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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
Endogenous opportunistic organisms that infect the GI tract
Enterococcus Streptococcus bovis Colostrum septicum Candida Aerobic gram negatives
26
Endogenous opportunistic organisms that infects the CNS
Toxoplasma gondii
27
Examples of exogenous opportunistic organisms from hands of hcp
Gram negative Staph aureus C diff Viruses
28
Examples of exogenous opportunistic organisms from water
Legionella Crypyosporidium
29
Examples of exogenous opportunistic organisms from soil, dust, and env
Rhodococcus Aspergillus Zygomycetes NTM
30
Do endospores in Bacillus spp. and Lactobacillus spp. stain?
No
31
Spirochetes
Treponema, Boirrelia, Leptospira
32
Are gram stains effective for spirochetes?
Not usually, but may be detected by darkfield flourescent microscopy
33
Stain for Cryptococcus neoformans in CSF
India ink
34
Stain for parasites in stool, including giardia, entamoeba, and endolimax
Trichrome
35
CSF: Predominant cell neturophil
Bacterial meningitis
36
CSF: predominant cell lymphocyte
Viral meningitis
37
CSF: predominant cell eisoinophil
Parasite or fungal meningitis (ie coccidioides)
38
Classic indicators of bacterial meningitis
Increased WBC Increased protein Decreased glucose
39
What CSF typically looks like for TB meningitis
lymphocytes low glucose
40
Which is preferred for lower respiratory culture: bronchoscopy or sputum sample?
Bronchoscopy, such as BAL
41
Less or more sensitive: POC tests for Group A strep and fly
less sensitive
42
When are surveillance cultures for staff appropriate?
Not routinely, only when staff implicated in cluster/ outbreak
43
Types of antibody tests
EIA Chromogenic immunoassay Hemagglutination Latex agglutination Fluorescent antibody tests Western Blot
44
Sensitivity and specificity for HCV RNA
Good sensitivity and specificity
45
Specificity of urine legionella EIA/ fluorescent antibody test
100% and also has good sensitivity
46
How reliable are tests for histo, coccidioides, and blastomyces?
High cross-reactivity with other fungi/ poor test reliability
47
Describe RPR
Screening test for syphilis, high sensitivity, so need confirmatory testing if positive
48
Specimen Collection Guidelines
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
49
Specimen Transport Guidelines
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
50
What samples should NEVER be refrigerated?
CSF, genital, eye, inner ear
51
Common transport media
Stuart, amies, carey-blair
52
Common blood culture contaminants
S. epidermindis Bacillus spp. Propionbacterium S. viridans
53
Modes of action of antimicrobials
- interfere with cell wall synthesis - inhibit protein synthesis - interfere with nucleic acid synthesis - inhibit metabolic pathway
54
Leukocytosis (>10,000 WBC) is a sign of
Acute infection
55
Leukopenia (<4000 WBC) is a sign of
Overwhelming infection: AIDS viral hepatitis Mononucleosis Legionairre's disease
56
Neutrophilia (increase) is a sign of
Inflammation Bacterial infection
57
Neutropenia is a sign of
Overwhelming bacterial infections viral infections (hep, flu)
58
What diseases cause an increase in basophils?
TB Smallpox Chickenpox Influenza
59
What diseases cause an increase in monocytes?
- Bacterial infections TB Subacute bacterial endocarditis syphillis
60
Diseases that cause lymphocytosis (increased >4000)
Infectious mononucleosis Viral URI CMV Measles Mumps Chickenpox Viral Hepatitis
61
Describe sensitivity
Good sensitivity - Detect sick people High sensitivity: false positives, confirmatory testing needed Low - more false negatives
62
Where are each of the following endemic: Histpplasma capsulatum Blastomyces dermatidis Coccidioides immitis
Histo: Mississippi and Ohio River Valley Blasto: acidic soil, "" Coccidioidies: Southwest/ south and central CA
63
Describe specificity
Good specificity: Health people test negative High specificity: more false negative, miss some cases Low specificity: more false positives
64
What can cold agglutination tests detect?
- mycoplasma pneumo - mono - viral pneumo
65
Diseases with positive C-reactive protein
Meningitis Pneumonia Sepsis TB
66
What does LAL (Limulus amebocyte lysate) test for?
Endotoxins
67
Organisms with endotoxins
- E coli - Salmonella - Shigella - Pseudomonas - Neisseria - H. influenzae - B. pertussis - V. cholera
68
What organisms with the weil-felix agglutination test detect?
Rickettsia illnesses: RMSF Q Fever Typhus Rickettisal pox
69
How do antibiotics work?
- interfere with cell wall biosynthesis - inhibit bacterial ribosomes - interfere with DNA replication or RNA transcription - inhibit metabolic pathways
70
Pharmacokinetic description for antibiotics
71
Best pharmodynamic parameters for beta-lactam drugs
Time > MIC
72
Drug of choice for susceptible enterococcus and Listeria
Aminopenicillins
73
What bacteria does pipercillin/ tazobactam (zosyn) cover, and what type of antibiotic is it?
Beta-lacatam (penicillin + beta-lactamase inhibitor) Used as empiric in combination with vanco Covers Gram + and pseudomonas
74
Cephalexin Cefazolin
1st gen cephalosporin
75
Cefotelan Cefoxitin Cefuroxime
2nd gen cephalosporin
76
Ceftriaxone Cefotaxime Cefdinar Ceftazidime
3rd gen cephalosporin (increasing gram - activity)
77
cefepime
4th gen cephalosporin (still covers some gram + (strep) and good coverage for gram -, pseudo,
78
Ceftraoline
5th gen cephalosporin MRSA and Pseudomonas
79
Best pharmadynamic for fluoroquinolones
AUC: MIC
80
Best pharmadynamic for aminoglycosides
Cmax/ MIC
81
Carbepenems effective against
gram -
82
Fluoroquinolone examples
Ciprofloxacin Levofloxacin
83
What is are fluoroquinolones used for?
gram negative
84
mechanism of fluoroquinolones
Inhibit bacterial enzymes
85
Describe tetracyclines
Static Inhibit protein synthesis at the ribosome
86
Describe aminoglycosides
Inhibit protein synthesis cidal Combo drug for serious gram - MDROs
87
Examples of aminoglycocides
Amikacin Gentamicin
88
Describe macrolides
Static Inhibit protein synthesis less serious infections
89
Examples of macrolides
Ezithromycin Azithromycin Clarithromycin
90
How does TMP-SMX (bactrim) work? What group does it belong to? What is it effective against?
interfere with bacterial folic acid synthesis sulfanimide UTI/ oral option MRSA/ Nocardia
91
Examples tetracyclines
tetracycline monocycline Doxycycline
92
Describe glycopeptides
Vancomycin concentration dependent (AUC) MRSA coverage, Staph, Strep, Enterococci Acts at site of cell wall
93
Describe use of Linezolid uses
Gram + Static- oral MRSA but not BSI Activity against vancomycin resistant bugs
94
Describe daptomycin uses
Gram + cocci (but not strep) cidal vancomycin resistant bugs Acts at cell membrane
95
Clindamycin uses
Think above the belt Mostly gram + static
96
Metronidazole uses
Think below the belt Anaerobes, mostly gram negative
97
What is rifampin used for?
N. meningitidis TB
98
What does successful antimicrobial therapy depend on?
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
99
What are oral options for MRSA?
Clindamycin, Doxycycline, TMP-SMX, and Linezolid
100
Bacterial resistance mechanisms
Efflux pumps Enzyme Alteration of target site: Decrease porins structure mutation Decrease uptake
101
presumptive dx of TB in CSF
Lymphocytic pleocytosis (increase in lymphocytes) hypoglycorrhacia (low glucose in CSF)
102
Toxicity of TB treatment
Occular and liver
103
Treatment for active TB
Months 1-2- Isoniazid (INH), rifampin (RIF), pyrazinamide (PZA) , and ethambutol (EMB) Months 3-6 (up to 12 mos)- INH and RIF
104
How often should sputum samples be taken for active TB patients?
monthly
105
Latent TB therapy
9 months- INH 4 months- RIF and monitor for active TB
106
When is someone contagious with influenza?
24 hours before, 3-5 days after but up to 7 days
107
Who should get antivirals for influenza?
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
108
Parts of virus identification
Virus Type/ Place/ Strain #/ Year/ Virus Subtype A/ Sydney/ 05/ 97 (H3N2)
109
Pandemic influenza Phase: Education- flu symptoms/ isolation Vaccine Facility plans for surge Exp management plans Just-in-time training plans Comm plans
Phase 1-3 No human to human transmission
110
Phase? Est # HCP needed Start to increase isolation capacity Review exposure management plan Plan to sustain operation Visitor screening plan Staffing guidance for cases
Phase 4 Limited human- human transmission
111
Phase? Enhanced screening and surveillance Just-in time training Schedule staff communications Incident command
Phase 5 Sustained human to human transmission
112
Phase? Implement surge strategy, staffing, supplies, and space Cancel elective procedures Implement employee exposure management plan
Phase 6 Efficient and widespread human - human transmission
113
Influenza iPC Plan
- early ID and isolation of patients - annual education - Vaccine to patients and HCP - restrict ill patients and HCP
114
How long should flu pt be in isolation?
Private room, 7 days after onset and fever free for 24 hours
115
PEP for flu
High risk setting OB- antivirals for 2 weeks
116
Incubation for Hep A
28 days (15-50 days)
117
How long does the prodromal phase of Hep A last in symptomatic patients? and the iciteric phase?
Prodromal (ILI, nausea, vomit)- 1-2 weeks Iciteric Phase (jaundice, dark urine, pale stool, itch): up to 6 months
118
Window period for Hep A IgM test
5-10 days, within 3 weeks of exposure
119
Incubation for Hep B
90 days (60-150 days)
120
Describe when each of the Hep tests will become positive: HBsAg HBeAg anti-HBC anti-HBS HBV-DNA
HBsAg- 30 days HBeAg- 30 days anti-HBC- symptom onset anti-HBS- after recovery HBV-DNA- 30 days
121
Hep C incubation
2-12 weeks (15-160 days)
122
Window period for anti-HCV and HCV RNA
Anti-HCV- 8-11 weeks HCV RNA- 1-2 weeks after exposure
123
Testing for exposure to Hep C
Test ASAP and again 3-6 weeks after , RNA can detect earlier than anti-HCV
124
4th leading cause of community acquired pneumo
Legionella pneumophila
125
What increases the risk for aspiration of Legionella?
Intubation Gen anesthesia Nasogastric tube
126
Describe testing for legionella
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
127
Symptoms Legionnaire's DIsease
Infiltrate in lungs nonpurlent cough pleural chest pain Fever of 104 confusion* hypoatremia (low sodium)
128
Incubation and recovery time pontiac fever
24-48 hours 2-5 days, self-limited
129
Treatment for legionella
quinolones and macrolides
130
Steps water safety plan
Describe H2O system Assess risks Control Risks Audit
131
What are C. Diff toxins?
Toxin A Toxin B Binary toxin
132
Surge capacity: how many weeks should you have adequate resources available for?
6-8 weeks
133
Category: Brucellosis
B
134
Category: epsilon toxin Clostrium perfringens
B
135
Category: Food safety threats
B
136
Category: Glanders (burkholderia mallei
B
137
Category: Nipah virus
C
138
Category: Melloidosis (burkholderia pseudomallei)
B
139
Category: hantavirus
C
140
Category: Influenza
C
141
Category: Anthrax
A
142
Category: Smallpox
A
143
Category: Psittacosis (chlamydia pssitaci)
B
144
Category: Q Fever
B
145
Category: Ricin
B
146
Category: SARS
C
147
Category: Botulism
A
148
Category: Rabies
C
149
Category: Q fever (Coxiella Burnetti)
B
150
Category: Staphylococcol entertoxin B
B
151
Category: typhus fever (Rickettsia prowazecki)
B
152
Category: MDR-TB
C
153
Category: Plague
A
154
Category: Tularemia (Francisella tularensis)
A
155
Category: Yellow Fever
C
156
Category: Viral encephalitis
B
157
Category: Tickborne hemorrhagic
C
158
Category: Viral hemorrhagic fevers
A
159
Category: water safety threats
B
160
Precautions for fever >101.1F and cough in children
Droplet and contact
161
Precautions for vomitting
Standard
162
Precautions for watery or explosive stools, with or without blood
Contact
163
Precautions fever and rash
airborne
164
Precautions fever, upper chest rash, and stiff/ sore neck
Droplet
165
precautions eye infections
Standard
166
Precautions itchy rash without fever
Contact
167
Precautions petechial/ erythyromotic rash with fever
Droplet for 24 hours of antimicrobial therapy
168
Precautions: rash, positive history of travel to area with current outbreak of VHF in 10 days before onset
Droplet, contact, eye protection. Add N95 for aerosol generating procedures
169
Precautions macoulopapular rash with cough, coryza, fever
Airborne
170
Precautions vesicular rash in centrifugal pattern
Airborne and contact
171
What category of agents can be transmitted during autopsy? Which diseases is it unsafe to handle the dead bodies?
A Choloera VHF smallpox
172
What are the two types of viral hemorrhagic fevers?
