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Ash's Certification Study > CIC: To Review > Flashcards

CIC: To Review Flashcards

1
Q

Bacteria/ Viral/ Fungi/ TB: Opening pressure in CSF analysis

A

Bacteria: Elevated
Virus: Usually normal
Fungi: variable
TB: Variable

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2
Q

Bacteria/ Viral/ Fungi/ TB: Glucose e in CSF analysis

A

Bacteria: normal to decreased
Virus: usually normal
Fungi: Low
TB: Variable

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3
Q

Bacteria/ Viral/ Fungi/ TB: Predominate inflammatory cell in CSF analysis

A

Bacteria: Neutrophils (early or partially treated may have lymphocyte predominance)
Virus: Lymphocytes
Fungi: Lymphocytes
TB: Lymphocytes

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4
Q

Bacteria/ Viral/ Fungi/ TB: WBC Counts in CSF analysis

A

Bacteria: >=1000/mm^3
Virus: <100/ mm^3
Fungi: variable
TB: variable

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5
Q

Bacteria/ Viral/ Fungi/ TB: Total protein in CSF analysis

A

Bacteria: Elevated
Virus: Normal to elevated
Fungi: elevated
TB: elevated

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6
Q

Bacteria/ Viral/ Fungi/ TB: Staining in CSF analysis

A

Bacteria: Gram stain shows gram positive or gram negative
Virus: Gram stain negative
Fungi: India ink, positive
TB: AFB stain positive

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7
Q

Urgent threats

A

1) carbepenem resistant acinotobacter
2) candida auris
3) clostridioides difficile
4) carbepenem-resistant enterobacterales
5) drug-resistant Neisseria gnorrhoaea

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8
Q

Serious threats

A

-drug resistant campylobacter
-drug resistant candida
-esbl producing enterobacterales
-vancomycin resistant enterococci
-multidrug resistant pseudomonas aeruginosa
- drug resistant salmonella (both non typhi and typhi)
- drug resistant shigella
-mrsa
- drug resistant strep pneumonia
- drug resistant TB

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9
Q

Concerning threats

A

Erythromycin resistant GAS
Clindamycin resistant group B strep

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10
Q

Describe high temp sterilization

A

Steam (apprx. 40 min) or dry heat (1-6 hours depending on temp). Use for heat-tolerant critical surgical items

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11
Q
A
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12
Q

What is the modified toluidine blue stain used for?

A

Resp tract parasites and fungi
Ex) pneumocystis jerovecii

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13
Q

What is the trichrome stain used for?

A

Cysts, trophozites, parasites in stool

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14
Q

What is the wright gimesa stain used for?

A

Parasites in blood

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15
Q

What organisms is the beta lactamase test used for?

A

Strep and pseudomonas

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16
Q

What is the disk approximation test used for?

A

Clindamycin resistance in staph

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17
Q

Types virulence factors

A
  • Adhesins
  • exoenzymes
  • toxins
  • ability for antigenic variation
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18
Q

Steps of pathogenesis

A

1) exposure
2) adhesion
3) invasion
4) infection (multiplication)

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19
Q

Purpose of glycocalx

A

Facilitates attachment of bacteria to plastic devices and interferes with penetration of water soluble antibiotics

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20
Q

What organisms causes most ssi within 24 hours?

A

Strep pyogenes

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21
Q

Types of granulocytes

A

Neutrophils
Basophils
Eosinophils

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22
Q

Prophylactic antibiotic for pneumocystis jerovecii

A

Tmp/smx

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23
Q

Endogenous opportunistic organisms of the lungs

A

M TB
Coccidioides
Histoplasma
Pneumocystis jerovecii

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24
Q

Endogenous opportunistic agents that infect the skin

A

Staph aureus
Coagulase negative staph
Maladsezia furfur
HSV
Herpes zoster

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25
Q

Endogenous opportunistic organisms that infect the GI tract

A

Enterococcus
Streptococcus bovis
Colostrum septicum
Candida
Aerobic gram negatives

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26
Q

Endogenous opportunistic organisms that infects the CNS

A

Toxoplasma gondii

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27
Q

Examples of exogenous opportunistic organisms from hands of hcp

A

Gram negative
Staph aureus
C diff
Viruses

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28
Q

Examples of exogenous opportunistic organisms from water

A

Legionella
Crypyosporidium

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29
Q

Examples of exogenous opportunistic organisms from soil, dust, and env

A

Rhodococcus
Aspergillus
Zygomycetes
NTM

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30
Q

Do endospores in Bacillus spp. and Lactobacillus spp. stain?

A

No

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31
Q

Spirochetes

A

Treponema, Boirrelia, Leptospira

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32
Q

Are gram stains effective for spirochetes?

A

Not usually, but may be detected by darkfield flourescent microscopy

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33
Q

Stain for Cryptococcus neoformans in CSF

A

India ink

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34
Q

Stain for parasites in stool, including giardia, entamoeba, and endolimax

A

Trichrome

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35
Q

CSF: Predominant cell neturophil

A

Bacterial meningitis

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36
Q

CSF: predominant cell lymphocyte

A

Viral meningitis

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37
Q

CSF: predominant cell eisoinophil

A

Parasite or fungal meningitis (ie coccidioides)

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38
Q

Classic indicators of bacterial meningitis

A

Increased WBC
Increased protein
Decreased glucose

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39
Q

What CSF typically looks like for TB meningitis

A

lymphocytes
low glucose

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40
Q

Which is preferred for lower respiratory culture: bronchoscopy or sputum sample?

A

Bronchoscopy, such as BAL

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41
Q

Less or more sensitive: POC tests for Group A strep and fly

A

less sensitive

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42
Q

When are surveillance cultures for staff appropriate?

A

Not routinely, only when staff implicated in cluster/ outbreak

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43
Q

Types of antibody tests

A

EIA
Chromogenic immunoassay
Hemagglutination
Latex agglutination
Fluorescent antibody tests
Western Blot

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44
Q

Sensitivity and specificity for HCV RNA

A

Good sensitivity and specificity

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45
Q

Specificity of urine legionella EIA/ fluorescent antibody test

A

100% and also has good sensitivity

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46
Q

How reliable are tests for histo, coccidioides, and blastomyces?

A

High cross-reactivity with other fungi/ poor test reliability

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47
Q

Describe RPR

A

Screening test for syphilis, high sensitivity, so need confirmatory testing if positive

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48
Q

Specimen Collection Guidelines

A

1) Use standard precautions for collecting and handling all clinical specimens

2) Use appropriate collection devices

3) Use sterile equipment and aseptic technique

4) Collect specimens during acute phase of the illness (or within 2-3 days for viruses)

5) Collect specimens before administration of antibiotics whenever possible

6) Avoid contamination with indigenous flora from surrounding tissues, organs, or secretions

7) Optimized the capture of anaerobic bacteria from specimens by using proper procedures

8) Collect sufficient volume of specimen to ensure that all tests requested may be performed

9) Proper label: pt name, source, specific site, date, time of collection, and initials of collector

10) Provide clear/ specific instructions on proper collection technique to patients getting their own sample

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49
Q

Specimen Transport Guidelines

A

1) transport promptly to lab (preferably within 2 hours of collection)

2) Transport in container designed to ensure survival or suspected agents

3) Label properly, package, and protect during transport. Can use transport medium to preserve viability of microbes

4) leak-proof specimen containers and transport in sealable, leak-proof plastic bags

5) Never transport syringes with needles attacched

6) labs must have enforceable criteria to reject unsuitable specimens

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50
Q

What samples should NEVER be refrigerated?

A

CSF, genital, eye, inner ear

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51
Q

Common transport media

A

Stuart, amies, carey-blair

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52
Q

Common blood culture contaminants

A

S. epidermindis
Bacillus spp.
Propionbacterium
S. viridans

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53
Q

Modes of action of antimicrobials

A
  • interfere with cell wall synthesis
  • inhibit protein synthesis
  • interfere with nucleic acid synthesis
  • inhibit metabolic pathway
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54
Q

Leukocytosis (>10,000 WBC) is a sign of

A

Acute infection

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55
Q

Leukopenia (<4000 WBC) is a sign of

A

Overwhelming infection:
AIDS
viral hepatitis
Mononucleosis
Legionairre’s disease

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56
Q

Neutrophilia (increase) is a sign of

A

Inflammation
Bacterial infection

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57
Q

Neutropenia is a sign of

A

Overwhelming bacterial infections
viral infections (hep, flu)

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58
Q

What diseases cause an increase in basophils?

A

TB
Smallpox
Chickenpox
Influenza

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59
Q

What diseases cause an increase in monocytes?

A
  • Bacterial infections
    TB
    Subacute bacterial endocarditis
    syphillis
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60
Q

Diseases that cause lymphocytosis (increased >4000)

A

Infectious mononucleosis
Viral URI
CMV
Measles
Mumps
Chickenpox
Viral Hepatitis

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61
Q

Describe sensitivity

A

Good sensitivity - Detect sick people
High sensitivity: false positives, confirmatory testing needed
Low - more false negatives

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62
Q

Where are each of the following endemic:
Histpplasma capsulatum
Blastomyces dermatidis
Coccidioides immitis

A

Histo: Mississippi and Ohio River Valley
Blasto: acidic soil, “”
Coccidioidies: Southwest/ south and central CA

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63
Q

Describe specificity

A

Good specificity: Health people test negative
High specificity: more false negative, miss some cases
Low specificity: more false positives

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64
Q

What can cold agglutination tests detect?

A
  • mycoplasma pneumo
  • mono
  • viral pneumo
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65
Q

Diseases with positive C-reactive protein

A

Meningitis
Pneumonia
Sepsis
TB

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66
Q

What does LAL (Limulus amebocyte lysate) test for?

A

Endotoxins

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67
Q

Organisms with endotoxins

A
  • E coli
  • Salmonella
  • Shigella
  • Pseudomonas
  • Neisseria
  • H. influenzae
  • B. pertussis
  • V. cholera
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68
Q

What organisms with the weil-felix agglutination test detect?

A

Rickettsia illnesses:
RMSF
Q Fever
Typhus
Rickettisal pox

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69
Q

How do antibiotics work?

A
  • interfere with cell wall biosynthesis
  • inhibit bacterial ribosomes
  • interfere with DNA replication or RNA transcription
  • inhibit metabolic pathways
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70
Q

Pharmacokinetic description for antibiotics

A
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71
Q

Best pharmodynamic parameters for beta-lactam drugs

A

Time > MIC

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72
Q

Drug of choice for susceptible enterococcus and Listeria

A

Aminopenicillins

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73
Q

What bacteria does pipercillin/ tazobactam (zosyn) cover, and what type of antibiotic is it?

A

Beta-lacatam (penicillin + beta-lactamase inhibitor)
Used as empiric in combination with vanco
Covers Gram + and pseudomonas

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74
Q

Cephalexin
Cefazolin

A

1st gen cephalosporin

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75
Q

Cefotelan
Cefoxitin
Cefuroxime

A

2nd gen cephalosporin

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76
Q

Ceftriaxone
Cefotaxime
Cefdinar
Ceftazidime

A

3rd gen cephalosporin (increasing gram - activity)

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77
Q

cefepime

A

4th gen cephalosporin (still covers some gram + (strep) and good coverage for gram -, pseudo,

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78
Q

Ceftraoline

A

5th gen cephalosporin
MRSA and Pseudomonas

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79
Q

Best pharmadynamic for fluoroquinolones

A

AUC: MIC

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80
Q

Best pharmadynamic for aminoglycosides

A

Cmax/ MIC

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81
Q

Carbepenems effective against

A

gram -

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82
Q

Fluoroquinolone examples

A

Ciprofloxacin
Levofloxacin

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83
Q

What is are fluoroquinolones used for?

A

gram negative

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84
Q

mechanism of fluoroquinolones

A

Inhibit bacterial enzymes

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85
Q

Describe tetracyclines

A

Static
Inhibit protein synthesis at the ribosome

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86
Q

Describe aminoglycosides

A

Inhibit protein synthesis
cidal
Combo drug for serious gram - MDROs

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87
Q

Examples of aminoglycocides

A

Amikacin
Gentamicin

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88
Q

Describe macrolides

A

Static
Inhibit protein synthesis
less serious infections

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89
Q

Examples of macrolides

A

Ezithromycin
Azithromycin
Clarithromycin

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90
Q

How does TMP-SMX (bactrim) work? What group does it belong to? What is it effective against?

A

interfere with bacterial folic acid synthesis
sulfanimide
UTI/ oral option MRSA/ Nocardia

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91
Q

Examples tetracyclines

A

tetracycline
monocycline
Doxycycline

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92
Q

Describe glycopeptides

A

Vancomycin
concentration dependent (AUC)
MRSA coverage, Staph, Strep, Enterococci
Acts at site of cell wall

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93
Q

Describe use of Linezolid uses

A

Gram +
Static- oral MRSA but not BSI
Activity against vancomycin resistant bugs

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94
Q

Describe daptomycin uses

A

Gram + cocci (but not strep)
cidal
vancomycin resistant bugs
Acts at cell membrane

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95
Q

Clindamycin uses

A

Think above the belt
Mostly gram +
static

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96
Q

Metronidazole uses

A

Think below the belt
Anaerobes, mostly gram negative

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97
Q

What is rifampin used for?

A

N. meningitidis
TB

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98
Q

What does successful antimicrobial therapy depend on?

A

BUG: virulence and susceptibility of the organism
DRUG: activity of the antimicrobial at site of infection
HOST: immunocompromise of host
SITE: body site of infection

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99
Q

What are oral options for MRSA?

A

Clindamycin, Doxycycline, TMP-SMX, and Linezolid

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100
Q

Bacterial resistance mechanisms

A

Efflux pumps
Enzyme
Alteration of target site:
Decrease porins
structure mutation
Decrease uptake

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101
Q

presumptive dx of TB in CSF

A

Lymphocytic pleocytosis (increase in lymphocytes)
hypoglycorrhacia (low glucose in CSF)

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102
Q

Toxicity of TB treatment

A

Occular and liver

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103
Q

Treatment for active TB

A

Months 1-2- Isoniazid (INH), rifampin (RIF), pyrazinamide (PZA) , and ethambutol (EMB)

Months 3-6 (up to 12 mos)- INH and RIF

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104
Q

How often should sputum samples be taken for active TB patients?

A

monthly

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105
Q

Latent TB therapy

A

9 months- INH
4 months- RIF
and monitor for active TB

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106
Q

When is someone contagious with influenza?

A

24 hours before, 3-5 days after but up to 7 days

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107
Q

Who should get antivirals for influenza?

A

Younger than 2, older than 65
immunosuppressed
Pregnant or 2 weeks post partum
Morbid obesity
CC resident
American Indian/ Alaskan native
Less than 19 on aspirin
Chronic conditions

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108
Q

Parts of virus identification

A

Virus Type/ Place/ Strain #/ Year/ Virus Subtype

A/ Sydney/ 05/ 97 (H3N2)

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109
Q

Pandemic influenza Phase:
Education- flu symptoms/ isolation
Vaccine
Facility plans for surge
Exp management plans
Just-in-time training plans
Comm plans

A

Phase 1-3
No human to human transmission

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110
Q

Phase?
Est # HCP needed
Start to increase isolation capacity
Review exposure management plan
Plan to sustain operation
Visitor screening plan
Staffing guidance for cases

A

Phase 4
Limited human- human transmission

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111
Q

Phase?
Enhanced screening and surveillance
Just-in time training
Schedule staff communications
Incident command

A

Phase 5
Sustained human to human transmission

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112
Q

Phase?
Implement surge strategy, staffing, supplies, and space
Cancel elective procedures
Implement employee exposure management plan

A

Phase 6
Efficient and widespread human - human transmission

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113
Q

Influenza iPC Plan

A
  • early ID and isolation of patients
  • annual education
  • Vaccine to patients and HCP
  • restrict ill patients and HCP
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114
Q

How long should flu pt be in isolation?

A

Private room, 7 days after onset and fever free for 24 hours

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115
Q

PEP for flu

A

High risk setting OB- antivirals for 2 weeks

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116
Q

Incubation for Hep A

A

28 days
(15-50 days)

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117
Q

How long does the prodromal phase of Hep A last in symptomatic patients? and the iciteric phase?

A

Prodromal (ILI, nausea, vomit)- 1-2 weeks
Iciteric Phase (jaundice, dark urine, pale stool, itch): up to 6 months

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118
Q

Window period for Hep A IgM test

A

5-10 days, within 3 weeks of exposure

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119
Q

Incubation for Hep B

A

90 days
(60-150 days)

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120
Q

Describe when each of the Hep tests will become positive:
HBsAg
HBeAg
anti-HBC
anti-HBS
HBV-DNA

A

HBsAg- 30 days
HBeAg- 30 days
anti-HBC- symptom onset
anti-HBS- after recovery
HBV-DNA- 30 days

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121
Q

Hep C incubation

A

2-12 weeks
(15-160 days)

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122
Q

Window period for anti-HCV and HCV RNA

A

Anti-HCV- 8-11 weeks
HCV RNA- 1-2 weeks after exposure

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123
Q

Testing for exposure to Hep C

A

Test ASAP and again 3-6 weeks after , RNA can detect earlier than anti-HCV

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124
Q

4th leading cause of community acquired pneumo

A

Legionella pneumophila

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125
Q

What increases the risk for aspiration of Legionella?

A

Intubation
Gen anesthesia
Nasogastric tube

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126
Q

Describe testing for legionella

A

Culture- 100% specific, 80% sensitive, use special selective media
Urinary antigen - sensitivity 80-90% and specificity 90-100%
DFA- Direct Fluorescent Antibody
Does not gram stain

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127
Q

Symptoms Legionnaire’s DIsease

A

Infiltrate in lungs
nonpurlent cough
pleural chest pain
Fever of 104
confusion*
hypoatremia (low sodium)

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128
Q

Incubation and recovery time pontiac fever

A

24-48 hours
2-5 days, self-limited

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129
Q

Treatment for legionella

A

quinolones and macrolides

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130
Q

Steps water safety plan

A

Describe H2O system
Assess risks
Control Risks
Audit

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131
Q

What are C. Diff toxins?

A

Toxin A
Toxin B
Binary toxin

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132
Q

Surge capacity: how many weeks should you have adequate resources available for?

A

6-8 weeks

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133
Q

Category: Brucellosis

A

B

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134
Q

Category: epsilon toxin Clostrium perfringens

A

B

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135
Q

Category: Food safety threats

A

B

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136
Q

Category: Glanders (burkholderia mallei

A

B

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137
Q

Category: Nipah virus

A

C

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138
Q

Category: Melloidosis (burkholderia pseudomallei)

A

B

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139
Q

Category: hantavirus

A

C

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140
Q

Category: Influenza

A

C

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141
Q

Category: Anthrax

A

A

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142
Q

Category: Smallpox

A

A

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143
Q

Category: Psittacosis (chlamydia pssitaci)

A

B

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144
Q

Category: Q Fever

A

B

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145
Q

Category: Ricin

A

B

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146
Q

Category: SARS

A

C

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147
Q

Category: Botulism

A

A

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148
Q

Category: Rabies

A

C

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149
Q

Category: Q fever (Coxiella Burnetti)

A

B

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150
Q

Category: Staphylococcol entertoxin B

A

B

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151
Q

Category: typhus fever (Rickettsia prowazecki)

A

B

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152
Q

Category: MDR-TB

A

C

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153
Q

Category: Plague

A

A

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154
Q

Category: Tularemia (Francisella tularensis)

A

A

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155
Q

Category: Yellow Fever

A

C

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156
Q

Category: Viral encephalitis

A

B

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157
Q

Category: Tickborne hemorrhagic

A

C

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158
Q

Category: Viral hemorrhagic fevers

A

A

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159
Q

Category: water safety threats

A

B

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160
Q

Precautions for fever >101.1F and cough in children

A

Droplet and contact

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161
Q

Precautions for vomitting

A

Standard

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162
Q

Precautions for watery or explosive stools, with or without blood

A

Contact

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163
Q

Precautions fever and rash

A

airborne

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164
Q

Precautions fever, upper chest rash, and stiff/ sore neck

A

Droplet

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165
Q

precautions eye infections

A

Standard

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166
Q

Precautions itchy rash without fever

A

Contact

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167
Q

Precautions petechial/ erythyromotic rash with fever

A

Droplet for 24 hours of antimicrobial therapy

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168
Q

Precautions: rash, positive history of travel to area with current outbreak of VHF in 10 days before onset

A

Droplet, contact, eye protection. Add N95 for aerosol generating procedures

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169
Q

Precautions macoulopapular rash with cough, coryza, fever

A

Airborne

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170
Q

Precautions vesicular rash in centrifugal pattern

A

Airborne and contact

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171
Q

What category of agents can be transmitted during autopsy? Which diseases is it unsafe to handle the dead bodies?

A

A
Choloera
VHF
smallpox

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172
Q

What are the two types of viral hemorrhagic fevers?

A

Filoviruses
Arenaviruses

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173
Q

Describe cutaneous anthrax

A

Incubation 1-12 days
Bulla develops and turns into necrosis
Standard and contact if copious drainage

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174
Q

Describe respiratory antrhax

A

Incubation 1-7 days
ILI progresses to dyspnea, shock, death in 85-90% untreated
Std precautions (not P2P)
If facility site of release or aerosolization: N95 or PAPR
PEP: vax + 60 days doxy or cipro

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175
Q

Describe botulism

A

Ingest/ inhale toxin
Incubation 1-5 days
Descending paralysis, resp failure
Standard precautions

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176
Q

Describe ebola

A

Transmission: mucous membranes, resp tract, broken skin/ percutaneous injury to body fluids of infected pt

Incubation: 5-10 days, up to 19

Symptoms: Vom, diarrhea, fever, hypotension, shock, hemorrhage

Precautions: Standard (esp HH, needle safety) + contact + droplet (or N95 for aerosol generating procedures)

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177
Q

Describe plague

A

inhalation
Incubation: 2-3 days
chills, ha, cough, dyspnea, rapid progression weakness and hemoptysis, circulatory collapse, bleeding diathesis
Precautions: standard and droplet for 48 hours after antibiotics
PEP for exposed HCP

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178
Q

Describe tularemia

A

Inhalation or ingestion
Incubation: 3-5 days
Symptoms: Pneumatic or typhoidal
Precautions: Standard
High risk: lab workers

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179
Q

Describe smallpox

A

Inhalation droplet/ contact with skin lesion
Incubation: 7-19 days
Symptoms: ILI vomit, centrifugal maculpapular rash around day 4 (more on face and extremities), and all lesions at same stage
Precautions: standard, contact, airborne for 3-4 weeks until all scabs separated
PEP: Vax within 4 days

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180
Q

IP for smallpox vax

A

cover vax site with guaze and semi-permeable dressing until scab separates (approx 21 days)

Adverse event:
- standard and contact until lesions crusted

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181
Q

Enteric:
onset 8-16 hours, lasts 24-48 hours, from meats, stews, gravies, vanilla sauce, vegetables, and milk products

A

Bacillus cereus

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182
Q

Enteric:
Onset 2-5 days, lasts 2-10 days
Symptoms: diarrhea, cramps, fever, vomiting, diarrhea, may be bloody
Source: Raw and undercooked poultry, unpasteurized milk, contaminated water

A

Campylobacter

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183
Q

Enteric:
Incubation: 8-16 hours, lasts 24-48 hours
Symptoms: Watery diarrhea, nausea, abdominal cramps, fever rare
Source: Meats, poultry, gravy, dried or precooked foods, time and/ or temp abused food

A

Clostridium perfrigens toxin

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184
Q

Enteric:
incubation 1-8 days, lasts 5-10 days
Symptoms: severe bloody diarrhea, abdominal pain, vomit, no fever
Source: undercooked beef (esp hamburger), unpasteurized milk and juice, raw fruits and vegetables, contaminated water

A

EHEC

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185
Q

Enteric:
Incubation 1-3 days, lasts 3-7 days
Symptoms: Watery diarrhea, abdominal cramps, some vomit
Source: Contaminated water or food

A

ETEC

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186
Q

Enteric:
Deadly for infants within a few days old

A

Cronobacter sakazakii

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187
Q

Enteric:
Incubation: 9-48 hours
Symptoms: Fever, muscle ache, nausea, diarrhea. Invasive disease within 2-6 weeks.
Source: fresh and soft cheese, unpasteurized milk, ready to eat deli meats, hot dogs

A

Listeria monocytogenes

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188
Q

Complications of Listeria monocytogenes

A

Pregnant women- premature delivery and stillbirth

Elderly/ immunocompromised- bacteremia or meningitis

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189
Q

Enteric:
Incubation 1-3 days, lasts 4-7 days
Symptoms: diarrhea, fever, abdominal cramps, vomiting
Sources: contaminated eggs, poultry, unpasteurized milk or juice, cheese, contaminated raw fruits and veggies

A

Salmonella spp

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190
Q

Enteric:
Incubation 24-48 hours, lasts 4-7 days
Symptoms: abdominal cramps, fever, diarrhea with blood and mucous
Source: ready to eat foods touched by infected workers, not common

A

Shigella

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191
Q

Enteric:
Incubation: 1-6 hours, lasts 24-48 hours
Symptoms: sudden onset of severe nausea and vomiting
Source: unrefrigerated meats, potato salad, and egg salads, cream pastries

A

S. aureus (entertoxin)

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192
Q

Enteric:
Incubation: 1-7 days, lasts 2-8 days
Symptoms: vomiting, diarrhea, abdominal pain, bacteremia, and wound infections
Source: undercooked or raw shellfish, especially oysters

A

Vibrio vulnificus

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193
Q

Complications of vibrio vulnificus

A

Immunocompromised or chronic liver disease: can be fatal

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194
Q

Enteric:
Incubation 24-48 hours, last 1-3 weeks
Symptoms: Appendicitis-like symptoms and vomiting, erythema nodosum
Source: undercooked pork, unpasteurized milk, tofu, contaminated water

A

Yersinia enterocolitica

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195
Q

Enteric:
Incubation period: 28 days, lasts 2-3 weeks
Symptoms: Diarrhea, dark urine, jaundice, ILI
Source: Shellfish, raw produce, contaminated drinking water, undercooked foods, foods handled by infected food handler

A

Hep A

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196
Q

Enteric:
Incubation: 12-48 hours, lasts 12-60 hours
Symptoms: Nausea, vomiting, ab cramping, diarrhea, fever, myalgia
Source: hands of HCP, P2P, aerosolized vomit, water

A

Norovirus

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197
Q

Enteric:
Incubation: 1-3 days, lasts 4-8 days
Symptoms: vomiting, watery diarrhea, low-grade fever
Risk: children, immunocompromised, elderly
Source: close contact within households, foods touched by infected workers
Very common childhood illness

A

Rotavirus

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198
Q

Prevention for rotavirus

A

Vaccine

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199
Q

Enteric:
Incubation: 3-4 days, sheds up to 35 days
Symptoms: watery diarrhea
Source: Shellfish, water, fomites

A

Astrovirus

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200
Q

Enteric:
Incubation: 8-10 days, last 2 weeks
Risk: Children under 4
Symptoms: Protracted diarrhea, or asymptomatic
Source: fecal/oral, droplet, transplants, p2P

A

Enteric adenovirus

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201
Q

Precautions for adenoviruses

A

Contact and droplet

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202
Q

Enteric:
Incubation 2-10 days
Symptoms- diarrhea, stomach cramps, slight fever, remits and relapses
Source: drinking water, undercooked food, food handled by sick food handler

A

Cryptosporidium

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203
Q

Enteric:
Incubation: 1-14 days
Symptoms: diarrhea, loss of appetite, substantial weight loss and fatigue
Source: fresh produce (berries), water, usually imported goods or related to travel

A

Cyclospora

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204
Q

Enteric:
Incubation period 1-2 weeks
Symptoms: malodorous diarrhea, malaise, flatulence, weight loss
Source: contaminated food or water, person to person

A

Giardia lamblia

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205
Q

Enteric:
Incubation 2-3 days to 1-4 weeks
Symptom: diarrhea for 1-6 weeks
Source: uncooked food or food contaminated by food handler, drinking water

A

Entamoeba histolytica

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206
Q

Enteric:
Incubation 5-23 days, or at birth in infants, lasts months
Symptoms: asymptomatic, lymphadenopathy, CNS in immunocompromised patients
Source: ingestion cat feces, raw/ partly cooked meat, perinatal

A

Toxoplasmosis

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207
Q

Enterobacteriaceae- lactose fermenters

A

E. coli
Citrobacter
Klebsiella
Enterobacter

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208
Q

Enterobacteriaceae- non-lactose fermenter

A

Salmonella
Shigella
Proteus
Pseudomonas

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209
Q

This virulence factor in gram-negative bacteria activates macrophages, white blood cells, releases cytotoxin, and causes septic shock, necrosis, DIC, and death

A

Lipid A endotoxin

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210
Q

This virulence factor provides resistance to antibodies, production of toxins, hemolysins, chromosomal or plasmid mediated

A

Pathogenic Islands

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211
Q

Virulence factor that helps Enterobacteriaceae evade immune mechanisms and phagocytosis

A

K antigens (capsule)

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212
Q

Virulence factor that helps Enterobacteriaceae with motility and adherence to GI and urinary epithelial cells

A

H antigens (Flagellar)

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213
Q

What antibiotics are carbapenemase producing klebsiella pneunominae resistant to?

