A clinical sign or group of clinical signs that characterize a disease or other abnormal condition= ?
syndrome
The number of new cases of disease that occur in a known population over a designated period of time
incidence
The number of instances of disease (new and old) in a known population at a designated time
= prevalence
Which of the following is true?
A Targeted approaches have a lack of specificity, but can be a useful surveillance tool
B The five main elements for a successful surveillance program include a written plan, consistency over time, appropriate personnel resources and mandates, review of the program, and use of available resources and experts so as not to reinvent the wheel
C Comparison of data between facilities is easy to interpret
D Past surveillance programs have no impact on the interpretation of a cluster investigation
A syndromic … lacks specificity
B true
C difficult
D biases
How long can you consider an instrument sterile if it is placed in a plastic heat sealed pouch and sterilized with ETO
1 year for heat sealed plastic
True or false? Incidence conveys information About the risk of contracting the disease, whereas prevalence indicates how widespread the disease is
True