Filoviruses Arenaviruses
173
Describe cutaneous anthrax
Incubation 1-12 days Bulla develops and turns into necrosis Standard and contact if copious drainage
174
Describe respiratory antrhax
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
175
Describe botulism
Ingest/ inhale toxin Incubation 1-5 days Descending paralysis, resp failure Standard precautions
176
Describe ebola
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)
177
Describe plague
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
178
Describe tularemia
Inhalation or ingestion Incubation: 3-5 days Symptoms: Pneumatic or typhoidal Precautions: Standard High risk: lab workers
179
Describe smallpox
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
180
IP for smallpox vax
cover vax site with guaze and semi-permeable dressing until scab separates (approx 21 days) Adverse event: - standard and contact until lesions crusted
181
Enteric: onset 8-16 hours, lasts 24-48 hours, from meats, stews, gravies, vanilla sauce, vegetables, and milk products
Bacillus cereus
182
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
Campylobacter
183
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
Clostridium perfrigens toxin
184
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
EHEC
185
Enteric: Incubation 1-3 days, lasts 3-7 days Symptoms: Watery diarrhea, abdominal cramps, some vomit Source: Contaminated water or food
ETEC
186
Enteric: Deadly for infants within a few days old
Cronobacter sakazakii
187
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
Listeria monocytogenes
188
Complications of Listeria monocytogenes
Pregnant women- premature delivery and stillbirth Elderly/ immunocompromised- bacteremia or meningitis
189
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
Salmonella spp
190
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
Shigella
191
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
S. aureus (entertoxin)
192
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
Vibrio vulnificus
193
Complications of vibrio vulnificus
Immunocompromised or chronic liver disease: can be fatal
194
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
Yersinia enterocolitica
195
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
Hep A
196
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
Norovirus
197
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
Rotavirus
198
Prevention for rotavirus
Vaccine
199
Enteric: Incubation: 3-4 days, sheds up to 35 days Symptoms: watery diarrhea Source: Shellfish, water, fomites
Astrovirus
200
Enteric: Incubation: 8-10 days, last 2 weeks Risk: Children under 4 Symptoms: Protracted diarrhea, or asymptomatic Source: fecal/oral, droplet, transplants, p2P
Enteric adenovirus
201
Precautions for adenoviruses
Contact and droplet
202
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
Cryptosporidium
203
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
Cyclospora
204
Enteric: Incubation period 1-2 weeks Symptoms: malodorous diarrhea, malaise, flatulence, weight loss Source: contaminated food or water, person to person
Giardia lamblia
205
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
Entamoeba histolytica
206
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
Toxoplasmosis
207
Enterobacteriaceae- lactose fermenters
E. coli Citrobacter Klebsiella Enterobacter
208
Enterobacteriaceae- non-lactose fermenter
Salmonella Shigella Proteus Pseudomonas
209
This virulence factor in gram-negative bacteria activates macrophages, white blood cells, releases cytotoxin, and causes septic shock, necrosis, DIC, and death
Lipid A endotoxin
210
This virulence factor provides resistance to antibodies, production of toxins, hemolysins, chromosomal or plasmid mediated
Pathogenic Islands
211
Virulence factor that helps Enterobacteriaceae evade immune mechanisms and phagocytosis
K antigens (capsule)
212
Virulence factor that helps Enterobacteriaceae with motility and adherence to GI and urinary epithelial cells
H antigens (Flagellar)
213
What antibiotics are carbapenemase producing klebsiella pneunominae resistant to?
Cephalosporins monobactams carbapenems
214
Enterobacteriaceae in the top 10 CLABSIs
Klebsiella Enterobacter E. Coli
215
Top Enterobacteriaceae for VAP
Klebsiella
216
Top Enterobacteriaceae for HAP
Enterobacter Klebsiella E. Coli
217
Top Enterobacteriaceae for HAI CAUTI
1) E. Coli 2) Klebsiella 3) Proteus 4) Enterobacter 5) Serratia
218
What HAIs does E. Coli typically cause?
CAUTI CLABSI VAP SSI
219
What HAIs does Enterobacter cause?
Lower resp infections UTI wounds infections Septecemias
220
Concern for Enterobacteriaceae
Multi-drug resistance, so treatment usually carbepenem
221
Motile fermenters Enterobacteriaceae
E. coli Enterobacter Serratia
222
Non-motile fermenter Enterobacteriaceae
Klebsiella
223
Motile non-lactose fermenters Enterobacteriaceae
Salmonella Proteus
224
Non-motile, non lactose fermenting Enterobacteriaceae
Shigella Yersinia
225
3 As of Klebsiella
Alcoholics, abscesses, aspiration
226
Carbepenemase producing genes
KPC NDM IMP NDM OXA-48
227
What antibiotic still typically works for CRE?
Fluoroquinolones
228
Most common flu strains in the last 30 years
H3N2 H1N1
229
TPN contamination
Fungi: C. albicans *most freq*, malassazia furfur Gram + bacteria: Coagulase - staph Gram - bacteria: E. coli, pseudomonas
230
Most common ESBL
Klebsiella and E. Coli
231
What antibiotics are ESBL resistant to?
third generation cephalosporins monobactams
232
Common commensals that contaminate blood cultures
Corynebacterium Bacillus Propionibacterium Coagulase-negative staph Viridans group strep Aerococcus spp. Micrococcus spp.
233
Definition CLABSI (commensal)
2 positive cultures of common commensals from 2+ sets of blood cultures drawn <2 days apart AND patient has symptoms (fever, chills, hypotension)
234
Components of effective antimicrobial stewardship programs
1) leadership and culture 2) timely and appropriate antibiotic initiation 3) appropriate admin and deescalation 4) Data monitoring and reporting
235
Strategies for antimicrobial stewardship:
- Pharmacy restriction of meds - audit and feedback - antibiotic timeouts - automatic stop orders - documented indication - dose optimization - De-escalation (IV- oral)
236
Cultures that are NOT suitable for anaerobic culture and why
Why: contamination with resident anaerobic flora Sputum rectal swab nasal/ throat Urethral swab Voided urine
237
Percentage of population exposed to coccidiodies in endemic regions
50%
238
Scabies incubation
4-6 weeks
239
RSV precautions
Contact + standard for duration of illness (mask when appropriate under standard precautions)
240
Most common cause of epidemic GI illness worldwide
Noro
241
Five major control factors for foodborne pathogens
1) person hygiene 2) adequate cooking 3) avoid cross-contamination 4) Keep food at safe temp 6) avoid foods from unsafe sources
242
Test for WNV
positive IgM- goes to public health lab
243
Precautions rabies
Contact precautions and eyewear and mask or face shield to protect mucous membranes
244
Shape of Borrelia burgdorferi
Spirochete
245
Primary causative agent transient aplastic crisis
Parvovirus B19
246
Treatment for parvovirus B19 in immunocompromised
immunoglobulin therapy
247
Precautions parvovirus B19
Droplet precautions
248
Resistance of Parvovirus B19
resistant to detergents, solvents, and heat. Stays in the environment for a long time
249
Symptoms parvovirus B19
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
250
Incubation for parvovirus
4-14 days Rash appears 2-3 weeks after infection
251
How parvovirus B19 transmitted
Droplet/ fomite, blood transfusion, vertical transmission
252
Complications parvovirus B19
spontaneous abortion in first 20 weeks of pregnancy Transient aplastic crisis
253
Symptoms parvovirus in fetus
first trimester infection: anencephaly, spontaneous abortion Second trimester: fetal hydrops and severe anemia
254
How long to isolate parvovirus B19 patient in transient aplastic crisis
7 days after admission, droplet or hospital stay if immunosuppressed
255
Surface proteins RSV
F (fusion) G (attachment) SH (small hydrophobic)
256
Infection control RSV
- HH - cough etiquette - cleaning/disinfection - droplet and contact precautions
257
Most common cause of hospitalization for respiratory disease in chlidren
RSV
258
Incubation RSV, and when contagious
2-8 days symptom onset until 3-8 days later
259
Treatment RSV
Palivizumab for high risk
260
Commensal fungi in GI tract and female genital tract
Candida albicans
261
Risk factors for fungal infections
Broad spectrum antibiotics CVC Immunosuppression Neutropenia Urinary catheter Prothesis TPN
262
When should you suspect candidemia?
High-risk patients with unexplained fever (esp if on broad spectrum antibiotics) or unexplained CNS signs and symptoms
263
Max hang time for lipid containing infusions
12 hours
264
Clinical presentation of aspergillus
cavitation/ fungal balls in the lungs/ fever/ hemoptysis
265
Most common viruses to cause meningitis
HSV, enteroviruses, arboviruses, mumps
266
Where does meningitis typically stem from?
organisms that colonize the nasophyrnyx
267
Precautions bacterial meningitis
H. influenzae and n. meningitidis- droplet 24 hours after appropriate microbial therapy
268
Precautions for aseptic meningitis
typically standard
269
Testing for CJD
- 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
270
Highly infectious tissue CJD
Brain Dura matter Pituitary tissue Spinal cord Eye *not CSF listed as low infectivity
271
Iatrogenic transmission of CJD
- 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
272
4 chemicals that work on CJD
Chlorine Phenol Guanidine thiocyante Sodium hydroxide
273
Parameters of pre-sterilization (before normal sterilization process from cleaning- sterilization) for CJD
prevac sterilizer- 134F- 18 min Gravity displacement sterilizer- 132F- 1 hour NaOh- 1 hour
274
How to clean contaminated surfaces with CJD
1:10 dilution sodium hypochlorite for 15 inutes
275
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
alpha-hemolysis
276
Complete lysis of red blood cells leading to a clear (transparent) zone surrounding the colony on a blood agar plate.
beta-hemolysis
277
Exotoxin produced by certain bacteria that have the ability to trigger excessive inflammatory immune response
Superantigen- examples: Strep pyogenes, S. dysgalactiae, S. equi
278
Group Strep A clinical
Pharyngitis Scarlet fever Erysipelas Impetigo Cellulitis Necrotizing fascitis Streptococcal toxic shock syndrome
279
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
GAS, different from other beta-hemolytic strep because it's susceptible to bacitracin
280
Gene to type for GAS
emm gene (codes for virulence factor)
281
If a patient has a sore throat, white spots, but a negative rapid antigen detection test for GAS, does that rule out strep?
No, test has 80-90% specificity so should culture
282
Precautions- Major GAS skin, wound, or burn infection that is draining
droplet, contact, and standard until 24 hours after initiation of effective therapy
283
Precautions GAS pharyngitis
Droplet until 24 hours after effective therapy
284
Precautions Scarlet fever
droplet for 24 hours after initiation of effective therapy
285
Precautions for strep pyogenes(GAS)
Droplet for 24 hours after initiation of effective therapy
286
Precautions group b strep neonatal disease
Standard
287
Precautions Strep pneumo, drug resistant
Standard, contact
288
Precautions non-drug resistant strep pneumo
standard
289
Risk factors for group b strep to infant born to colonized mother
- preterm delivery - prolonged membrane repture during labor - maternal fever during labor - maternal history of prior infant with GBS sepsis
290
Most common cause of adult bacterial meningitis in the U.S.
Strep pneumo
291
Culture: gram +, α-hemolysis with partial lysis of red blood cells leaving a zone of greenish discoloration
Viridans group strep
292
Types of strep
GAS, GBS, viridans group strep, group C strep (animals), Group D strep (colon cancer, GI)
293
What are the common staph HAIs?
Bacteremia Endocarditis Pneumonia Osteomylitis SSI Skin and soft tissue infections Device associated infections
294
Risk factors for HA- MRSA
- LOS in hospital - chronic wounds - catheters - antibiotics
295
MRSA resistance
Beta-lactams macrolides clindamycin tetracycline quinolones aminoglycoside
296
Most common organism to infect CSF shunts
Staph epidermidis
297
How to dx scabies
prep skin with India ink to see burrows, microscopic examination of mites, or PCR
298
Treatment for scabies
Topical scabicide
299
Incubation scabies
4-6 weeks, as little as 10 days
300
Precautions scabies
Contact until 24 hours after treatment, may be longer for crusted scabies
301
PEP for scabies
Treatment for household members and intimate contacts
302
Outbreak response: scabies
Treat entire population at risk over the same 24-48 hour period, whether or not symptoms present and wash all clothing on hot cycle
303
Temp to kill scabies
Hot water wash at 122F for at least 10 minutes, and 10 minute dry OR put linens in bag for 10 days
304
Survival of lice and lice eggs outside of host
2 days for head lice 30 days for eggs
305
Kill lice on personal items
140F for 5-10 min Seal in bag 10-14 days Freeze in bag for 12-24 hours
306
Human infestation of fly larvae
Myiasis
307
Kill bed bugs on personal items
Hot water wash at 120F for 10-20 minutes or freeze items Heat items in room to 118 for 1 hour
308
Serogroups N. meningitidis
A, B, C, X, Y, W-135
309
Ages impacted by N. meningitidis
<5 years, 21 years, 65+
310
5 clinical manifestations of N. meningitidis
1) Bacteremia 2) Meningocomcemia without meningitis 3) Menigitis with or withouth meningococemia (70%) 4) Meningococcal encephalitis 5) Meningococcal pneumonia
311
What rash is commonly associated with N. meningitidis?
Petechial or purpuric rash
312
What condition related to a rash can lead to death from a N. meningitidis patient?
Purpura fulminans
313
What is a risk factor for meningococcal pneumonia?
Recent infection with virus
314
Antibiotics for N. meningitis
penicillin G and cephalosporins
315
When is vaccine for N. meningitiidis recommended?
Routine: - all children 11 or 12 -Booster at 16-18 Campaign: -3 cases from same serogroup in community <3 months
316
PEP for N. meningitidis
24 hours- 14 days after exposure Rifampin Ciprofloxacin Ceftriaxone
317
Most common cause of encephalitis
Enterovirus (Coxsackievirus)
318
Period of communicability for N. meningitidis
7 days before onset to 24 hours after antimicrobial therapy
319
Incubation/ TBP/ HCP restriction/ PEP: conjunctivitis
Incubation: 24-72 hours TBP: viral- contact and standard bacterial- standard Restriction: Pt contact and pt env until discharge ceases
320
Incubation/ TBP/ HCP restriction/ PEP: acute diarrheal illness
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
321
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Diphtheria
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
322
Incubation/ Symptom/ TBP/ HCP restriction/ PEP: Enterovirus (Coxsackie/ echovirus)
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
323
Common name for coxsackie virus (which is an enterovirus)
Hand, foot, and mouth
324
Incubation/ TBP/ HCP restriction/ PEP Hep 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
325
Incubation/ TBP/ HCP restriction/ PEP Hep B
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
326
Incubation/ TBP/ HCP restriction/ PEP Herpes
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
327
Incubation/ TBP/ HCP restriction/ PEP HIV
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
328
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Measles
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
329
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: meningococcal disease
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
330
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: mumps
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
331
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Pediculosis
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)
332
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Pertussis
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
333
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Rubella
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
334
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Staph aureus
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
335
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: GAS
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
336
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Active TB
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
337
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Varicella zoster
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
338
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Herpes zoster
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)
339
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Ebola
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
340
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Scabies
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
341
Contagious period for measles
1-2 days before until 4 days after rash
342
3 cs of measles prodromal phase
Cough, coryza, conjunctivitis
343
Word to describe measles rash
Morbiliform
344
Complications of measles
- otitis media - bronchopneumonia - bronchitis - splenomegaly - encephalitis - death
345
Condition that may occur years after measles infection in the very young
Subacute sclerosing panencephalitis (SSPE)
346
transport of measles test specimen
ASAP- measles liable 4 degrees C (freezing causes loss of virus) sample early in acute phase
347
What vitamin deficiency is related to measles?