A

Cephalosporins
monobactams
carbapenems

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214
Q

Enterobacteriaceae in the top 10 CLABSIs

A

Klebsiella
Enterobacter
E. Coli

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215
Q

Top Enterobacteriaceae for VAP

A

Klebsiella

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216
Q

Top Enterobacteriaceae for HAP

A

Enterobacter
Klebsiella
E. Coli

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217
Q

Top Enterobacteriaceae for HAI CAUTI

A

1) E. Coli
2) Klebsiella
3) Proteus
4) Enterobacter
5) Serratia

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218
Q

What HAIs does E. Coli typically cause?

A

CAUTI
CLABSI
VAP
SSI

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219
Q

What HAIs does Enterobacter cause?

A

Lower resp infections
UTI
wounds infections
Septecemias

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220
Q

Concern for Enterobacteriaceae

A

Multi-drug resistance, so treatment usually carbepenem

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221
Q

Motile fermenters Enterobacteriaceae

A

E. coli
Enterobacter
Serratia

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222
Q

Non-motile fermenter Enterobacteriaceae

A

Klebsiella

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223
Q

Motile non-lactose fermenters Enterobacteriaceae

A

Salmonella
Proteus

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224
Q

Non-motile, non lactose fermenting Enterobacteriaceae

A

Shigella
Yersinia

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225
Q

3 As of Klebsiella

A

Alcoholics, abscesses, aspiration

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226
Q

Carbepenemase producing genes

A

KPC
NDM
IMP
NDM
OXA-48

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227
Q

What antibiotic still typically works for CRE?

A

Fluoroquinolones

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228
Q

Most common flu strains in the last 30 years

A

H3N2
H1N1

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229
Q

TPN contamination

A

Fungi: C. albicans most freq, malassazia furfur

Gram + bacteria: Coagulase - staph

Gram - bacteria: E. coli, pseudomonas

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230
Q

Most common ESBL

A

Klebsiella and E. Coli

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231
Q

What antibiotics are ESBL resistant to?

A

third generation cephalosporins
monobactams

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232
Q

Common commensals that contaminate blood cultures

A

Corynebacterium
Bacillus
Propionibacterium
Coagulase-negative staph
Viridans group strep
Aerococcus spp.
Micrococcus spp.

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233
Q

Definition CLABSI (commensal)

A

2 positive cultures of common commensals from 2+ sets of blood cultures drawn <2 days apart AND patient has symptoms (fever, chills, hypotension)

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234
Q

Components of effective antimicrobial stewardship programs

A

1) leadership and culture
2) timely and appropriate antibiotic initiation
3) appropriate admin and deescalation
4) Data monitoring and reporting

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235
Q

Strategies for antimicrobial stewardship:

A
  • Pharmacy restriction of meds
  • audit and feedback
  • antibiotic timeouts
  • automatic stop orders
  • documented indication
  • dose optimization
  • De-escalation (IV- oral)
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236
Q

Cultures that are NOT suitable for anaerobic culture and why

A

Why: contamination with resident anaerobic flora

Sputum
rectal swab
nasal/ throat
Urethral swab
Voided urine

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237
Q

Percentage of population exposed to coccidiodies in endemic regions

A

50%

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238
Q

Scabies incubation

A

4-6 weeks

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239
Q

RSV precautions

A

Contact + standard for duration of illness (mask when appropriate under standard precautions)

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240
Q

Most common cause of epidemic GI illness worldwide

A

Noro

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241
Q

Five major control factors for foodborne pathogens

A

1) person hygiene
2) adequate cooking
3) avoid cross-contamination
4) Keep food at safe temp
6) avoid foods from unsafe sources

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242
Q

Test for WNV

A

positive IgM- goes to public health lab

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243
Q

Precautions rabies

A

Contact precautions and eyewear and mask or face shield to protect mucous membranes

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244
Q

Shape of Borrelia burgdorferi

A

Spirochete

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245
Q

Primary causative agent transient aplastic crisis

A

Parvovirus B19

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246
Q

Treatment for parvovirus B19 in immunocompromised

A

immunoglobulin therapy

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247
Q

Precautions parvovirus B19

A

Droplet precautions

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248
Q

Resistance of Parvovirus B19

A

resistant to detergents, solvents, and heat. Stays in the environment for a long time

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249
Q

Symptoms parvovirus B19

A

Most asymptomatic
Slapped cheek rash (erythema infectiosum or fifth’s disease)
Prodrome: low-grade fever, cold symptoms
Few days later- rash
Infectious from symptom onset- 7 days after, most infectious in first 2 days

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250
Q

Incubation for parvovirus

A

4-14 days
Rash appears 2-3 weeks after infection

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251
Q

How parvovirus B19 transmitted

A

Droplet/ fomite, blood transfusion, vertical transmission

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252
Q

Complications parvovirus B19

A

spontaneous abortion in first 20 weeks of pregnancy
Transient aplastic crisis

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253
Q

Symptoms parvovirus in fetus

A

first trimester infection: anencephaly, spontaneous abortion
Second trimester: fetal hydrops and severe anemia

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254
Q

How long to isolate parvovirus B19 patient in transient aplastic crisis

A

7 days after admission, droplet or hospital stay if immunosuppressed

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255
Q

Surface proteins RSV

A

F (fusion)
G (attachment)
SH (small hydrophobic)

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256
Q

Infection control RSV

A
  • HH
  • cough etiquette
  • cleaning/disinfection
  • droplet and contact precautions
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257
Q

Most common cause of hospitalization for respiratory disease in chlidren

A

RSV

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258
Q

Incubation RSV, and when contagious

A

2-8 days
symptom onset until 3-8 days later

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259
Q

Treatment RSV

A

Palivizumab for high risk

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260
Q

Commensal fungi in GI tract and female genital tract

A

Candida albicans

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261
Q

Risk factors for fungal infections

A

Broad spectrum antibiotics
CVC
Immunosuppression
Neutropenia
Urinary catheter
Prothesis
TPN

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262
Q

When should you suspect candidemia?

A

High-risk patients with unexplained fever (esp if on broad spectrum antibiotics) or unexplained CNS signs and symptoms

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263
Q

Max hang time for lipid containing infusions

A

12 hours

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264
Q

Clinical presentation of aspergillus

A

cavitation/ fungal balls in the lungs/ fever/ hemoptysis

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265
Q

Most common viruses to cause meningitis

A

HSV, enteroviruses, arboviruses, mumps

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266
Q

Where does meningitis typically stem from?

A

organisms that colonize the nasophyrnyx

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267
Q

Precautions bacterial meningitis

A

H. influenzae and n. meningitidis- droplet 24 hours after appropriate microbial therapy

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268
Q

Precautions for aseptic meningitis

A

typically standard

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269
Q

Testing for CJD

A
  • Western blot on brain tissue
  • immunohistochemical tests for PrP on fixed tissue
  • analysis of DNA extracted from blood or brain
  • analysis of CSF for 14-3-3 protein
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270
Q

Highly infectious tissue CJD

A

Brain
Dura matter
Pituitary tissue
Spinal cord
Eye

*not CSF listed as low infectivity

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271
Q

Iatrogenic transmission of CJD

A
  • pts exposed directly to infectious prion materials via inadequately sterilized neuro equip
  • contaminated dura matter
  • corneal transplants
  • cortical electroencephalogram electrodes
  • injections of cadaveric pituitary-derived growth hormone
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272
Q

4 chemicals that work on CJD

A

Chlorine
Phenol
Guanidine thiocyante
Sodium hydroxide

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273
Q

Parameters of pre-sterilization (before normal sterilization process from cleaning- sterilization) for CJD

A

prevac sterilizer- 134F- 18 min
Gravity displacement sterilizer- 132F- 1 hour
NaOh- 1 hour

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274
Q

How to clean contaminated surfaces with CJD

A

1:10 dilution sodium hypochlorite for 15 inutes

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275
Q

Reduction of red blood cell hemoglobin to methemoglobin leading to a green or brown zone of discoloration surrounding the colony on a blood agar plate

A

alpha-hemolysis

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276
Q

Complete lysis of red blood cells leading to a clear (transparent) zone surrounding the colony on a blood agar plate.

A

beta-hemolysis

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277
Q

Exotoxin produced by certain bacteria that have the ability to trigger excessive inflammatory immune response

A

Superantigen- examples: Strep pyogenes, S. dysgalactiae, S. equi

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278
Q

Group Strep A clinical

A

Pharyngitis
Scarlet fever
Erysipelas
Impetigo
Cellulitis
Necrotizing fascitis
Streptococcal toxic shock syndrome

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279
Q

Culture: white-to-gray colonies, 1 to 2 mm in diameter, and are surrounded by clear, colorless zones within which the red blood cells in the medium have been completely lysed

A

GAS, different from other beta-hemolytic strep because it’s susceptible to bacitracin

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280
Q

Gene to type for GAS

A

emm gene (codes for virulence factor)

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281
Q

If a patient has a sore throat, white spots, but a negative rapid antigen detection test for GAS, does that rule out strep?

A

No, test has 80-90% specificity so should culture

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282
Q

Precautions- Major GAS skin, wound, or burn infection that is draining

A

droplet, contact, and standard until 24 hours after initiation of effective therapy

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283
Q

Precautions GAS pharyngitis

A

Droplet until 24 hours after effective therapy

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284
Q

Precautions Scarlet fever

A

droplet for 24 hours after initiation of effective therapy

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285
Q

Precautions for strep pyogenes(GAS)

A

Droplet for 24 hours after initiation of effective therapy

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286
Q

Precautions group b strep neonatal disease

A

Standard

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287
Q

Precautions Strep pneumo, drug resistant

A

Standard, contact

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288
Q

Precautions non-drug resistant strep pneumo

A

standard

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289
Q

Risk factors for group b strep to infant born to colonized mother

A
  • preterm delivery
  • prolonged membrane repture during labor
  • maternal fever during labor
  • maternal history of prior infant with GBS sepsis
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290
Q

Most common cause of adult bacterial meningitis in the U.S.

A

Strep pneumo

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291
Q

Culture: gram +, α-hemolysis with partial lysis of red blood cells leaving a zone of greenish discoloration

A

Viridans group strep

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292
Q

Types of strep

A

GAS, GBS, viridans group strep, group C strep (animals), Group D strep (colon cancer, GI)

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293
Q

What are the common staph HAIs?

A

Bacteremia
Endocarditis
Pneumonia
Osteomylitis
SSI
Skin and soft tissue infections
Device associated infections

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294
Q

Risk factors for HA- MRSA

A
  • LOS in hospital
  • chronic wounds
  • catheters
  • antibiotics
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295
Q

MRSA resistance

A

Beta-lactams
macrolides
clindamycin
tetracycline
quinolones
aminoglycoside

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296
Q

Most common organism to infect CSF shunts

A

Staph epidermidis

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297
Q

How to dx scabies

A

prep skin with India ink to see burrows, microscopic examination of mites, or PCR

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298
Q

Treatment for scabies

A

Topical scabicide

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299
Q

Incubation scabies

A

4-6 weeks, as little as 10 days

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300
Q

Precautions scabies

A

Contact until 24 hours after treatment, may be longer for crusted scabies

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301
Q

PEP for scabies

A

Treatment for household members and intimate contacts

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302
Q

Outbreak response: scabies

A

Treat entire population at risk over the same 24-48 hour period, whether or not symptoms present and wash all clothing on hot cycle

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303
Q

Temp to kill scabies

A

Hot water wash at 122F for at least 10 minutes, and 10 minute dry

OR put linens in bag for 10 days

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304
Q

Survival of lice and lice eggs outside of host

A

2 days for head lice
30 days for eggs

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305
Q

Kill lice on personal items

A

140F for 5-10 min
Seal in bag 10-14 days
Freeze in bag for 12-24 hours

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306
Q

Human infestation of fly larvae

A

Myiasis

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307
Q

Kill bed bugs on personal items

A

Hot water wash at 120F for 10-20 minutes or freeze items
Heat items in room to 118 for 1 hour

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308
Q

Serogroups N. meningitidis

A

A, B, C, X, Y, W-135

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309
Q

Ages impacted by N. meningitidis

A

<5 years, 21 years, 65+

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310
Q

5 clinical manifestations of N. meningitidis

A

1) Bacteremia
2) Meningocomcemia without meningitis
3) Menigitis with or withouth meningococemia (70%)
4) Meningococcal encephalitis
5) Meningococcal pneumonia

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311
Q

What rash is commonly associated with N. meningitidis?

A

Petechial or purpuric rash

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312
Q

What condition related to a rash can lead to death from a N. meningitidis patient?

A

Purpura fulminans

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313
Q

What is a risk factor for meningococcal pneumonia?

A

Recent infection with virus

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314
Q

Antibiotics for N. meningitis

A

penicillin G and cephalosporins

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315
Q

When is vaccine for N. meningitiidis recommended?

A

Routine:
- all children 11 or 12
-Booster at 16-18
Campaign:
-3 cases from same serogroup in community <3 months

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316
Q

PEP for N. meningitidis

A

24 hours- 14 days after exposure
Rifampin
Ciprofloxacin
Ceftriaxone

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317
Q

Most common cause of encephalitis

A

Enterovirus (Coxsackievirus)

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318
Q

Period of communicability for N. meningitidis

A

7 days before onset to 24 hours after antimicrobial therapy

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319
Q

Incubation/ TBP/ HCP restriction/ PEP: conjunctivitis

A

Incubation: 24-72 hours

TBP:
viral- contact and standard
bacterial- standard

Restriction: Pt contact and pt env until discharge ceases

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320
Q

Incubation/ TBP/ HCP restriction/ PEP: acute diarrheal illness

A

Incubation: Varies

TBP: Contact for diapered and incontinent for duration of illness, may need negative stool samples

Restriction: pt contact, pt env, food until symptoms resolve

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321
Q

Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Diphtheria

A

Incubation 2-5 days

TBP: Droplet until off antibiotics and 2 negative cultures 24 hours apart

Restriction: Exclude from duty until antimicrobial therapy complete and there are 2 negative samples

PEP: Exclusion and antibiotics

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322
Q

Incubation/ Symptom/ TBP/ HCP restriction/ PEP: Enterovirus (Coxsackie/ echovirus)

A

Incubation: 3-6 days

Symptom: resp, fever, rash, mouth sores

Contact: diapered or incontinent for duration of illness

Restriction: restrict from care of infants, neonates, and immunocompromised until symptoms resolved

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323
Q

Common name for coxsackie virus (which is an enterovirus)

A

Hand, foot, and mouth

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324
Q

Incubation/ TBP/ HCP restriction/ PEP Hep A

A

Incubation: Approx 28 days (15-50 days)

TBP: contact for diapered and incontinent until 1 week after jaundice, unless <3 years old and that is for duration of hospitalization

HCP: restrict from pt contact, pt env, and food handling until 1 week after jaundice

PEP: Hep A vax within 2 weeks

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325
Q

Incubation/ TBP/ HCP restriction/ PEP Hep B

A

Incubation: 90 days (60-150)

TBP: std, hemodialysis get their own space and equip

HCP: panel review exposure prone procedures

PEP: Source HBsAg positive and HCP susceptible- Hep B vax and HBIG

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326
Q

Incubation/ TBP/ HCP restriction/ PEP Herpes

A

Incubation: 2-12 days

Contact for severe/ disseminated disease until lesions dry and crust

Restrictions:
Herpetic whitlow: HCP from pt contact/ pt env until lesions dry and crust
Orofacial- cover and restrict from patient care immunocompromised

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327
Q

Incubation/ TBP/ HCP restriction/ PEP HIV

A

Incubation: 1-6 weeks

Standard precautions

restrictions: panel review for invasive exposure prone procedures/ local/ state health regs

PEP: within 72 hours, PEP will depend on pt viral load

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328
Q

Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Measles

A

Incubation: 10-12 days to symptoms, 14 days to rash

TBP: airborne and standard until 4 days after rash onset

Restriction: Exclude for 7 days after rash onset

PEP: exclude day 5-21 if exposed and no symptoms, 4 days after rash if one develops

Vax within 72 hours of exposure or Immunoglobulin within 6 days

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329
Q

Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: meningococcal disease

A

Incubation: 2-10 days

TBP: droplet for 24 hours after initiation of effective therapy

Restriction: exclude from duty until 24 hours after effective therapy

PEP: prophy antibiotics within 24 hours for HCP without mask and close contact (intubation, mouth to mouth, suctioning), household, partners

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330
Q

Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: mumps

A

Incubation: 16-18 days (12-25 days)

TBP: Droplet until 5 days after parotitis onset (updated from 9)

Restrict: exclude from duty until 5 days after parotitis (updated from 9)

Post exposure: Exclude susceptible days 12-26 or 5 days after parotitis

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331
Q

Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Pediculosis

A

Incubation: 7-10 days

TBP: contact until 24 hours after initiation of therapy

Restrict: no patient contact until treated and observed lice free (24 hours after initiation of therapy)

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332
Q

Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Pertussis

A

Incubation: 7-10 days (6-21 days)

TBP: Droplet until 5 days start of antibiotics

Restriction: Exclude until 5 days after the start of effective therapy

PEP: Z-pack

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333
Q

Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Rubella

A

Incubation: 14 days (12-23 days)

TBP:
congenital: contact until 1 year old
Adult: droplet for 7 days after rash onset

Restriction: Exclude until 5 days after rash onset

Post-exposure: Exclude susceptible day 7- day 21

PEP: Vax within 72 hours in non-pregnant, susceptible contacts

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334
Q

Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Staph aureus

A

Incubation: Varies

TBP: furunculosis/ draining lesions: contact until wounds stop draining

Restriction: Draining lesions: restrict from pt contact, pt env, and food until lesions no longer draining

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335
Q

Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: GAS

A

Incubation: varies

TBP: Droplet, contact if lesions present for 24 hours after start of appropriate therapy

Restrictions: pt care, pt env, and food until 24 hours after effective antimicrobial therapy

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336
Q

Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Active TB

A

TBP: airborne, draining lesions- contact and airborne until effective therapy, improving, and 3 consecutive negative sputum smears 8-24 hours apart

Restriction: exclude HCP until deemed non-infectious

Post exposure: test immediately and 12 weeks after exposure

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337
Q

Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Varicella zoster

A

Incubation: 14-16 days (10-21 days)

TBP: Airborne and contact (but no mask for vax, no recommendations for surgeon or N95 for susceptible) until all lesions crust and dry

Restriction: Exclude until all lesions crust and dry

Post exposure: Exclude susceptible day 10-day 21 (28 for VZIG)

PEP: Vax within 5 days, VZIG for preg and immunocompromised

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338
Q

Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Herpes zoster

A

TBP:
Localized immunocompetent- standard
Disseminated immunocompetent: airborne and contact
Disseminated or localized immunocompromised: airborne and contact
For duration of illness

Restriction:
Localized: cover lesions, restrict from high risk patients until all lesions crust and dry
Generalized or immunocompromised: restrict from pt contact until lesions crust and dry

Post exposure: susceptible exposed to disseminated or immunosuppressed pt: exclude from day 10 - day 21 (28 VZIG)

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339
Q

Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Ebola

A

Incubation: 8-10 days (2-21)

TBP: Droplet, standard, and contact for duration of illness

Exclusion: Exclude for duration of illness

Post exposure: State regs differ- exclusion may be for 21 days post exposure

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340
Q

Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Scabies

A

Incubation: 4-6 weeks

TBP: contact until 24 hours after start of effective therapy

Restriction: restrict from pt contact/ pt env for 24 hours after effective therapy

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341
Q

Contagious period for measles

A

1-2 days before until 4 days after rash

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342
Q

3 cs of measles prodromal phase

A

Cough, coryza, conjunctivitis

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343
Q

Word to describe measles rash

A

Morbiliform

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344
Q

Complications of measles

A
  • otitis media
  • bronchopneumonia
  • bronchitis
  • splenomegaly
  • encephalitis
  • death
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345
Q

Condition that may occur years after measles infection in the very young

A

Subacute sclerosing panencephalitis (SSPE)

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346
Q

transport of measles test specimen

A

ASAP- measles liable
4 degrees C (freezing causes loss of virus)
sample early in acute phase

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347
Q

What vitamin deficiency is related to measles?

A

Vitamin A

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348
Q

Vaccine info for MMR

A

Live attenuated
Give at 12 months and before school (4-6 years)

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349
Q

Who should not receive the MMR vaccine?

A

Pregnant
Severely immunocompromised
Recent recipients of immunoglobulin or blood products

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350
Q

If another patient was exposed to a measles case and is susceptible, what is recommended for the exposed pt?

A
  • AIIR for 5-21 days after exposure
  • Vax within 72 hours
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351
Q

Contagious period mumps

A

1-2 days before until 5 (formerly 9) days after parotitis

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352
Q

% of mumps patients that are asymptomatic

A

30-40%

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353
Q

When is the highest risk for congenital rubella?

A

early pregnancy in first 12 weeks

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354
Q

Symptoms congenital rubella

A
  • retarded growth
  • mental retardation
  • congenital heart disease
  • deafness
  • ocular abnormalities
  • anemia
  • hepatosplenomegaly
  • increased miscarriages
  • increase stillbirths
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355
Q

Rubella symptoms adult

A

25-50% asymptomatic

otherwise prodrome with ILI and then maculopapular rash, arthritis, and arthralgia (in women) for 3-5 days

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356
Q

Contagious window for rubella

A

7 days before rash until 7-14 days after rash

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357
Q

Testing: rubella

A

Send to CDC for confirmation
Usually use serology (IgM or paired IgG) since viral iso difficult

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358
Q

Typical age range for mumps cases

A

5-19 years old

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359
Q

Primary virulence factor for pertussis

A

Pertussis toxin

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360
Q

How does pertussis toxin work?

A

PT prevents migration of lymphocytes to areas of infection and adversely affects phagocytosis and glucose metabolism, causing compensated insulinemia

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361
Q

Complications of pertussis:

A

pneumonia
seizures
encephalopathy
death

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362
Q

Describe the vaccine for pertussis

A

Acellular vaccine
4 doses DTAP (2,4,6, and 15-18 months)
Booster 4-6 years
TDAP- 11-18 years (best around 11-12)
Every pregnancy
19+- Tdap for adults that never received a dose

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363
Q

Recommendations if multiple patients exposed to pertussis?

A

PEP and cohort

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364
Q

additional measures for more extensive respiratory outbreaks/ community spread

A

Universal masking
limit visitation
exclude sick children from daycare

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365
Q

Herpes viruses

A

HH1 (HSV-1)
HH2 (HSV-2)
HH3 (VZV)
HH4 (EBV)
HH5 (CMV)
HH6 (HHV-6)
HH7 (HHV-7)
HH8 (KSHV)

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366
Q

HHV that causes:
B cell lymphoma
Hodgkin lymphoma
NP carcinoma
Hairy leukopenia

A

EBV

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367
Q

Common name for HHV-6 and HHBV-7

A

Roseola

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368
Q

HHV that can cause:
Primary effusion lymphoma
Multicentric Castleman disease

A

HHV-8 Kaposi Sarcoma

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369
Q

HHV that causes gingivostomatitis

A

HSV-1

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370
Q

What differentiates chickenpox and measles:

A

Measles: conjunctivitis, rash appears on forehead, hacking cough, koplik spots

Chickenpox: rash appears on chest, face and back, decreased appetite, spots turn into itchy blisters

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371
Q

Symptoms congenital CMV

A
  • petechiae (blueberry muffin rash)
  • jaundice
  • hepatosplenomegaly
  • microcephaly
  • hearing loss
  • eye abnormalities
  • developmental delays
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372
Q

Type of virus herpes

A

DNA

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373
Q

Life threatening herpes virus for patients with severe skin conditions like burns

A

Eczema herpeticum

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374
Q

Biggest complications risk for Varicella

A

Secondary bacterial infection

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375
Q

Healthcare populations of concern for herpes viruses

A

Immunocompromised
Solid Organ transplants
Hematopoietic stem cell transplants

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376
Q

Most common disease to cause birth defects in the United States

A

CMV

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377
Q

Illness that causes gray baby syndrome (Pallor, hypotension, and resp destress) in preterm babies infected after transfusion

A

CMV

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378
Q

Clinical outcomes of AIDS and transplant recipients that get CMV

A

Interstitial pneumonia
Cytomegalo-retinitis
Cytomegalo-enteritis (GI issues)

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379
Q

What is the mortality rate of post-transplant lymhoproliferative disease from EBV?

