aseptic technique

Question 1

The practice of avoiding contact with bodily fluids, by means of the wearing of nonporous articles such as gloves, goggles, and face shield. The practice was introduced in 1985

Answer 1

universal precautions

Question 2

how should every person be treated

Answer 2

as though they have an infectious disease

Question 3

In 1996, universal precautions was replaced with _____________. “A set of precautions designed to prevent transmission of HIV, Hepatitis B virus (HBV), and other blood borne pathogens when first aid or health care

Answer 3

standard precautions

Question 4

what does standard precautions include

Answer 4

■ Hand washing
■ Appropriate personal protective equipment:
– Gloves
– Gowns
– Masks

Question 5

body fluids to be careful about

Answer 5

■ Blood
■ Semen and vaginal secretions
■ Cerebrospinal fluid ( Cerebrospinal fluid (found in the spine)
■ Synovial fluid (found in joints)
■ Pleural fluid (found in lungs)
■ Peritoneal fluid (found in abdominal cavity)
■ Pericardial fluid
■ Amniotic fluid Amniotic fluid (pregnancy)

Question 6

what can you get from body fluids

Answer 6

HIV, Hepatitis A, B, C, Staph and Strep infections, Gastroenteritis salmonella, and shigella, Pneumonia, Syphilis, TB, Malaria, Measles, Chicken Pox, Herpes, Urinary tract infections, and Blood infections.

The greatest risks are from HIV and Hepatitis B and C

Question 7

used for infections spread in large droplets by coughing, talking, or sneezing such as influenza

Answer 7

droplet precautions

Question 8

used for infections spread in small particles in the air such as chicken pox

Answer 8

airborne precautions

Question 9

used for infections spread by skin to skin contact or contact with other surfaces such as herpes simplex virus

Answer 9

contact precautions

Question 10

it is the process of destruction of disease causing microorganisms to prevent infection in patients body surface. the process may be either bactericidal or bacteriostatic

Answer 10

antisepsis

Question 11

it is a process of killing pathogenic organisms from inanimate objects such as surgical instruments

Answer 11

disinfection

Question 12

chemical substance used on inanimate objects to kill pathogens

Answer 12

disinfectant

Question 13

chemical substance which kills the pathogenic organism or inhibits growth

Answer 13

antiseptic agent

Question 14

process of destruction or removal of all microorganisms including spores from article, surface, or medium

Answer 14

sterilization

Question 15

The skin and hair are colonized with these various organisms. The stratum corneum layer of the epidermis is colonized with a polymicrobial flora

Answer 15

• Staphylococcus aureus
• Staphylococcus epidermidis
• various Streptococcus species
• viruses, yeasts, and molds

Question 16

what is the most common cause of wound infections

(Many of these organisms are nonpathogenic, even when placed in environments considered appropriate for infection)

Answer 16

S. aureus

Question 17

Some species, such as__________, are pathologic only when inoculated into deeper layers of the skin and soft tissue

Answer 17

S. epidermidis

Question 18

For most infections, a significant inoculation is required to create a critical level for microbial growth to occur._________ decreases bacterial exposure and reduces the level of potentially pathologic organisms.

Answer 18

Aseptic technique

Question 19

is S. aureus prevalence in nasal carriage higher among male HCW or female

Answer 19

male

Question 20

what department is s. aureus carriage rate highest

Answer 20

highest in orthopedics department
followed by surgery and gyn departments

Question 21

all staph aureus isolates are sensitive to what drugs

Answer 21

vancomycin and linezolid

Question 22

what is the ecological niche of S aureus

Answer 22

anterior nares of humans

Question 23

Approximately 20% of the individuals almost always carry one type of strain and they are called

Answer 23

persistent carriers

Question 24

A large proportion of the population (60%) harbors S. aureus intermittently, and the strains change with varying frequencies. Such persons are called

Answer 24

intermittent carriers

Question 25

A minority of the people (20%) almost never carry S. aureus and they are called

Answer 25

non carriers

Question 26

Routine and adequate provider disinfection in the clinical setting includes: also how to prevent iatrogenic infections

Answer 26

– Hand washing – Use of clean and disinfected personal diagnostic equipment (e.g., stethoscopes) – Wearing appropriately cleaned coats and clothing

Question 27

What is the right way to wash your hands?

Answer 27

■ Follow the five steps below to wash your hands the right way every time. ■ Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap. ■ Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails. ■ Scrub your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday" song from beginning to end twice. ■ Rinse your hands well under clean, running water. ■ Dry your hands using a clean towel or air dry them

Question 28

There are very few contraindications to the maintenance of adequate clinical aseptic technique.

Answer 28

1. Extreme clinical circumstance in which TIME does not allow proper aseptic technique, as in an emergent thoracotomy. 2. Allergies and sensitivities to latex and antiseptic solutions. ALWAYS, ALWAYS check allergies!!!

Question 29

can be divided into skin disinfection and sterile technique

Answer 29

aseptic technique

Question 30

removes any microorganisms found on the skin and decreases potential contamination during the procedure

Answer 30

skin disinfection

Question 31

involves the application and scrubbing of a disinfectant preparation onto the skin

Answer 31

disinfection

Question 32

how to disinfect simple procedures, such as injections or venipunctures

Answer 32

little disinfection, Wipe the skin with gauze that has been impregnated with 70% isopropyl alcohol for simple procedures. The alcohol has an antibacterial effect. The mere force of wiping the skin reduces bacterial counts.

Question 33

how to disinfect for more comprehensive skin preparation

Answer 33

Povidone iodine, 2% iodine tincture, and chlorhexidine are the most commonly used skin antiseptic solutions

Question 34

Povidone iodine solution is highly germicidal for

Answer 34

Gram-positive and Gram-negative bacteria, viruses, fungi, protozoa, and yeasts.