Vitamin A
348
Vaccine info for MMR
Live attenuated Give at 12 months and before school (4-6 years)
349
Who should not receive the MMR vaccine?
Pregnant Severely immunocompromised Recent recipients of immunoglobulin or blood products
350
If another patient was exposed to a measles case and is susceptible, what is recommended for the exposed pt?
- AIIR for 5-21 days after exposure - Vax within 72 hours
351
Contagious period mumps
1-2 days before until 5 (formerly 9) days after parotitis
352
% of mumps patients that are asymptomatic
30-40%
353
When is the highest risk for congenital rubella?
early pregnancy in first 12 weeks
354
Symptoms congenital rubella
- retarded growth - mental retardation - congenital heart disease - deafness - ocular abnormalities - anemia - hepatosplenomegaly - increased miscarriages - increase stillbirths
355
Rubella symptoms adult
25-50% asymptomatic otherwise prodrome with ILI and then maculopapular rash, arthritis, and arthralgia (in women) for 3-5 days
356
Contagious window for rubella
7 days before rash until 7-14 days after rash
357
Testing: rubella
Send to CDC for confirmation Usually use serology (IgM or paired IgG) since viral iso difficult
358
Typical age range for mumps cases
5-19 years old
359
Primary virulence factor for pertussis
Pertussis toxin
360
How does pertussis toxin work?
PT prevents migration of lymphocytes to areas of infection and adversely affects phagocytosis and glucose metabolism, causing compensated insulinemia
361
Complications of pertussis:
pneumonia seizures encephalopathy death
362
Describe the vaccine for pertussis
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
363
Recommendations if multiple patients exposed to pertussis?
PEP and cohort
364
additional measures for more extensive respiratory outbreaks/ community spread
Universal masking limit visitation exclude sick children from daycare
365
Herpes viruses
HH1 (HSV-1) HH2 (HSV-2) HH3 (VZV) HH4 (EBV) HH5 (CMV) HH6 (HHV-6) HH7 (HHV-7) HH8 (KSHV)
366
HHV that causes: B cell lymphoma Hodgkin lymphoma NP carcinoma Hairy leukopenia
EBV
367
Common name for HHV-6 and HHBV-7
Roseola
368
HHV that can cause: Primary effusion lymphoma Multicentric Castleman disease
HHV-8 Kaposi Sarcoma
369
HHV that causes gingivostomatitis
HSV-1
370
What differentiates chickenpox and measles:
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
371
Symptoms congenital CMV
- petechiae (blueberry muffin rash) - jaundice - hepatosplenomegaly - microcephaly - hearing loss - eye abnormalities - developmental delays
372
Type of virus herpes
DNA
373
Life threatening herpes virus for patients with severe skin conditions like burns
Eczema herpeticum
374
Biggest complications risk for Varicella
Secondary bacterial infection
375
Healthcare populations of concern for herpes viruses
Immunocompromised Solid Organ transplants Hematopoietic stem cell transplants
376
Most common disease to cause birth defects in the United States
CMV
377
Illness that causes gray baby syndrome (Pallor, hypotension, and resp destress) in preterm babies infected after transfusion
CMV
378
Clinical outcomes of AIDS and transplant recipients that get CMV
Interstitial pneumonia Cytomegalo-retinitis Cytomegalo-enteritis (GI issues)
379
What is the mortality rate of post-transplant lymhoproliferative disease from EBV?
50%
380
95% of children are infected with this disease by age 3
HH6 (roseola)
381
Concerns for HHV6 in transplant recepients
- HSCT can reactivate Allogenic transplants- can cause graft rejection
382
Screening recommendations for HIV
once age 13-64 more frequently (every 6 months- 1 year for higher risk behavior)
383
Most common opportunisitic infections HIV
Pneumocysitis jiroveci TB Disseminated mycobacterium avium Disseminated mycobacterium kansasaii
384
CDC core strategies for HIV
1) Dx 2) Prevent 3) Treat 4) Respond
385
Tests for HIV and description:
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)
386
Work restrictions for hcp with RSV
HCP with acute resp symptoms should NOT provide care to high-risk patients
387
When to provide education about MDROs
At hire and routinely as changes occur
388
Elements of an occupational health program
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
389
Elements of a the respiratory protection program:
- 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
390
Elements of exposure control plan and how often to review
Annually 1) protective measures provided by employer 2) engineering/ work practice controls 3) PPE 4) HBV vax within 10 days of hire 5) Training
391
Ways to measure needlestick injuries
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
392
General HIV PEP
Most exposures warrant 2 drug regimen with: 2 nuceloside reverse transcriptase inhibitors (NRTIs) or 1 NRTI and 1 nucleotide reverse transcriptase inhibitor
393
What are the components of a successful occupational health
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
394
What's the recommendation for MMR if born before 1957?
If no immunity per lab evidence for rubella, get 1 dose of MMR
395
If exposure to varicella occurs after vaccination series is started, does HCP need to be exluded?
No, but they should be monitored for symptoms daily days 10-21 (or 28 if they get VZIG)
396
When should meningitis PEP be started?
within 24 hours of exposure, no more than 2 weeks
397
What antibiotics for meningitis PEP are contraindicated for pregnant women?
Rifampin Cipro They can take ceftriaxone
398
unique symptom of Hep B
Scleral icturus
399
When to test for HCV after exposure
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
400
When to test for HIV after exposure
Baseline, follow up testing for 6 months
401
Timeline to start HIV PEP
72 hours
402
Higher risk HIV exposures
Patient symptomatic, has AIDS or high viral load Exposure from large hollow needle, deep puncture, needle used in patient artery or vein
403
When would you use an expanded 3-drug PEP for HIV?
PT HIV class 2 for less severe or more severe exposure OR PT HIV class 1, but there is a more severe exposure
404
What PEP is most often recommended for mucous membrane exposures to HIV?
2-drug unless patient HIV class II and large volume of blood into mucous membrane
405
How to make IVs and central lines safer for HCP
Replace IV, aerterial, and central line tubes with needless or blunt canula devices
406
What can be done to make scalpels safer
round tipped scalpel blades alternative material blades (silicone) retractable, disposable blades
407
Hierarchy of controls
Most effective to lease effective: Elimination substitution engineering administrative controls PPE
408
What vaccine contain egg?
MMR and influenza
409
What vaccines contain thimerosal?
DTAP, DT, Td Influenza Meningococcal
410
Who should avoid live vaccine?
- Pregnant or planning to become pregnant in 28 days - Symptomatic HIV - Treatment induced immunosuppression - Malignancy - Receipt of antibody production within window of vax
411
Immunoglobulin available for these diseases
Hepatitis A Hepatitis B Chickenpox Tetanus Measles Rubella Rabies
412
Who is considered at risk and should get the Hep B vaccine?
- 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
413
What age group should not get LAIV?
>49 years (higher risk for severe complications from flu)
414
How many doses of MMR and how far apart?
2 doses, 28 days apart, after 1st bday
415
Can you give MMR vaccine and the TST test at the same time?
Yes, same day as vaccine or wait 4 weeks for TST
416
Can you give live vaccines at the same time?
Yes, but you should give them the same day OR wait until 28 days between live vaccine if not the same day
417
Can patients with HIV get the MMR vaccine?
Yes if asymptomatic and CD4 >15%
418
What is a potential side effect of rubella vaccine in adults
increased risk of arthritis and arthralgias
419
If getting an elective splenectomy, when should you get the pneumococcal vaccine?
2 weeks before
420
GBS linked to what vaccines?
Flu (1970s) Tdap? COVID
421
Is there an indication for Tdap as part of an outbreak response?
No
422
What type of vaccine is vaccinia?
Live vaccine- smallpox
423
Who should be vaccinated for smallpox in a routine non-emergency? How often?
- 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)
424
How long should you wait to do a TST after smallpox vaccine
1 month
425
What is a concern for vaccinia vacine?
Live vaccine can cause the virus to be transmitted to close contacts
426
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
Vaccinia vaccine
427
What are the side effects of the vaccinia vaccine? Note, most people will have at least 1 adverse event
Rash Inadvertent ocular inoculation myocarditis
428
This live vaccine can cause a rash in immunocompromised and potentially transmit disease to others
Varicella
429
Proof of immunity: varicella
1) written 2-dose vax record 2) lab evidence 3) physician verified dx
430
Indications for meningococcal vaccine
- asplenia - travel to countries with endemic meningococcal disease - lab employees with exposure
431
Goals of the HCP vax program
1) achieve high rates of immunization 2) Devise and implement specific vaccine strategies 3) provide education about vaccine 4) Justify the cost
432
Can Hep B vaccine be frozen?
No
433
Do HCP born before 1957 have to provide lab evidence of disease?
Yes- all HCP must have documented immunity against measles
434
Is there a booster for polio?
Yes, booster recommended for high-risk
435
What vaccines should be frozen?
Vaccinia Powdered varicella vaccine
436
Recommended vaccines for healthcare workers
Hep B Influenza MMR Tdap
437
Type of temperature monitoring device recommended by CDC
Digital Data Logger
438
Way to measure temperature in vaccine fridge
Buffered temp probe with buffer (glycol, glass beads, sand, teflon)
439
difference between expiration date and beyond use dates on vaccines
Expiration - final day that vaccine can be used Beyond use- last date or time that vaccine can be safely used after it was moved
440
When to discard multi-dose vials
after max number of doses drawn, exp date, or 28 days after first puncture, whichever comes first
441
What is the maximum number of transport + clinic hours for a vaccine?
8 hours
442
Vaccine storage requirements
- original packaging, , labeled separate containers - middle shelf away from walls/ ceiling/ floor/ door - temp stable area - store with diluent - leave room for circulation
442
What should be used to keep vaccines cold during transport?
Phase change materials
443
What diseases are standard precautions the only preventative measure?
CMV (Std) HCV (std) Parvovirus B19 (droplet) TB (airborne)
444
What vaccines are contraindicated for pregnant women?
HPV Live flu (LAIV) MMR Varicella Zoster
445
What vaccines are recommended during pregnancy?
inactivated flu Hep A if indicated Hep B sometimes Tdap
446
What is the concern if a pregnant woman cares for an immunocompromised patient with chronic anemia?
Parvovirus B19
447
What diseases can pregnant women take PEP chemoprophylaxis for?
N. meningitidis Syphillis HIV
448
What birth defects can varicella cause?
- malformations (skin, limb, CNS, eye)
449
Requirements for volunteers, contract workers, etc..
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
450
What education should be offered to nonemployee HCP
- 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
451
Actions taken to decrease the potential impact of a sitution
mitigation
452
measures taken before an event that help prepare an individual, facility, or community to respond to the emergency
preparedness
453
Intervention undertaken in response to a known or suspected event
Response
454
Intervention implemented after the emergency has been declared over
Recovery
455
Water needed for emergency management
25 gal a day for pt care
456
Control to reduce the likelihood of an exposure by altering the manner in which the task is accomplished
administrative and work practice controls Example- training HCP on safer technique to recap needle
457
Clinical symptom primary TB
Erythema nodosum Fever Cough Gohn complex
458
Parts of the TB control plan
1) risk assessment 2) Administrative controls (methods to ID pts and get to AII) 3) Environmental Controls 4) Respiratory protection
459
Leading cause of NTM in the U.S.
Mycobacterium avium complex
460
Bacteria that cause pneumonia most often in older adults (65+)
Strep pneumo Klebsiella pneumo Pseudomanas Legionella
461
How long should chemoprophylaxis continue during a flu outbreak?
at least 14 days, 7 days after the last case
462
What vaccines are recommended for older adults (as routine vax)
Flu (high antigen) COVID TDAP (if never had one before) and TD every 10 years Pneumo Zoster
463
Most common HAI in neonates
BSIs Pneumonia
464
Standard Precaution Components
- Hand hygiene - Appropriate use of PPE - Respiratory hygiene/ cough etiquette - Proper placement of patients - Safe injection practices - Disinfection and sterilization of reusable medical equipment
465
5 moments of hand hygiene
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
466
Are ambulatory centers required to use precautions for MDROs?
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
467
How much space should there be around furniture/ procedure tables in ambulatory centers?
3 feet
468
Recognize antigens, differentiate into plasma cells that secrete antibodies (immunoglobulins), which inactivate microorganisms alone or in combination with complement phagocytes
B-lymphocyte
469
Help or suppress cell function, may also be cytotoxic, killing target cells that express foreign antigens
T-lymphocytes
470
Immune cells that help fight bacteria and fungi, migrate toward site of infection (chemotaxis), ingest and kill microbes
phagocytes (including neutrophils, eosinophils, basophils, monocytes, and macrophages)
471
What is are the precautions for a TB autopsy?
N95
472
What patients are at increased risk for fungal infections?
- 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
473
Do antimicrobials in multidose vials protect against: Bacteria Viruses
Bacteria- yes Viruses- no
474
What do you look for during an antibiotic time out? When should the timeout occur?