A

50%

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380
Q

95% of children are infected with this disease by age 3

A

HH6 (roseola)

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381
Q

Concerns for HHV6 in transplant recepients

A
  • HSCT can reactivate
    Allogenic transplants- can cause graft rejection
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382
Q

Screening recommendations for HIV

A

once age 13-64
more frequently (every 6 months- 1 year for higher risk behavior)

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383
Q

Most common opportunisitic infections HIV

A

Pneumocysitis jiroveci
TB
Disseminated mycobacterium avium
Disseminated mycobacterium kansasaii

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384
Q

CDC core strategies for HIV

A

1) Dx
2) Prevent
3) Treat
4) Respond

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385
Q

Tests for HIV and description:

A

1) rapid antibody tests (23-90 days after infection), require confirmation for positive with HIV antibody differentiation immunoassay
2) Viral p24 antigen/ antibody test (venous 18-45 days after exposure, fingerprick (18-90 days after exposure)
3) NAAT (10-33 days after exposure)

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386
Q

Work restrictions for hcp with RSV

A

HCP with acute resp symptoms should NOT provide care to high-risk patients

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387
Q

When to provide education about MDROs

A

At hire and routinely as changes occur

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388
Q

Elements of an occupational health program

A

1) Educate HCP about IP and their responsibility for IP
2) Investigate exposures to OBs
3) Provide care to HCP with work-related illness/ exposure
4) ID infection risk to preventative measures
5) contain costs by preventing infectious diseases that result in absenteeism/ disability

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389
Q

Elements of a the respiratory protection program:

A
  • Person specially trained to oversee program
  • administrator evaluate effectiveness of program
  • training & demonstration of use by employee
  • Sufficient number, models, and sizes
  • Fit test annually or as needed
  • Seal check with each use
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390
Q

Elements of exposure control plan and how often to review

A

Annually
1) protective measures provided by employer
2) engineering/ work practice controls
3) PPE
4) HBV vax within 10 days of hire
5) Training

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391
Q

Ways to measure needlestick injuries

A

Occupied Beds: Needlesticks / Bed/ Year:
# needlesticks/ total occupied beds

Occupation: Needlesticks/ nurses/ year
# needlesticks reported by nurses/ # full time nurses employed

Device-based rate: needlesticks/ device type/ year
# needlesticks from device type/ # device type used or purchased

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392
Q

General HIV PEP

A

Most exposures warrant 2 drug regimen with:
2 nuceloside reverse transcriptase inhibitors (NRTIs) or
1 NRTI and 1 nucleotide reverse transcriptase inhibitor

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393
Q

What are the components of a successful occupational health

A

1) leadership and management
2) Communication, collaboration, assessment, and reduction of risk for HCP
3) Medical evaluations
4) Occupational education and training for infection prevention including essential precautions for disease transmission
5) Management of testing protocols and return to work guidelines
6) HCP treatment
7) Immunizations
8) Testing protocols
9) management of potentially infectious exposures and responses

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394
Q

What’s the recommendation for MMR if born before 1957?

A

If no immunity per lab evidence for rubella, get 1 dose of MMR

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395
Q

If exposure to varicella occurs after vaccination series is started, does HCP need to be exluded?

A

No, but they should be monitored for symptoms daily days 10-21 (or 28 if they get VZIG)

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396
Q

When should meningitis PEP be started?

A

within 24 hours of exposure, no more than 2 weeks

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397
Q

What antibiotics for meningitis PEP are contraindicated for pregnant women?

A

Rifampin
Cipro

They can take ceftriaxone

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398
Q

unique symptom of Hep B

A

Scleral icturus

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399
Q

When to test for HCV after exposure

A

Baseline testing for anti-HCV and ALT, RNA testing at 4-6 weeks after exposure, then repeat anti-HCV and ALT at 4-6 months after exposure

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400
Q

When to test for HIV after exposure

A

Baseline, follow up testing for 6 months

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401
Q

Timeline to start HIV PEP

A

72 hours

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402
Q

Higher risk HIV exposures

A

Patient symptomatic, has AIDS or high viral load

Exposure from large hollow needle, deep puncture, needle used in patient artery or vein

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403
Q

When would you use an expanded 3-drug PEP for HIV?

A

PT HIV class 2 for less severe or more severe exposure
OR
PT HIV class 1, but there is a more severe exposure

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404
Q

What PEP is most often recommended for mucous membrane exposures to HIV?

A

2-drug unless patient HIV class II and large volume of blood into mucous membrane

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405
Q

How to make IVs and central lines safer for HCP

A

Replace IV, aerterial, and central line tubes with needless or blunt canula devices

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406
Q

What can be done to make scalpels safer

A

round tipped scalpel blades
alternative material blades (silicone)
retractable, disposable blades

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407
Q

Hierarchy of controls

A

Most effective to lease effective:

Elimination
substitution
engineering
administrative controls
PPE

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408
Q

What vaccine contain egg?

A

MMR and influenza

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409
Q

What vaccines contain thimerosal?

A

DTAP, DT, Td
Influenza
Meningococcal

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410
Q

Who should avoid live vaccine?

A
  • Pregnant or planning to become pregnant in 28 days
  • Symptomatic HIV
  • Treatment induced immunosuppression
  • Malignancy
  • Receipt of antibody production within window of vax
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411
Q

Immunoglobulin available for these diseases

A

Hepatitis A
Hepatitis B
Chickenpox
Tetanus
Measles
Rubella
Rabies

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412
Q

Who is considered at risk and should get the Hep B vaccine?

A
  • STI treatment facilities
  • HIV testing and treatment facilities
  • drug abuse treatment/ prevention
  • healthcare targeting MSM/ drug/users
  • correctional facilities
  • hemodialysis
  • developmental disabilities
  • HCP with risk to blood exposure
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413
Q

What age group should not get LAIV?

A

> 49 years (higher risk for severe complications from flu)

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414
Q

How many doses of MMR and how far apart?

A

2 doses, 28 days apart, after 1st bday

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415
Q

Can you give MMR vaccine and the TST test at the same time?

A

Yes, same day as vaccine or wait 4 weeks for TST

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416
Q

Can you give live vaccines at the same time?

A

Yes, but you should give them the same day OR wait until 28 days between live vaccine if not the same day

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417
Q

Can patients with HIV get the MMR vaccine?

A

Yes if asymptomatic and CD4 >15%

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418
Q

What is a potential side effect of rubella vaccine in adults

A

increased risk of arthritis and arthralgias

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419
Q

If getting an elective splenectomy, when should you get the pneumococcal vaccine?

A

2 weeks before

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420
Q

GBS linked to what vaccines?

A

Flu (1970s)
Tdap?
COVID

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421
Q

Is there an indication for Tdap as part of an outbreak response?

A

No

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422
Q

What type of vaccine is vaccinia?

A

Live vaccine- smallpox

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423
Q

Who should be vaccinated for smallpox in a routine non-emergency? How often?

A
  • Lab workers who work with vaccinia or orthopox viruses that infect humans (every 3 years)

Those who administer smallpox vaccine to others (every 10 years)

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424
Q

How long should you wait to do a TST after smallpox vaccine

A

1 month

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425
Q

What is a concern for vaccinia vacine?

A

Live vaccine can cause the virus to be transmitted to close contacts

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426
Q

What vaccine are the follow considerations for close contacts for:
- cardiac disease
- eye disease with topical steroids
- immunodeficiency disorders
- eczema
- pregnancy
- breastfeeding mothers
- infants
- 3 or more cardiac risk factors (hypertension, diabetes, high cholesterol)
- latex sensitivity

A

Vaccinia vaccine

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427
Q

What are the side effects of the vaccinia vaccine? Note, most people will have at least 1 adverse event

A

Rash
Inadvertent ocular inoculation
myocarditis

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428
Q

This live vaccine can cause a rash in immunocompromised and potentially transmit disease to others

A

Varicella

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429
Q

Proof of immunity: varicella

A

1) written 2-dose vax record
2) lab evidence
3) physician verified dx

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430
Q

Indications for meningococcal vaccine

A
  • asplenia
  • travel to countries with endemic meningococcal disease
  • lab employees with exposure
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431
Q

Goals of the HCP vax program

A

1) achieve high rates of immunization
2) Devise and implement specific vaccine strategies
3) provide education about vaccine
4) Justify the cost

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432
Q

Can Hep B vaccine be frozen?

A

No

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433
Q

Do HCP born before 1957 have to provide lab evidence of disease?

A

Yes- all HCP must have documented immunity against measles

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434
Q

Is there a booster for polio?

A

Yes, booster recommended for high-risk

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435
Q

What vaccines should be frozen?

A

Vaccinia

Powdered varicella vaccine

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436
Q

Recommended vaccines for healthcare workers

A

Hep B
Influenza
MMR
Tdap

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437
Q

Type of temperature monitoring device recommended by CDC

A

Digital Data Logger

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438
Q

Way to measure temperature in vaccine fridge

A

Buffered temp probe with buffer (glycol, glass beads, sand, teflon)

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439
Q

difference between expiration date and beyond use dates on vaccines

A

Expiration - final day that vaccine can be used

Beyond use- last date or time that vaccine can be safely used after it was moved

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440
Q

When to discard multi-dose vials

A

after max number of doses drawn, exp date, or 28 days after first puncture, whichever comes first

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441
Q

What is the maximum number of transport + clinic hours for a vaccine?

A

8 hours

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442
Q

Vaccine storage requirements

A
  • original packaging, , labeled separate containers
  • middle shelf away from walls/ ceiling/ floor/ door
  • temp stable area
  • store with diluent
  • leave room for circulation
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442
Q

What should be used to keep vaccines cold during transport?

A

Phase change materials

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443
Q

What diseases are standard precautions the only preventative measure?

A

CMV (Std)
HCV (std)
Parvovirus B19 (droplet)
TB (airborne)

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444
Q

What vaccines are contraindicated for pregnant women?

A

HPV
Live flu (LAIV)
MMR
Varicella
Zoster

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445
Q

What vaccines are recommended during pregnancy?

A

inactivated flu
Hep A if indicated
Hep B sometimes
Tdap

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446
Q

What is the concern if a pregnant woman cares for an immunocompromised patient with chronic anemia?

A

Parvovirus B19

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447
Q

What diseases can pregnant women take PEP chemoprophylaxis for?

A

N. meningitidis
Syphillis
HIV

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448
Q

What birth defects can varicella cause?

A
  • malformations (skin, limb, CNS, eye)
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449
Q

Requirements for volunteers, contract workers, etc..

A

1) review medical eval and immunizations programs for facility
2) Process for management of job-related illnesses and exposures, including work restrictions
3) Counseling services related to exposure
4) maintenance and confidentiality of health records

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450
Q

What education should be offered to nonemployee HCP

A
  • IP policies and procedures and their locations
  • chain of infection/ modes of transmission
  • BBP exposure prevention and plan
  • TB education and plan
  • HH
  • PPE
  • Fed, state, and local regulations
  • process to report events, near misses, and unsafe work practices
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451
Q

Actions taken to decrease the potential impact of a sitution

A

mitigation

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452
Q

measures taken before an event that help prepare an individual, facility, or community to respond to the emergency

A

preparedness

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453
Q

Intervention undertaken in response to a known or suspected event

A

Response

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454
Q

Intervention implemented after the emergency has been declared over

A

Recovery

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455
Q

Water needed for emergency management

A

25 gal a day for pt care

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456
Q

Control to reduce the likelihood of an exposure by altering the manner in which the task is accomplished

A

administrative and work practice controls
Example- training HCP on safer technique to recap needle

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457
Q

Clinical symptom primary TB

A

Erythema nodosum
Fever
Cough
Gohn complex

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458
Q

Parts of the TB control plan

A

1) risk assessment
2) Administrative controls (methods to ID pts and get to AII)
3) Environmental Controls
4) Respiratory protection

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459
Q

Leading cause of NTM in the U.S.

A

Mycobacterium avium complex

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460
Q

Bacteria that cause pneumonia most often in older adults (65+)

A

Strep pneumo
Klebsiella pneumo
Pseudomanas
Legionella

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461
Q

How long should chemoprophylaxis continue during a flu outbreak?

A

at least 14 days, 7 days after the last case

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462
Q

What vaccines are recommended for older adults (as routine vax)

A

Flu (high antigen)
COVID
TDAP (if never had one before) and TD every 10 years
Pneumo
Zoster

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463
Q

Most common HAI in neonates

A

BSIs
Pneumonia

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464
Q

Standard Precaution Components

A
  • Hand hygiene
  • Appropriate use of PPE
  • Respiratory hygiene/ cough etiquette
  • Proper placement of patients
  • Safe injection practices
  • Disinfection and sterilization of reusable medical equipment
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465
Q

5 moments of hand hygiene

A

1) before touching a patient
2) before a clean or aseptic procedure
3) after body fluid exposure risk
4) after touching a patient
5) after touching patient surroundings

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466
Q

Are ambulatory centers required to use precautions for MDROs?

A

No, Due to the shorter stays and typically lower intensity of care, the risk of spread of MDROs in outpatient facilities is generally reduced and as a result, many ambulatory facilities may choose to not use precautions

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467
Q

How much space should there be around furniture/ procedure tables in ambulatory centers?

A

3 feet

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468
Q

Recognize antigens, differentiate into plasma cells that secrete antibodies (immunoglobulins), which inactivate microorganisms alone or in combination with complement phagocytes

A

B-lymphocyte

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469
Q

Help or suppress cell function, may also be cytotoxic, killing target cells that express foreign antigens

A

T-lymphocytes

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470
Q

Immune cells that help fight bacteria and fungi, migrate toward site of infection (chemotaxis), ingest and kill microbes

A

phagocytes (including neutrophils, eosinophils, basophils, monocytes, and macrophages)

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471
Q

What is are the precautions for a TB autopsy?

A

N95

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472
Q

What patients are at increased risk for fungal infections?

A
  • Leukemia
  • Solid tumors and leukopenia
  • Bone marrow transplant
  • Injection drug users
  • Pts with intra-abdominal or cardiothoracic surgery
  • Burn victims
  • Premature/ low birth weight infants
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473
Q

Do antimicrobials in multidose vials protect against:
Bacteria
Viruses

A

Bacteria- yes
Viruses- no

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474
Q

What do you look for during an antibiotic time out? When should the timeout occur?

A
  • Correct dose
  • Duration of therapy
  • Indication for treatment

24-48 hours after culture results

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475
Q

How far must sterile items be stored from the ceiling or sprinklers?

A

18 inches

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476
Q

How far must sterile items be stored from the floor?

A

8-10 inches

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477
Q

What type of pressure is needed in a sterile storage room

A

positive

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478
Q

How many ACH for sterile storage rooms?

A

at least 4, but 10 preferred

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479
Q

Temperature of sterile storage room

A

65-72F

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480
Q

What infections require mothers to withhold breastmilk?

A

HIV
HSV on breast
WNV
Human T-cell lymphotropic virus type I or II
Active TB (but can pump and give milk to baby if treatment not contraindicated)

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481
Q

Humidity sterile storage

A

35-75%

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482
Q

ACH/ pressure for decontamination/ contaminated storage area

A

Negative, 10 ACH

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483
Q

Portals of entry for CVCs

A
  • Stopcocks for medicine injection (cap when not in use, closed systems preferred)
  • Admin IV infusions
  • Collection of blood samples
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484
Q

Which type of alcohol has greater activity against:
Bacteria
Viruses

A

Bacteria: isopropyl alcohol
Viruses: ethyl alcohol

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485
Q

Types of antiseptics

A
  • Alcohol
  • Chlorohexidine
  • Chlorine
  • Hexachlorophene
  • Iodine
  • Chloroxylenol (PCMX)
  • Quat ammonium
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486
Q

Indications for hand washing

A
  • visibly soiled
  • Before eating
  • Before preparing food
  • after using the bathroom
  • exposed to spire-forming organisms
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487
Q

Per fire code, what is the minimum width of the corridor with hand sanitizer dispensers, and how far apart must they be?

A
  • 6 feet
  • 4 feet apart
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488
Q

What antiseptic agents have persistent activity against bacteria?

A

CHG
Iodophers

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489
Q

Process for surgical hand antisepsis

A

remove jewelry, clean nails, wash hands and arms

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490
Q

How to improve HH?

A
  • administrative support
  • convenient and acceptable products/ dispensers
  • monitoring and feedback
  • role modeling- excellent HH
  • Motivational/ incentive programs
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491
Q

What is required for HH by the TJC?

A

Education, monitoring, and feedback

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492
Q

Type of hand hygiene monitoring with the following pros:
Real-time corrections
- assess HH technique and durations
- ID reasons for missed HH opportunities
- Pts and families can observe and notify

A

Direct Observation

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493
Q

Type of hand hygiene monitoring with the following pros:
- Always in place
- Capture all HCP and visitors
- Minimized hawthorne effect
- Not time consuming
- Just-in-time reminders
- Consistent

A

Automated monitoring (sensing devices)

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494
Q

Type of hand hygiene monitoring with the following pros:
- Less time and resources
- All the time
- Better for difficult to observe areas, like the OR

A

Product volume monitoring

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495
Q

Type of hand hygiene monitoring with the following cons:
- Time consuming
- Difficult to recruit observers
- Variability of observers
- Hawthorne effect
- Biased to weekday/ day shifts, captures small portion of HCP

A

Direct observation

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496
Q

Type of hand hygiene monitoring with the following cons:
- $$
- HCP need special badge
- Rely on entry/ exit but may not detect other HH moments
- No immediate feedback
- Unpopular with HCP

A

Automated Monitoring

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497
Q

Type of hand hygiene monitoring with the following cons:
- Need accurate supply info at the unit level
- documenting data can delay distribution
- cannot assess technique or duration
- cannot discern HCP/ visitor use

A

Product volume monitoring

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498
Q

Calculations for HH through product volume monitoring

A

Volume used (specific product) / 1000 pt days

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499
Q

Reasons for poor HH adherence

A
  • Lack of knowledge
  • Increased demands with less time
  • Irritated, dry hands
  • Lack of soap and paper towels
  • Inaccessible sinks
  • Shortage of sinks
  • Belief that wearing gloves replace need tor HH
  • Lack of administrative sanctions
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500
Q

This ruling protects employees from unprotected contact with patient blood, body fluid, secretions, excretions, mucous membranes, and non-intact skin

A

OSHA Bloodborne Pathogen Standard (1991)

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501
Q

What is needed for success of a BBP program

A
  • administrative support
  • Education
  • Policies and procedures
  • Institutional culture
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502
Q

When to use gloves under standard precautions

A

Touching:
- mucous membranes
- non-intact skin
- blood
- body fluids
- secretions
- excretions
- contaminated objects

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503
Q

Examples of safe work practices

A
  • check PPE before contact (so not re-adjusting)
  • Position pt so sprays/ splatters –> away from HCP
  • Barrier for resuscitation
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504
Q

What patients should be prioritized if single room is not available?

A

Pts with poor hygiene/ etiquette or increased risk for severe outcomes

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505
Q

Standard precautions

A
  • Hand hygiene
  • PPE
  • Resp/ cough etiquette
  • Safe work practices
  • Env cleaning
  • Safe injection practices
  • Patient placement
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506
Q

What HCP should be restricted from working with patients on airborne precautions?

A
  • immunocompromised
  • pregnant
  • Susceptible
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507
Q

What policies and procedures are needed regarding transmission based precautions?

A
  • Chemoprophylaxis
  • PEP
  • Immunization
  • TB screening for HCP
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508
Q

When to use contact precautions

A

Heavy environmental contamination
Diseases transmitted by contact with pt or pt env

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509
Q

PPE for contact precautions

A

Gown and gloves

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510
Q

What PPE should env where for cleaning contact precautions rooms.

A

Gown and gloves

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511
Q

What should be used for terminal cleaning of contact precaution rooms

A

HP or UV light

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512
Q

Distance between patients for droplet precautions

A

6 ft

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513
Q

Type of masks required for:
TB
Smallpox
Measles
Chickenpox

A

TB- N95
Smallpox - N95
Measles- N95 or surgical mask (if not immune)
Chickenpox- N95 or surgical mask (if not immune)

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514
Q

How many ACH for protective env

A

12 ACH

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515
Q

Administrative measures for MDRO control

A
  • implement active surveillance culturing (based on risk assessment)
  • activate computer alerts for colonized patients
  • provide accessible and frequent sinks/ abhr dispensers
  • maintain nurse staffing levels
  • enforce HH adherence
  • enforce contact precaution adherence (including cohorting pts)
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516
Q

Surveillance for MDROs

A
  • monitor microbiology isolates
  • calculate incidence/ infection rates
    Use molecular typing for investigating outbreaks
  • active culture surveillance
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517
Q

Planning for active surveillance cultures

A
  • provide additional personnel to obtain cultures and additional lab personnel to process cultures
  • ensure turnaround time for screening results
  • monitor adherence to contact precautions
  • provide mechanism for communicating results to HCP
  • measure outcomes to evaluate the effectiveness of active surveillance cultures and contact precautions
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518
Q

Control methods for MDROs

A
  1. Administrative measures/ adherence monitoring
  2. MDRO education
  3. Judicious use of antimicrobials
  4. Surveillance
  5. Isolation precautions
  6. Environmental measures
  7. Decolonization
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519
Q

How long MDRO patients are on contact precautions

A

Duration of hospital stay

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520
Q

Antimicrobial agents that may be targeted for MDRO control

A
  • vancomycin
  • third generation cephalosporins (including for ESBLs)
  • anti-anaerobic agents VRE
  • quinolones
  • carbepenems
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521
Q

If single rooms/ cohorting patients with the same MDRO is ot possible, who should room with a patient with an MDRO

A

pts at low risk of getting the MDRO (lower acuity), have short lengths of stay, and are not associate with adverse outcomes

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522
Q

How long after surgery should you use sterile gloves?

A

24 hours

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523
Q

How long after surgery should you use sterile dressings?

A

24-48 hours

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524
Q

When to use clean technique

A
  • wound care
  • peripheral venous catheters
  • respiratory suctioning
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525
Q

Pressure for OR

A

positive

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526
Q

Type of gloves and type of technique for wound cleaning

A

Clean gloves, clean technique

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527
Q

Type of gloves and type of technique for routine dressing changes without debidement

A

Clean gloves, clean technique

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528
Q

Type of gloves and type of technique for dressing change with mechanical, chemical, or enzymatic debridement

A

clean gloves, clean technique

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529
Q

Type of gloves and type of technique for dressing change with sharp, conservative bedside debridement

A

sterile gloves, sterile technique

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530
Q

Type of gloves and type of technique for central line dressing change

A

Sterile gloves, sterile technique

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531
Q

Type of gloves and type of technique for tracheal suctioning when the tracheal suction is not within a closed sheath

A

Sterile gloves, clean technique

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532
Q

Type of gloves and type of technique for tracheostomy care or suctioning within a closed sheath

A

Clean gloves, clean technique

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533
Q

What are the aspects of aseptic technique

A
  • barriers
  • patient and equipment preparation
  • environmental controls
  • contact guidelines
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534
Q

process for keeping away disease producing microorganisms

A

asepsis

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535
Q

Technique to prevent the transfer of any organisms from one person to another or from one body site to another

A

Surgical asepsis/ sterile technique

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536
Q

Technique to practice interventions that reduce the numbers of microorganisms to prevent and reduce transmission risk from one person (or place) to another

A

Medical asepsis/ clean technique

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537
Q

Timeline to follow superficial SSI

A

30 days

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538
Q

Timeline to follow secondary incisional SSI

A

30 days

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539
Q

Surgeries that require 90 day follow up for deep incisional or organ space SSI

A
  • Breast surgery
  • Cardiac surgery
  • Coronary artery bypass graft
  • Craniotomy
  • Spinal fusion
  • Open reduction of fracture
  • Herniorrhaphy
  • Hip prosthesis
  • Knee prosthesis
  • Pacemaker surgery
  • Peripheral vascular bypass surgery
  • Ventricular shunt
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540
Q

Signs/ symptoms deep tissue/ organ space infections

A
  • abscess
  • deep incisional (primary/ secondary)
  • osteomyletis
  • -itis of the surrounding organ or space (ie endocarditis)
  • arterial/ venous infection
  • intrabdominal, not specified elsewhere
  • other infections of lower respiratory system
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541
Q

NHSN Superficial SSI definition

A
  • DOE within 30 days of operative procedure
  • AND involves only skin and subcutaneous tissue of the incision
  • AND pt has at least one of the following:
    1) purulent drainage from the incision
    2) organism ID’d from superficial site by culture or non-culture
    3) Dx of SSI
    4) Superficial incision deliberately opened by HCP and further testing not performed AND patient has one of the following:
    a) localized pain
    b) tenderness
    c) localized swelling
    d) erythema/ or heat
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542
Q

NHSN deep incisional SSI definition

A
  • DOE within 30 or 90 days of procedure
  • AND involves deep soft tissues of incision (facial/ muscle layers)
  • AND patient has least one of the following
    1) purulent drainage from deep incision
    2) Abscess or other evidence of infection involving deep incision detected in fross anatomical or histopathological exam or imaging test
    3) Deep incision spontaneously dehices (bursts open) or is deliberately opened or aspirated
    a) AND organism from deep soft tissue ID’d from culture/ non-culture
    b) AND patient as either fever or localized pain and tenderness
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543
Q

NHSN organ/ space SSI definition

A
  • DOE- withing 30 or 90 days of the procedure
  • AND involves any part of the body deeper than the facial/ muscle layers
  • AND patient has at least on of the following:
    1) Purulent drainage from drain placed into organ/ space
    2) Organisms ID’d from fluid or tissue in organ/ space by culture or non-culture test
    3) An abscess or other evidence of infection involving the organ/ space detected on gross anatomical or histopathological exam, or imaging test evidence suggestive of infection
  • AND infection in an organ/ space (ie osteomyletis, Pharyngitis, meningitis, joint or bursa infection, disc space infection, etc.)
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544
Q

What information is collected for each operative procedure?

A
  • wound class
  • ASA score
  • Trauma
  • Closure technique
  • Duration of procedure
  • General anesthesia?
  • emergency procedure?
  • Diabetes mellitus
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545
Q

Uninfected, operative wound in which no inflammation is encountered and the respiratory, ailmentary, genital, or uninfected urinary tract is not entered. Primarily closed, and if necessary, drained with closed drainage.

A

Clean wounds

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546
Q

Wounds class of operative incisional wounds that follow nonpenetrating (blunt) trauma

A

Clean wound

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547
Q

Operative wound in which the respiratory, ailmentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination.

A

Clean contaminated wound

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548
Q

Wound class for operations of biliary tract (ie chloecystectomy)

A

Clean contaminated wound

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549
Q

Wound class for operations of the appendix (appendectomy)

A

Clean contaminated wound

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550
Q

Wound class for operations of the vagina (hysterectomy)

A

Clean contaminated

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551
Q

Wound class for operations of the oropharynx (tonsilectomy)

A

Clean contaminated

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552
Q

Open, fresh, accidental wounds. Operations with major breaks in sterile technique or gross spillage from the GI tract, and incisions in which acute, nonpurulent inflammation is encountered.

A

Contaminated

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553
Q

Wound class of open cardiac massage

A

Contaminated

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554
Q

Wound class perforated bowel

A

Contaminated

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555
Q

Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera.

