AP Exam 4 part V Flashcards
what are standard precautions
the basic level of infection control protocols that reduce the risk of dz transmission when providing pt care
what are the components of “standard precautions”
- hand hygiene 2. PPE 3. respiratory hygiene 4. safe injection practices 5. equipment and environmental cleaning, disinfection, and sterilization
transmission based precautions
- in addition to standard precautions 2. followed once pt develops sx of an infection to reduce transmission
categories of transmission based precautions
- contact 2. droplet 3. airborne
a part of standard precautions, is respiratory hygiene, what is this?
- covering mouth and nose with tissue when coughing/sneezing 2. dispose of tissue after use in waste bin 3. performs hand hygiene following contact with respiratory secretions 4. do not perform patient care when infected or ill
safe injection practices
- avoid recapping needles, discard used needles/syringes into sharps container 2. use syringes, needles, and needless access devices only once, even for the same patient 3. use infusion, pump syringe, and IV administration sets only once. 4. do not use bags or bottles of IV solution as a common source of diluent for multiple patients 5. clean and process IV infusion and syringe pumps according to manufacturer rec btwn pts 6. use 70% alcohol to clean diaphragm prior to access when removing cap from a new vial 7. use single dose vials for medications when available. 8. dedicate multi-dose vials to a single patient when possible - label date and discard within 28 days of opening
microorganisms can be transferred between the anesthesia machine and the patient by _____________________
the anesthesia provider
hand hygiene should be performed before and after removing all PPE except for ________________
respirators
what precaution would be necessary for an infection spread by close contact with respiratory secretions (3ft)?
droplet
if transmissable infection is suspected, transmission based precautions should be taken until when?
diagonistic testing confirms or denies the presence of infection
to reduce the risk of infection, what should you do the anesthesia cart at the beginning of each case?
- clean with germicide between each case 2. place clean covering on top of anesthesia cart at beginning of case
T/F: HMEs are effective in decreassing transmission of microorganisms
FALSE
T/F: anesthesia breathing circuits are single patient use
TRUE
breathing system filters are __________-use, and are assessed according to their _________________ & ______________
single; bacterial filtration efficiency; viral filtration efficiency
characteristics of ideal skin prep
- decreased microorganism count 2. inhibit rebound and regrowth of microorganisms 3. activate quickly 4. should be effective against a variety of microbes
T/F: all skin prep solutions work the same
false; all have different MOA, adv & disadv
what is the preferred skin prep
chlorohexidine
what is a suitable skin prep alternative when chlorohexidine is contraindicated
povidone-iodine
iodine base with alcohol is a highly effective skin prep, but it is ____________________
highly flammable
what skin prep characteristics (in some) pose a fire risk
those that are alcohol based or have flammable properties
Aseptic technique in OR
- equipment: maximal sterile barriers (mask, gloves, gowns, drapes) 2. anitseptic skin preparation of patient prior to procedure 3. close doors during operative procedure 4. minimize unnecessary staff and traffic in/out of OR 5. take precautions to mitigate contact with non-sterile surfaces and objects
in limiting/preventing environmental contamination during airway management, what si the priority
maintenace of oxygenation take priority over all issues
what are the recommendations for decreasing environmental contamination during airway management
- double glove prior to airway manipulation 2. following airway management removed outer gloves and then perform necessary actions to assure airway security and patency 3. when situation is stable remove inner gloves - perform hand hygiene - don new gloves - cont pt care
infection prevention: invasive procedure techniques
- perform hand hygiene before assembling equipment, before, and after procedure 2. all invasive procedures performed using strict aseptic technique
ensuring proper hand hygiene and aseptic techniques during invasive procedures will prevent adverse event such as:
- surgical site infection 2. CLABSI 3. CAUTI
___________________ for procedures like vascular access and catheter placement have been show to reduce infection rates and improve pt satisfaction
ultrasound guidance
ultrasound guided infection prevention procedure
- skin prep with appropriate agent 2. single patient use container 3. sterile sheath, sterile probe cover, sterile ultrasound gel 4. disinfect ultrasound probes btwn each procedure and pt per manufacturer guidelines
infection prevention considerations for epidurals and continuous peripheral nerve block catheters
- strict aseptic technique and single use sterile gel 2. maximal sterile barriers during procedure 3. appropriate skin prep 4. dress insertion site with sterile transparent occlusive dressing 5. use CHG impregnanted dressing at insertion site to reduce epidural skin entry point colonization 6. check insertion site and overal pt status at least daily for early id of infection, and sensory/motor status 7. remove once no longer clinically indicated
if a CVC is to remain in place for > 5 days, what type of catheter should be used
antibiotic impregnated catheter
arterial catheters that are needed for > 5 days should be replaced when?
only if evidence of infection is observed. They should not be routinely changed
when the pressure monitoring system of a-line is accessed via diaphragm rather than stop cock, how do you prevent risk of infection?
scrub with antiseptic agent before accessing the system
when accessing stop cock, apply ______________ prior to access
70% alcohol
preferred site for CVC placement
RIJ or subclavian (cleaner, less infection risk)
what sites are best for a-line due to decreased infection risk
- radial 2. brachial 3. dorsalis pedis
what is creutzfeldt-jakob dz
fatal neurodegenerative dz d/t the accumulation of pathologic proteins (prions); transmissible spongiform encephalopathy
way to prevent transmission of creutzfeldt-jakob dz with multiple use devices
- use disposable equipment when possible 2. destroy laryngoscopes and supraglottic devices used on pts with CJD 3. safely discard devices that are difficult/impossible to clean 4. clean and perform steam sterilization of instruments for 30-60 min at 132 C 5. perform steam sterilization for 18 min at 134-138 C when using a prevacuum sterilizer 6. immerse instruments in 1 N sodium hydroxide for 1 hr at RT followed by steam sterilization for 30 min at 121 C (as alt to prevacuum sterilizer) 7. disinfect noncritical items and environmental surfaces with bleach or 1N sodium hydroxide for 15 min at RT 8. consult CDC for best practices
transmission based precautions for TB
airborne/droplet
s/sx of TB
- cough that lasts 3 wks or longer 2. chest pain 3. productive cough with blood/sputum 4. fatigue 5. weight loss 6. lack of appetitie 7. fever 8. night sweats
infection control with TB
- HEPA filter btwn patient and breathing system 2. sterilize or perform high level disinfection on equipment used on patients with cases of suspected or confirmed Tb
T/F: after performing anesthetic/airway manipulation for pt with TB culturing anesthetic equipment is required
FALSE
2 categories of the immune system
- innate 2. adaptive
what are the two “arms” of the adaptive immune system
- humoral (B cell - Ab) 2. cell - mediated (phagocytes, T lympohocytes, cytokines)
hypersensitivity reaction
intolerance to an immune system response to foreign/environmental allergen exposure
type I hypersensitivity rxn occurs within
15-30 min
type I hypersensitivity reaction is mediated by ________________
IgE
s/sx of type I hypersensitivity reaction
- mild cutaneous 2. GI issues 3. bronchospasm 4. CV collapse + death
60-70% of anesthesia related hypersensitivity reactions are what type
type I
what anesthetic drug is responsible for causing most anesthetic related type I hypersensitivity reactiosn
NMBA
place in order from greatest to least: NMBA that cause type I hypersensitivity reactions
succinylcholine > vecuronium/rocuronium>pancuronium > cisatracurium
________________ hypersensitivity reaction = immediate
type I