- Correct dose - Duration of therapy - Indication for treatment 24-48 hours after culture results
475
How far must sterile items be stored from the ceiling or sprinklers?
18 inches
476
How far must sterile items be stored from the floor?
8-10 inches
477
What type of pressure is needed in a sterile storage room
positive
478
How many ACH for sterile storage rooms?
at least 4, but 10 preferred
479
Temperature of sterile storage room
65-72F
480
What infections require mothers to withhold breastmilk?
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)
481
Humidity sterile storage
35-75%
482
ACH/ pressure for decontamination/ contaminated storage area
Negative, 10 ACH
483
Portals of entry for CVCs
- Stopcocks for medicine injection (cap when not in use, closed systems preferred) - Admin IV infusions - Collection of blood samples
484
Which type of alcohol has greater activity against: Bacteria Viruses
Bacteria: isopropyl alcohol Viruses: ethyl alcohol
485
Types of antiseptics
- Alcohol - Chlorohexidine - Chlorine - Hexachlorophene - Iodine - Chloroxylenol (PCMX) - Quat ammonium
486
Indications for hand washing
- visibly soiled - Before eating - Before preparing food - after using the bathroom - exposed to spire-forming organisms
487
Per fire code, what is the minimum width of the corridor with hand sanitizer dispensers, and how far apart must they be?
- 6 feet - 4 feet apart
488
What antiseptic agents have persistent activity against bacteria?
CHG Iodophers
489
Process for surgical hand antisepsis
remove jewelry, clean nails, wash hands and arms
490
How to improve HH?
- administrative support - convenient and acceptable products/ dispensers - monitoring and feedback - role modeling- excellent HH - Motivational/ incentive programs
491
What is required for HH by the TJC?
Education, monitoring, and feedback
492
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
Direct Observation
493
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
Automated monitoring (sensing devices)
494
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
Product volume monitoring
495
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
Direct observation
496
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
Automated Monitoring
497
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
Product volume monitoring
498
Calculations for HH through product volume monitoring
Volume used (specific product) / 1000 pt days
499
Reasons for poor HH adherence
- 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
500
This ruling protects employees from unprotected contact with patient blood, body fluid, secretions, excretions, mucous membranes, and non-intact skin
OSHA Bloodborne Pathogen Standard (1991)
501
What is needed for success of a BBP program
- administrative support - Education - Policies and procedures - Institutional culture
502
When to use gloves under standard precautions
Touching: - mucous membranes - non-intact skin - blood - body fluids - secretions - excretions - contaminated objects
503
Examples of safe work practices
- check PPE before contact (so not re-adjusting) - Position pt so sprays/ splatters --> away from HCP - Barrier for resuscitation
504
What patients should be prioritized if single room is not available?
Pts with poor hygiene/ etiquette or increased risk for severe outcomes
505
Standard precautions
- Hand hygiene - PPE - Resp/ cough etiquette - Safe work practices - Env cleaning - Safe injection practices - Patient placement
506
What HCP should be restricted from working with patients on airborne precautions?
- immunocompromised - pregnant - Susceptible
507
What policies and procedures are needed regarding transmission based precautions?
- Chemoprophylaxis - PEP - Immunization - TB screening for HCP
508
When to use contact precautions
Heavy environmental contamination Diseases transmitted by contact with pt or pt env
509
PPE for contact precautions
Gown and gloves
510
What PPE should env where for cleaning contact precautions rooms.
Gown and gloves
511
What should be used for terminal cleaning of contact precaution rooms
HP or UV light
512
Distance between patients for droplet precautions
6 ft
513
Type of masks required for: TB Smallpox Measles Chickenpox
TB- N95 Smallpox - N95 Measles- N95 or surgical mask (if not immune) Chickenpox- N95 or surgical mask (if not immune)
514
How many ACH for protective env
12 ACH
515
Administrative measures for MDRO control
- 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)
516
Surveillance for MDROs
- monitor microbiology isolates - calculate incidence/ infection rates Use molecular typing for investigating outbreaks - active culture surveillance
517
Planning for active surveillance cultures
- 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
518
Control methods for MDROs
1. Administrative measures/ adherence monitoring 2. MDRO education 3. Judicious use of antimicrobials 4. Surveillance 5. Isolation precautions 6. Environmental measures 7. Decolonization
519
How long MDRO patients are on contact precautions
Duration of hospital stay
520
Antimicrobial agents that may be targeted for MDRO control
- vancomycin - third generation cephalosporins (including for ESBLs) - anti-anaerobic agents VRE - quinolones - carbepenems
521
If single rooms/ cohorting patients with the same MDRO is ot possible, who should room with a patient with an MDRO
pts at low risk of getting the MDRO (lower acuity), have short lengths of stay, and are not associate with adverse outcomes
522
How long after surgery should you use sterile gloves?
24 hours
523
How long after surgery should you use sterile dressings?
24-48 hours
524
When to use clean technique
- wound care - peripheral venous catheters - respiratory suctioning
525
Pressure for OR
positive
526
Type of gloves and type of technique for wound cleaning
Clean gloves, clean technique
527
Type of gloves and type of technique for routine dressing changes without debidement
Clean gloves, clean technique
528
Type of gloves and type of technique for dressing change with mechanical, chemical, or enzymatic debridement
clean gloves, clean technique
529
Type of gloves and type of technique for dressing change with sharp, conservative bedside debridement
sterile gloves, sterile technique
530
Type of gloves and type of technique for central line dressing change
Sterile gloves, sterile technique
531
Type of gloves and type of technique for tracheal suctioning when the tracheal suction is not within a closed sheath
Sterile gloves, clean technique
532
Type of gloves and type of technique for tracheostomy care or suctioning within a closed sheath
Clean gloves, clean technique
533
What are the aspects of aseptic technique
- barriers - patient and equipment preparation - environmental controls - contact guidelines
534
process for keeping away disease producing microorganisms
asepsis
535
Technique to prevent the transfer of any organisms from one person to another or from one body site to another
Surgical asepsis/ sterile technique
536
Technique to practice interventions that reduce the numbers of microorganisms to prevent and reduce transmission risk from one person (or place) to another
Medical asepsis/ clean technique
537
Timeline to follow superficial SSI
30 days
538
Timeline to follow secondary incisional SSI
30 days
539
Surgeries that require 90 day follow up for deep incisional or organ space SSI
- 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
540
Signs/ symptoms deep tissue/ organ space infections
- 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
541
NHSN Superficial SSI definition
- 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
542
NHSN deep incisional SSI definition
- 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
543
NHSN organ/ space SSI definition
- 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.)
544
What information is collected for each operative procedure?
- wound class - ASA score - Trauma - Closure technique - Duration of procedure - General anesthesia? - emergency procedure? - Diabetes mellitus
545
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.
Clean wounds
546
Wounds class of operative incisional wounds that follow nonpenetrating (blunt) trauma
Clean wound
547
Operative wound in which the respiratory, ailmentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination.
Clean contaminated wound
548
Wound class for operations of biliary tract (ie chloecystectomy)
Clean contaminated wound
549
Wound class for operations of the appendix (appendectomy)
Clean contaminated wound
550
Wound class for operations of the vagina (hysterectomy)
Clean contaminated
551
Wound class for operations of the oropharynx (tonsilectomy)
Clean contaminated
552
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.
Contaminated
553
Wound class of open cardiac massage
Contaminated
554
Wound class perforated bowel
Contaminated
555
Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera.
Dirty/ infected
556
Wound class: wound with purulence/ existing clinical infection
Dirty/ infected
557
Wound class: wound with perforated viscera
Dirty/ infected
558
Wound class: open traumatic wounds >4 hours
Dirty/ infected
559
Wound class: wound with devitalized tissue
Dirty/ infected
560
Wound class: wound with penetrating injuries > 4 hours
Dirty/ infected
561
Wound class: Wound with acute, nonpurulent inflammation
Contaminated
562
Wound class: wound with gross (any) spillage from the GI tract (bile)
Contaminated
563
Wound class: wound with infarcted or necrotic bowel (non-perforated)
Contaminated
564
Wound class: open, fresh, accidental wounds
Contaminated
565
Wound class: major break in sterile technique
Contaminated
566
Would class: operation entered the respiratory, GI, or genitourniary tract
Clean/ contaminated
567
Wound from operation that did not enter the resp, GI, or genitourniary tract and shows no sign of infection
Clean
568
ASA score: The patient was previously healthy and fit
1
569
ASA score: current smoker
2
570
ASA score: social alcohol drinker
2
571
ASA score: pregnant
2
572
ASA score: obesity
2
573
ASA score: well-controlled diabetes melitus
2
574
ASA score: well controlled hypertension
2
575
ASA score: mild lung disease
2
576
ASA score: the patient has mild systemic controlled disease
2
577
ASA score: the patient has severe, but not incapacitating systemic disease
3
578
ASA score: patient has substanive functional limitations
3
579
ASA score: patient has one or more moderate to severe disease
3
580
ASA score: poorly controlled diabetes
3
581
ASA score: poorly controlled hypertension
3
582
ASA score: COPD
3
583
ASA score: morbid obesity
3
584
ASA score: active hepatitis
3
585
ASA score: alcohol dependence
3
586
ASA score: implanted pacemaker
3
587
ASA score: moderate reduction of ejection fraction (systolic heart failure)
3
588
ASA score: end-stage renal disease undergoing regular dialysis
3
589
ASA score: myocardial infarction (heart attack) > 3 months ago
3
590
ASA score: CVA (cerebrovascular accident or stroke) > 3 months ago
3
591
ASA score: transient ischemic attack (TIA AKA mini-stroke) > 3 months ago
3
592
ASA score: coronary artery disease (CAD) or stent > 3 months ago
3
593
ASA score: patient has incapacitating systemic disease
4
594
ASA score: recent myocardial infarction (heart attack) in last 3 months
4
595
ASA score: CVA (cerebrovascular accident or stroke) in last 3 months ago
4
596
ASA score: transient ischemic attack (TIA AKA mini-stroke) within 3 months
4
597
ASA score: coronary artery disease (CAD) or stent within 3 months
4
598
ASA score: ongoing cardiac ischemia or severe valve dysfunction
4
599
ASA score: severe reduction of ejection fraction (systolic heart failure)
4
600
ASA score: sepsis
4
601
ASA score: Disseminated intravascular coagulation (DIC) (blood clots)
4
602
ASA score: ARDS (acute respiratory distress syndrome)
4
603
ASA score: end stage renal disease (ESRD)
4
604
ASA score: the patient is moribund and not expected to survive 24 hours
5
605
ASA score: ruptured abdominal/ thoracic aneurysm
5
606
ASA score: massive trauma
5
607
ASA score: intracranial bleed with mass effect
5
608
ASA score: ischemic bowel in the face of significant cardiac pathology (blood flow to bowel completely blocked)
5
609
ASA score: multiple organ/ system dysfunction
5
610
Closure technique: closure of skin during original surgery (any portion of incision by any manner, even if there are drains)
Primary closure
611
Closure technique: closure of wound in way that leaves the skin completely open following surgery (may be packed with guaze)
Non-primary closure
612
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
non-primary closure
613
Closure technique: the abdomen was left completely open after the surgery (open abdomen)
non-primary closure
614
What is the most common HAI - making up 32% of HAIs?
Pneumonia
615
Infection present day of admission (day 1), 2 days before admission, and 1 calendar day after admission
Present on Admission
616
How long must a patient be on mechanical ventilation for VAP?
>2 calendar days
617
Definition PNU-2 (Pneumonia with common bacterial, fungal, or viral pathogens
- Imaging test evidence - AND Clinically defined signs and symptoms - AND specific lab findings
618
Definition PNU-1 (pneumonia based on clinical findings
- imaging test evidence - AND clinically defined signs and symptoms
619
What would show up on test imaging for VAP?
- 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)
620
How many chest images does a patient with underlying disease need to meet NHSN's VAP definition? A healthy patient?
2 for patient with underlying disease 1 for healthy patient
621
NHSN- need at least one of these key symptoms for VAP classification in people > 1 year
1) Fever 2) Leukopenia or leukocytosis (>1 year, 12k) 3) Altered mental status with no other cause
622
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
- 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)
623
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?
pulse oximetry <94% increased O2 requirement
624
NHSN, what are the symptoms for children <=1 year for VAP (need 3)
- 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
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
- Virus - Bordetella pertussis - Legionella pneumophila - Chlamydia pneumoniae - Mycoplasma pneumoniae
626
What tests for legionella pneumonphila fall under the NHSN defintion for VAP
- 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
NHSN: what are the pathogen exclusions for VAP unless they are ID'd from lung tissue or pleural fluid
- Candida species or yeast - Coagulase-negative staph - Enterococcus
628
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
They rarely cause or are not known to cause HAIs
629
Is sputum a minimally contaminated LRT specimen?
NO
630
What are acceptable specimens for pneumo testing?
- bronchoalveolar lavage (BAL) - protected specimen brushing - endotrachael aspirate
631
NHSN: HAI VAP: Where do organisms need to be ID'd from?
Blood/ pleural fluid
632
NHSN: HAI pneumo histopathlogical lab results
- abscess formation or consolidation - lung parenchyma invasion by fungi
633
NHSN: VAP: specimen sources for positive quantitaive culture
- minimally contaminated LRT specimen (BAL, protected specimen brushing, or endotracheal aspirate) - lung culture
634
NHSN: VAP >= _________% BAL-obtained cells contain intracellular bacteria on direct microscope examination
5%
635
How do symptoms of immunocompromised people differ for the definition of NHSN VAP?
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
Is physician DX enough to classify as VAP in NHSN?
No
637
What is the rate equation for VAP in NHSN?
of VAP in location/ # ventilator days in location *1000
638
How long does a central line have to be in to be considered a CLABSI in NHSN?
at least 2 days, so may be a CLABSI on or after the 3rd calendar day
639
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
Central line
640
Is ECMO considered a central line?
No
641
Are peripheral IVs or midlines considered central lines?
No
642
Are ventricular assist devices considered central lines?