A

Dirty/ infected

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556
Q

Wound class: wound with purulence/ existing clinical infection

A

Dirty/ infected

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557
Q

Wound class: wound with perforated viscera

A

Dirty/ infected

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558
Q

Wound class: open traumatic wounds >4 hours

A

Dirty/ infected

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559
Q

Wound class: wound with devitalized tissue

A

Dirty/ infected

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560
Q

Wound class: wound with penetrating injuries > 4 hours

A

Dirty/ infected

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561
Q

Wound class: Wound with acute, nonpurulent inflammation

A

Contaminated

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562
Q

Wound class: wound with gross (any) spillage from the GI tract (bile)

A

Contaminated

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563
Q

Wound class: wound with infarcted or necrotic bowel (non-perforated)

A

Contaminated

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564
Q

Wound class: open, fresh, accidental wounds

A

Contaminated

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565
Q

Wound class: major break in sterile technique

A

Contaminated

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566
Q

Would class: operation entered the respiratory, GI, or genitourniary tract

A

Clean/ contaminated

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567
Q

Wound from operation that did not enter the resp, GI, or genitourniary tract and shows no sign of infection

A

Clean

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568
Q

ASA score: The patient was previously healthy and fit

A

1

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569
Q

ASA score: current smoker

A

2

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570
Q

ASA score: social alcohol drinker

A

2

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571
Q

ASA score: pregnant

A

2

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572
Q

ASA score: obesity

A

2

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573
Q

ASA score: well-controlled diabetes melitus

A

2

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574
Q

ASA score: well controlled hypertension

A

2

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575
Q

ASA score: mild lung disease

A

2

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576
Q

ASA score: the patient has mild systemic controlled disease

A

2

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577
Q

ASA score: the patient has severe, but not incapacitating systemic disease

A

3

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578
Q

ASA score: patient has substanive functional limitations

A

3

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579
Q

ASA score: patient has one or more moderate to severe disease

A

3

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580
Q

ASA score: poorly controlled diabetes

A

3

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581
Q

ASA score: poorly controlled hypertension

A

3

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582
Q

ASA score: COPD

A

3

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583
Q

ASA score: morbid obesity

A

3

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584
Q

ASA score: active hepatitis

A

3

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585
Q

ASA score: alcohol dependence

A

3

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586
Q

ASA score: implanted pacemaker

A

3

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587
Q

ASA score: moderate reduction of ejection fraction (systolic heart failure)

A

3

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588
Q

ASA score: end-stage renal disease undergoing regular dialysis

A

3

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589
Q

ASA score: myocardial infarction (heart attack) > 3 months ago

A

3

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590
Q

ASA score: CVA (cerebrovascular accident or stroke) > 3 months ago

A

3

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591
Q

ASA score: transient ischemic attack (TIA AKA mini-stroke) > 3 months ago

A

3

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592
Q

ASA score: coronary artery disease (CAD) or stent > 3 months ago

A

3

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593
Q

ASA score: patient has incapacitating systemic disease

A

4

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594
Q

ASA score: recent myocardial infarction (heart attack) in last 3 months

A

4

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595
Q

ASA score: CVA (cerebrovascular accident or stroke) in last 3 months ago

A

4

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596
Q

ASA score: transient ischemic attack (TIA AKA mini-stroke) within 3 months

A

4

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597
Q

ASA score: coronary artery disease (CAD) or stent within 3 months

A

4

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598
Q

ASA score: ongoing cardiac ischemia or severe valve dysfunction

A

4

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599
Q

ASA score: severe reduction of ejection fraction (systolic heart failure)

A

4

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600
Q

ASA score: sepsis

A

4

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601
Q

ASA score: Disseminated intravascular coagulation (DIC) (blood clots)

A

4

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602
Q

ASA score: ARDS (acute respiratory distress syndrome)

A

4

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603
Q

ASA score: end stage renal disease (ESRD)

A

4

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604
Q

ASA score: the patient is moribund and not expected to survive 24 hours

A

5

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605
Q

ASA score: ruptured abdominal/ thoracic aneurysm

A

5

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606
Q

ASA score: massive trauma

A

5

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607
Q

ASA score: intracranial bleed with mass effect

A

5

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608
Q

ASA score: ischemic bowel in the face of significant cardiac pathology (blood flow to bowel completely blocked)

A

5

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609
Q

ASA score: multiple organ/ system dysfunction

A

5

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610
Q

Closure technique: closure of skin during original surgery (any portion of incision by any manner, even if there are drains)

A

Primary closure

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611
Q

Closure technique: closure of wound in way that leaves the skin completely open following surgery (may be packed with guaze)

A

Non-primary closure

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612
Q

Closure technique: laparotomy in which the incision was closed to the level of the deep tissue layers, sometimes called the fascial layers, but the skin level was left open

A

non-primary closure

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613
Q

Closure technique: the abdomen was left completely open after the surgery (open abdomen)

A

non-primary closure

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614
Q

What is the most common HAI - making up 32% of HAIs?

A

Pneumonia

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615
Q

Infection present day of admission (day 1), 2 days before admission, and 1 calendar day after admission

A

Present on Admission

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616
Q

How long must a patient be on mechanical ventilation for VAP?

A

> 2 calendar days

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617
Q

Definition PNU-2 (Pneumonia with common bacterial, fungal, or viral pathogens

A
  • Imaging test evidence
  • AND Clinically defined signs and symptoms
  • AND specific lab findings
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618
Q

Definition PNU-1 (pneumonia based on clinical findings

A
  • imaging test evidence
  • AND clinically defined signs and symptoms
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619
Q

What would show up on test imaging for VAP?

A
  • infiltrate (substance that’s denser than air, such as blood, pus, or protein, that lingers in the lungs)
  • consolidation (fluid replaces air in lungs)
  • cavitation (gas-filled area in the center of a lung nodule)
  • pneumatoceles (air filled cysts)
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620
Q

How many chest images does a patient with underlying disease need to meet NHSN’s VAP definition? A healthy patient?

A

2 for patient with underlying disease
1 for healthy patient

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621
Q

NHSN- need at least one of these key symptoms for VAP classification in people > 1 year

A

1) Fever
2) Leukopenia or leukocytosis (>1 year, 12k)
3) Altered mental status with no other cause

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622
Q

NHSN- Need at least two of the following symptoms for VAP in anyone >1 (in addition to fever, leukopenia or leukcytosis, or altered mental status) in people >1 year

A
  • new or worsening sputum, increased secretions or suctioning
  • new or worsening cough, dypsnea, tachpnea
  • rales or bronchial breath sounds
  • worsening gas exchange (ie increased O2 demand)
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623
Q

NHSN: If child is 1 year old or less, they need to have worsening air exchanged to be classified with VAP. How does that present?

A

pulse oximetry <94%
increased O2 requirement

624
Q

NHSN, what are the symptoms for children <=1 year for VAP (need 3)

A
  • temp instability
  • leukopenia or leukocytosis (15k in <=1 year old)
  • new or change to sputum, increased resp secretions or suctioning
  • apnea, tachypnea, nasal flaring
  • wheezing, rales, rhonchi
  • cough
  • bradycardia or tachycardia
625
Q

If these organisms are detected in respiratory secretions or tissue, and the individual has symptoms and chest imagining findings, they person has VAP per NHSN

A
  • Virus
  • Bordetella pertussis
  • Legionella pneumophila
  • Chlamydia pneumoniae
  • Mycoplasma pneumoniae
626
Q

What tests for legionella pneumonphila fall under the NHSN defintion for VAP

A
  • culture or non-culture based micro test
  • fourfold rise in serogroup 1 antibody titer to >=1:128 by indirect IFA
  • Detection in urine by RIA or EIA
627
Q

NHSN: what are the pathogen exclusions for VAP unless they are ID’d from lung tissue or pleural fluid

A
  • Candida species or yeast
  • Coagulase-negative staph
  • Enterococcus
628
Q

Unless ID’d from lung tissue or pleural fluid, these community associated fungal pathogens are excluded from the NHSN VAP definition, why?

  • cryptococcus
  • histoplasma
  • coccidioides
  • paracoccidiodes
  • blastomyces
  • pneumocystis
A

They rarely cause or are not known to cause HAIs

629
Q

Is sputum a minimally contaminated LRT specimen?

630
Q

What are acceptable specimens for pneumo testing?

A
  • bronchoalveolar lavage (BAL)
  • protected specimen brushing
  • endotrachael aspirate
631
Q

NHSN: HAI VAP: Where do organisms need to be ID’d from?

A

Blood/ pleural fluid

632
Q

NHSN: HAI pneumo histopathlogical lab results

A
  • abscess formation or consolidation
  • lung parenchyma invasion by fungi
633
Q

NHSN: VAP: specimen sources for positive quantitaive culture

A
  • minimally contaminated LRT specimen (BAL, protected specimen brushing, or endotracheal aspirate)
  • lung culture
634
Q

NHSN: VAP >= _________% BAL-obtained cells contain intracellular bacteria on direct microscope examination

635
Q

How do symptoms of immunocompromised people differ for the definition of NHSN VAP?

A

Immunocompetent need 1 primary symptom (fever, leukopenia or leukocytosis, or altered mental status) and at least 2 other resp symptoms and imaging

Immunocompromised people need just one symptom (primary symptoms or resp syptoms) and a lab (which can include candida or fungi)

636
Q

Is physician DX enough to classify as VAP in NHSN?

637
Q

What is the rate equation for VAP in NHSN?

A

of VAP in location/ # ventilator days in location *1000

638
Q

How long does a central line have to be in to be considered a CLABSI in NHSN?

A

at least 2 days, so may be a CLABSI on or after the 3rd calendar day

639
Q

Intravascular catheter that terminates at or close to the heart or in one of the great vessels used for infusion, withdrawal of blood, or hemodynamic monitoring

A

Central line

640
Q

Is ECMO considered a central line?

641
Q

Are peripheral IVs or midlines considered central lines?

642
Q

Are ventricular assist devices considered central lines?

643
Q

What are the 3 types of central lines?

A
  1. Temporary central line (non-tunneled, non-implanted catheter)
  2. Permanent central line (tunneled or implantable catheter)
  3. Umbilical catheter
644
Q

What are the common commensals for CLABSIs?

A
  • Diphtheroids
  • Bacilus spp.
  • Propionibacterium
  • Coagulase-negative staph
  • Virdans group strep
  • aerococcus
  • micrococcus
  • rhodococcus
645
Q

LCBI 1

A
  • recognized bacterial or fungal pathogen ID’d from at least 1 culture and organism ID’d in blood is not related to another site
646
Q

Are symptoms required for an LCBI 1?

A

No (related to pathogens, not common comensals)

647
Q

What are the parameters for an LCBI 2 if common commensals are detected?

A
  • @ least 1 symptoms (fever or hypotension)
  • AND organisms not related to infection at another site
  • AND same common commensal ID’d from 2+ blood specimens collected on separate occasions (within 2 days - same or consecutive days)
648
Q

What are the different CLABSI symptoms for LCBI (common commensal in neonates and infants)?

A
  • Fever
  • Hypothermia
  • apnea
  • Bradycardia

Other are the same as LCBI 2

649
Q

What does LCBI stand for?

A

Lab-confirmed Bloodstream Infection

650
Q

Generally, what are the rules to be defined as a mucosal barrier injury-lab-confirmed bloodstream infection?

A

LCBI
AND allogenic HSCT recipient in past year with GI GVHD or massive amounts of diarrhea OR neutropenic

Commensals include viridans group strep or rothia spp

651
Q

SIR

A

observed HAIs/ predicted HAIs

652
Q

Equation for CLABSI rate

A

CLABSIs for location/ # central line days for that location *1000

653
Q

Equation for Central line DUR

A

central line days for location/ pt days for that location

654
Q

Equation for central line SUR

A

observed central line days/ # predicted central line days

655
Q

What are some complications of CAUTIs?

A
  • cystitis
  • pylenoephritis
  • gram negative bacteremia
  • endocarditis
  • vetebral osteomyelitis
  • septic arthritis
  • endopthalmitis
  • meningitis
656
Q

Timeline for a healthcare associated infection, example if admitted to hospital on June 3

A

Date of event occurs on or after third calendar day of admission to inpatient location (where the date of admission is day 1)

Example: admitted to the hospital on the June 3
June 1- June 4 - POA
June 5 and later- HAI

657
Q

UTI where indwelling catheter in place for more than 2 consecutive days in an inpatient location and the catheter is in place on the DOE or the day before

658
Q

Drainage tube inserted into urinary bladder through the urethra, left in place, and connected to a drainage bag

A

Foley catheter

659
Q

What devices are not included in CAUTI rates?

A
  • condom caths
  • straight in and out caths
  • nephrostemy tubes
  • ileoconduits
  • suprapubic caths
660
Q

Describe a catheter associated symptomatic UTI (SUTI)

A
  • Indwelling catheter in place 3+ days and present any portion of DOE or removed day before DOE
  • AND pt has signs/ symptoms
  • AND pt has positive urine culture (no more than 2 species, @ least 1 is >=10^5 CFU/mL)
661
Q

Signs/ symptoms of CAUTI (need 1)

A
  • Fever
  • Suparpubic tenderness
  • costovetebreal angle pain or tenderness

CANNOT BE USED WHEN CATH IN PLACE:
- urinary urgency
- urinary frequency
- dysuria (burning while urinating)

662
Q

NHSN definition, non-catheter associated UTI

A

No cath or cath in place <2 days
- signs/ symptoms of UTI
- Urine culture with no more than 2 species and at least 1 bacteria is >=10^5 CFU/ mL

663
Q

What are the additional symptoms for UTI/ CAUTIs in kids < 1 year old

A
  • Fever
  • Hypothermai
  • Apnea
  • Bradycardia
  • Lethargy
  • Vom
  • Suprapubic tenderness
664
Q

10^5

665
Q

If someone has a urine culture with <2 species and 1 bacteria is >100,000 CFU, mL, but they are asymptomatic, could they have a CAUTI?

A

Yes, but they would need a matching organism ID’d in a blood specimen

666
Q

Do fungi meet the case definition for CAUTIs?

A

No, bacteria only

667
Q

Do parasites meet the case def for CAUTIs?

A

No, bacteria only

668
Q

Equation for CAUTI rate

A

cautis/ # cath days *1000

669
Q

Equation for DUR

A

of urinary cath days/ # patient days *1000

670
Q

MRSA- staph aureus specimen that tests positive for ____ resistance, _____ resistance, or _____ resistance via susceptibility, PCR or other methods

A

oxacillin-resistance, cefoxitin- resistance, or methicillin-resistance

671
Q

Cefoxitin

A

2nd generation cephalosporin

672
Q

Ceftazidime

A

3rd gen cephalosporin

673
Q

Cefotaxime

A

3rd generation cephalosporin

674
Q

Cefepime

A

4th generation cephalosporin

675
Q

CephR-Klebsiella

A

Resistant to Ceftazidime, cefotaxime, and cefepime

676
Q

What are the genes that code for resistance to carbepenems?

A

KPC
NDM
CIM
IMP
Oxa-48

677
Q

What are MDRO-Acinetobacter spp resistant to?

A

@ least one of each:
Aminoclycoside
Carbapenems
Fluoroquinolones

678
Q

LabID even specimen collected >3 days after admission to the facility (on or after day 4)

A

Healthcare facility onset

679
Q

LabID event specimen collected in outpatient location or an inpatient location <=3 days after admission to the facility (days 1-3)

A

Community onset

680
Q

LabID event collected from a patient who was discharged from the facility <=4 weeks prior to the date current stool specimen was collected

A

Community-onset Healthcare facility associated

681
Q

When is a LabID event considered recurrent?

A

If it’s been >14 days and <8 weeks or 56 days

682
Q

What is the leading cause of death from infection in the hospitalized patient?

683
Q

What are the parameters for healthcare associated pneumo?

A
  • acute care hosp for 2+ days within 90 days of infection
  • resided in nursing home or LTC
  • Received IV antibiotics, chemo, or wound care within 30 days
  • attended hosp or hemodialysis clinic
684
Q

How long does someone have to be in the hospital to be considered a hospital-acquired pneumonia case/

A

at least 48 hours

685
Q

Most common organisms CAP

A
  • S pneumo
  • S aureus
  • H influenzae
  • M orexellacatarhallis
686
Q

What are the most common causes of atypical CAP?

A
  • Legionella
  • Chlamydia penumoniae
  • Mycoplasma pneumoniae
  • enterobacter
687
Q

Risk factors for S. aureus pneumo

A
  • end stage renal disease
  • IV drug s
  • prior flu
  • prior antibiotic use with quinolones
688
Q

How does MRSA pneumo impact neutrophils

A

Causes severe neutropenia

689
Q

Risks for HAP/ HCAP

A
  • antimicrobials in past 90 days
  • hosp 5+ days
  • high freq MDROs in community
  • immunosupressed
690
Q

CAP quality measures from the TJC

A
  • blood culture within 24 hours and before antibiotics
  • antibiotic timing
  • antibiotic selection
  • pneumococcal vax
  • influenza vax
  • smoking cessation counseling
691
Q

Resp therapy equipment maintenance guidance

A
  • only change circuit when soiled or malfunctioning
  • drain and discard condensate
  • sterile water for bubbling humidifiers
  • only filter suspected TB
692
Q

Prevention for HAP, HCP, and VAP

A
  • flu and pneumo vax
  • HH & glove use
  • Resp therapy equip maintenance
  • Avoid endotracheal intubation
  • selective oral decontamination
  • subglottic secretion drainage
  • Iso pts with resistant organisms
  • reduce nasogastric tubes
  • start enteral feeding 24-48 hours after intubation
  • ventilator bundle
693
Q

Why are vascular access devices used to access the vascular system?

A
  • hemodynamic monitoring
  • admin medication
  • infusions
  • blood sampling
  • dialysis
694
Q

Short term or long term: peripheral access device

A

Short term

695
Q

Short term or long term: midline catheter

A

Short term

696
Q

Short term or long term: PICC line

697
Q

Short term or long term: Tunneled CVAD

698
Q

Short term or long term: Port

699
Q

Short term or long term: Non-tunneled percutaneous

A

Short-term

700
Q

Length time for peripheral IV

A

<5 days
If UV guided up to 14 days

701
Q

Length of time: midline cath

702
Q

Length of time: non-tunneled intravenous device

A

<= 14 days

703
Q

When is midline preferred to PICC?

704
Q

When is a non-tunneled intravenous device preferred to a PICC?

A

<=14 days in critically ill patients

705
Q

Timeline for PICC line

A

6+ days (weeks - months)

706
Q

Length of time for tunneled intravenous device

A

> =15 days

707
Q

What type of CVC is preferred for >=31 days

A

Implanted port

708
Q

Can you administer vesicants in a peripheral access device?

A

No, not a central line, does not terminate in heart

709
Q

Can Midline catheters accommodate vesicants?

710
Q

What CVCs can accommodate irritants and vesicants?

A
  • PICC lines
  • Percutaneous short-term CVADs
  • Tunneled long-term CVADs
  • Implanted ports
711
Q

CVC used for ongoing, high frequency access and can be accessed for months before requiring replacement

712
Q

CVC used for temporary central access in critical and inpactient acute care setting

A

Non-tunneled

713
Q

Complications of PICCS

A
  • localized/ central infection
  • thrombosis
  • mechanical failure
714
Q

Complications of implantable device insertion

A
  • Catheter embolism
  • malposition
  • pneumothorax
  • thrombosis
715
Q

Where do CVCs terminate?

A
  • Superior vena cava
  • cavoatrial junction
716
Q

When are cuffs present on catheters?

A

present on tunneled, not on non-tunneled

717
Q

How are ports accessed?

A

Non-coring huber needle

718
Q

What catheter has the lowest levels of BSI?

A

PICCs and Implanted ports

719
Q

Coating on CVC to prevent colonization

A
  • minocycline-rifampin
  • chlorohexidine-silver sulfadizine
  • platinum/ silver
720
Q

Top microorganisms that cause CLABSIs

A

skin microbes:
- coagulase negative staph
- staph aureus
- enterococcus facalius
- klebsiella spp/
- candida albicans
= enterococus faceium

721
Q

What is the source of most endemic CLABSIs?

A

Contamination of VAD

722
Q

What is the source of most epidemic CLABSIs?

A

contamination of infusate

723
Q

Pathology of BSI

A
  • skin organisms –> percutaneous –> blood during insertion or days following
  • Microbes contaminate catheter hub and lumen when catheter inserted
  • Contaminated fluids
  • another remote source of infection (not as common)
724
Q

What size drape does a peripheral arterial cannulation require?

A

Small, sterile drape

All other lines require large, sterile full body drapes

725
Q

How often to change wound dressing and gauze over central lines

A

Gauze- while wound draining, change every 2 days
Polyurethane film dressing- every 7 days

726
Q

Are add on systems to central lines recommended?

727
Q

How often should central line add-one be replacd?

A

Every 96 hours

728
Q

How often should parenteral nutrition be changed?

A

not to exceed 24 hours

729
Q

How often should blood products/ lipid emulsions be changed?

A

Lipid- 12 hours
generally 12-24 hours

730
Q

What personal hygiene recommendation do they make for skin decolinization for people with central lines?

A

Chlorohexidine bathing

731
Q

Are topical antimicrobials recommended for patients with central lines?

A

No, only for hemodialysis catheter exit sites

732
Q

What are the VADA-BSI measures if the bundles and basic measures are not working?

A
  • antiseptic/ antimicrobial impregnanted catheters
  • chlorohexidine dressings
  • antiseptic containing needleless connectors
  • antimicrobial locks solution for CVADs
733
Q

Who is antibiotic lock solution best suited for?

A
  • long-term hemodialysis with limited venous access
  • history recurrent BSIs
  • High risk - ie prosthetic heart valve
734
Q

Maximum dwell time to Antibiotic lock solution (ALS)

735
Q

What ALS antibiotic is best for a staph aureus infection?

736
Q

What ALS antibiotic is best for MRSA?

A

Vancomycin

737
Q

What ALS antibiotic is best for gram-negative bacteria

A

Ceftazidime, gentamicin, ciprofloxacin

738
Q

What ALS antibiotic is best for enterococcus?

A

ampicillin

If resistant- vancomycin

739
Q

What ALS solution is best for mixes of gram positive and gram netative?

740
Q

prophylaxis may be used during hemodialysis to prevent _______

A

Thrombolysis

741
Q

Antisepsis for neonates and infants

A

iodine, need to remove after asepsis

742
Q

When to use chlorhexidine-gluconate impregnated sponge for catheters?

A

Oncology patients

743
Q

General: management of short-term CVAD with VADA-BSI (fever/ inflammation/ staph bacteremia/ candidemia)?

A

Culture and remove
Replace in a new site if needed

744
Q

General management of long-term CVAD with VADA -BSI

A

do not always need to remove, but remove when:
- persistent exit site infection
- tunnel infected
- endocarditis, septic thrombosis, or septic pulmonary emboli
- Most organisms other than coagulase-negative staph and enterococcus

745
Q

A patient has a CLABSI from S. aureus, and they were treated with antibitoics and is now feeling better and symptoms appear to have resolved. Should the CVAD be removed?

746
Q

What waterborne pathogens can cause BSI that require the CVC to be removed?

A
  • Stentrophomonas
  • Burkholderia
  • Pseudomonas
747
Q

Antibiotic for gram negative CLABSI

A

4th gen cephalosporin
carbapenem

748
Q

Antimicrobial for candidemia

A

IV fluconazole

749
Q

Is a midline a central line?

750
Q

What organisms are most likely to contaminate the catheter hub?

A
  • endogenous skin flora
  • exogenous - HCW hands
751
Q

What organisms are most likely to be introduced through the exit site?

A
  • endogenous skin flora
  • extrinsic organisms on HCW hands or contaminated disinfectant
752
Q

Is contaminated infusate typical with short-term IVDs?

753
Q

Infusion contaminated at the manufactuerer

A

Intrinsic contamination

754
Q

Infusate contaminated during sterile compounding or on-site

755
Q

What catheters are responsible for most infections?

A

1) hemodialysis: non-cuffed
2) pulmonary artery catheter (Swan ganz)
3) Short-term non medicated CVCs

756
Q
A

Swan Ganz or pulmonary artery catheter

757
Q

Which is the lowest risk for skin antisepsis for VADA BSIS: 70% alcohol. 10% povidone iodine, or 2% chlorohexidine

A

2% chlorhexidine

758
Q

Patient placement for CVC placement

A

tendelenburg for most
Supine- PICC / femoral

759
Q

Most BSIs are of cutaneous origin that access the site ____________

A

extraluminally

760
Q

What level disinfectant for environmental cleaning for surfaces infected with blood/ body fluids in dialysis center

A

Intermediate level

761
Q

Reasons for infection in dialysis

A
  • break in IP practices
  • Bacterial seeding from remote site
  • poor hygiene of care access arm
762
Q

Types of dialysis infections

A
  • access site infection
  • bacteremia
  • peritonitis
763
Q

What organism is the biggest concern for fistulas?

A

Staph aureus

764
Q

Infection prevention fistula

A
  • patients wash access site daily and before hemodialysis
  • Staff to practice HH, wear masks and gloves before accessing sites
  • patients recognize infection sign/ symptoms
  • antiseptic used - CHG + alcohol preferred
765
Q

Decreasing risk for dialysis

A
  • strict adherence to aseptic technique for ALL dialysis procedures
  • Disinfection/ maintenance of equipment
  • Well-trained staff
  • Monitoring for bacterial contamination
  • Patient education
  • Active surveillance
766
Q

What do you need to test for every 4 hours in dialysis?

A

Chloramine and chlorine

767
Q

What is the CMS limit that requires disinfection within 48 hours for bacteria/ endotoxins?

A

Bacteria: action at 50 CFU/mL, limit 200
Endotoxin: action at 0.125 EU/ml, limit 2

768
Q

What is the problem with bacteria and endotoxins in the dialysate?

A

fever
bacteremia

769
Q

How often to test dialysis treated water and dialysate?

A

At least monthly
- weekly if new water system or change to system

770
Q

Methods for dialysate/ treated water testing?

A
  • membrane filter
  • spread plate

NO calibrated loop

771
Q

How often to disinfect mixing tank for bicarbonate in dialysis

A

Daily before first patient

772
Q

What infections can result from improper cleaning and disinfection of priming waste?

A

Gram- negative rods
enterococcus

773
Q

Most common pathogens in peritoneal dialysis

A
  • staph aureus/ staph
  • pseudomonas aeruginosa
  • enterobacteriaceae
774
Q

Most common sources dialysis infections

A
  • patients skin or nares
  • dialysate delivery system
  • breaks in technique
  • extrinsic or intrinsic contamination
  • migration from GI tract
  • vaginal leaks
775
Q

Catheter placement peritoneal dialysis

A
  • avoid skin folds and beltline
  • easily accessible for pt inspection and care
  • downward in pediatric patients
776
Q

What is preferred for peritoneal dialysis: double cuff or single cuff?

A

double cuff

777
Q

How often should hemodialysis patients receive Hep serology?