Question 35

Iodine rapidly reduces bacterial counts on the skin surface and these effects last up to _____ hours

Answer 35

3

Question 36

how does iodine solution kill bacteria

Answer 36

Allow the iodine solution to dry and then wipe it from the skin with 70% alcohol prior to beginning the procedure. The iodine solutions work by oxidation and cross-linking of sulfhydryl groups, killing bacteria as the solution dries

Question 37

what is used as a substitute in iodine allergic or sensitive patients

Answer 37

chlorhexidine or hexachlorophene

Question 38

how does chlorhexidine differ from iodine

Answer 38

- much longer antimicrobial activity (up to 48 hours) - more gentle on the skin

Question 39

how does chlorhexidine kill bacteria

Answer 39

destroys cell membranes of gram-positive and gram- negative bacteria while precipitating the intracellular contents

Question 40

what precedes a procedure

Answer 40

■ Time Out ■ Inform patient about risks and advantages of the procedure ■ Obtain consent either via the patient or the guardian ■ Preparation - Will you be performing the procedure? Attending? ■ Set up ■ Is there a study required to confirm placement? ■ Procedure note

Question 41

what is a time out

Answer 41

■ The procedure is not started until all questions or concerns are resolved. ■ Conduct a time-out immediately before starting the invasive procedure or making the incision. ■ A designated member of the team starts the time-out. ■ The time-out is standardized.

Question 42

who is part of the time out

Answer 42

the immediate members of the procedure team: the individual performing the procedure, anesthesia providers, circulating nurse, operating room technician, and other active participants who will be participating in the procedure from the beginning

Question 43

During the time-out, the team members agree, at a minimum, on the following:

Answer 43

– Correct Patient Identity – Correct Site – Procedure to be done

Question 44

what do you do at the end of a time out

Answer 44

Document the completion of the time-out. The organization determines the amount and type of documentation

Question 45

how to explain the procedure to a patient

Answer 45

■ Always set down and explain what you are about to do. BE HONEST!! ■ If it hurts tell the patient this will hurt! ■ Use phrases such as, “I apologize, we will make you as comfortable as possible”. Explain what analgesic you are going to use (ie. Lidocaine). ■ If no pain meds are required, such as when removing a chest tube, tell the patient “this will only take a moment, we will work together, but there is nothing I can give you to take away the pain.” The same with removing a ureter stent.

Question 46

before any procedure what must you obtain

Answer 46

■ Informed Consent! ■ Make sure at your institution “you” can obtain consent!!! ■ Obtaining consent means obtaining the patient’s authorization for diagnosis and treatment. ■ The person consenting must be legally and actually competent and must bebinformed. ■ The burden of consent rests with the person performing the procedure. ■ Hospitals and/or hospital staff have been consistently cleared in legal proceedings when consent is concerned.

Question 47

It is the responsibility of the physician or the physician's representative to discuss what with the patient:

Answer 47

– Indications for the procedure – Risks – Benefits – Alternatives

Question 48

how to prepare for a procedure

Answer 48

■ Gather all equipment necessary. ■ Place it on a small procedure stand. ■ Not having the necessary supplies may delay the procedure, make the patient more uncomfortable and can be dangerous.

Question 49

how to set up for a procedure

Answer 49

Do not use the patient or their bed to set up supplies or equipment. Place sterile drapes or towels to form a field wide enough to allow for a comfortable work space. Drape the area near the patient closest to the bedside procedure table. This will minimize inadvertent contamination in moving from the table to the patient

Question 50

how to set up for a procedure

Answer 50

■ Make a small flat sterile area near the procedure site to allow for placement of important items that must be immediately available. ■ Open all caps, position stopcocks, and prepare all devices prior to starting the procedure. The likelihood of contamination increases if devices are not adequately prepared, thus requiring manipulation during the critical portion of a procedure. ■ Adhere to universal precautions guidelines. Use eye and face protection during the procedure. This should be applied before donning gowns and gloves.

Question 51

how do you set up your mayo stand

Answer 51

A sterile drape is used to cover your stand. Drapes come in various sizes and shapes depending upon the procedure. ■ Drapes may be individually wrapped or come in a pre- packaged procedure kit. ■ They may be plastic, paper or cloth but are usually fluid resistant. ■ The inner surface is sterile, except for a 1 inch border around the edges. You may grasp this border to apply the drape. Any instrument or sterile item that contacts this 1 inch border must be removed from the field, it is not longer considered sterile.

Question 52

Prior to opening a sterile item, the following should be verified:

Answer 52

- The integrity of the packaging material is intact, eg no perforations, tears or evidence of strike-through. - Confirm expiration date, if present.

Question 53

how to add to the sterile field for small and large objects

Answer 53

Small items can be dropped 6-8 inches above the sterile field. Larger objects should be set down gently on the field

Question 54

how to apply disinfectant solution

Answer 54

Place the disinfectant solution onto either a sterile sponge or sterile gauze if it is not supplied inside a single-use applicator. ■ The application of disinfectant to the skin is in a circular motion, beginning with the central area of the procedure and working out toward the periphery of the sterile field ■ repeat the application process three or four times using a new sponge, gauze square, or applicator each time. ■ This technique ensures that the central area where the procedure is to be performed is the most sterile area of the field. The area of disinfection must be much larger than the primary area of the procedure, as the number of organisms increases toward the periphery of the prepped area

Question 55

what goes into a procedure note

Answer 55

■ Name of the procedure ■ Indication for the procedure ■ Consent (name of person giving consent, risks, benefits, potential complications) ■ Anesthesia ■ Details of the procedure ■ Findings ■ Complications ■ Note if X-ray pending or if has been confirmed