No
643
What are the 3 types of central lines?
1. Temporary central line (non-tunneled, non-implanted catheter) 2. Permanent central line (tunneled or implantable catheter) 3. Umbilical catheter
644
What are the common commensals for CLABSIs?
- Diphtheroids - Bacilus spp. - Propionibacterium - Coagulase-negative staph - Virdans group strep - aerococcus - micrococcus - rhodococcus
645
LCBI 1
- 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
Are symptoms required for an LCBI 1?
No (related to pathogens, not common comensals)
647
What are the parameters for an LCBI 2 if common commensals are detected?
- @ 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
What are the different CLABSI symptoms for LCBI (common commensal in neonates and infants)?
- Fever - Hypothermia - apnea - Bradycardia Other are the same as LCBI 2
649
What does LCBI stand for?
Lab-confirmed Bloodstream Infection
650
Generally, what are the rules to be defined as a mucosal barrier injury-lab-confirmed bloodstream infection?
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
SIR
observed HAIs/ predicted HAIs
652
Equation for CLABSI rate
CLABSIs for location/ # central line days for that location *1000
653
Equation for Central line DUR
central line days for location/ pt days for that location
654
Equation for central line SUR
observed central line days/ # predicted central line days
655
What are some complications of CAUTIs?
- cystitis - pylenoephritis - gram negative bacteremia - endocarditis - vetebral osteomyelitis - septic arthritis - endopthalmitis - meningitis
656
Timeline for a healthcare associated infection, example if admitted to hospital on June 3
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
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
CAUTI
658
Drainage tube inserted into urinary bladder through the urethra, left in place, and connected to a drainage bag
Foley catheter
659
What devices are not included in CAUTI rates?
- condom caths - straight in and out caths - nephrostemy tubes - ileoconduits - suprapubic caths
660
Describe a catheter associated symptomatic UTI (SUTI)
- 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
Signs/ symptoms of CAUTI (need 1)
- Fever - Suparpubic tenderness - costovetebreal angle pain or tenderness CANNOT BE USED WHEN CATH IN PLACE: - urinary urgency - urinary frequency - dysuria (burning while urinating)
662
NHSN definition, non-catheter associated UTI
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
What are the additional symptoms for UTI/ CAUTIs in kids < 1 year old
- Fever - Hypothermai - Apnea - Bradycardia - Lethargy - Vom - Suprapubic tenderness
664
10^5
100,000
665
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?
Yes, but they would need a matching organism ID'd in a blood specimen
666
Do fungi meet the case definition for CAUTIs?
No, bacteria only
667
Do parasites meet the case def for CAUTIs?
No, bacteria only
668
Equation for CAUTI rate
cautis/ # cath days *1000
669
Equation for DUR
of urinary cath days/ # patient days *1000
670
MRSA- staph aureus specimen that tests positive for ____ resistance, _____ resistance, or _____ resistance via susceptibility, PCR or other methods
oxacillin-resistance, cefoxitin- resistance, or methicillin-resistance
671
Cefoxitin
2nd generation cephalosporin
672
Ceftazidime
3rd gen cephalosporin
673
Cefotaxime
3rd generation cephalosporin
674
Cefepime
4th generation cephalosporin
675
CephR-Klebsiella
Resistant to Ceftazidime, cefotaxime, and cefepime
676
What are the genes that code for resistance to carbepenems?
KPC NDM CIM IMP Oxa-48
677
What are MDRO-Acinetobacter spp resistant to?
@ least one of each: Aminoclycoside Carbapenems Fluoroquinolones
678
LabID even specimen collected >3 days after admission to the facility (on or after day 4)
Healthcare facility onset
679
LabID event specimen collected in outpatient location or an inpatient location <=3 days after admission to the facility (days 1-3)
Community onset
680
LabID event collected from a patient who was discharged from the facility <=4 weeks prior to the date current stool specimen was collected
Community-onset Healthcare facility associated
681
When is a LabID event considered recurrent?
If it's been >14 days and <8 weeks or 56 days
682
What is the leading cause of death from infection in the hospitalized patient?
Pneumonia
683
What are the parameters for healthcare associated pneumo?
- 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
How long does someone have to be in the hospital to be considered a hospital-acquired pneumonia case/
at least 48 hours
685
Most common organisms CAP
- S pneumo - S aureus - H influenzae - M orexellacatarhallis
686
What are the most common causes of atypical CAP?
- Legionella - Chlamydia penumoniae - Mycoplasma pneumoniae - enterobacter
687
Risk factors for S. aureus pneumo
- end stage renal disease - IV drug s - prior flu - prior antibiotic use with quinolones
688
How does MRSA pneumo impact neutrophils
Causes severe neutropenia
689
Risks for HAP/ HCAP
- antimicrobials in past 90 days - hosp 5+ days - high freq MDROs in community - immunosupressed
690
CAP quality measures from the TJC
- blood culture within 24 hours and before antibiotics - antibiotic timing - antibiotic selection - pneumococcal vax - influenza vax - smoking cessation counseling
691
Resp therapy equipment maintenance guidance
- only change circuit when soiled or malfunctioning - drain and discard condensate - sterile water for bubbling humidifiers - only filter suspected TB
692
Prevention for HAP, HCP, and VAP
- 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
Why are vascular access devices used to access the vascular system?
- hemodynamic monitoring - admin medication - infusions - blood sampling - dialysis
694
Short term or long term: peripheral access device
Short term
695
Short term or long term: midline catheter
Short term
696
Short term or long term: PICC line
Long term
697
Short term or long term: Tunneled CVAD
Long-Term
698
Short term or long term: Port
Long-term
699
Short term or long term: Non-tunneled percutaneous
Short-term
700
Length time for peripheral IV
<5 days If UV guided up to 14 days
701
Length of time: midline cath
<=14 days
702
Length of time: non-tunneled intravenous device
<= 14 days
703
When is midline preferred to PICC?
<=14 days
704
When is a non-tunneled intravenous device preferred to a PICC?
<=14 days in critically ill patients
705
Timeline for PICC line
6+ days (weeks - months)
706
Length of time for tunneled intravenous device
>=15 days
707
What type of CVC is preferred for >=31 days
Implanted port
708
Can you administer vesicants in a peripheral access device?
No, not a central line, does not terminate in heart
709
Can Midline catheters accommodate vesicants?
No
710
What CVCs can accommodate irritants and vesicants?
- PICC lines - Percutaneous short-term CVADs - Tunneled long-term CVADs - Implanted ports
711
CVC used for ongoing, high frequency access and can be accessed for months before requiring replacement
Tunneled
712
CVC used for temporary central access in critical and inpactient acute care setting
Non-tunneled
713
Complications of PICCS
- localized/ central infection - thrombosis - mechanical failure
714
Complications of implantable device insertion
- Catheter embolism - malposition - pneumothorax - thrombosis
715
Where do CVCs terminate?
- Superior vena cava - cavoatrial junction
716
When are cuffs present on catheters?
present on tunneled, not on non-tunneled
717
How are ports accessed?
Non-coring huber needle
718
What catheter has the lowest levels of BSI?
PICCs and Implanted ports
719
Coating on CVC to prevent colonization
- minocycline-rifampin - chlorohexidine-silver sulfadizine - platinum/ silver
720
Top microorganisms that cause CLABSIs
skin microbes: - coagulase negative staph - staph aureus - enterococcus facalius - klebsiella spp/ - candida albicans = enterococus faceium
721
What is the source of most endemic CLABSIs?
Contamination of VAD
722
What is the source of most epidemic CLABSIs?
contamination of infusate
723
Pathology of BSI
- 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
What size drape does a peripheral arterial cannulation require?
Small, sterile drape All other lines require large, sterile full body drapes
725
How often to change wound dressing and gauze over central lines
Gauze- while wound draining, change every 2 days Polyurethane film dressing- every 7 days
726
Are add on systems to central lines recommended?
No
727
How often should central line add-one be replacd?
Every 96 hours
728
How often should parenteral nutrition be changed?
not to exceed 24 hours
729
How often should blood products/ lipid emulsions be changed?
Lipid- 12 hours generally 12-24 hours
730
What personal hygiene recommendation do they make for skin decolinization for people with central lines?
Chlorohexidine bathing
731
Are topical antimicrobials recommended for patients with central lines?
No, only for hemodialysis catheter exit sites
732
What are the VADA-BSI measures if the bundles and basic measures are not working?
- antiseptic/ antimicrobial impregnanted catheters - chlorohexidine dressings - antiseptic containing needleless connectors - antimicrobial locks solution for CVADs
733
Who is antibiotic lock solution best suited for?
- long-term hemodialysis with limited venous access - history recurrent BSIs - High risk - ie prosthetic heart valve
734
Maximum dwell time to Antibiotic lock solution (ALS)
48 hours
735
What ALS antibiotic is best for a staph aureus infection?
Cefazolin
736
What ALS antibiotic is best for MRSA?
Vancomycin
737
What ALS antibiotic is best for gram-negative bacteria
Ceftazidime, gentamicin, ciprofloxacin
738
What ALS antibiotic is best for enterococcus?
ampicillin If resistant- vancomycin
739
What ALS solution is best for mixes of gram positive and gram netative?
Ehtanol
740
prophylaxis may be used during hemodialysis to prevent _______
Thrombolysis
741
Antisepsis for neonates and infants
iodine, need to remove after asepsis
742
When to use chlorhexidine-gluconate impregnated sponge for catheters?
Oncology patients
743
General: management of short-term CVAD with VADA-BSI (fever/ inflammation/ staph bacteremia/ candidemia)?
Culture and remove Replace in a new site if needed
744
General management of long-term CVAD with VADA -BSI
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
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?
Yes
746
What waterborne pathogens can cause BSI that require the CVC to be removed?
- Stentrophomonas - Burkholderia - Pseudomonas
747
Antibiotic for gram negative CLABSI
4th gen cephalosporin carbapenem
748
Antimicrobial for candidemia
IV fluconazole
749
Is a midline a central line?
No
750
What organisms are most likely to contaminate the catheter hub?
- endogenous skin flora - exogenous - HCW hands
751
What organisms are most likely to be introduced through the exit site?
- endogenous skin flora - extrinsic organisms on HCW hands or contaminated disinfectant
752
Is contaminated infusate typical with short-term IVDs?
No
753
Infusion contaminated at the manufactuerer
Intrinsic contamination
754
Infusate contaminated during sterile compounding or on-site
Extrinsic
755
What catheters are responsible for most infections?
1) hemodialysis: non-cuffed 2) pulmonary artery catheter (Swan ganz) 3) Short-term non medicated CVCs
756
Swan Ganz or pulmonary artery catheter
757
Which is the lowest risk for skin antisepsis for VADA BSIS: 70% alcohol. 10% povidone iodine, or 2% chlorohexidine
2% chlorhexidine
758
Patient placement for CVC placement
tendelenburg for most Supine- PICC / femoral
759
Most BSIs are of cutaneous origin that access the site ____________
extraluminally
760
What level disinfectant for environmental cleaning for surfaces infected with blood/ body fluids in dialysis center
Intermediate level
761
Reasons for infection in dialysis
- break in IP practices - Bacterial seeding from remote site - poor hygiene of care access arm
762
Types of dialysis infections
- access site infection - bacteremia - peritonitis
763
What organism is the biggest concern for fistulas?
Staph aureus
764
Infection prevention fistula
- 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
Decreasing risk for dialysis
- 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
What do you need to test for every 4 hours in dialysis?
Chloramine and chlorine
767
What is the CMS limit that requires disinfection within 48 hours for bacteria/ endotoxins?
Bacteria: action at 50 CFU/mL, limit 200 Endotoxin: action at 0.125 EU/ml, limit 2
768
What is the problem with bacteria and endotoxins in the dialysate?
fever bacteremia
769
How often to test dialysis treated water and dialysate?
At least monthly - weekly if new water system or change to system
770
Methods for dialysate/ treated water testing?
- membrane filter - spread plate NO calibrated loop
771
How often to disinfect mixing tank for bicarbonate in dialysis
Daily before first patient
772
What infections can result from improper cleaning and disinfection of priming waste?
Gram- negative rods enterococcus
773
Most common pathogens in peritoneal dialysis
- staph aureus/ staph - pseudomonas aeruginosa - enterobacteriaceae
774
Most common sources dialysis infections
- patients skin or nares - dialysate delivery system - breaks in technique - extrinsic or intrinsic contamination - migration from GI tract - vaginal leaks
775
Catheter placement peritoneal dialysis
- avoid skin folds and beltline - easily accessible for pt inspection and care - downward in pediatric patients
776
What is preferred for peritoneal dialysis: double cuff or single cuff?
double cuff
777
How often should hemodialysis patients receive Hep serology?
admission, then every 3-6 months
778
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?
- culture processed water and dialysate - review cleaning and disinfection - review multi-use vials processes
779
Steps after dialysis center sees positive HBsAg for first time
- report to HD - Isolate - did they get vax in last 30 days? - follow up tests for confirmation of infection - medical record review (eposures?)
780
Normal treatment for uncomplicated cystitis
nitrofuraton monohydrate/ macrocrystals (Macrobid) or TMP-SMX (bactrim)
781
What organisms typically causes epididymitis related to UTIs in males >35 years
E. coli Pseudomonas
782
Symptoms of pyelonephritis
abrupt onset fever unilateral costovertebral angle tenderness
783
Risks for pyelonephritis
- female - sex - new sex partner - spermicide - maternal history of UTI - recent UTI - Diabetes - smoking - incontenence
784
How to get a sample from a patient with an indwelling urinary catheter?
Sample port using aseptic technique, do NOT use leg bag
785
What is indicative of a contaminated urine sample?
3 or more species in the sample
786
Symptoms UTI in children
- fussy - fever - anoerexia - emesis - ab pain - neonatal jaundice - poor weight gain - enuresis - hematuria
787
Risk factors UTI in reproductive age female
- spermicide - delayed postcoital micturition - multiple sex partners - more freq sex
788
Screening and treatment for UTIs in pregnant women
- screen at 12-16 - treat even if asymptomatic - admit for pyelonephritis - avoid TMP-SMX after 32 weeks of pregnancy
789
Should you treat asymptomatic UTIs in elderly patients?