A

admission, then every 3-6 months

778
Q

What to review when there is an increase in infection caused by water-associated gram-negative organisms or endotoxin-like reactions at the dialysis location?

A
  • culture processed water and dialysate
  • review cleaning and disinfection
  • review multi-use vials processes
779
Q

Steps after dialysis center sees positive HBsAg for first time

A
  • report to HD
  • Isolate
  • did they get vax in last 30 days?
  • follow up tests for confirmation of infection
  • medical record review (eposures?)
780
Q

Normal treatment for uncomplicated cystitis

A

nitrofuraton monohydrate/ macrocrystals (Macrobid)
or
TMP-SMX (bactrim)

781
Q

What organisms typically causes epididymitis related to UTIs in males >35 years

A

E. coli
Pseudomonas

782
Q

Symptoms of pyelonephritis

A

abrupt onset fever
unilateral costovertebral angle tenderness

783
Q

Risks for pyelonephritis

A
  • female
  • sex
  • new sex partner
  • spermicide
  • maternal history of UTI
  • recent UTI
  • Diabetes
  • smoking
  • incontenence
784
Q

How to get a sample from a patient with an indwelling urinary catheter?

A

Sample port using aseptic technique, do NOT use leg bag

785
Q

What is indicative of a contaminated urine sample?

A

3 or more species in the sample

786
Q

Symptoms UTI in children

A
  • fussy
  • fever
  • anoerexia
  • emesis
  • ab pain
  • neonatal jaundice
  • poor weight gain
  • enuresis
  • hematuria
787
Q

Risk factors UTI in reproductive age female

A
  • spermicide
  • delayed postcoital micturition
  • multiple sex partners
  • more freq sex
788
Q

Screening and treatment for UTIs in pregnant women

A
  • screen at 12-16
  • treat even if asymptomatic
  • admit for pyelonephritis
  • avoid TMP-SMX after 32 weeks of pregnancy
789
Q

Should you treat asymptomatic UTIs in elderly patients?

790
Q

What pathogens are responsible for UTIs in LTC males?

A

E. coli
Proteus morabilis

791
Q

Treatment for complicated UTIs (males, children, diabetics with symptoms)

A

Fluroquinolones

792
Q

What pathogens cause UTIs in diabetics?

A

E. coli
Klebsiella
Group B Strep

793
Q

Most common HAI (correct)

794
Q

How do most CAUTIs in males happen?

A

intraluminal route from contaminated drainage bag

795
Q

How do most CAUTIs in females happen?

A

transeurethral migration up extraluminal surface of catheter

796
Q

Indications for indwelling unrinary catheters

A
  • anatomic, urinary retention, bladder obstruction
  • measure urinary output in critically ill patient
  • perioperative use for certain surgeries
  • assist in health open sacral or perineal wounds in incontenent pts
  • improve comfort for end of life, pt preference
797
Q

What position is best served to give catheter removal reminders?

798
Q

What is the time limit for urinary catheter use in surgery?

A

<=48 hours

799
Q

IPs role in preventing CAUTIs

A
  • appropriate infrastructure to prevent CAUTI
  • CAUTI surveillance
  • education and training
  • appropriate technique during catheter insertion
  • appropriate management indwelling catheters
  • accountability
  • performance measures
800
Q

What organisms commonly cause HAI UTIs?

A

E. coli
Enterobacteriaceae (pseudomonas, Serratia)

801
Q

carotid endarterectomy

A

removes plaque in the coritid artery

802
Q

Laminectomy

A

Removal of the roof of the spinal cord

803
Q

Anoscope

A

examines anus and rectum

804
Q

Thorascoscope

A

examines chest organs through small incision

805
Q

arthroscope

A

examines joint through incision above knee

806
Q

Colposcope

A

Examines cervix through vagina

807
Q

Endoscopic retrograde cholangiopancreatography

A

combines X-rays with upper GI endoscopy to diagnose or treat problems with the bile and pancreatic ducts.

808
Q

Enteroscopy

A

Used to examine your small intestines via your mouth or anus.

809
Q

Proctoscope

A

examine the anal cavity, rectum, or sigmoid colon (just the rectum and colon)

810
Q

Hysteroscope

A

examination of the inside of the uterus

811
Q

Sigmoidoscope

A

shorter version of a colonoscopy, focusing on the rectum and the lower part of the colon

812
Q

Mediastinoscope

A

examine the space between your lungs via an incision above your sternum.

813
Q

thoractomy

A

surgical procedure that allows a surgeon to access the chest’s pleural space and thoracic organs, cut between the ribs

814
Q

thorascope

A

examine your chest cavity and its contents (your lungs and the covering of the lungs) via an incision in your chest.

815
Q

Chromoendoscope

A

technique that uses a specialized stain or dye on the lining of the intestine during an endoscopy procedure.

816
Q

duodenoscope

A

flexible, lighted, hollow tube that doctors use to examine and treat issues in the pancreas and bile ducts

817
Q

Reasons for outbreaks from endoscopy

A
  • defective equipment
  • inability to access elevator channels during cleaning and disinfection
  • inadequate cleaning and disinfection
  • contaminated automatic endoscope reprocessor (AER)
  • Biolfilms in endoscope or AER
  • Contaminated multidose vials, needles, y=syringes for anethesia
818
Q

How often to discard endoscope detergent

A

After each use

819
Q

What organisms have been associated with endoscopy outbreaks?

A
  • Hep B
  • Hep C
  • CRE
  • P. aeruginosa
  • S. marcescens
  • M. tb
820
Q

What is the general manual parameters for HLD of endoscopes?

A
  • > 2% glutaraldehyde at 25C, 20-90 minutes
  • rinse with large amounts of water
821
Q

When does cleaning the endoscope with brushes occur?

A

Before HLD

822
Q

Difference between alcohol % for antisepsis versus in the endoscope rinse after disinfection.

A

Antisepsis: 60-95%
Disinfection rinse: 70-90%

823
Q

IP for bronchoscopy

A
  • immunizations (esp flu) and TB screening
  • disposable caps/ valves
  • screen for symptoms
824
Q

IP for if someone has resp symptoms and is due for a bronchoscopy procedures

A
  • push back date of procedure
  • complete in AIIR
  • PPE
  • Thoroughly clean room before next patient
  • allow enough time for airborne agents to dissipate
825
Q

If the endoscope breaks the mucousal barrier, what level of disinfection is required?

A

Sterilization

826
Q

Cleaning/ disinfection process for water bottle used to clean lens/ irrigation during procefure

A
  • clean bottle and connecting tube with HLD at least daily
  • Use only sterile water
827
Q

MEC

A

Minimum effective concentration for disinfection

828
Q

Who do reports need to go to if there is an outbreak related to endoscopy equipment?

A
  • IP
  • physician
  • CDC
  • FDA
  • manufacturer
829
Q

Outbreak response for endoscopy

A
  • report
  • remove and label the equipment after possible failure
  • isolates
  • env sampling- standard OB inv
  • evaluate policies and procedures, technique of personnel, and handling of equipment
830
Q

Endopthalmitis

A

Inflammation of intraoccular cavities

831
Q

What are the common reservoirs for adenoviruses in opthalmology?

A
  • HCP hands
  • tears
  • Contaminated equipment
  • contaminated environment
  • contaminated medications (lower risk)
832
Q

What equipment can spread adenoviruses through contamination?

A
  • tonomometer tips
  • opthalmoscopes
  • slit lamps
  • trial contact lenses
833
Q

Prevention for adenoviruses in opthalmology

A
  • meticulous HH
  • gloves during outbreaks and when exposed to patients excretions or tears
  • disinfect tonometer tups
  • single dose vials
  • clean and disinfect surfaces before patients, between patients, and EOD
834
Q

In ophthalmology, what viruses are spread in similar ways to adenoviruses?

A
  • Coxsackievirus
  • Enterovirus
835
Q

Methods for disinfecting tonometer tips

A

5-10 minute soak in:
- 3% hp
- 70% isopropyl or ethyl alcohol
- 5000 ppm bleach

836
Q

blepharitis

A

inflammation/ infection of the eyelid

837
Q

Endopthalmitis

A

inflammation/ infection of the intraocular fluids (anterior and vitreous tissues)

838
Q

Intravitreal

A

Injection of meds into vitreous chamber

839
Q

intracameral

A

injection of meds into anterior chamber

840
Q

Keratitis

A

inflammation and/or infection of the ocular external surfaces (conjunctiva and cornea)

841
Q

inflammation of the retina

842
Q

Noninfectious inflammation of vitreous and/or anterior chamber following intravitreal injections and/or surgery

A

sterile endophthalmitis

843
Q

Toxic anterior segment syndrom

A

acute, sterile inflammation following anterior segment surgery

844
Q

What disease is associated with contact lenses?

845
Q

What microorganisms are associated with contact lenses?

A

P. aeruginosa
Filamentous fungi

846
Q

What organisms are most often associated with infectious endothalmitis

A

Skin commensals
esp Staph and strep

847
Q

The U.S sees most of the following compared to other countries:
- gram negative isolates
- gram positive isolates
- fungal isolates
- parasitic isolates

A

Gram negative isolates

848
Q

Source of infectious endophthalmitis

A
  • organisms introduced at time of surgery/ trauma
849
Q

Level of disinfection for diagnostic laser lens

850
Q

Level of disinfection for fundus contact lenses

A

HLD with 1:10 bleach for 25 minutes

851
Q

Level disinfection lacrimal lavage probe

A

sterilization

852
Q

Level of disinfection- occuluders

A

Low level, wipe with 70% alcohol

853
Q

Level of disinfection: Opthalmoscopes

A

Low level, wipe with 70% alcohol

854
Q

Level of disinfection phoropter

A

low- wipe with 70% alcohol

855
Q

Level of disinfection: scleral depressor, lid elevertors, specula, forceps

856
Q

level of disinfection- tweezers in eye doctor

857
Q

IP for tonopen

A

use sterile, disposable tonopen cover for each pt exam

858
Q

Organisms that penetrate intact epithelium

A
  • N. gonorrhoeae
  • N. meningitidis
  • S. pneumoniae
  • L. monocytogenes
  • C. diphtheriae
859
Q

What bacteria are associated with kertitis in cooler climates?

A

S. aureus
C. albicans

860
Q

What bacteria are associated with eye infection in homeless populations?

A

S. pneumo
Moracella spp.

861
Q

Most common virus to cause pink eye

A

Adenovirus

862
Q

Most common bacteria to cause pink eye

A

S. penumo
S. aerues

863
Q

Organisms most commonly associated with eye infections in infants

A
  • gonnorrhea
  • chlamydia
864
Q

If patients require this medical device, they are more likely to get eye infections with gram negative bacteria like kelbsiella, proteus, and pseudomonas

A

ventilator

865
Q

What risks are associated with keratitis

A

contact lenses
trauma
refractive surgery

866
Q

What microorganisms cause keratitis after refractive surgery

A

S. aureus
NTM

867
Q

What disease have potential to be spread through corneal transplant?

A
  • CJD
  • HBV
  • Rabies
  • HSV
868
Q

Sources for TASS

A
  • handling/ cleaning surgical instruments
  • contaminated solutions
  • contaminated intraocular lenses
  • toxic meds
  • powder gloves
  • residue on instruments
869
Q

How do most bacterial healthcare associated pneumonias occur?

A

Organisms colonizing the oropharynx or upper GI tract are aspirated

870
Q

Bacteria associated with contaminated aerosols that cause penumonia

A

Legionella
Aspergillus
Serratia marcescens

871
Q

Most common routes of transmission associated with respiratory care

A
  • Droplet nuclei
  • direct contact with contaminated fluids, hands, and equipment
872
Q

measures how fast and how much air you breathe out

A

spirometer

873
Q

Which is safer, enteral or parenteral nutrition?

874
Q

When should you change the ventilator circuit?

A

if visibly soiled or malfunctioning

875
Q

Risks for respiratory infections

A
  • age
  • severe underlying disease
  • immunosupression
  • enteral feeding
  • thoracic or abdominal surgery
  • invasive ventilator support
876
Q

Where are the following organisms found as common commensals?
- viridans strep
- coagulase negative staph
- Haemophilus spp.
- Neisseria spp.
- Moracella spp.
- Peptostretococcus spp. (gram positive cocci)
- Stomatococcus spp. (gram positive cocci)
- Prevotella (gram negative cocobacilli)
- Candida

A

Respiratory tract/ upperGI

877
Q

What level of disinfection is required for mechanical ventilators

A

LLD of surfaces

878
Q

Caring for breathing circuits, humidifiers, and het/ moisture exchangers (HME)

A
  • don’t change unless visibly soiled or malfunctioning
  • periodically discard condensate
879
Q

Level of disinfection for nebulizers between patients

880
Q

Level of disinfection between patients for mist tents

881
Q

Level of disinfection for portable respirometers and vent. thermometers

882
Q

Level of disinfection for resuscitation bags

883
Q

Do you have change mist tents for the same patient

A

No, not recommended to change

884
Q

Disinfection for small volume nebulizer in between uses for the same patient

A

clean, disinfect, rinse with sterile water

885
Q

Level of disinfection incentive spirometry and airway clearing devices

A

Single use

886
Q

Cleaning/ disinfection for pulmonary function testing

A

None for internal machinery
change mouthpiece and filter between patients
LLD of surfaces handled by patient between patients

887
Q

IP for tracheostomy care

A
  • tracheostomy - sterile conditions
  • use gown, gloves, aseptic technique to replace trach tube
  • no antibiotic cream
  • NO routine cuff deflation
  • ensure proper cuff pressure
888
Q

Level of disinfection for trach tube

A

HLD or sterilization

889
Q

IP suctioning resp secretions

A
  • open system- use new sterile catheter each time
  • Sterile saline
890
Q

IP for artificial airways

A
  • tracheostomies only for critically ill pts needing long term intubation
  • elevate head 30-45 degrees
  • oral over nasal intubation
  • ensure proper cuff pressure
  • No routine cuff deflation
891
Q

PPE for suctioning a trach

A

Eye protection
mask
gloves
gown

892
Q

Is routine PEP with antimicrobials to prevent VAP recommended?

893
Q

Pressure for OR

A

Positive pressure

894
Q

ACH in OR

895
Q

humidity OR

896
Q

Temp OR

897
Q

Traffic zones in surgery

A

Unrestricted
Semi-restricted (hosp attire and cap required)
Restricted zones (masks required, keep door closed)

Goal to limit traffic

898
Q

What are the four levels and gowns and what is the most resistant to fluid?

A

4 levels
Level 4 is the most impermeable

899
Q

Skin prep for surgery

A
  • pre-op cleansing (night before and morning of surgery)
  • Apply antiseptic and allow to dry
  • if hair removal necessary, remove with clippers right before surgery
900
Q

% probability that the product is sterile

A

microbiological safety index, the higher the number, the more sterile

901
Q

How often should the policy for aseptic technique be reviewed

902
Q

scrub process surgeons

A
  • remove jewelry
  • clean nails
  • scrub with antimicrobial soap for manufacturers recommended time (2-6 minutes)
  • Use ABHR with persistent activity
903
Q

What if TB patient needs emergency surgery?

A
  • intubate/ extubate in negative pressure room
  • surgery at time with minimum surgeons and personnel
  • portable HEPA filter
  • N95s
  • Anesthesia circuit for .3 um, and change after surgery
904
Q

True or false: HCP are at increased risk of latex allergy

905
Q

Who to give SSI data and feedback to

A

individual surgeons confidentially

906
Q

What increases the risk of a surgical site infection (pathogenesis)?

A

1) inoculum of bacteria
2) virulence
3) Adjuvant effects of the microenvironment
4) Impaired host defenses

907
Q

What body systems have higher numbers of bacteria and therefore can increase the inoculum of bacteria?

A

GI
Female genitourinary
Respiratory tract

908
Q

Bacteria that cause SSIs and can cause severe infections due to their virulence

A

S. aureus
S. pyogenes
C. perfringens

909
Q

Example of bacterial synergism

A

Bacteroides fragilis + gram negative bacteria- much more virulent

910
Q

Wound left open at end of surgery, heals by granulation and contraction

A

Secondary closure

911
Q

Part of healing process in which pink tissue containing connective tissue and capillaries forms around edges of wound

A

Granulation

912
Q

Wounds closed a few days after surgery

A

Secondary closure

913
Q

When might secondary closure be preferred?

A

Massive contamination

914
Q

Polyester foam over wound, transparent plastic adhesive drape over foam and surrounding skin, suction at port site that removes inflammatory fluids

A

Negative pressure wound therapy (NPWT)

915
Q

Is pressure irrigation recommended for high-risk grossly contaminated wounds?

A

No studies, may make contamination worse

916
Q

Surgical Care improvement Project Measures

A

1) antibiotic given 60 minutes pre surgery (or 120 for vanco or fluoroquinolones)
2) Consistent with recommendations based on most likely organisms
3) Discontinued 24 hours post-op (or 48 hours for coronary artery bypass graft)

917
Q

Steps to managing a wound

A
  1. open and drain the wound (get culture here)
  2. Debridement
  3. Remove foreign body (suture material, judgement for implants)
  4. antimicrobial management
  5. wound management
918
Q

When managing an open wound, what is the best method to cover?

A

saline-soaked, loosely packed gauze

919
Q

How often to change saline-soaked gauze in open wound?

A

3x per day

920
Q

ASA score: 21 year old, well conditioned male athlete undergoing elective groin hernia repairs

921
Q

ASA score: 46 year old woman with mild but controlled hypertension undergoing a laparoscopic cholecytectomy

922
Q

cholecytectomy

A

Surgical procedure to remove gall bladder

923
Q

ASA score: a 53- year old man with insulin-dependent diabetes and coronary artery disease undergoing elective aortofemoral bypass

924
Q

aortofemoral bypass

A

procedure that bypasses blocked or diseased large blood vessels in the abdomen and groin

925
Q

ASA score: a 62-year old woman on chronic renal hemodialysis undergoing emergency laparotomy for perforative divertivulitis

926
Q

ASA score: a 58-year old man with morbid obesity, type 2 diabetes, and shock undergoing extensive debridement for streptococcal necrotizing fascilitis

927
Q

Carotid endarterectomy

A

Surgery to remove plaque buildup in common carotid artery

928
Q

Laminectomy

A

Surgery in which surgeon removes part or all of the vertebral bone to help ease pressure in spinal cord

929
Q

Laparotomy

A

Surgical incision cut into abdominal cavity

930
Q

Craniotomy

A

Part of skill temporarily removed to expose brain and perform intracranial procedure

931
Q

Ventricular shunt

A

Cerebral shunt that drains excess CSF when there is an obstruction

932
Q

Coronary artery bypass graft

A

surgical procedure that restores blood flow to the heart by bypassing blockages in the coronary arteries

933
Q

Colon resection

A

surgical procedure to remove part or all of the colon or rectum

934
Q

Common organisms that infect indwelling medical devices

A

S. aureus
S. epidermidis

935
Q

Pathways for infection of indwelling medical devices

A
  1. Introduction of organism at time of surgical implant
  2. contiguous spread of post-op wound infection
  3. hematogenous seeding
936
Q

Host risk factors for indwelling medical device infections

A
  • Previous surgery at the same site
  • infection elsewhere in body
  • diabetes
  • corticosteroids
  • poor nutritional status
  • irritative skin conditions
  • obesity

(generally things that lead to slower skin healing)

937
Q

3 types of prosthetic joint infections

A
  1. early infection (within 3 months)
  2. delayed infection (3-24 months after surgery)
  3. late infection (2+ years after surgery)
938
Q

What is late infection of a prosthetic joint typically from?

A

hematogenous seeding

939
Q

What organisms typically causes late, fulminant infection of prosthetic joints?

A

S. aureus
GAS

940
Q

What organisms typically cause indolent late infection of prosthetic joints?

A

coagulase-negative staph
Propinobacterium

941
Q

How to test for and dx prosthetic joint infections

A

clinical symptoms
Imaging
labs (aspiration of synovial fluid (leukocytes, gram stain and culture)
histopathology (after surgery)

942
Q

How to prevent implantable joint infections

A
  • screen host and treat infections before surgery
  • OR environment
  • surgical prep (skin prep, hair removal with clippers, prophy antibiotics)
943
Q

How to manage infections in implanted devices

A

Surgery and 6+ week antibiotics
- Single stage exchange
- 2 stage exchange
- arthrotomy and debridement and 6-8 weeks antibiotics (only select pts)

944
Q

What typically causes early prosthetic valve endocarditis (PVE) within 12 months of valve replacement?

A

perioperative or immediate post op HH

945
Q

What organism is responsible for most prosthetic valve endocarditis infections and mortality?

946
Q

What symptom is most common with prosthetic valve endocarditis

947
Q

What are the common echocardiogram findings in prosthetic cardiogram endocarditits?

A
  • vegetations
  • periprosthetic abscess
  • new paravalvular regurgitation
948
Q

What is paravalvular regurgitation?

A

Leak caused by space between the heart tissue and valve replacement

949
Q

What organisms to expect if there are symptoms for prosthetic valve endocarditis but cultures are negative

A

HACEK group

950
Q

What is the treatment for prosthetic valve endocarditis?

A

antimicrobials for 6+ weeks and likely requires surgery

951
Q

Prevention for prosthetic valve endocarditis

A

prophy antibiotics with vanco/ gentamycin

952
Q

Most common cause of defibrillator/ pacemaker (cardiovascular implantable electronic device) infections

A

hematogenous seeding of bacteria, esp S. aureus

953
Q

Ways that cardiovascular implantable electronic device infection presents

A

Generator pocket infection or
Intravascular electrode infection

954
Q

What should be a consideration if there is a recurrent pocket infection?

A

Endocarditis

955
Q

Most common organism to cause generator pocket infection

956
Q

When should the cardiovascular implantable electronic device be removed?

A

If there is a intravascular electrode infection

957
Q

Prevention for cardiovascular implantable electronic devices

A

Prophy antibiotics

958
Q

The following sites are infection locations for this type of device:
- surgical site
- driveline exit site * most common
- device pocket
- pump
- pump pocket

A

Left ventricular assist device

959
Q

Symptoms of systemic left ventricular assist device infection

A

abscess formation on pump\
fever, pain, local swelling
Sepsis, endocarditis, cerebral embolism, multiorgan failure, death

960
Q

Best method to dx endocarditis

A

transesophageal echocardiogram

961
Q

Diseases that can be passed through tissue allograft implants

A

CJD
HIV
Hep B
Hep C
HSV
Cytomegalovirus
Clostridium
Fungi
Rabies
HPV

962
Q

Who screens tissue for tissue allograft

A

American Association of Tissue Banks

963
Q

Prevention of infection in implants: pre-operative

A
  • Screen patient (medical history, clinical evaluation, pre-op testing)
  • ID and treat infections before elective surgery including dental surgery for cardiac
  • Pre-op antiseptic shower
  • skin prep
  • hair removal by clippers before surgery
964
Q

how to prevent spinal implant infection

A

make sure implant is sterile and cover with a sterile drape

965
Q

Treatment for spinal implant infection

A

removal and 4-6 weeks antimicrobial thearpy

966
Q

Prevention of infection in implants: Peri-operative

A
  • help maintain normothermia
  • prophy antibiotics and maintain levels throughout surgery
  • HH & sterile technique
  • 3 sets of gloves- outer set for draping
  • OR environment
  • prevent hematoma formation
967
Q

Prevention of infection in implants: post- surgical

A
  • minimize hematoma
  • monitor wound/ infections
  • heart valves- antibiotics for dental and high risk procedures
968
Q

If someone with an implant has S. aureus, what is the assumption

A

assume infected hardware

969
Q

Out of all the implantable devices, what one has the highest risk of infection?

A

Ventricular assist device

970
Q

ventriculoperitoneal (VP) shunt

A

surgical procedure that involves implanting a thin plastic tube to drain excess cerebrospinal fluid (CSF) from the brain’s ventricles to the abdomen’s peritoneal cavity

971
Q

Endocarditis symptoms

A

FROM JANE
Fever
Roth spots
Osler nodes
Murmur

Janeway lesions
Anemia
Nail-bed hemorrhage
Emboli

972
Q

Gram negative fasticious coccobacilliary organismms that grow slowly in blood culture media and can cause endocarditis

A

HACEK group
Haemophilus
Actinobacillus actinomycetemcomitans
Cardiobacterium hominis
Eckinella
Kingella

973
Q

Process of combining, mixing, or altering ingredients to create a medication tailored to the needs of an individual patient when there is not a drug commercially available

A

Drug compounding

974
Q

What are the most common products of sterile compounding?

A
  • large volume IV solutions
  • small volume IV solutions
975
Q

What type of hood do they use for sterile compounding?

A

Laminar airflow + Hepa filter

976
Q

Pharmacy responsibilities

A
  1. handle preparation and storage of compounded sterile and nonsterile preparations
  2. actively participate in aseptic training of staff to prepare compounded preparations
  3. management- ID staff who would benefit from education and evaluation of aseptic technique
  4. Coordinate medicine recalls
977
Q

What is the primary engineering control for preventing contamination of compounded sterile preparations?

A

Compounding unit capable of ISO 5 air cleanliness + laminar airflow + biosafety cabinet

978
Q

<= 100 particles per cubic ft or 3520 particles per cubic meter

A

International Organization for Standardization Class 5 (ISO 5)

979
Q

Where do all PN fluids need to be prepared? (Iso class)

A

ISO class 5

980
Q

What type of unit is required for hazardous drug preparation?

A

Biological safety cabinet or compounding aseptic containment isolator

981
Q

How often do sterile compounding employees have to train and demonstrate competency?

A

at least annually
Every 6 months for garbing and HH

982
Q

How do they test that hcp maintains sterility in compounding

A

Finger and thumb sampling on gloves, expect 0 cfu/mL and <=3 CFU/ mL after media testing

983
Q

PPE in compounding

A

Sterile gloves
cap
shoe covers
mask
gown (only reusable item)

984
Q

Infection prevention used in sterile compounding to maintain sterility of gloves

A

regularly clean gloves with 70% isopropyl alcohol

985
Q

Iso class 3- Iso class 8- what happens as you increase in #

A

Iso class 3 starts at 35.2
Every isoclass is 10x the number of particles from the iso class before it

986
Q

How many air exchanges and what type of filter is required for sterile compounding?

A

at least 15 ACH
HEPA filter

987
Q

What is an example of a department where it’s appropriate to do regular airborne sampling?

A

Sterile compounding for particulate matter

988
Q

These diseases can be found in immunocompromised patients if nearby ground is disturbed or there is exposure to bird droppings

A

Aspergillus
Cryptococcus neoformans
Histoplasma capsulatum
Coccidioides immitis

989
Q

What organism is associated with “cloud shedding”

A

Staph aureus

990
Q

What are the requirements for air intake?

A

Outlets need to be at least 25 ft from air intake systems
Bottom of outdoor intakes:
- 6 ft above ground
- 3 ft above roof level
Away from medical surgical vac systems
Away from areas with car fumes

991
Q

Filtration methods for pre-filters (Low-medium efficiency, 20-40%)

A
  • Straining
  • Impingement
  • Interception
992
Q

Filtration methods for high-efficiency filters (>=90%) used in most areas of the hospitals

A
  • Diffusion
  • Electrostatic
993
Q

How are high efficiency filters tested?