No
790
What pathogens are responsible for UTIs in LTC males?
E. coli Proteus morabilis
791
Treatment for complicated UTIs (males, children, diabetics with symptoms)
Fluroquinolones
792
What pathogens cause UTIs in diabetics?
E. coli Klebsiella Group B Strep
793
Most common HAI (correct)
UTIs
794
How do most CAUTIs in males happen?
intraluminal route from contaminated drainage bag
795
How do most CAUTIs in females happen?
transeurethral migration up extraluminal surface of catheter
796
Indications for indwelling unrinary catheters
- 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
What position is best served to give catheter removal reminders?
nurses
798
What is the time limit for urinary catheter use in surgery?
<=48 hours
799
IPs role in preventing CAUTIs
- appropriate infrastructure to prevent CAUTI - CAUTI surveillance - education and training - appropriate technique during catheter insertion - appropriate management indwelling catheters - accountability - performance measures
800
What organisms commonly cause HAI UTIs?
E. coli Enterobacteriaceae (pseudomonas, Serratia)
801
carotid endarterectomy
removes plaque in the coritid artery
802
Laminectomy
Removal of the roof of the spinal cord
803
Anoscope
examines anus and rectum
804
Thorascoscope
examines chest organs through small incision
805
arthroscope
examines joint through incision above knee
806
Colposcope
Examines cervix through vagina
807
Endoscopic retrograde cholangiopancreatography
combines X-rays with upper GI endoscopy to diagnose or treat problems with the bile and pancreatic ducts.
808
Enteroscopy
Used to examine your small intestines via your mouth or anus.
809
Proctoscope
examine the anal cavity, rectum, or sigmoid colon (just the rectum and colon)
810
Hysteroscope
examination of the inside of the uterus
811
Sigmoidoscope
shorter version of a colonoscopy, focusing on the rectum and the lower part of the colon
812
Mediastinoscope
examine the space between your lungs via an incision above your sternum.
813
thoractomy
surgical procedure that allows a surgeon to access the chest's pleural space and thoracic organs, cut between the ribs
814
thorascope
examine your chest cavity and its contents (your lungs and the covering of the lungs) via an incision in your chest.
815
Chromoendoscope
technique that uses a specialized stain or dye on the lining of the intestine during an endoscopy procedure.
816
duodenoscope
flexible, lighted, hollow tube that doctors use to examine and treat issues in the pancreas and bile ducts
817
Reasons for outbreaks from endoscopy
- 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
How often to discard endoscope detergent
After each use
819
What organisms have been associated with endoscopy outbreaks?
- Hep B - Hep C - CRE - P. aeruginosa - S. marcescens - M. tb
820
What is the general manual parameters for HLD of endoscopes?
- >2% glutaraldehyde at 25C, 20-90 minutes - rinse with large amounts of water
821
When does cleaning the endoscope with brushes occur?
Before HLD
822
Difference between alcohol % for antisepsis versus in the endoscope rinse after disinfection.
Antisepsis: 60-95% Disinfection rinse: 70-90%
823
IP for bronchoscopy
- immunizations (esp flu) and TB screening - disposable caps/ valves - screen for symptoms
824
IP for if someone has resp symptoms and is due for a bronchoscopy procedures
- push back date of procedure - complete in AIIR - PPE - Thoroughly clean room before next patient - allow enough time for airborne agents to dissipate
825
If the endoscope breaks the mucousal barrier, what level of disinfection is required?
Sterilization
826
Cleaning/ disinfection process for water bottle used to clean lens/ irrigation during procefure
- clean bottle and connecting tube with HLD at least daily - Use only sterile water
827
MEC
Minimum effective concentration for disinfection
828
Who do reports need to go to if there is an outbreak related to endoscopy equipment?
- IP - physician - CDC - FDA - manufacturer
829
Outbreak response for endoscopy
- 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
Endopthalmitis
Inflammation of intraoccular cavities
831
What are the common reservoirs for adenoviruses in opthalmology?
- HCP hands - tears - Contaminated equipment - contaminated environment - contaminated medications (lower risk)
832
What equipment can spread adenoviruses through contamination?
- tonomometer tips - opthalmoscopes - slit lamps - trial contact lenses
833
Prevention for adenoviruses in opthalmology
- 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
In ophthalmology, what viruses are spread in similar ways to adenoviruses?
- Coxsackievirus - Enterovirus
835
Methods for disinfecting tonometer tips
5-10 minute soak in: - 3% hp - 70% isopropyl or ethyl alcohol - 5000 ppm bleach
836
blepharitis
inflammation/ infection of the eyelid
837
Endopthalmitis
inflammation/ infection of the intraocular fluids (anterior and vitreous tissues)
838
Intravitreal
Injection of meds into vitreous chamber
839
intracameral
injection of meds into anterior chamber
840
Keratitis
inflammation and/or infection of the ocular external surfaces (conjunctiva and cornea)
841
inflammation of the retina
Retinitis
842
Noninfectious inflammation of vitreous and/or anterior chamber following intravitreal injections and/or surgery
sterile endophthalmitis
843
Toxic anterior segment syndrom
acute, sterile inflammation following anterior segment surgery
844
What disease is associated with contact lenses?
Keratitis
845
What microorganisms are associated with contact lenses?
P. aeruginosa Filamentous fungi
846
What organisms are most often associated with infectious endothalmitis
Skin commensals esp Staph and strep
847
The U.S sees most of the following compared to other countries: - gram negative isolates - gram positive isolates - fungal isolates - parasitic isolates
Gram negative isolates
848
Source of infectious endophthalmitis
- organisms introduced at time of surgery/ trauma
849
Level of disinfection for diagnostic laser lens
HLD
850
Level of disinfection for fundus contact lenses
HLD with 1:10 bleach for 25 minutes
851
Level disinfection lacrimal lavage probe
sterilization
852
Level of disinfection- occuluders
Low level, wipe with 70% alcohol
853
Level of disinfection: Opthalmoscopes
Low level, wipe with 70% alcohol
854
Level of disinfection phoropter
low- wipe with 70% alcohol
855
Level of disinfection: scleral depressor, lid elevertors, specula, forceps
Sterilize
856
level of disinfection- tweezers in eye doctor
Sterilize
857
IP for tonopen
use sterile, disposable tonopen cover for each pt exam
858
Organisms that penetrate intact epithelium
- N. gonorrhoeae - N. meningitidis - S. pneumoniae - L. monocytogenes - C. diphtheriae
859
What bacteria are associated with kertitis in cooler climates?
S. aureus C. albicans
860
What bacteria are associated with eye infection in homeless populations?
S. pneumo Moracella spp.
861
Most common virus to cause pink eye
Adenovirus
862
Most common bacteria to cause pink eye
S. penumo S. aerues
863
Organisms most commonly associated with eye infections in infants
- gonnorrhea - chlamydia
864
If patients require this medical device, they are more likely to get eye infections with gram negative bacteria like kelbsiella, proteus, and pseudomonas
ventilator
865
What risks are associated with keratitis
contact lenses trauma refractive surgery
866
What microorganisms cause keratitis after refractive surgery
S. aureus NTM
867
What disease have potential to be spread through corneal transplant?
- CJD - HBV - Rabies - HSV
868
Sources for TASS
- handling/ cleaning surgical instruments - contaminated solutions - contaminated intraocular lenses - toxic meds - powder gloves - residue on instruments
869
How do most bacterial healthcare associated pneumonias occur?
Organisms colonizing the oropharynx or upper GI tract are aspirated
870
Bacteria associated with contaminated aerosols that cause penumonia
Legionella Aspergillus Serratia marcescens
871
Most common routes of transmission associated with respiratory care
- Droplet nuclei - direct contact with contaminated fluids, hands, and equipment
872
measures how fast and how much air you breathe out
spirometer
873
Which is safer, enteral or parenteral nutrition?
Enteral
874
When should you change the ventilator circuit?
if visibly soiled or malfunctioning
875
Risks for respiratory infections
- age - severe underlying disease - immunosupression - enteral feeding - thoracic or abdominal surgery - invasive ventilator support
876
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
Respiratory tract/ upperGI
877
What level of disinfection is required for mechanical ventilators
LLD of surfaces
878
Caring for breathing circuits, humidifiers, and het/ moisture exchangers (HME)
- don't change unless visibly soiled or malfunctioning - periodically discard condensate
879
Level of disinfection for nebulizers between patients
HLD
880
Level of disinfection between patients for mist tents
HLD
881
Level of disinfection for portable respirometers and vent. thermometers
HLD
882
Level of disinfection for resuscitation bags
HLD
883
Do you have change mist tents for the same patient
No, not recommended to change
884
Disinfection for small volume nebulizer in between uses for the same patient
clean, disinfect, rinse with sterile water
885
Level of disinfection incentive spirometry and airway clearing devices
Single use
886
Cleaning/ disinfection for pulmonary function testing
None for internal machinery change mouthpiece and filter between patients LLD of surfaces handled by patient between patients
887
IP for tracheostomy care
- tracheostomy - sterile conditions - use gown, gloves, aseptic technique to replace trach tube - no antibiotic cream - NO routine cuff deflation - ensure proper cuff pressure
888
Level of disinfection for trach tube
HLD or sterilization
889
IP suctioning resp secretions
- open system- use new sterile catheter each time - Sterile saline
890
IP for artificial airways
- 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
PPE for suctioning a trach
Eye protection mask gloves gown
892
Is routine PEP with antimicrobials to prevent VAP recommended?
No
893
Pressure for OR
Positive pressure
894
ACH in OR
20
895
humidity OR
20-60%
896
Temp OR
68-75
897
Traffic zones in surgery
Unrestricted Semi-restricted (hosp attire and cap required) Restricted zones (masks required, keep door closed) Goal to limit traffic
898
What are the four levels and gowns and what is the most resistant to fluid?
4 levels Level 4 is the most impermeable
899
Skin prep for surgery
- 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
% probability that the product is sterile
microbiological safety index, the higher the number, the more sterile
901
How often should the policy for aseptic technique be reviewed
annually
902
scrub process surgeons
- remove jewelry - clean nails - scrub with antimicrobial soap for manufacturers recommended time (2-6 minutes) - Use ABHR with persistent activity
903
What if TB patient needs emergency surgery?
- 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
True or false: HCP are at increased risk of latex allergy
True
905
Who to give SSI data and feedback to
individual surgeons confidentially
906
What increases the risk of a surgical site infection (pathogenesis)?
1) inoculum of bacteria 2) virulence 3) Adjuvant effects of the microenvironment 4) Impaired host defenses
907
What body systems have higher numbers of bacteria and therefore can increase the inoculum of bacteria?
GI Female genitourinary Respiratory tract
908
Bacteria that cause SSIs and can cause severe infections due to their virulence
S. aureus S. pyogenes C. perfringens
909
Example of bacterial synergism
Bacteroides fragilis + gram negative bacteria- much more virulent
910
Wound left open at end of surgery, heals by granulation and contraction
Secondary closure
911
Part of healing process in which pink tissue containing connective tissue and capillaries forms around edges of wound
Granulation
912
Wounds closed a few days after surgery
Secondary closure
913
When might secondary closure be preferred?
Massive contamination
914
Polyester foam over wound, transparent plastic adhesive drape over foam and surrounding skin, suction at port site that removes inflammatory fluids
Negative pressure wound therapy (NPWT)
915
Is pressure irrigation recommended for high-risk grossly contaminated wounds?
No studies, may make contamination worse
916
Surgical Care improvement Project Measures
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
Steps to managing a wound
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
When managing an open wound, what is the best method to cover?
saline-soaked, loosely packed gauze
919
How often to change saline-soaked gauze in open wound?
3x per day
920
ASA score: 21 year old, well conditioned male athlete undergoing elective groin hernia repairs
1
921
ASA score: 46 year old woman with mild but controlled hypertension undergoing a laparoscopic cholecytectomy
2
922
cholecytectomy
Surgical procedure to remove gall bladder
923
ASA score: a 53- year old man with insulin-dependent diabetes and coronary artery disease undergoing elective aortofemoral bypass
3
924
aortofemoral bypass
procedure that bypasses blocked or diseased large blood vessels in the abdomen and groin
925
ASA score: a 62-year old woman on chronic renal hemodialysis undergoing emergency laparotomy for perforative divertivulitis
4
926
ASA score: a 58-year old man with morbid obesity, type 2 diabetes, and shock undergoing extensive debridement for streptococcal necrotizing fascilitis
5
927
Carotid endarterectomy
Surgery to remove plaque buildup in common carotid artery
928
Laminectomy
Surgery in which surgeon removes part or all of the vertebral bone to help ease pressure in spinal cord
929
Laparotomy
Surgical incision cut into abdominal cavity
930
Craniotomy
Part of skill temporarily removed to expose brain and perform intracranial procedure
931
Ventricular shunt
Cerebral shunt that drains excess CSF when there is an obstruction
932
Coronary artery bypass graft
surgical procedure that restores blood flow to the heart by bypassing blockages in the coronary arteries
933
Colon resection
surgical procedure to remove part or all of the colon or rectum
934
Common organisms that infect indwelling medical devices
S. aureus S. epidermidis
935
Pathways for infection of indwelling medical devices
1. Introduction of organism at time of surgical implant 2. contiguous spread of post-op wound infection 3. hematogenous seeding
936
Host risk factors for indwelling medical device infections
- 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
3 types of prosthetic joint infections
1. early infection (within 3 months) 2. delayed infection (3-24 months after surgery) 3. late infection (2+ years after surgery)
938
What is late infection of a prosthetic joint typically from?
hematogenous seeding
939
What organisms typically causes late, fulminant infection of prosthetic joints?