994
Q

What size particle do HEPA filters remove, and how efficient are they?

A

> =0.3 um
99.97% efficient

995
Q

Where to use HEPA filters

996
Q

Test for HEPA filter

A

Diothlphthalate (DOP) test

997
Q

What organisms does ultraviolet germicidal irradiation work for?

A
  • vegetative bacteria
  • vegetative fungi

Do not work to kill fungal spores

998
Q

Temperature for air in most occupied spaces

999
Q

Pace of laminar air flow

A

90 ft/ min

1000
Q

How far does med prep have to be from the sink?

1001
Q

There are several limitations of air sampling, give a few examples

A
  • lack of standards linking fungal spore levels with infection*
  • lack of standard protocols for testing
  • substantial lab support needed
  • culture issues (false negatives, lag time)
  • unknown incubation period for aspergillus spp infection
  • Variability in sampler redings
  • sensitivity of sampler used (volume of air sampled)
  • Lack of details in literature about describing sampling circumstances (unoccupied rooms versus occupied rooms)
  • Lack of correlation between fungal strain from env and clinical specimen
  • confounding variables with high risk patients (visitors, time outside PE)
  • Need to determine idea temp for incubating cultures
1002
Q

In this method of air sampling, you put a petri dish with agar in the area you want to sample

A

Settle plate

1003
Q

What are settle plates best suited to measure?

A

Larger particles, not sensitive to respirable

1004
Q

This method of air sampling collects large volumes of air in a short period

A

Solid impactor (slit or sieve impactors)

1005
Q

What are solid impactors best suited to measure?

A

Detect low numbers of fungal spores in highly filtered areas

1006
Q

Survival time s. aureus

1007
Q

Survival time C. diff

1008
Q

Survival time norovirus

1009
Q

Survival time acinetobacter

1010
Q

Survival time pseudomonas

1011
Q

removal of foreign mater material from object normally accomplished using water with detergents and enzymatic products

1012
Q

Reduction in microbial population on an inanimate object to a safe or relative safe level

A

Sanitizing

1013
Q

Elimination of many or all pathogenic organisms with exception of bacterial spores

A

Disinfection

1014
Q

What should IP know about their detergents/ disinfectants?

A
  • name
  • active ingredient
  • directions
  • where/ how used
  • manufacturer info
1015
Q

What are the two zones of care

A

Patient zone
Healthcare zone

1016
Q

Moments of HH for environmental services

A
  • Before entering room/ gloving
  • After leaving room/ removing gloves
  • Before handling clean linens
  • After bagging soiled linen and placing it on a linen cart
  • After collecting and bagging trash and placing it in a trash cart
  • After handling soiled equip (mops, cloths/ buckets)
  • After using bathroom
  • Before/ after eating
1017
Q

Survival time enterococcus

1018
Q

Survival time klebsiella

1019
Q

Who should write the cleaning and disinfection policies?

A

Multidisciplinary team

1020
Q

disinfecting agent to kill most viruses and all vegetative bacteria, except tubercle bacilli

A

Low-level disinfection

1021
Q

Disinfectants that kill most bacteria, fungi, viruses, and mycobacteria, but not bacterial spores

A

Intermediate-level disinfection

1022
Q

Disinfectants that eliminate all microorganisms from an instrument or surface, except for a small number of bacterial spores

A

High-level disinfection

1023
Q

Common disinfectants used in environmental services

A
  • quat ammonia
  • bleach
  • hydrogen peroxide
1024
Q

Bleach dilution for nonpourous surfaces

1025
Q

Bleach dilutions for pourous surfaces

1026
Q

Chemical to clean room with or after C. diff patient

A

1:10 bleach or EPA sporicidal agent

1027
Q

terminal cleaning of C. diff room

A
  • UV or HP recommended
  • replace privacy curtain
1028
Q

When should EVS change the privacy curtain?

A

C. Diff
Noro
MDRO

1029
Q

Terminal cleaning of room with noro/ diarrheal outbreak

A
  • UV/ HP
  • Steam clean carpet upholstry
1030
Q

What chemical is recommended to clean nurseries?

1031
Q

Chemical to clean rooms for SARS

A

1:100 bleach

1032
Q

PPE for EVS in SARs room

A

Gown
Gloves
Mask
Protective eyewear

1033
Q

Indicators of bed bugs

A

Bites
Casings
Fecal stains
Skin casts
Sweet musty odor

1034
Q

How EVS to clean room with bed bugs

A
  • Place belongings in plastic bags/ sealed containers
  • Remove clutter
  • Vacuum with HEPA filter
  • Clean reusable equipment (ie walker)
  • call exterminator
  • HCP- Protective gown/ gloves
1035
Q

Cleaning policies and procedures are required to include:

A
  • address dept concerns
  • specify cleaning procedures
  • list cleaning agents and equipment
  • provide cleaning schedules
  • optional: quality control
1036
Q

Cleaning mattresses and pillows

A
  • discard when cracked, torn, or permanently stained
  • disinfect between patients and when visibly soiled
1037
Q

EVS commode

A

clean and disinfect daily and when visibly soiled
Dump and decontaminate before taking out of room

1038
Q

EVS bathroom cleaning frequency

A

daily and when soiled
During diarrheal outbreaks- 3x per day

1039
Q

Types of antiseptics

A

Chlorohexidine*
Tricolsan
Chloroeylenol (PCMX)*
Iodophor
Quat
Alcohol*

*most popular

1040
Q

How often to change mop solution

A

Every 3 rooms or after 60 minutes, whichever comes first

1041
Q

Describe UV radiation for terminal cleaning

A
  • terminal cleaning
  • No need to shut off HVAC
  • Move furniture away from walls
1042
Q

Describe HP for terminal cleaning

A
  • 2-5 hours
  • shut off HVAC and tape doors
1043
Q

Process for cleaning OR

A

1) before first case of day: wipe and disinfect horizontal surfaces
2) After each case:
- decontaminate horizontal surfaces, equip, exam tables, anethesia machines, med carts, other equip
- change cloths freq and after cleaning blood and body fluid
- clean and disinfect floor around pt area
3) conclusion of day:
- decontaminate all items and wet vac

1044
Q

Methods to evaluate effectiveness of cleaning

A
  • visual
  • ATP bioluminescense (not indicative of pathogen- acceptable or unacceptable)
  • Fluorescent markers (tag before cleaning)
1045
Q

Most effective at immediately reducing bacterial counts on hands

1046
Q

Most persistent antimicrobial activity in antiseptic

1047
Q

Does alcohol have a residual antimicrobial effect?

1048
Q

Concern with Hexachlorophene as surgical scrub

A

Absorbed into blood after repeated use

1049
Q

Microbe detected in outbreaks in neonatal units, military field hospitals

A

Acinetobacter

1050
Q

Sources acinetobacter outbreaks/ infections

A
  • hydrotherapy burn unit
  • Hands of HCP
  • Contaminated irrigation tubing, burn unit
  • contaminated endoscopes for upper GI/ biliary
  • other sources: sinks, resp theapy equip, disinfectants, distilled water
1051
Q

This organism survives in moist environmentsl and has minimal nutritional requirements. It tolerates a variety of temps, and has innat antibiotic resistance

A

P. aeruginosa

1052
Q

What organism is most likely to contaminant a disinfectant, germicide, solution, or antiseptic?

A

P. aeruginosa

1053
Q

Environmental gram negative that is associated with cystic fibrosis patients

A

Burkholderia

1054
Q

Sources of outbreaks of burkholderia

A
  • intra-aoritic balloon pumps
  • contaminated water
  • resp therapy equip
  • contaminated disinfectants
1055
Q

This environmental gram negative can cause abcesses, meningitis, conjunctivitis, wound infections, pneumonia, and has antimicrobial resistance. It has been associated with resp therapy equip, contaminated disinfectants, and ice machines

A

Stentophomonas maltophila

1056
Q

Where do enterococci colonize?

A

Human GI tract and biliary tract

1057
Q

Enterococci have both intrinsic and acquired resistance to many anti-microbials, what do they have intrinsic resistance to?

A
  • B-lactams
  • aminoglycosides
  • clindamycin
  • fluoroquinolones
  • TMP-SMX
1058
Q

Disease that enterococci is often associated with

A

Prosthetic heart valve endocarditis

1059
Q

Enterococci is the ____ most common cause of SSIs

1060
Q

IP guidance for VRE:

A
  • antimicrobial stewardship, esp for vancomycin and cephalosporins
  • facility-wide education on infection control, including HH
  • Early detection, prompt implementation of barrier precautions
  • Decolonization
1061
Q

Organisms associated with water

A
  • pseudomonas
  • acinetobacter
  • moraxella
  • aeromonas
  • xanthomonas
  • legionella
  • aspergillus
  • fusarium
  • atypical mycobacterium
1062
Q

Diseases that pass through contaminated equipment

A

Pseudomonas
NTM

1063
Q

Most commonly reported waterborne pathogesn

A

Pseudomonas
Legionella

1064
Q

This type of organism may be found when there is excessive moisture around pipes and insulation, condensation in drain pans, or flooding

1065
Q

Organisms that can grow in eyewash stations

A

Acanthaemobae
Pseudomonas
Legionella

1066
Q

IP for potable water system

A
  • sufficient pressure to operate at max demand
  • isolation valves to separate/ turn off parts of water system
  • install vac breaker on faucets, prevent backflow
  • avoid floor drains
  • no drainage piping in ceiling or exposed
  • avoid dead ends
1067
Q

These organisms can grow in ice chests and machines

A

Cryptococcus
NTM
Pseudomonas
Legionella
Enterobacter

1068
Q

What is the HACCP?

A

Hazard analysis and critical control point plan
Water risk assesment

1069
Q

Weekly- monthly cleaning process for ice machine

A

discard ice, clean chest with detergent then chlorine solution, let dry and return to service

1070
Q

Monthly- quarterly cleaning process for ice machine

A

Discard ice from machine, clean with detergent, take apart and check lines, circulate 50 PPM chlorine for 4 hours, remove chlorine solution, flush with tap, return to service

1071
Q

How often should pools be filtered?

A

3x per day

1072
Q

How often should pools be drained and disinfected?

A

every 1-2 weeks

1073
Q

How to clean after flooding/ leakage

A

remove moisture source
clean in 24-48 hours
disinfect with bleach solution
thoroughly dry

1074
Q

IP for water management

A
  • facility risk assessment for areas of potential growth or transmission
  • designs to reduce risk of microbial growth/ release
  • compliance to maintenance practices that help control transmission risk
  • employ remediation measures during emergencies
  • consider disinfection modalities when surveillance or risk assessment indicates a need
1075
Q

Problems with hyper-chlorination treatment of water system

A

Temporary
Byproduct trihalomethanes
Corrosion
Taste and odor

1076
Q

Benefit of monochloramine treatment of water system

A

Can penetrate biofilms

1077
Q

Problems with monochloramine treatment of water system

A

Taste and odor problems
Trihalomethanes

1078
Q

Benefits of chlorine dioxide treatment of water system

A

No by-products
Breaks down biofilm
Long-term effects
minimal corrosion

1079
Q

Problems with copper/ silver ionization treatment of water system

A

Copper may deposit, localized corrosion
Copper toxic to aquatic species

1080
Q

Benefits of copper/ silver treatment of water system

A

no by products
long term-effects for hot water

1081
Q

Problems of ozonation treatment of water system

A

Some toxic byproducts
Odor problems
potential corrosion
No long term effects
does not work on biofilms

1082
Q

How to test biofilms

A

cannot culture
PCR, sequencing of NAAT

1083
Q

What is the amount of increased resistance of biofilms to antibiotics

1084
Q

What are the clinical consequences of biofilms?

A
  • metastasis (release) of attached microorganism to distal sites
  • Fragments of the biofilm can spread infection
  • increased resistance to antibiotics
  • Neutralization of host defense mechanisms
  • enhanced exchange of genetic material: more virulence and resistance
  • increased # organisms per unit of tissue in indwelling medical device
  • increased occlusion and reduced flow of catheter lumens
1085
Q

Diseases associated with biofilms

A
  • otitis media
  • sinusitis
  • valve endocarditis
  • Cystic fibrosis
1086
Q

What organisms are in healthcare textiles?

A
  • Gram negative bacteria
  • Coagulase negative staph
  • Bacillus spp.
  • Normal skin flora
1087
Q

Clean state, free of pathogens in sufficient numbers to minimize infection risk (specifically for textiles)

A

Hygienically clean

1088
Q

Regulating agencies for healthcare textiles

A

FDA
OSHA
EPA

1089
Q

What is the ideal level of moisture in healthcare setting walls/ floors/ etc.

1090
Q

Process to assess the impact of construction and renovation on HCF on ICP programs and practices, and ensures new construction is designed to meet the needs of the anticipated pt population

A

Infection Control Risk Assessment (ICRA)

1091
Q

Written work process and equipment requirements to manage potential infection risk from proposed construction

A

Infection control risk mitigation recommendations (ICRMR)

1092
Q

Agency that writes construction and renovation in healthcare standards

A

Facilities guideline institute (FGI)

1093
Q

Who should help write the ICRA?

A

IP, safety, engineering, HCP from affected area

1094
Q

Design considerations for ICRA

A
  • # , location, and types of iso rooms and AIIR
  • special HVAC needs
  • # , location, and types of HH stations
  • Risk assessment (including for waterborne pathogens)
  • selection of surface finishing and furnishing materials
1095
Q

What to include in ICRMR

A
  • pt location relative to construction, pt relocation
  • containment barriers
  • construction phases, impact on plumbing and HVAC
  • effect of traffic flow, access to exits, life safety
  • training for staff, construction workers, pts, visitors
  • lav/ cafe areas for construction workers
  • rqmt that new materials clean and free of damage
  • how ICRMR monitored, written procedures to stop work if needed
1096
Q

Pressure of construction zone

1097
Q

What is the IP’s role in construction and renovation?

A
  • assess needs and risks of patient staff, visitors, and population affected by construction
  • Address infection prevention needs of pt and HCP that will occupy the space after construction
  • provide evidence- based guidance on IP to the project design team
1098
Q

Considerations for plumbing design

A
  • CMS requires water mgmt plan
  • remove deadlegs or at least use valve to isolate
  • consider points to inject the chlorine/ disinfectant
1099
Q

What can be used to contain a small job (working on ceiling)

A

Portable containment unit with negative air pressure machine
All workers and tools must fit in unit

1100
Q

Isolating ventilation in the construction space

A
  • wrap return ducts that serve other areas in plastic
  • prevent leaks
  • fan and filtered exhaust grill to exterior of building
  • HEPA filter required if air cannot be exhausted outside
  • shutting of HVAC can negatively impact air pressure in other parts of the building
1101
Q

When is an anteroom required?

A
  • for combined AII/ PE room
1102
Q

Who should be present at construction rounds?

A

Project manager
Safety
Security
Contractor Reps

1103
Q

What surveillance is recommended during construction projects?

A

active surveillance:
- airborne infection in immunocompromised patients
- review labs and postmortem data

1104
Q

Best practices for construction and renovation

A
  • avoid routing construction personnel through the hospital
  • strictly maintain negative pressure at all times
  • prevent circulation of dust with tight barriers or enclosures
  • use dust containment carts
  • protect HVAC so as not to hinder negative pressure
  • Recommend anteroom where workers can change into protective apparel and store and clean equipment
  • Use clean and properly sized walk-off tacky mats
1105
Q

Positive pressure rooms

A

ORs, protective environment, special procedure rooms

1106
Q

Negative pressure rooms

A
  • Airborne isolation rooms
  • toilet rooms
  • bronchoscopy
  • triage, waiting room at the ER
  • radiology waiting room
1107
Q

ASHRAE scale for filters

A

Minimum efficiency reporting values (MERV)
Scale: 1-16, where 16 is the highest filtration rate

1108
Q

Surgery airflow

A

noninduction, unidirectional difffusion
25-35 fpm

1109
Q

Where should exhaust outlets from contaminated areas be located?

A

Above roof

1110
Q

OR and cath lab pressure and ACH

A

positive pressure, minimum of 15 + 3 outdoor

1111
Q

Should you change pressure in OR for TB patient?

A

No, get back to AII ASAP

1112
Q

Minimum number of ACH for PE

1113
Q

Minimum % filter for PE

A

95%, filter .3 microns

1114
Q

Minimum ACH in AIIR

A

12
Add HEPA if there are less

1115
Q

Ancillary support areas ACH, pressure, and filtration:
Food service
Dx imagining
Treatment rooms
Sterilizing/ clean supply distribution
Other service areas

A

+ pressure

10 ACH

90% filtration

1116
Q

What is the temp for AII or PE

1117
Q

Planning checklist for environmental surveillance

A
  1. determine plan and purpose of surveillance
  2. Review literature for published information to guide baseline values or threshold
  3. establish facility-specific baseline or threshold (range of acceptable values)
  4. Determine actions if values exceeded
  5. Ensure micro lab involved in plan
  6. Determine sampling methods and culturing techniques
  7. ensure collecting/ sampling personnel trained for consistency
  8. Conduct sampling and quantify results
  9. determine if values exceed established threshold
  10. Analyze and communicate results, follow action plan if needed
1118
Q

Describe the ACH, pressure, temp, and humidity for: soiled/ decontamination

A

10 ACH
negative pressure
60-65 F
30-60% RH

1119
Q

Describe the ACH, pressure, temp, and humidity for: Assembly/ prep and pack

A

10 ACH
Positive
68-73 F
30-60% RH

1120
Q

Describe the ACH, pressure, temp, and humidity for: Sterilizer loading/ unloading

A

10 ACH
Positive
68-73 F
30-60%

1121
Q

Describe the ACH, pressure, temp, and humidity for: Sterile Storage

A

4 (downward draft)
Positive
up to 75F
<70

1122
Q

What is needed for waste to cause infection

A
  1. Dose
  2. Host susceptibility
  3. presence of a pathogen
  4. Virulence of a pathogen
  5. portal of entry
1123
Q

How to process microbiological waste

A

Chemical, thermal (autoclave), or radiological (irradiation) treatment prior to disposal as nonhazardous waste, or ship off-site as regulated waste

1124
Q

How to process animal waste

A

Evaluate for potential zoonotic exposure risk and treat on site prior to disposal

1125
Q

How to process waste with blood saturated materials or bulk liquids

A

Collect as regulated waste, use chemical bleach or thermal treatment on site to decontaminate and solidify bulk blood if transported off-site

1126
Q

How to process sharps waste

A

Place in appropriate rigid puncture- resistant, closeable and leakproof container for immediate disposal

1127
Q

How to process pathology waste

A

formalin fixation to reduce infectious material, then incinerate or grinding acceptable, cannot release recognizable body parts into waste stream

1128
Q

Who regulates waste management?

A

OSHA, DOT, and EPA

1129
Q

Objectives of waste management plan

A
  • infectious waste safe for disposal
  • minimal risk to HCP, visitors, community
  • mtg or exceeding local, state, and fed regs
  • educate HCP about HCP-risks and handling medical waste
1130
Q

Parts of the waste management chain

A

Designation
segregation
packaging
storage
transport
treatment
disposal
contingency planning
staff training

1131
Q

What disease has been passed between patients in a surgical plume?

1132
Q

Types of regulated infectious waste

A
  • contaminated sharps
  • microbiological waste
  • animal waste
  • pathology waste
  • blood/ blood products
  • Cat A isolation waste
1133
Q

Best method to transport infectious waste to be transported

A

leakproof carts that are cleanable

1134
Q

What are the documents that have to travel with waste to it’s final destination

A

Waste manifest

1135
Q

How to treat contaminated waste?

A
  • Steam sterilization
  • chemical disinfection
  • gas/ vapor sterilization
  • irradiation
  • incineration
1136
Q

How to determine if sterilization of infectious waste worked

A

use a biological indicator

1137
Q

Parts of OSHA and DOT required training for WM

A
  • Definition of infectious waste
  • handling procedures
  • appropriate PPE
  • HH
  • Labeling IW
  • Post exposure management
1138
Q

How often does OSHA require waste management training?

A

First 90 days and every 3 years

1139
Q

Preferred waste management method for Category A waste

A

Use on-site inactivation (autoclave or incineration)

1140
Q

FDA class- device not life supporting of life-sustaining or for a use which is of substantial importance in preventing impairment of human health (example bandages, enema kits)

1141
Q

FDA class: General controls alone are insufficient to provide reasonable assurance of the device’s safety and effectiveness, and there is sufficient info to establish special controls (ex- surgical gloves, contact lenses, powered wheelchairs)

1142
Q

FDA class: life supporting or life-sustaining device or devices for a use which is of substantial importance in preventing impairment of human health, or the device presents a potential unreasonable risk of illness or injury (ex implantable pacemaker, automated external deibrillators)

1143
Q

Animals that are not specific to the patient

A

Animal assisted activities

1144
Q

Animals are specific to patient’s therapy

A

Animal assisted therapy

1145
Q

Rule about raw food for animals in AAA or AAT

A

Animal cannot have eaten raw animal foods in past 90 days

1146
Q

How far in advance does a visiting animal have to bathe?

1147
Q

Are animals allowed on the bed?

A

If an animal goes on the bed, there should be a barrier between the patient and the animal, preferred animal is in a carrier or on a short leash

1148
Q

What patients should be excluded from AAA/ AAT?

A

open wounds
burns
trachea
immunosuppressed
isolation
zoonotic diseases (Salmonella, TB, campy, shigella, Strep A, MRSA, ringworm, giardia, amebiasis)

1149
Q

What are the rules if a personal pet is allowed to visit?

A
  • bath within 24 hours
  • record of current vax before visit
  • short leash/ carrier
  • Staff escort in/ out of facility
  • Only allowed to interact with owner and no other staff or patients
  • visits limited based on predetermined factors
  • inform handler they may be asked to remove pets at any time
1150
Q

Are comfort/ emotional support animals service animals?

1151
Q

Where are service animals allowed?

A

Everywhere but ORs, burn units, and sterile environment

1152
Q

Can service animals be where food is prepared and sold?

1153
Q

Can be used to measure pressure

1154
Q

What is the risk of rinsing medical care equipment with tap water?

A

Gram negative bacteria

1155
Q

What are some organisms that can grow in contaminated solutions (ie solution of bleach) and disinfectants?

A
  • Pseudomonas*
  • Burkholderia
  • Serratia marcesens
  • Stenotrophmas maltophila
1156
Q

Bacteria that are associated with resp equipment

A

Burkholderia cepacia
Stentrophomonas maltophila
Acinetobacter
Enterobacter

1157
Q

What is/ are the source(s) of Mycobacterium abcessus

A

medical instruments that were not sterilized properly

1158
Q

What is/ are the source(s) of Mycobacterium avium complex

A

potable water

1159
Q

What is/ are the source(s) of Mycobacterium chelonae

A
  • Improperly sterilized medical instruments
  • contaminated solutions
  • hydrotherapy tanks
  • Jet injectors
  • Bronchoscopy
1160
Q

What is/ are the source(s) of Mycobacterium fortuitum

A
  • Aerosols from showers/ other water sources
  • ice
  • medical instruments not sterilized properly
  • hydrotherapy tanks
  • deionized water
  • intrinsically contaminated lab solutions
1161
Q

What is/ are the source(s) of Mycobacterium marinum

A

Hydrotherapy tanks
fish tanks

1162
Q

What is/ are the source(s) of Mycobacterium ulcerans

A

potable water

1163
Q

What is/ are the source(s) of Mycobacterium kansasii

A

potable water

1164
Q

Which NTM are more resistant to chlorine (rapid or slow-growing?)

A

slow-growing

1165
Q

If water is down, where should you use sterile/ bottled water?

A
  • surgical scrub
  • ER surgical procedures
  • pharma preparations
  • pt care equip
1166
Q

What is the temp for heat flushing water?

1167
Q

What type of ice should you use for medicine/ solution transport

A

Sterile ice

1168
Q

What type of ice should you use for immunocompromised patients

A

Sterile ice

1169
Q

Who should be restricted from using hydrotherapy tanks and wounds

A

Pts with draining lessions

1170
Q

Examples of intermediate level disinfectants

A
  • chlorine containing compounds
  • alcohols
  • some phenolics
  • some iodphors
1171
Q

Examples of low level disinfection chemicals

A
  • quat ammonia
  • some phenolics
  • some iodophors
1172
Q

What practices may lead a cleaning solution to be contaminated with pseudomonas or seratia (esp in phenolics or quat)

A
  • re-dip dirty cloth into solution
  • solution not changed frequently enough
  • solution prepared in dirty container
  • solution stored too long
  • solution not prepared correctly
1173
Q

Infection control for cleaning solutions

A

Prepare daily and discard remaining solution at end of day and dry out container

Use ready-to-use wipes or solution

1174
Q

These chemicals help to clean off proteins, fats, etc

A

Detergents

1175
Q

If using detergents to clean, what is an important step

1176
Q

Probe that helps to look at the esophagus and determine if it is working properly

A

Esophageal manometry probe

1177
Q

Examples of equipment that require HLD

A
  • resp therapy equipment
  • anesthesia equipment
  • GI endoscopes
  • Bronchoscopes
  • Laryngoscopes
  • Esophageal manometry probes
  • anorectal manometry catheters
  • Endocavitary probes (vaginal and rectal)
  • Prostate biopsy probes
  • infrared coagulation devices
  • Diaphragm fitting rings
1178
Q

HLD chemicals

A
  • Gluteraldehyde (2%)
  • hydrogen peroxide (7.5%)
  • accelerated HP (2%)
  • Improved HP
  • Paracetic acid with HP
  • Paracetic acid (0.2%)
  • ortho-phtaladehyde (0.55%)
  • chlorine based products
1179
Q

how often do disinfection and sterilization team members get training and competency checks?

A

Hire and yearly

1180
Q

What is AAMI’s benchmark for residual protein on instruments?

A

<6.4 ug/ cm

1181
Q

Common places for biofilms to form

A
  • Whirlpools
  • dental water lines
  • hemodialysis systems
  • urinary catheters
  • CVCs
  • endoscopes
1182
Q

Exposure time and temperature for most HLD

A

8 minutes - 45 minutes at 20C (68F)

1183
Q

How long after an uneventful surgery does TASS usually occur?

A

12-48 hours

1184
Q

How to spot clean surfaces with CJD

A

1:10 solution

1185
Q

Which is faster- UV light or HP for terminal cleaning?

1186
Q

Which terminal cleaning supplement is more effective for spores: HP or UV light?

1187
Q

What is the temperature and time for a washer disinfector

A

93C (199F), 10 minutes

1188
Q

Washer sterilizer temp

A

285F (washer followed by short steam cycle)

1189
Q

Washer pasteurizer temp and time

A

70C (158F), 30 min

1190
Q

Time required for most liquid chemical sterilants

A

3-12 hours

1191
Q

Time and temp for paracetic acid as a liquid chemical sterilant

A

12 minutes @ 50-56C (122-132F)

1192
Q

Limitations to liquid chemical sterilants

A

Cannot be wrapped

1193
Q

Generally what are the most resistant organisms to disinfection?