S. aureus GAS
940
What organisms typically cause indolent late infection of prosthetic joints?
coagulase-negative staph Propinobacterium
941
How to test for and dx prosthetic joint infections
clinical symptoms Imaging labs (aspiration of synovial fluid (leukocytes, gram stain and culture) histopathology (after surgery)
942
How to prevent implantable joint infections
- screen host and treat infections before surgery - OR environment - surgical prep (skin prep, hair removal with clippers, prophy antibiotics)
943
How to manage infections in implanted devices
Surgery and 6+ week antibiotics - Single stage exchange - 2 stage exchange - arthrotomy and debridement and 6-8 weeks antibiotics (only select pts)
944
What typically causes early prosthetic valve endocarditis (PVE) within 12 months of valve replacement?
perioperative or immediate post op HH
945
What organism is responsible for most prosthetic valve endocarditis infections and mortality?
S. aureus
946
What symptom is most common with prosthetic valve endocarditis
Fever
947
What are the common echocardiogram findings in prosthetic cardiogram endocarditits?
- vegetations - periprosthetic abscess - new paravalvular regurgitation
948
What is paravalvular regurgitation?
Leak caused by space between the heart tissue and valve replacement
949
What organisms to expect if there are symptoms for prosthetic valve endocarditis but cultures are negative
HACEK group
950
What is the treatment for prosthetic valve endocarditis?
antimicrobials for 6+ weeks and likely requires surgery
951
Prevention for prosthetic valve endocarditis
prophy antibiotics with vanco/ gentamycin
952
Most common cause of defibrillator/ pacemaker (cardiovascular implantable electronic device) infections
hematogenous seeding of bacteria, esp S. aureus
953
Ways that cardiovascular implantable electronic device infection presents
Generator pocket infection or Intravascular electrode infection
954
What should be a consideration if there is a recurrent pocket infection?
Endocarditis
955
Most common organism to cause generator pocket infection
S. aureus
956
When should the cardiovascular implantable electronic device be removed?
If there is a intravascular electrode infection
957
Prevention for cardiovascular implantable electronic devices
Prophy antibiotics
958
The following sites are infection locations for this type of device: - surgical site - driveline exit site * most common - device pocket - pump - pump pocket
Left ventricular assist device
959
Symptoms of systemic left ventricular assist device infection
abscess formation on pump\ fever, pain, local swelling Sepsis, endocarditis, cerebral embolism, multiorgan failure, death
960
Best method to dx endocarditis
transesophageal echocardiogram
961
Diseases that can be passed through tissue allograft implants
CJD HIV Hep B Hep C HSV Cytomegalovirus Clostridium Fungi Rabies HPV
962
Who screens tissue for tissue allograft
American Association of Tissue Banks
963
Prevention of infection in implants: pre-operative
- 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
how to prevent spinal implant infection
make sure implant is sterile and cover with a sterile drape
965
Treatment for spinal implant infection
removal and 4-6 weeks antimicrobial thearpy
966
Prevention of infection in implants: Peri-operative
- 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
Prevention of infection in implants: post- surgical
- minimize hematoma - monitor wound/ infections - heart valves- antibiotics for dental and high risk procedures
968
If someone with an implant has S. aureus, what is the assumption
assume infected hardware
969
Out of all the implantable devices, what one has the highest risk of infection?
Ventricular assist device
970
ventriculoperitoneal (VP) shunt
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
Endocarditis symptoms
FROM JANE Fever Roth spots Osler nodes Murmur Janeway lesions Anemia Nail-bed hemorrhage Emboli
972
Gram negative fasticious coccobacilliary organismms that grow slowly in blood culture media and can cause endocarditis
HACEK group Haemophilus Actinobacillus actinomycetemcomitans Cardiobacterium hominis Eckinella Kingella
973
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
Drug compounding
974
What are the most common products of sterile compounding?
- large volume IV solutions - small volume IV solutions
975
What type of hood do they use for sterile compounding?
Laminar airflow + Hepa filter
976
Pharmacy responsibilities
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
What is the primary engineering control for preventing contamination of compounded sterile preparations?
Compounding unit capable of ISO 5 air cleanliness + laminar airflow + biosafety cabinet
978
<= 100 particles per cubic ft or 3520 particles per cubic meter
International Organization for Standardization Class 5 (ISO 5)
979
Where do all PN fluids need to be prepared? (Iso class)
ISO class 5
980
What type of unit is required for hazardous drug preparation?
Biological safety cabinet or compounding aseptic containment isolator
981
How often do sterile compounding employees have to train and demonstrate competency?
at least annually Every 6 months for garbing and HH
982
How do they test that hcp maintains sterility in compounding
Finger and thumb sampling on gloves, expect 0 cfu/mL and <=3 CFU/ mL after media testing
983
PPE in compounding
Sterile gloves cap shoe covers mask gown (only reusable item)
984
Infection prevention used in sterile compounding to maintain sterility of gloves
regularly clean gloves with 70% isopropyl alcohol
985
Iso class 3- Iso class 8- what happens as you increase in #
Iso class 3 starts at 35.2 Every isoclass is 10x the number of particles from the iso class before it
986
How many air exchanges and what type of filter is required for sterile compounding?
at least 15 ACH HEPA filter
987
What is an example of a department where it's appropriate to do regular airborne sampling?
Sterile compounding for particulate matter
988
These diseases can be found in immunocompromised patients if nearby ground is disturbed or there is exposure to bird droppings
Aspergillus Cryptococcus neoformans Histoplasma capsulatum Coccidioides immitis
989
What organism is associated with "cloud shedding"
Staph aureus
990
What are the requirements for air intake?
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
Filtration methods for pre-filters (Low-medium efficiency, 20-40%)
- Straining - Impingement - Interception
992
Filtration methods for high-efficiency filters (>=90%) used in most areas of the hospitals
- Diffusion - Electrostatic
993
How are high efficiency filters tested?
Dust spot
994
What size particle do HEPA filters remove, and how efficient are they?
>=0.3 um 99.97% efficient
995
Where to use HEPA filters
PE
996
Test for HEPA filter
Diothlphthalate (DOP) test
997
What organisms does ultraviolet germicidal irradiation work for?
- vegetative bacteria - vegetative fungi Do not work to kill fungal spores
998
Temperature for air in most occupied spaces
68-73
999
Pace of laminar air flow
90 ft/ min
1000
How far does med prep have to be from the sink?
3 ft
1001
There are several limitations of air sampling, give a few examples
- 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
In this method of air sampling, you put a petri dish with agar in the area you want to sample
Settle plate
1003
What are settle plates best suited to measure?
Larger particles, not sensitive to respirable
1004
This method of air sampling collects large volumes of air in a short period
Solid impactor (slit or sieve impactors)
1005
What are solid impactors best suited to measure?
Detect low numbers of fungal spores in highly filtered areas
1006
Survival time s. aureus
12 months
1007
Survival time C. diff
5 months
1008
Survival time norovirus
2 weeks
1009
Survival time acinetobacter
11 months
1010
Survival time pseudomonas
16 months
1011
removal of foreign mater material from object normally accomplished using water with detergents and enzymatic products
Cleaning
1012
Reduction in microbial population on an inanimate object to a safe or relative safe level
Sanitizing
1013
Elimination of many or all pathogenic organisms with exception of bacterial spores
Disinfection
1014
What should IP know about their detergents/ disinfectants?
- name - active ingredient - directions - where/ how used - manufacturer info
1015
What are the two zones of care
Patient zone Healthcare zone
1016
Moments of HH for environmental services
- 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
Survival time enterococcus
46 months
1018
Survival time klebsiella
30 months
1019
Who should write the cleaning and disinfection policies?
Multidisciplinary team
1020
disinfecting agent to kill most viruses and all vegetative bacteria, except tubercle bacilli
Low-level disinfection
1021
Disinfectants that kill most bacteria, fungi, viruses, and mycobacteria, but not bacterial spores
Intermediate-level disinfection
1022
Disinfectants that eliminate all microorganisms from an instrument or surface, except for a small number of bacterial spores
High-level disinfection
1023
Common disinfectants used in environmental services
- quat ammonia - bleach - hydrogen peroxide
1024
Bleach dilution for nonpourous surfaces
1:100
1025
Bleach dilutions for pourous surfaces
1:10
1026
Chemical to clean room with or after C. diff patient
1:10 bleach or EPA sporicidal agent
1027
terminal cleaning of C. diff room
- UV or HP recommended - replace privacy curtain
1028
When should EVS change the privacy curtain?
C. Diff Noro MDRO
1029
Terminal cleaning of room with noro/ diarrheal outbreak
- UV/ HP - Steam clean carpet upholstry
1030
What chemical is recommended to clean nurseries?
Quat
1031
Chemical to clean rooms for SARS
1:100 bleach
1032
PPE for EVS in SARs room
Gown Gloves Mask Protective eyewear
1033
Indicators of bed bugs
Bites Casings Fecal stains Skin casts Sweet musty odor
1034
How EVS to clean room with bed bugs
- 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
Cleaning policies and procedures are required to include:
- address dept concerns - specify cleaning procedures - list cleaning agents and equipment - provide cleaning schedules - optional: quality control
1036
Cleaning mattresses and pillows
- discard when cracked, torn, or permanently stained - disinfect between patients and when visibly soiled
1037
EVS commode
clean and disinfect daily and when visibly soiled Dump and decontaminate before taking out of room
1038
EVS bathroom cleaning frequency
daily and when soiled During diarrheal outbreaks- 3x per day
1039
Types of antiseptics
Chlorohexidine* Tricolsan Chloroeylenol (PCMX)* Iodophor Quat Alcohol* *most popular
1040
How often to change mop solution
Every 3 rooms or after 60 minutes, whichever comes first
1041
Describe UV radiation for terminal cleaning
- terminal cleaning - No need to shut off HVAC - Move furniture away from walls
1042
Describe HP for terminal cleaning
- 2-5 hours - shut off HVAC and tape doors
1043
Process for cleaning OR
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
Methods to evaluate effectiveness of cleaning
- visual - ATP bioluminescense (not indicative of pathogen- acceptable or unacceptable) - Fluorescent markers (tag before cleaning)
1045
Most effective at immediately reducing bacterial counts on hands
Alcohol
1046
Most persistent antimicrobial activity in antiseptic
CHG
1047
Does alcohol have a residual antimicrobial effect?
No
1048
Concern with Hexachlorophene as surgical scrub
Absorbed into blood after repeated use
1049
Microbe detected in outbreaks in neonatal units, military field hospitals
Acinetobacter
1050
Sources acinetobacter outbreaks/ infections
- 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
This organism survives in moist environmentsl and has minimal nutritional requirements. It tolerates a variety of temps, and has innat antibiotic resistance
P. aeruginosa
1052
What organism is most likely to contaminant a disinfectant, germicide, solution, or antiseptic?
P. aeruginosa
1053
Environmental gram negative that is associated with cystic fibrosis patients
Burkholderia
1054
Sources of outbreaks of burkholderia
- intra-aoritic balloon pumps - contaminated water - resp therapy equip - contaminated disinfectants
1055
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
Stentophomonas maltophila
1056
Where do enterococci colonize?
Human GI tract and biliary tract
1057
Enterococci have both intrinsic and acquired resistance to many anti-microbials, what do they have intrinsic resistance to?
- B-lactams - aminoglycosides - clindamycin - fluoroquinolones - TMP-SMX
1058
Disease that enterococci is often associated with
Prosthetic heart valve endocarditis
1059
Enterococci is the ____ most common cause of SSIs
3rd
1060
IP guidance for VRE:
- antimicrobial stewardship, esp for vancomycin and cephalosporins - facility-wide education on infection control, including HH - Early detection, prompt implementation of barrier precautions - Decolonization
1061
Organisms associated with water
- pseudomonas - acinetobacter - moraxella - aeromonas - xanthomonas - legionella - aspergillus - fusarium - atypical mycobacterium
1062
Diseases that pass through contaminated equipment
Pseudomonas NTM
1063
Most commonly reported waterborne pathogesn
Pseudomonas Legionella
1064
This type of organism may be found when there is excessive moisture around pipes and insulation, condensation in drain pans, or flooding
Fungi
1065
Organisms that can grow in eyewash stations
Acanthaemobae Pseudomonas Legionella
1066
IP for potable water system
- 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
These organisms can grow in ice chests and machines
Cryptococcus NTM Pseudomonas Legionella Enterobacter
1068
What is the HACCP?
Hazard analysis and critical control point plan Water risk assesment
1069
Weekly- monthly cleaning process for ice machine
discard ice, clean chest with detergent then chlorine solution, let dry and return to service
1070
Monthly- quarterly cleaning process for ice machine
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
How often should pools be filtered?
3x per day
1072
How often should pools be drained and disinfected?
every 1-2 weeks
1073
How to clean after flooding/ leakage
remove moisture source clean in 24-48 hours disinfect with bleach solution thoroughly dry
1074
IP for water management
- 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
Problems with hyper-chlorination treatment of water system
Temporary Byproduct trihalomethanes Corrosion Taste and odor
1076
Benefit of monochloramine treatment of water system
Can penetrate biofilms
1077
Problems with monochloramine treatment of water system
Taste and odor problems Trihalomethanes
1078
Benefits of chlorine dioxide treatment of water system
No by-products Breaks down biofilm Long-term effects minimal corrosion
1079
Problems with copper/ silver ionization treatment of water system
Copper may deposit, localized corrosion Copper toxic to aquatic species
1080
Benefits of copper/ silver treatment of water system
no by products long term-effects for hot water
1081
Problems of ozonation treatment of water system
Some toxic byproducts Odor problems potential corrosion No long term effects does not work on biofilms
1082
How to test biofilms
cannot culture PCR, sequencing of NAAT
1083
What is the amount of increased resistance of biofilms to antibiotics
1000 x
1084
What are the clinical consequences of biofilms?
- 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
Diseases associated with biofilms
- otitis media - sinusitis - valve endocarditis - Cystic fibrosis
1086
What organisms are in healthcare textiles?