A

Prions
Spores
oocysts and eggs
Mycobacteria

1194
Q

What are the most susceptible organisms to disinfection?

A

Most viruses
Vegetative fungi
Vegetative bacteria

1195
Q

What are examples of high temperature sterilization with processing times?

A

Steam: 40 minutes
Dry heat 1-6 hours

1196
Q

What are the types of low temperature sterilization and their processing times?

A
  • Ethylene oxide gas (15 hours)
  • Hydrogen peroxide gas plasma (28-52 minutes)
  • Ozone (4 hours)
  • Hydrogen peroxide vapor (55 minutes)
1197
Q

Least preferred sterilization method because items cannot be wrapped and difficult to maintain sterility

A

Liquid immersion sterilization

1198
Q

What is the heat-automated HLD method, and it’s processing time?

A

Pasteurization (65-77C, 30 min)

1199
Q

Describe intermediate level disinfectants. What can they be used on?

A

EPA-registered hospital disinfectant with claim against tuberculocidal activity
Noncritical patient care items

1200
Q

Low-level disinfection descriptions

A

EPA registered hospital disinfectant with no TB claim

1201
Q

Peracetic acid/ hydrogen peroxide advantages

A
  • no activation required
  • odor or irritation not significant
1202
Q

Peracetic acid/ hydrogen peroxide disadvantages

A
  • material compatibility concerns- cosmetic and functional (lead, brass, zinc)
  • Limited clinical experience
  • potential for eye/ skin damage
1203
Q

Glutaraldehyde advantages

A
  • Numerous use studies published
  • relatively inexpensive
  • excellent material compatability
1204
Q

Glutaraldehyde disadvantages

A
  • Respiratory irritation
  • pungent and irritating odor
  • Relatively slow mycobactericidal activity (unless phenolics or alcohol added)
  • Coagulates blood and fixes tissue to surfaces
  • Allergic contact dermatitis
1205
Q

Hydrogen peroxide advantages

A
  • no activation required
  • may enhance removal of organic matter and organisms
  • no disposal issues
  • no odor or irritation issues
  • does not coagulate blood or fix tissues to surface
  • inactivates cryptosporidium
  • use studies published
1206
Q

Hydrogen peroxide disadvantages

A
  • material compatibility concerns- cosmetic and functional (brass, zinc, copper, and nickel/ silver)
  • serious eye damage with contact
1207
Q

Ortho-phthaladehyde (OPA) advantages

A
  • fast acting high-level disinfectant
  • no activation required
  • odor not significant
  • excellent materials compatibility claim
  • does not coagulate blood or fix tissues to surfaces claim
1208
Q

Ortho-phthaladehyde (OPA) disadvantages

A
  • stains protein gray
  • limited clinical experience
  • more expensive than glutaraldehyde
  • eye irritation with contact
  • slow sporicidal activity
  • anaphylactic reactions to OPA in bladder cancer patients with repeated exposure through cystoscopy
1209
Q

Advantages of peracetic acid

A
  • rapid sterilization cycle time (30-45 min)
  • low temp (50-55C) liquid immersion sterilization
  • environmentally friendly by-products (acetic acid, O2, H2O)
  • Fully automated
  • single use system eliminates need for concentration testing
  • standardized cycle
  • May enhance removal of organic material and endotoxin
  • no adverse health effects to operators under normal conditions
  • compatible with many materials and instruments
  • does not coagulate blood of fix tissues to surfaces
  • sterilant flows through scope, facilitating salt, protein, and microbe removal
  • rapidly sporicidal
  • provides procedure standardization (constant dilution, perfusion of channel, temps, exposure)
1210
Q

Disadvantages of peracetic acid

A
  • potential material incompatibility (aluminum anodized coating becomes dull)
  • used for immersible instruments only
  • Biological indicator may not be suitable for routine monitoring
  • one scope or a small number of instruments can be processed in a cycle
  • More expensive than HLD
  • serious eye and skin damage
  • point of use system, no sterile storage
  • 2% peracetic acid only cleared by FDA as HLD in AER
1211
Q

Advantages: Improved hydrogen peroxide

A
  • no activation required
  • no odor
  • non-staining
  • no special venting requirements
  • manual or automated applications
  • 12 month shelf life, 14-day re-use
  • 8 min at 20C HLD claim
1212
Q

Disadvantages of improved HP

A
  • material compatibility concerns due to limited clinical experience
  • organic material resistance concerns due to limited data
1213
Q

Advantages Steam sterilization

A
  • nontoxic
  • cycle easy to control and monnitor
  • rapidly microbioicdal
  • least affected by organic/ inorganic soils among sterilization processes listed
  • rapid cycle time
  • penetrates medical packing and device lumens
1214
Q

Disadvantages of steam

A
  • deleterious for heat sensitive instruments
  • microsurgical instruments damaged by repeated exposure
  • may leave instruments wet, causing them to rust
  • potential for burns
1215
Q

Advantages of HP gas plasma

A
  • safe for the environment
  • leave no toxic residuals
  • cycle time is 28 minutes and no aeration necessary
  • used for heat and moisture sensitive items sine process temp <50C
  • simple to operate, install, and monitor
  • compatible with most medical devices
  • only requires electrical outlet
1216
Q

Disadvantages for HP Gas plasma

A
  • Cellulose (paper), linens, and liquids cannot be processed
  • endoscope or medical device restrictions based on lumen internal diameter and length
  • requires synthetic packaging (polypropylene wraps, polyolefin pouches) and soecial container tray
  • may be toxic at levels greater than 1 ppm
1217
Q

Advantages of ethylene oxide

A
  • penetrates packaging materials, device lumens
  • single-dose cartridge and negative-pressure chamber minimizes the potential for gas leak and ETO exposure
  • simple to operate and monitor
  • compatible with most medical materials
1218
Q

Disadvantages of ETO

A
  • requires aeration time to remove ETO residue
  • toxic!, carcinogen, and flammable
  • emission regulated by states
  • cartridges should be stored in flammable liquid storage cabinets
  • lengthy cycle/ aeration time
1219
Q

Advantages of vaporized hydrogen peroxide

A
  • safe for the environment and hcp
  • no toxic residue, no aeration
  • fast cycle time, 55 min
  • used for heat and moisture sensitive items (metal and nonmetal)
1220
Q

Disadvantages of HP vapor

A
  • medical device restrictions based on lumen internal diameter and length
  • not used for liquid, linens, powders, or cellulose
  • requires synthetic packaging
  • limited materials compatibility data
  • limited clinical use
1221
Q

Who should be involved with decisions to reprocess SUDs?

A

-Admin
-Risk assess
- Legal
- Supply chain admin
- Infection control

1222
Q

How often to test HLD?

A

Daily, discard if chemical indicator shows chemical is < minimum
Discard at end of re-use life per manufacturers instructions

1223
Q

What are the advantages of AERs?

A
  • reduce errors prone to manual cleaning
  • enhance efficiency and reliability of HLD
  • automated and standardized reprocessing strips
  • reduce personnel exposure to chemicals
  • filtered tap H2O
1224
Q

What are the disadvantages of automated endoscope reprocessors

A
  • failure linked to OBs
  • does not eliminate pre-clean
  • incompatible with certain side-viewing duodenoscopes
  • biofilm buildup
  • inadequate channel connectors
  • scope placement MUST ensure exposure of internal surfaces to HLD/ sterilant
1225
Q

Should you do environmental sampling in sterile processing?

A

No, only if there is epi risk

1226
Q

Filter for sterile storage room

1227
Q

What is the shelf life for re-processed endoscopes?

1228
Q

What infections have been transmitted by improperly disinfected GI endoscopes?

A

Salmonella
Pseudomonas
Over 150 infections transmitted

1229
Q

What infections have been transmitted by improperly disinfected bronchoscopy equipment?

A

Mycobacterium tuberculosis
NTM
Pseudomonas aieruginosa

1230
Q

Steps to reprocessing endoscope

A
  1. clean (water and enzymatic cleaner)
  2. disinfect (immerse)
  3. rinse
  4. dry (forced air + alcohol)
  5. store
1231
Q

Removes fine soil from instruments after manual cleaning, before HLD and sterilization

A

Ultrasonic cleaner

1232
Q

What type of water should be used in an automated washer/ disinfector

1233
Q

How often does AAMI recommend monitoring washier disinfectors with a challenge test? and what does the challenge test entail?

A

Once a week
Challenge test mimics protein, dried blood, polysaccharides

1234
Q

When do you complete the instrument inspection?

A

Clean side, after cleaning, before HLD or sterilization

1235
Q

Chemical indicator: external time/ temp/ and pressure (says item went through the autoclave, on tape or peel pack)

1236
Q

Chemical indicator: Bowie Dick test- looks at efficiency of air removal

1237
Q

Chemical indicator: Internal time and temp (rarely used)

1238
Q

Chemical indicator: internal, reacts to two or more parameters (rarely used outside of ETO)

1239
Q

Chemical indicator: integrators- melted chemical pellet reacts to all parameters in steam cycle

1240
Q

Emulating indicators- cycle specific

1241
Q

What type of sterilizer is the Bowie Dick test used in?

A

Pre-vac (not gravity)

1242
Q

How often should the Bowie Dick test be run?

1243
Q

What does the class 5 chemical indicator measure (integrators)

A

time, temp, steam
Add to each layer in the most challenging place

1244
Q

When you run a biological indicator, you should also run a ______

1245
Q

When to use BI

A
  • during installation of sterilizer
  • once daily (before first load for steam and HP
  • Every gravity steam load
  • every ETO load
  • all implant loads
1246
Q

Where to place BI in steam sterilizer

A

Loaded chamber over drain (coolest part of sterilizer)

1247
Q

Where to place BI in gas sterilizer

A

Middle of loaded chamber

1248
Q

Where to place BI in HP sterilizer

A

Lowest shelf towards back of chamber

1249
Q

Causes of sterilization failure

A
  • improper cleaning
  • improper packaging
  • wrong pack material
  • excessive packaging
  • improper loading/ overloading
  • No separation between packages or cassettes
  • improper timing and temp
  • incorrect operation of sterilizer
1250
Q

What is used to vaporize HP in HP gas plasma sterilization?

A

Radio frequency

1251
Q

Probability of microbe surviving sterilization is 1 in ______

1252
Q

Probability of single viable microbe living on product after sterilization

A

Sterility assurance level

1253
Q

What is the SAL before and after sterilization?

A

Sterility reduces microbe from 10^3 to 10^6

1254
Q

Types of high temp steam sterilizers

A
  1. Gravity Displacement (250 F)
  2. Dynamic air removal (270-275F)
1255
Q

Types of Dynamic air removal steam sterilizers

A
  1. pre-vac steam sterilizer (sucks out the air)
  2. Steam flush pressure pulse sterilizer (above atmospheric pressure)
1256
Q

Parameters of steam sterilizer

A
  1. steam
  2. pressure
  3. temperature
  4. time
1257
Q

Steam process

A
  1. conditioning
  2. exposure
  3. exhaust
  4. drying
1258
Q

Gravity displacement sterilizer exposure time and temp

A

250 for 30 minutes

1259
Q

Dynamic air removal pre-vac steam sterilizer exposure time and temp

A

270 for 4 minutes

1260
Q

Time and temp for IUSS

A

132C (270) for 3- 10 minutes

1261
Q

Exposure time and aeration time for ETO

A

2.5- 6 hour exposure
8-12 hour aeration

1262
Q

How ETO works to sterilize

A

Alkylation

1263
Q

BI spore to test ETO

A

Bacillus atrophes

1264
Q

BI to test most sterilizers

A

Geobacillus stearothermophilus

1265
Q

What materials are not compatible with HP gas plasma

A

-liquids/ powders
- materials that absorb liquids
- items with cellulose (cotton, paper, linens, towels, gauze, sponges)

1266
Q

Run time for HP gas plasma sterilization

A

28-75 minutes

1267
Q

Run time for ozone sterilization

A

4 hours 15 minutes

1268
Q

rendering item safe to handle

A

Decontamination

1269
Q

Declaration by med device manufacturers that a product is sterile on the basis of physical or chemical process data after validating the cycle using BIs

A

Parametric release

1270
Q

Part of CI labeling that provides a value or values of a critical variable at which the indicator is designed to reach it’s end point as delivered by the manufacturer

A

Stated value

1271
Q

Where should the decontamination air be exhausted?

1272
Q

PPE for decontamination

A
  • Gloves (heavy duty)
  • Fluid resistant mask
  • Eyewear
  • Gown
  • shoe covers
  • surgical attire (hc laundered scrubs)

No long nails or polish, no jewelry

1273
Q

Instrument sets going into the sterilizer should not weigh more than ____ lbs

1274
Q

What are the types of packaging materials?

A
  • textile wraps (woven- reusable/ nonwoven- disposable)
  • Peel pouches
  • rigid containers (metal or plastic)
1275
Q

When are peel pouches preferred?

A

When visibility is important

1276
Q

Which side of peel pouch can you write on?

A

plastic side only

1277
Q

What are the parameters of sterilizers that must be tracked?

A
  • Temperature
  • time
  • pressure
  • vacuum levels
  • moisture conditions/ relative humidity
  • chemical concentrations
  • adequate air removal
1278
Q

If physical monitors of sterilizer are not correct, what next?

A
  • Do not release for use
  • notify supervisor to initiate follow-up
  • recall items in load
1279
Q

When to read external CIs

A

When unloading sterilizer, dispensing/ issuing for use, and before item opened in ER

1280
Q

Per AAMI ST79, is a recall required if the cause of failure is immediately ID’d as the result of operator error and confined to one load

1281
Q

Documentation for sterilization

A
  • sterilizer lot information

cycle documentation;
- lot #
- date
- time
- contents of load
- dept

Description of items
- exposure time and temp
- operator name
- results BI and Bowie Dick, CI in PCD, any reports of inconclusive or nonresponse challlenges

1282
Q

Where should heavy items be stored in sterilized item storage?

A

middle shelf

1283
Q

Item sterile unless integrity of packaging compromised

A

Event related sterility

1284
Q

What compromises event related sterility

A
  • env source contamination (moisture, vermin, air movement with traffic)
  • storage and distribution practices (open versus closed shelving, transport)
  • inventory control
  • frequency of handling between distribution and user
1285
Q

Who regulates sterile processing?

A

OSHA
EPA
FDA

1286
Q

Who makes recommendations for sterile processing?

A

HICPAC
AAMI
AORN
FGI

1287
Q

What document regarding disinfection and sterilization do TJC and CMS use for accredidation?

A

ANSI/ AAMI ST 79- Comprehensive Guide to Steam Sterility in HCF

1288
Q

Sink requirements for decontamination

A

3 bay sink
Clean
Initial rinse
Final Rinse

1289
Q

How far do sinks need to be from the floor in decontamination? How deep?

A

36 inches from floor
8-10 inches deep

1290
Q

How often to change enzymatic cleaner

A

After each use (no antimicrobial)

1291
Q

How often to run cleaning verification tests? (ie bioluminescence markers/ cavitation testing in ultrasonic cleaner)

1292
Q

How often to empty, clean, and disinfect ultrasonic washer

A

@ least daily, better if after each use

1293
Q

How to disinfect ultrasonic cleaner

A

wipe with 70-90% alcohol
Dry with lint-free cloth

1294
Q

How often to test washer/ disinfectors and washer/ decontaminators

1295
Q

What level of disinfection does a cart washer/ disinfector offer?

A

low-intermediate level disinfection

1296
Q

How often to test/ clean cart washer/ disinfector?

1297
Q

How often to test AER and how often to use CI or test strip?

A

Weekly testing
Use test strip or CI before each use

1298
Q

Process for manual cleaning verification

A
  • visible inspection (with magnifying glass or camera)
  • test with soil/ protein/ ATP and or hemoglobin tests
1299
Q

What is considered clean?

A

<6.4 ug/cm^2

1300
Q

How often to test manual cleaning process

A

Daily
when new types of equip used
Test endoscopes and difficult to clean items

1301
Q

How often to test mechanical cleaners

A

daily, on all cycles
installation
after major repair
new type of solution

1302
Q

What is the test for ultrasonic cleaners?

A

Cavitation test (aluminum foil videos online)

1303
Q

Documentation required for HLD solution

A

Shelf life
Date opened
Use-of life open container
Date activated/ diluted/ poured
Re-use life of solution

1304
Q

Tips for loading the sterilizer

A
  • absorbent materials at the top
  • stand peel pounces on side and in same direction
  • containers should be same manufacturer
  • tilt anything that may hold water on edge
1305
Q

Tips for unloading the sterilizer

A
  • ensure cycle parameters met
  • allow to cool before unloading
  • check package and CI/ BI
  • any wet/ damaged or failed BI need to be returned to decontamination
1306
Q

What tests need to be run after a sterilizer is installed, relocated, malfunctioning, repaired, or had a process failure?

A

3 BI PCD (preferably from different manufacturers)
follow with 3 Bowie dick
run on shortest cycles

1307
Q

What regulatory agency approves chemical indicators?

1308
Q

What to do if CI fails

A

Return load to SP
SP investigates
Do not use machine again until BI PCD known

1309
Q

What chemical indicators are typically used for steam sterilizers?

A

Type 5 or 6 CI

1310
Q

What chemical indicators are typically used for EO sterilizers?

A

Type 4 or 5

1311
Q

How often should routine monitoring happen for sterilizers?

A

At least once a week, but daily preferred

1312
Q

How often to use BI in EO sterilizer

1313
Q

How often to use BI with HP sterilizer

A

at least daily

1314
Q

Steps to recalling sterilized loads:

A

Review log of items in load
Retrieve unused items
ID cause of failure
Quality testing
Recall report
Surveillance of involved patients

1315
Q

How often to clean and decontaminate reusable brushes for deontamination

A

Daily but preferably before each use

1316
Q

Objectives of product evaluation

A
  • good performance
  • good patient outcomes
  • safe
  • cost effective
1317
Q

what characteristics make a product evaluation program successful?

A
  • executive oversight and support
  • culture embraces product evaluation
  • data-driven decision making process
1318
Q

Benefits of product standardization

A
  • reduces inventory
  • HCP more comfortable with product
1319
Q

What should be part of the cost considerations during product evaluation?

A
  • cost of product
  • costs beyond product (re-training staff)
1320
Q

% breakdown of time product evaluation committee should spend on cost and utilization

A

20% cost/ 80% utilization

1321
Q

Who should be on the product evaluation steering committee?

A

Sr. admin
nursing exec
med exec
supply chain exec
finance exec
quality improvement exec
PEC leaders

1322
Q

Who has this role on the product evaluation committee?
- actively participates in discussions and content of PEC meeting
- leads team
- develops and follows agenda
- schedules meetings
- communicates with team members between meetings

A

Team leader or chairperson

1323
Q

Who has this role on the product evaluation committee?
- provides support and guidance on navigating political and administrative challenges
- acts as liaison between PEC and other standing committees
- keeps executive management team informed on PEC activities
- Champions PEC program

A

Administrative representative

1324
Q

Who has this role on the product evaluation committee?
- provides supporting information on clinical need and product relevance
- champions PEC program to medical staff

A

physician reps

1325
Q

Who has this role on the product evaluation committee?
- Coordinates PEC logistics and activities
- provides direction on team and project management
- maintains PEC focus
- Manages team dynamics

A

Facilitator

1326
Q

Who has this role on the product evaluation committee?
- Documents discussions, ideas, actions, and decisions
- publishes PEC minutes
- maintains PEC history
- maintains and publishes log of financial impact of PEC decisions

A

Recorder/ Secretary

1327
Q

Who has this role on the product evaluation committee?
- may serve dual capacity as project team leaders, assembling task forces to work on specific PEC initiatives
- represents the facility, not their department
- provides clinical expertise and knowledge of literature, best practices, and patient care

A

Team members

1328
Q

IP role in product evaluation

A

assess product safety and consider cost and potential infection risks of products

1329
Q

The product evaluation process (8 steps)

A
  1. ID need for product (review and if needed, assign PM)
  2. Develop functional product specs
    3 review literature, product info, other product uses
  3. review safety/ IP implications
  4. Develop product trial protocol
  5. Conduct product trial
  6. Evaluate trail results
  7. present to PEC- final decision
1330
Q

What needs to happen after a product is selected?

A

Train employees on use
complete post-implementation surveillance

1331
Q

OSHA BBP mandates for selecting needles/ sharps

A
  • safety engineered sharps/ needleless systems
  • solicit input from front-line workers
  • document solicitation in exposure control plan
  • maintain sharps injury log
1332
Q

What is the process to reprocess single use devices?

A

Decontaminate
Functional testing
Repackage
Relabel
Sterilize

1333
Q

What forms are required for reprocessing Class 1 and 2 SUD?

A

FDA Pre-market notification 510K

1334
Q

What forms are required for reprocessing class 3 SUD?

A

premarket approval application

1335
Q

Can facilities reprocess SUD on site?

A

No, should use third party and recommend site visit

1336
Q

What cannot be reprocessed?

A

Hemodialysis filter
implants
non-hosp setting equip

1337
Q

General components of licensing and agreements with FDA for reprocessing SUD

A
  • register with FDA
  • report adverse events
  • track reprocessed SUD medical devices
  • report corrections (repairs) and removals (removed from use)
  • good manufacturing process requirements
  • labeling
  • pre-market notification approval
1338
Q

Strategy to assist facilities in using their own NHSN data to generate reports that help target infection prevention efforts to areas of greatest need

A

Targeted assessment for prevention (TAP)

1339
Q

CMS requirement for IPs at hospitals

A
  • Hospitals must have active, hospital wide program for surveillance, prevention, and control of HAIs and other infectious diseases
  • Antimicrobial stewardship program
1340
Q

The US HHS wrote the National Action Plan to Prevent HAI: Roadmap to Elimination. What are it’s targets?

A
  • CLABSI
  • CAUTI
  • SSIs
  • Incidence of invasive HAI MRSA
  • MRSA BSI
  • C. Diff infections
  • C. diff hospitalizations
1341
Q

What are the principle goals for infection prevention and control programs?

A
  1. protect the patient
  2. protect HCP, visitors, and others in the healthcare env
  3. cost-effectively accomplish the previous goals whenever possible
1342
Q

What are the principle functions of IPC programs?

A
  1. To obtain and manage critical data and information, including surveillance for infections
  2. To develop and recommend policies and procedures
  3. to intervene directly to prevent infections and interrupt the transmission of infectious diseases
  4. to educate and train HCP, patients, and nonmedical caregivers
1343
Q

Multidisciplinary IP committee (not required by TJC)

A
  • nursing
  • admin
  • EVS
  • Laboratory
  • engineering
  • pharmacy
  • building management
  • physicians
  • surgeons
1344
Q

IPC responsibilities

A
  • education
  • consultation
  • surveillance
  • implementation science
  • patient safety
  • quality improvement
1345
Q

These are the roles of this committee:
-advocate for prevention and control of infections in the facility
- formulate and monitor patient care policies
- educate staff
- provide political support that empowers the team

A

Infection prevention committee

1346
Q

Once certified, what is the next development step?

A

Proficient practioner bridge

1347
Q

What is the APIC opportunity for advanced professionals?

A

Fellow of APIC (FAPIC)

1348
Q

Cost effectiveness: Economic evaluations- types of economic analysis studies

A
  1. cost effectiveness
  2. cost utility
  3. cost-benefit
1349
Q

This economic analysis compares products or interventions with different costs and potential outcomes of care. Examples are # cases of disease prevented, # lives saved, and # life years saved

A

Cost-effectiveness

1350
Q

This economic analysis adjusts the benefits of a specific intervention in terms of health prevention sores (ie quality of life years (QALY) gained(

A

Cost-utility

1351
Q

This economic analysis looks at outcomes in terms of cost

A

cost-benefit

1352
Q

Aside from cost-savings, what other benefits from IP programs can be measured?

A
  • regulatory compliance
  • decreasing malpractice claims
  • protecting employees from injury
  • assisting in pt safety efforts
  • enhancing org. image
1353
Q

7 step method to create a business case

A
  1. frame the problem and develop a hypothesis about potential solutions
  2. Meet with key administrators
  3. Determine the annual cost
  4. Determine what costs can be avoided through reduced infection rates
  5. Determine costs associated with the infection of interest at your hospital
  6. Calculate the financial impact
  7. Include the additional financial health benefits
1354
Q

What is the goal of the IP annual risk assessment?

A

To set priorities and obtain support from key stakeholders

1355
Q

What are the steps for setting priorities in the IP annual risk assessment?

A
  1. establish a reliable, focused surveillance program based on the annual risk assessment
  2. Streamline data management activities
  3. aim for zero HAI rates
  4. Educate staff regarding prevention strategies
  5. ID opportunities for performance improvement
  6. Take leadership role in performance improvement teams
  7. Develop and implement action plans that outline the steps needed to accomplish each objective
  8. Evaluate the success of action plans in accomplishing the goals and objectives of the IPC plan
1356
Q

What should be identified in the IP annual risk assessment?

A

High-volume, high-risk, and problem-prone activities

1357
Q

What should the IP annual risk assessment be based upon?

A

Strategic goals and institutional findings from previous year’s activities

1358
Q

How to measure quality of ICP program

A
  • customer satisfaction
  • appropriateness
  • efficacy
  • timeliness
  • availability
  • effectiveness
  • efficiency
1359
Q

Who mandates an IP annual evaluation?

1360
Q

What is included in the annual evaluation?

A
  • achievements and activities of the program and support requirements
  • emphasize value of IPC program to organization
  • Patient outcomes and cost savings
1361
Q

Who should get copies of the IP annual evaluation

A

Widely disseminate to leaders throughout the organization (execs)

1362
Q

Professional & Practice Standard domains of infection preventionist

A
  1. leadership
  2. professional stewardship
  3. research
  4. IPC operations
  5. quality improvement
  6. IPC informatics
1363
Q

IP domain that includes communication, critical thinking, collaboration, behavioral science, program management, and mentorship

A

Leadership

1364
Q

IP domain that includes accountability, ethics, financial acumen, population health, continuum of care, and advocacy

A

Professional stewardship

1365
Q

IP domain that involves IP as a subject matter expert, performance improvement, patient safety, data utilization, risk assessment and risk reduction

A

Quality improvement

1366
Q

IP domain that includes epidemiology and surveillance, education, IPC rounding, cleaning, disinfection, and sterilization, outbreak detection and management, emerging technologies, antimicrobial stewardship, and diagnostic stewardship

A

IPC operations

1367
Q

IP Domain that includes surveillance technology, electronic medical records and electronic data warehouse, data management, analysis, and visualization, application of diagnostic testing data and techniques

A

IPC informatics

1368
Q

IP domain that includes evaluation of research, comparative effectiveness research, implementation and dissemination science, and conduct or participate in research or evidence based practice

1369
Q

Career stage: IP demonstrates effective emotional intelligence, listening, and learning skills and is acquiring baseline knowledge about each dept and team in which they interact. The IP is beginning to understand the diverse areas of responsibility in her new role and is developing relationships with department staff outside of IP.

1370
Q

Career stage: The IP collaborates well with peer groups and can work well with diverse groups
- the IP is developing collaboration skills by assuming a role in a focused group project
- with ongoing guidance, the IP is becoming more independent in collaborating with key stakeholders

A

Becoming proficient

1371
Q

Career stage:
- The IP actively suggests and seeks ideas to improve quality, efficiency, and effectiveness
- The IP is able to prepare for group meetings by identifying key issues and expectations and is able to identify resources most likely to guide project tasks
- The IP is able to engage all members in the discussion with respect and professionalism

A

Proficient

1372
Q

Career stage:
- The IP actively pursues collaboration and discussion by facilitating and leading diverse groups, welcoming opinions, respectfully challenging perspectives, and modeling effective listening skills
- The IP encourages ownership of the process by group members, highlights group successes, builds a sense of shared accomplishment, and reinforces successes by becoming an advocate for the group’s decisions

1373
Q

What are APIC’s professional development tools?

A
  • Roadmap for the novice IP
  • Self-assessment tool
  • Proficient practioner bridge
1374
Q

Benefits of IP certification per studies

A
  • more comprehensive antimicrobial stewardship programs
  • reduction in MDROs
  • increase in evidence based practices
  • implement best practices for immunizations, vaccine handling, and program management
  • increased perceived value- competency, professionalism, growth in one’s career
1375
Q

Agency that makes advisory reports for hospital execs, follows regulatory issues with HAIs, and maintains hospitals in pursuit of excellence

A

American Hospital Association

1376
Q

Agency focused on using science based research to improve IP

A

Association for Professionals in Infection Control and Prevention (APIC)

1377
Q

Agency focused on surveillance and runs NHSN, they also developed Healthcare control practices advisory committee (HICPAC) which provide guidance about IPC, surveillance strategies, control of HAI, and antimicrobial resistance

1378
Q

Agency responsible for conditions of participation, conditions for coverage, and tie HC quality to medical reimbursement through value based purchasing

1379
Q

What IP related items does CMS require?

A

IPC program
Antimicrobial stewardship program

1380
Q

IP certification board

A

Certification board of infection control and epidemiology (CBIC)

1381
Q

What does the FDA regulate?

A
  • Drugs/ biologics for human use
  • reprocessed equip
  • medical devices
  • antimicrobials
  • PPE
  • Device recall
1382
Q

What does the EPA regulate?

A
  • hazardous waste and chemicals into env
  • germicides applied to surfaces
1383
Q

This agency provides IP education, position papers, a journal, and compendium of strategies to prevent HAIs in acute care hospitals

A

Society of Healthcare Epidemiologists of America (SHEA)

1384
Q

Federal agency that protects health of Americans, and made HAIs a priority with the Roadmap to HAI elimination

A

U.S. Health and Human Services (HHS)

1385
Q

Agency that focuses on HAI innovation and implementing change

A

Institute of HC improvement

1386
Q

Accrediting agencies

A

The Joint Commission
DNV-GL

1387
Q

Regulate the types of devices used for employee protection (respirators, sharps, PPE)

A

National Institute for Occupational Safety and Health (NIOSH)

1388
Q

Regulate work related safety

A

Occupational Safety and Health Administration (OSHA)

1389
Q

IP regulations from OSHA

A

BBP standard of 1991, with 2001 update for sharps
General duty clause- TB
Respiratory protection standard

1390
Q

What should training and education be linked to?

A

An organizations vision, mission, and values

1391
Q

What are learning outcomes for HCP?

A
  • increased competence in ID’ing problems
  • critical thinking
  • managing existing situations
  • coping effectively with stress
1392
Q

Describe the adult learner

A

Autonomous and self-directed
Goal-oriented
Relevancy oriented
Practical

1393
Q

What are the three types of learning in Bloom’s taxonomy?

A

Cognitive- mental skills (knowledge)
Affective- growth in feelings or emotional areas (attitude of self)
Psychomotor- manual of physical skills (Skills)

1394
Q

Bloom’s taxonomy levels

A

remembering
Understanding
Applying
Analyzing
Evaluating
Creating

1395
Q

Can the learned recall or remember the information?

Define, duplicate, list, memorize, recall, repeat, reproduce

A

Remembering

1396
Q

Can the learner explain the ideas or concepts?
Classify, describe, discuss, explain, identify, locate, recognize, report, select, translate, paraphrase

A

Understanding

1397
Q

Can the learner use the information in a new way?
Choose, demonstrate, dramatize, employ, illustrate, interpret, operate, schedule, sketch, solve, use, write

1398
Q

Can the learner distinguish between the different parts?
Appraise, compare, contrast, criticize, differentiate, discriminate, distinguish, examine, experiment, questoin, test

1399
Q

Can the learner justify a stand or decision?
Appraise, argue, defend, judge, select, support, value, evaluate

A

Evaluating

1400
Q

Can the learner create new product or point of view?
Assemble, construct, create, design, develop, formulate, write

1401
Q

Amount that people retain by passive learning

1402
Q

Amount that people retain by active learning

1403
Q

Methods for active learning

A

Discussion group (50% retention)
Practice by doing (75% retention)
Teach others/ immediate use learning (90% retention)

1404
Q

Methods for passive learning

A

Lecture (5% retention)
reading (10% retention)
Audio-visual (20% retention)
Demonstration (30% retention)

1405
Q

Methods for educational needs assessment

A
  • Learner self-assessment
  • focus group
  • interest finder surveys
  • test development
  • personal interviews
  • job analysis and performance reviews
  • observational studies
  • review of internal reports (ie injury and illness reports)
1406
Q

Statements that communicate the intent of the curriculum and provide a direction for planning the education session (time and resources are defined)

1407
Q

Specific actions the learner will perform as a result of instruction (must be measurable and should use action verbs

A

Instructional objectives

1408
Q

Three common learning assessment tools

A

Koln’s learning style inventory
Dunn, Dunn, and Price Productivity Env preference survey
VARK inventory

1409
Q

Kolb learning style inventory- prefers concrete experience and active experimentation

A

Accomodative

1410
Q

Kolb learning style inventory- prefers abstract conceptualization and reflective observation

A

Assimilative

1411
Q

Kolb learning style inventory- prefers concrete experience and reflective observation

1412
Q

Kolb learning style inventory- prefers abstract conceptualization and active experimentation

A

Convergent

1413
Q

What does the Dunn, Dunn, Price and productivity preference survey determine preferences for?

A
  • Environmental (surroundings)
  • Sociological (study alone or in groups)
  • physical (visual, auditory, kinetic)
  • emotional (responsibility, persistence, motivation)
1414
Q

Grasha teaching style: IPs use vast knowledge base to inform learners and challenge them to be well prepared. This can be intimidating to the learner

1415
Q

Grasha teaching style: This style puts the IP in control of the learner’s knowledge acquisition. The IP is not concerned with learner-educator relationships but rather focuses on the content to be delivered

A

Formal authority

1416
Q

Grasha teaching style: the IP coaches, demonstrates, and encourages a more active learning style

A

Demonstrator or Personal Model

1417
Q

Grasha teaching style: Learner-centered, active learning strategies are encouraged. The accountability for learning is placed on the learner

A

Facilitator

1418
Q

Grasha teaching style: The IP role is that of a consultant and the learners are encouraged to direct the entire learning project

1419
Q

What should be evaluated for an IP educational program?

A
  • appropriateness of program design
  • adequacy of teaching and instructional resources
  • knowledge, skills, and attitudes learned by participants
1420
Q

What are the evaluations?

A

Formative and summative evaluation
Pre/post test
Observation of practice
Exit questionnaires
Interviews

1421
Q

Educational evaluation conducted during the planning of the educational session to provide immediate feedback and allow appropriate changes to be made

A

Formative evaluation

1422
Q

Education evaluation that occurs after the program is completed to determine the impact and overal effectiveness

A

Summative evaluation

1423
Q

In every community, someone doses something better than their peers although they have the same resources

A

Positive deviance

1424
Q

Parts of creating a network map

A
  1. initial network
  2. current network
  3. innovation network
  4. project network
  5. potential network
  6. social network
1425
Q

Social network analysis metrics

A
  1. awareness
  2. connector
  3. integration
1426
Q

When is lecture appropriate

A

More complex, high volume topics- symposiums and panels
QA time is improtant

1427
Q

When is train the trainer appropraite

A

training large numbers of staff over short span of time
Leader guides train person responsible for implementing program and training staff

1428
Q

What is a leader guide for train the trainer?

A

Simply written goals and objectives, course outline, instructional methods, references, and evaluation

1429
Q

Benefits of mentoring programs

A

Cost-effective, cross-training

1430
Q

Education that may be better suited to get information to employees on night shift

A

Education charts

1431
Q

HCP IP competency framework

A
  1. Describe the role of microorganisms in disease
  2. Describe how microorganisms are transmitted in HC
  3. demonstrate std and tbp for all pt contact
  4. describe occ health practices to prevent acquiring infection
  5. Describe occ health practices that protect HCP from transmitting infection to a pt
  6. Demonstrate ability to problem solve and apply knowledge to recognize, contain, and prevent infection transmission
  7. describe the importance of healthcare preparedness for a natural or human-made infectious disease disaster
1432
Q

Objectives of performance improvement program

A
  1. measure how facility controls/ complies with policies
  2. document results observed audits
  3. root cause analyses
  4. infection rate reports –> ind physician/ unit
  5. benchmark against community/ state/ national
1433
Q

Steps to move from novice to proficient

A
  • CIC
  • Consider advanced degree in field
  • serve in leadership position in local APIC chapter
1434
Q

Agency for HC Research Quality IP intiatives

A
  1. Improve HH
  2. Barrier precautions to prevent transmission
  3. Reduce C. diff and VRE through prudent antibiotic use
  4. Prevent UTIs
  5. Prevent CLABSI’s
  6. Prevent VAP
  7. Prevent SSI
1435
Q

What are the management types of power?

A

Coercive
Expert
Legitimate
Referent
Reward

1436
Q

Manager threatens with punishment

1437
Q

Manager has special knowledge, experience and skills

1438
Q

Manager was appointed or elected

A

Legitimate

1439
Q

Manager looks to individual group members and respects community beliefs

1440
Q

Manger grants something a person desires or removes what they do not

1441
Q

Agency that coordinates all federal QI efforts, key organization after to err is human

A

Agency for Healthcare Research and Quality (AHRQ)

1442
Q

What subjects require written IP polciies?

A
  • staff and pt care practices
  • construction/ renovation
  • emergency management
  • occupational health
  • sterilization/ disinfection
1443
Q

6 basic functions of a manager

A
  • plan
  • organize
  • staff
  • lead
  • control
  • motivate
1444
Q

Deficit reduction act requires hospitals to report HAIs that are…

A

High/cost high/volume
secondary dx- with a higher payment dx related group
Could have been prevented

1445
Q

What are the staffing requirements for ambulatory care?

A
  • at least 1 IP employed or regularly available
  • develop and maintain IP and occ health programs
  • sufficient supplies for std precautions
  • written policies and procedures
1446
Q

What do most IPs spend about 50% of their time doing?

A

Collecting, analyzing, and interpreting data on the occurrence of infections

1447
Q

Steps for positive devience

A
  1. Define
  2. Determine
  3. Discover
  4. Design
1448
Q

Precede/ proceed model components

A

Predisoposing factors: motivate people to make change (attitudes, beliefs, values)

Enabling factors: Capacity to change (do they have the necessary skills and capability? Do they have the necessary resources?)

Reinforcing: Behavior implemented, determines whether it will continue to be carried out (Responses/ interaction of team members, supervisors, role models, own experience)

1449
Q

Parts of the health belief model

A

Perceived security/ susceptibility
Modifying factors (demographics)
Perceived threat
Cues to action (heightened awareness)
Benefits minus barriers
Self-efficacy

All: Likelihood of action

1450
Q

Parts of social cognitive theory

A

Person
Behavior
Environment

1451
Q

Parts of transtheoretical model/ stage theory

A
  1. Precontemplation
  2. contemplation
  3. preparation
  4. action
  5. maintenance
1452
Q

Which stage of transtheoretical approach: mixed communications to highlight the problem of infection spread in hc settings

A

Precontemplation stage

1453
Q

Which stage of transtheoretical approach: communications and role modeling to show advantages, minimize disadvantages of best practice

A

Contemplation stage

1454
Q

Which stage of transtheoretical approach: ID resources and provide training for best practice techniques

A

Preparation group

1455
Q

Which stage of transtheoretical approach: coaching, training, reinforcing self-efficacy to master best practices, provide social reinforcement

A

Action group

1456
Q

Which stage of transtheoretical approach: Continue reinforcement, peer support, highlighting best practice compliance in small group settings

A

Maintenance group

1457
Q

Goals of SSI surveillance plans

A
  • ID risk factors for infection and adverse events
  • implement risk reduction measures
  • monitor effectiveness of interventions
1458
Q

What to review in SUD site-visit

A
  1. Policies
  2. Cleaning and decontamination
  3. inspection and testing
  4. sterilization load prep process
  5. quality control measures
1459
Q

Pneumatic tube spill processes

A
  • method to recognize spills/ leaks
  • communication protocol
  • cleaning and decontamination
  • retrieval of stuck items
  • restoration system
1460
Q

Process for SPD if single positive indicator is in a load with no implants

A

Check log- used correctly?
Contact maintenance
Test again- 3 consecutive cycles with paired BI from dif manufacturers

1461
Q

Maintenance of refrigerator/ freezers

A
  • compare features to match intended use
  • accurate temp monitoring (+ test accuracy)
  • record temp reg basis
  • routine monitoring of alarms
  • reg preventative maintenance
  • keep humidity low in walk-in units
  • train personnel on safe maintenance
1462
Q

How can IP support antimicrobial stewardship?

A
  • calculate MDRO incidence based on clinical culture results
  • Calculate MDRO infection rates
  • Use molecular typing for investigating outbreaks
  • detect asymptomatic carriers using active surveillance cultures
1463
Q

Incubation period pneumonic plague

A

2-4 days (1-6 days)

1464
Q

Pneumonic plague precautions

A

droplet until 48 hours after appropraite antimicrobials and clinically improving

1465
Q

SSI score components- what makes up risk index score

A

+1: asa of 3,4, or 5
+1: operation classified as contaminated/ dirty/ infected
+1: operation lasts longer than duration cut pt time in minutes

1466
Q

How to test for anthrax

A
  • measure antibodies or toxin in blood
  • test for B. antrharics in blood, skin, CSF, or resp secretions
1467
Q

What is included in the budget/

A
  • planned sales/ revenue
  • Resource quantities
  • costs and expenses
  • assets
  • liabilities
  • cash flow
1468
Q

What makes a good performance measure

A
  • evidence-based
  • well defined
  • clinically important for patient populations
  • broadly applicable in dif types of facilities
1469
Q

Ideal active/ passive education ratio

1470
Q

What should goals and objectives in the annual risk assessment be based off of?

A
  • strategic goals
  • data and findings of previous year
  • resources and data system needs
  • reviewed in context of goals
1471
Q

Used to measure efficiency of production, measures output:inputs

A

productivity

1472
Q

3 things that performance improvement focuses on

A
  1. clinical outcomes
  2. customer service
  3. customer satisfaction
1473
Q

How long is bleach in a spray/ brown opaque bottle stable for?

A

30 days and retain 50% concentration

1474
Q

How short-term IVDs get infected

A
  • cutaneous
  • extraluminal
  • occasionally intraluminal
1475
Q

How long-term IVDs get infected

A
  • contamination catheter hub
  • luminal fluid
1476
Q

Process for sentinel surveillance

A

Collect data from sample of reporting sites
Example- monitoring chickens for antibodies to arboviruses

1477
Q

What type of data can a run chart be used with?

A

Any numeric data (discrete or continuous)

1478
Q

IP for CRE

A
  • Rapidly ID pts with CRE and put on TBP
  • use antibiotics wisely
  • minimize device use
  • Surveillance- focus on high-risk settings or pts at high risk or from high risk setting
1479
Q

How PFGE works and what it is used for

A

Lyses organism
Restricts enzymes to digest DNA (fragments)
Fragments- pattern discrete bands
Bar code bacterial chromosome

Used to assess relatedness of different clinical isolates

1480
Q

Describe discrete data

A

Categorical or noncategorical
Whole #s, mutually exclusive
Example: infected/ not infected, male/ female

1481
Q

Describe noncategorical data

A

Can count events, but not non-events
Ex) patient falls/ 1000 pt days

1482
Q

Describe categorical data

A

Counts events and non-events
Ex) 10 SSIs in 100 surgical cases = 10 events, 90 non-events

1483
Q

Describe continuous data

A

Numeric values between the minimum and maximum
Ex) age, serum cholesterol level
Measurements

1484
Q

What does the RCA determine?

A
  • human and other factors
  • process of systems involved
  • underlying causes/ effects of process
  • risks and potential contributions to failure or adverse events
1485
Q

Steps to an initial OB investigation

A
  1. confirm outbreak present
  2. alert key partners
  3. lit review
  4. preliminary case definition
  5. methodology for case finding
  6. initial line list/ epi curve
  7. observe and review potentially implicated pt care activities
  8. Consider env sampling
  9. implement initial control measures
1486
Q

Conducting the needs assessment ID deficiencies in….

A
  • knowledge
  • skills
  • attitudes
1487
Q

How is surveillance used?

A
  • ID risk factors of infections and adverse events
  • implement risk reduction measures
  • monitor effectiveness of interventions
1488
Q

Human factor limitations that contribute to error:

A
  • limited memory capacity
  • negative effects of stress
  • negative influence fatigue
  • overdependence on multitasking
1489
Q

5 TJC IP standards

A
  1. Minimize HAI risk through IP program
  2. ID risk of transmission of infectious agents
  3. Effective management of the IP program
  4. collaboration relevant roles and functions
  5. adequate resources
1490
Q

Describe the model for improvement

A

Part 1:
1. set aims
2. establish measures
3. select changes that will make improvement

Part 2:
test changes in PDSA

1491
Q

What are the outcomes for low nurse staffing levels?

A

Increased:
- pneumo
- shock
- cardiac arrest
- UTI

Increase in non permanent staff leads to increase in HAIs

1492
Q

List of HAIs, most common to least common

A
  1. Pneumo
  2. SSI
  3. GI
  4. UTI
  5. BSI
1493
Q

Top HAI organisms, from most common to least common

A
  1. C. Diff
  2. Staph
  3. Klebsiella
  4. E coli
  5. Enterococcus
  6. Pseudomonas
1494
Q

What is included in a business plan?

A
  • set of business goals
  • reasons goals are attainable
  • plan to reach the goals
1495
Q

What are the goals of human factors engineering?

A

Minimize errors by:
- improving efficiency
- creativity
- productivity
- job satisfaction

1496
Q

What law requires meaningful use of EHR?

A

American Recovery and Reinvestment Act

1497
Q

Failure of planned action to be completed as intended or use of wrong plan to achieve an aim

A

Medical error

1498
Q

Serious, undesirable, unanticipated pt safety event that resulted in harm to the patient

A

Adverse event

1499
Q

Event that results in death, permenant harm, or severe, temporary harm

A

Sentinel event

1500
Q

Common causes of medical errors

A
  • communication problems
  • inadequate info flow
  • human probelms
  • pt related issues
  • org transfer knowledge
  • staffing patterns/ workflow
  • tech failures
  • inadequate policies and procedures
1501
Q

Standardized terminology and classification schema for near misses and adverse events

A

Public safety taxonomy

1502
Q

What are the patient safety event taxonomy classifications:

A
  1. impact
  2. type- implied of visible processes that were faulty or failed
  3. domain- characteristic of setting in which incident occurred, type of ind involved
  4. cause
  5. prevention
1503
Q

Within how many days of an event does the RCA have to be completed?

1504
Q

Systematic study of elements involving human-machine interface with the intent of improving working conditions or operations

A

Human factors analysis

1505
Q

Research in human pysch, social, physical, and biologic characteristics, concerned with design of tools, machines, and systems that consider human capabilities, limitations, and characteristics

A

Human Factors Engineering

1506
Q

Recognizes complex, high technology systems are subject to rare but usually catastrophic organizational accidents in which variety of contributing factors combine to breach safeguards and some accidents could be thwarted if front line acquired degree mindfulness about failure points

A

Error wisdom

1507
Q

Reasons for error types in error wisdom

A
  1. skill based (slip or lapse)
  2. rule based (how taught)
  3. knowledge based (new situation)
1508
Q

Study of a process to achieve a failure free operation over time to reduce process defects and improve system safety. Includes resilience

A

Reliability science

1509
Q

Intrinsic ability of system to adjust and sustain operations during periods of stress or after an event

A

resilience

1510
Q

5 Principles of reliability science

A
  1. preoccupation with failure
  2. sensitivity to operations (awareness of changes like changes in the community may impact need for care)
  3. reluctance to simplify (multidisciplinary)
  4. Commitment to resilience
  5. deference to expertise
1511
Q

Parts of FMEA

A
  • Failure- lack of success, nonperformance, etc
  • Mode- way failure occurs, impact on a process
  • Effect- consequences
  • Analysis- possible failure modes and effects, how serious are the effects?, how to eliminate or reduce failure to prevent harm
1512
Q

Set of values, guiding beliefs, or ways of thinking that are shared among members of an organization, feel of the organization that is quickly picked up by new members

1513
Q

Patient safety culture: why waste time on safety?

A

Pathological

1515
Q

Patient safety culture: Do something when there is an incident

1516
Q

Patient safety culture: Systems in place to manage all identified risks

A

Bureaucratic

1517
Q

Patient safety culture: always on alert for risks that might emerge

1518
Q

Patient safety culture: risk management is an integral part of everything we do

A

Generative

1519
Q

What makes a strong safety culture?

A
  • generative
  • uneasy about risk
  • constantly seek best practices
  • look for where next mistake will happen
  • work to prevent next mistake
1520
Q

Everyone holds each other accountable for patient safety

A

Reciprocal accountability

1521
Q

Science of studying people at work then designing tasks, jobs, information, tools, equipment, facilities, and the working env so that ppl can be safe, productive, and comfortable

A

Ergonomics

1522
Q

What do HCP want after they are involved with a patient safety event?

A
  1. system assessment
  2. support of colleagues
  3. sense of shared responsibility with leadership
  4. preventative action plan
  5. commitment to fix system problems
  6. psych counseling
1523
Q

Sets direction for where organization will go in the future, and what the organization must do to reach goal. mission, or vision

A

Strategic Plan

1524
Q

What are TJC requirements for the IP strategic plan

A
  1. Prioritize the ID’d risk for acquiring and transmitting infections
  2. Set goals that limit:
    - Unprotected exposure to pathogens
    - transmission of infections associated with procedure
    - transmission of infections associated with medical equipment, devices, and supplies
  3. describes activities and surveillance to minimize, reduce, or eliminate risk of infection
  4. describes process to evaluate efficacy of plan
1525
Q

Part of multi-disciplinary quality concept team- expert on team process, not process under review

A

Facilitator

1526
Q

Part of multi-disciplinary quality concept team- manager with process knowledge

A

Team leader

1527
Q

Part of multi-disciplinary quality concept team- front line employees

A

team members

1528
Q

Steps for failure mode effect analysis

A
  1. determine process to study (high risk of harm)
  2. multi-disciplinary team’
  3. Flow diagram with each step of process and subprocess
  4. Reasons process may fail and likert scale with severity and probability
  5. redesign process to eliminate failure
  6. develop outcome measure to redesign process
1529
Q

Parts of the six sigma/ lean approach

A

Define
Measure
Analyze
Improve
Control

1530
Q

Number of data points that run chart is best for

1531
Q

Number of data points control chart is best for

1532
Q

valid and reliable indicator that can be used to monitor and evaluate quality of functions that affect patient outcomes

1533
Q

Does it measure what it’s intended to measure?

1534
Q

Does it accurately and consistently ID events it is intended to ID across multiple HC settings?

1535
Q

Tool that provides an indication of organizations performance in relation to a specified process or outcome

A

Performance measure

1536
Q

Performance measure designed to evaluate the processes or outcomes of care associated with delivery of clinical services (condition specific, procedure specific)

A

Clinical measure

1537
Q

Measure that indicates result of performance

A

Outcome measure

1538
Q

What should be considered for outcome measures?

A
  • cost/ benefit
  • pt satisfaction
    Ex- clean needle exchange or pt dissatisfaction with iso
1539
Q

Measure that evaluates compliance with pt care activities

A

Process measure

1540
Q

What measure is best for uncommon outcomes?

A

Process measure

1541
Q

Chart for when comparing relationship between points is more important than the exact values of the data points

1542
Q

Best chart for how categories relate to each other with respect to a whole

1545
Q

Diseases seen in neutropenia from HSCT patients

A

Gram negative aerobes
Gram positive cocci
Candida
Aspergillus
Hsv

1546
Q

Diseases seen in neutropenia from HSCT patients

A

Gram negative aerobes
Gram positive cocci
Candida
Aspergillus
Hsv

1547
Q

Diseases seen hsct patients with cell mediated immunity

A
  • Viruses (CMV, EBV, adenovirus, EBV, resp viruses)
  • Intracellular facultative bacteria (listeria, mtb, etc)
  • fungi- pneumocystis jerovecii
  • protozoa - toxo
1548
Q

Diseases seen hsct patients with cell mediated immunity

A
  • Viruses (CMV, EBV, adenovirus, EBV, resp viruses)
  • Intracellular facultative bacteria (listeria, mtb, etc)
  • fungi- pneumocystis jerovecii
  • protozoa - toxo
1549
Q

Diseases seen in hsct patients with humoral immunity dysfunction

A

Encapsulated bacteria

1551
Q

Tjc standards

A
  1. Minimize the risk for development of an hai through an organization-wide infection prevention program
  2. Identify risk for the acquisition and transmission of infectious agents on an ongoing basis
  3. Effective management of the infection prevention and control program
  4. Collaboration of representatives from relevant components and functions within the organization in the implementation of the program
  5. Allocation of adequate resources to the infection prevention and control program
1552
Q

Tjc standards for ip program

A
  1. Minimize the risk for development of an hai through an organization-wide infection prevention program
  2. Identify risk for the acquisition and transmission of infectious agents on an ongoing basis
  3. Effective management of the infection prevention and control program
  4. Collaboration of representatives from relevant components and functions within the organization in the implementation of the program
  5. Allocation of adequate resources to the infection prevention and control program
1553
Q

Organizations process of defining its strategy or direction and making decisions on allocating its resources to pursue this strategy

A

Strategic planning

1554
Q

Organizations process of defining its strategy or direction and making decisions on allocating its resources to pursue this strategy

A

Strategic planning

1555
Q

What does the strategic planning process include?

A

Setting goals, determining actions to achieve the goals, and mobilizing resources to execute the action

1556
Q

Planned objectives that a department or organization strives to achieve they must be clear and measurable

A

Strategic goals

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