- Gram negative bacteria - Coagulase negative staph - Bacillus spp. - Normal skin flora
1087
Clean state, free of pathogens in sufficient numbers to minimize infection risk (specifically for textiles)
Hygienically clean
1088
Regulating agencies for healthcare textiles
FDA OSHA EPA
1089
What is the ideal level of moisture in healthcare setting walls/ floors/ etc.
<20%
1090
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
Infection Control Risk Assessment (ICRA)
1091
Written work process and equipment requirements to manage potential infection risk from proposed construction
Infection control risk mitigation recommendations (ICRMR)
1092
Agency that writes construction and renovation in healthcare standards
Facilities guideline institute (FGI)
1093
Who should help write the ICRA?
IP, safety, engineering, HCP from affected area
1094
Design considerations for ICRA
- #, 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
What to include in ICRMR
- 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
Pressure of construction zone
Negative
1097
What is the IP's role in construction and renovation?
- 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
Considerations for plumbing design
- CMS requires water mgmt plan - remove deadlegs or at least use valve to isolate - consider points to inject the chlorine/ disinfectant
1099
What can be used to contain a small job (working on ceiling)
Portable containment unit with negative air pressure machine All workers and tools must fit in unit
1100
Isolating ventilation in the construction space
- 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
When is an anteroom required?
- for combined AII/ PE room
1102
Who should be present at construction rounds?
Project manager Safety Security Contractor Reps
1103
What surveillance is recommended during construction projects?
active surveillance: - airborne infection in immunocompromised patients - review labs and postmortem data
1104
Best practices for construction and renovation
- 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
Positive pressure rooms
ORs, protective environment, special procedure rooms
1106
Negative pressure rooms
- Airborne isolation rooms - toilet rooms - bronchoscopy - triage, waiting room at the ER - radiology waiting room
1107
ASHRAE scale for filters
Minimum efficiency reporting values (MERV) Scale: 1-16, where 16 is the highest filtration rate
1108
Surgery airflow
noninduction, unidirectional difffusion 25-35 fpm
1109
Where should exhaust outlets from contaminated areas be located?
Above roof
1110
OR and cath lab pressure and ACH
positive pressure, minimum of 15 + 3 outdoor
1111
Should you change pressure in OR for TB patient?
No, get back to AII ASAP
1112
Minimum number of ACH for PE
12
1113
Minimum % filter for PE
95%, filter .3 microns
1114
Minimum ACH in AIIR
12 Add HEPA if there are less
1115
Ancillary support areas ACH, pressure, and filtration: Food service Dx imagining Treatment rooms Sterilizing/ clean supply distribution Other service areas
+ pressure 10 ACH 90% filtration
1116
What is the temp for AII or PE
70-75 F
1117
Planning checklist for environmental surveillance
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
Describe the ACH, pressure, temp, and humidity for: soiled/ decontamination
10 ACH negative pressure 60-65 F 30-60% RH
1119
Describe the ACH, pressure, temp, and humidity for: Assembly/ prep and pack
10 ACH Positive 68-73 F 30-60% RH
1120
Describe the ACH, pressure, temp, and humidity for: Sterilizer loading/ unloading
10 ACH Positive 68-73 F 30-60%
1121
Describe the ACH, pressure, temp, and humidity for: Sterile Storage
4 (downward draft) Positive up to 75F <70
1122
What is needed for waste to cause infection
1. Dose 2. Host susceptibility 3. presence of a pathogen 4. Virulence of a pathogen 5. portal of entry
1123
How to process microbiological waste
Chemical, thermal (autoclave), or radiological (irradiation) treatment prior to disposal as nonhazardous waste, or ship off-site as regulated waste
1124
How to process animal waste
Evaluate for potential zoonotic exposure risk and treat on site prior to disposal
1125
How to process waste with blood saturated materials or bulk liquids
Collect as regulated waste, use chemical bleach or thermal treatment on site to decontaminate and solidify bulk blood if transported off-site
1126
How to process sharps waste
Place in appropriate rigid puncture- resistant, closeable and leakproof container for immediate disposal
1127
How to process pathology waste
formalin fixation to reduce infectious material, then incinerate or grinding acceptable, cannot release recognizable body parts into waste stream
1128
Who regulates waste management?
OSHA, DOT, and EPA
1129
Objectives of waste management plan
- 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
Parts of the waste management chain
Designation segregation packaging storage transport treatment disposal contingency planning staff training
1131
What disease has been passed between patients in a surgical plume?
HPV
1132
Types of regulated infectious waste
- contaminated sharps - microbiological waste - animal waste - pathology waste - blood/ blood products - Cat A isolation waste
1133
Best method to transport infectious waste to be transported
leakproof carts that are cleanable
1134
What are the documents that have to travel with waste to it's final destination
Waste manifest
1135
How to treat contaminated waste?
- Steam sterilization - chemical disinfection - gas/ vapor sterilization - irradiation - incineration
1136
How to determine if sterilization of infectious waste worked
use a biological indicator
1137
Parts of OSHA and DOT required training for WM
- Definition of infectious waste - handling procedures - appropriate PPE - HH - Labeling IW - Post exposure management
1138
How often does OSHA require waste management training?
First 90 days and every 3 years
1139
Preferred waste management method for Category A waste
Use on-site inactivation (autoclave or incineration)
1140
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)
Class 1
1141
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)
Class 2
1142
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)
Class 3
1143
Animals that are not specific to the patient
Animal assisted activities
1144
Animals are specific to patient's therapy
Animal assisted therapy
1145
Rule about raw food for animals in AAA or AAT
Animal cannot have eaten raw animal foods in past 90 days
1146
How far in advance does a visiting animal have to bathe?
24 hours
1147
Are animals allowed on the bed?
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
What patients should be excluded from AAA/ AAT?
open wounds burns trachea immunosuppressed isolation zoonotic diseases (Salmonella, TB, campy, shigella, Strep A, MRSA, ringworm, giardia, amebiasis)
1149
What are the rules if a personal pet is allowed to visit?
- 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
Are comfort/ emotional support animals service animals?
No
1151
Where are service animals allowed?
Everywhere but ORs, burn units, and sterile environment
1152
Can service animals be where food is prepared and sold?
Yes
1153
Can be used to measure pressure
manometer
1154
What is the risk of rinsing medical care equipment with tap water?
Gram negative bacteria
1155
What are some organisms that can grow in contaminated solutions (ie solution of bleach) and disinfectants?
- Pseudomonas* - Burkholderia - Serratia marcesens - Stenotrophmas maltophila
1156
Bacteria that are associated with resp equipment
Burkholderia cepacia Stentrophomonas maltophila Acinetobacter Enterobacter
1157
What is/ are the source(s) of Mycobacterium abcessus
medical instruments that were not sterilized properly
1158
What is/ are the source(s) of Mycobacterium avium complex
potable water
1159
What is/ are the source(s) of Mycobacterium chelonae
- Improperly sterilized medical instruments - contaminated solutions - hydrotherapy tanks - Jet injectors - Bronchoscopy
1160
What is/ are the source(s) of Mycobacterium fortuitum
- Aerosols from showers/ other water sources - ice - medical instruments not sterilized properly - hydrotherapy tanks - deionized water - intrinsically contaminated lab solutions
1161
What is/ are the source(s) of Mycobacterium marinum
Hydrotherapy tanks fish tanks
1162
What is/ are the source(s) of Mycobacterium ulcerans
potable water
1163
What is/ are the source(s) of Mycobacterium kansasii
potable water
1164
Which NTM are more resistant to chlorine (rapid or slow-growing?)
slow-growing
1165
If water is down, where should you use sterile/ bottled water?
- surgical scrub - ER surgical procedures - pharma preparations - pt care equip
1166
What is the temp for heat flushing water?
160-170F
1167
What type of ice should you use for medicine/ solution transport
Sterile ice
1168
What type of ice should you use for immunocompromised patients
Sterile ice
1169
Who should be restricted from using hydrotherapy tanks and wounds
Pts with draining lessions
1170
Examples of intermediate level disinfectants
- chlorine containing compounds - alcohols - some phenolics - some iodphors
1171
Examples of low level disinfection chemicals
- quat ammonia - some phenolics - some iodophors
1172
What practices may lead a cleaning solution to be contaminated with pseudomonas or seratia (esp in phenolics or quat)
- 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
Infection control for cleaning solutions
Prepare daily and discard remaining solution at end of day and dry out container Use ready-to-use wipes or solution
1174
These chemicals help to clean off proteins, fats, etc
Detergents
1175
If using detergents to clean, what is an important step
RINSE!
1176
Probe that helps to look at the esophagus and determine if it is working properly
Esophageal manometry probe
1177
Examples of equipment that require HLD
- 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
HLD chemicals
- 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
how often do disinfection and sterilization team members get training and competency checks?
Hire and yearly
1180
What is AAMI's benchmark for residual protein on instruments?
<6.4 ug/ cm
1181
Common places for biofilms to form
- Whirlpools - dental water lines - hemodialysis systems - urinary catheters - CVCs - endoscopes
1182
Exposure time and temperature for most HLD
8 minutes - 45 minutes at 20C (68F)
1183
How long after an uneventful surgery does TASS usually occur?
12-48 hours
1184
How to spot clean surfaces with CJD
1:10 solution
1185
Which is faster- UV light or HP for terminal cleaning?
UV light
1186
Which terminal cleaning supplement is more effective for spores: HP or UV light?
HP
1187
What is the temperature and time for a washer disinfector
93C (199F), 10 minutes
1188
Washer sterilizer temp
285F (washer followed by short steam cycle)
1189
Washer pasteurizer temp and time
70C (158F), 30 min
1190
Time required for most liquid chemical sterilants
3-12 hours
1191
Time and temp for paracetic acid as a liquid chemical sterilant
12 minutes @ 50-56C (122-132F)
1192
Limitations to liquid chemical sterilants
Cannot be wrapped
1193
Generally what are the most resistant organisms to disinfection?
Prions Spores oocysts and eggs Mycobacteria
1194
What are the most susceptible organisms to disinfection?
Most viruses Vegetative fungi Vegetative bacteria
1195
What are examples of high temperature sterilization with processing times?
Steam: 40 minutes Dry heat 1-6 hours
1196
What are the types of low temperature sterilization and their processing times?
- Ethylene oxide gas (15 hours) - Hydrogen peroxide gas plasma (28-52 minutes) - Ozone (4 hours) - Hydrogen peroxide vapor (55 minutes)
1197
Least preferred sterilization method because items cannot be wrapped and difficult to maintain sterility
Liquid immersion sterilization
1198
What is the heat-automated HLD method, and it's processing time?
Pasteurization (65-77C, 30 min)
1199
Describe intermediate level disinfectants. What can they be used on?
EPA-registered hospital disinfectant with claim against tuberculocidal activity Noncritical patient care items
1200
Low-level disinfection descriptions
EPA registered hospital disinfectant with no TB claim
1201
Peracetic acid/ hydrogen peroxide advantages
- no activation required - odor or irritation not significant
1202
Peracetic acid/ hydrogen peroxide disadvantages
- material compatibility concerns- cosmetic and functional (lead, brass, zinc) - Limited clinical experience - potential for eye/ skin damage
1203
Glutaraldehyde advantages
- Numerous use studies published - relatively inexpensive - excellent material compatability
1204
Glutaraldehyde disadvantages
- 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
Hydrogen peroxide advantages
- 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
Hydrogen peroxide disadvantages
- material compatibility concerns- cosmetic and functional (brass, zinc, copper, and nickel/ silver) - serious eye damage with contact
1207
Ortho-phthaladehyde (OPA) advantages
- 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
Ortho-phthaladehyde (OPA) disadvantages
- 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
Advantages of peracetic acid
- 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
Disadvantages of peracetic acid
- 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
Advantages: Improved hydrogen peroxide
- 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
Disadvantages of improved HP
- material compatibility concerns due to limited clinical experience - organic material resistance concerns due to limited data
1213
Advantages Steam sterilization
- 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
Disadvantages of steam
- deleterious for heat sensitive instruments - microsurgical instruments damaged by repeated exposure - may leave instruments wet, causing them to rust - potential for burns
1215
Advantages of HP gas plasma
- 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
Disadvantages for HP Gas plasma
- 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
Advantages of ethylene oxide
- 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
Disadvantages of ETO
- 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
Advantages of vaporized hydrogen peroxide
- 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
Disadvantages of HP vapor
- 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
Who should be involved with decisions to reprocess SUDs?
-Admin -Risk assess - Legal - Supply chain admin - Infection control
1222
How often to test HLD?
Daily, discard if chemical indicator shows chemical is < minimum Discard at end of re-use life per manufacturers instructions
1223
What are the advantages of AERs?
- 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
What are the disadvantages of automated endoscope reprocessors
- 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
Should you do environmental sampling in sterile processing?
No, only if there is epi risk
1226
Filter for sterile storage room
HEPA
1227
What is the shelf life for re-processed endoscopes?
7 days
1228
What infections have been transmitted by improperly disinfected GI endoscopes?
Salmonella Pseudomonas Over 150 infections transmitted
1229
What infections have been transmitted by improperly disinfected bronchoscopy equipment?
Mycobacterium tuberculosis NTM Pseudomonas aieruginosa
1230
Steps to reprocessing endoscope
1. clean (water and enzymatic cleaner) 2. disinfect (immerse) 3. rinse 4. dry (forced air + alcohol) 5. store
1231
Removes fine soil from instruments after manual cleaning, before HLD and sterilization
Ultrasonic cleaner
1232
What type of water should be used in an automated washer/ disinfector
RO or DI
1233
How often does AAMI recommend monitoring washier disinfectors with a challenge test? and what does the challenge test entail?
Once a week Challenge test mimics protein, dried blood, polysaccharides
1234
When do you complete the instrument inspection?
Clean side, after cleaning, before HLD or sterilization
1235
Chemical indicator: external time/ temp/ and pressure (says item went through the autoclave, on tape or peel pack)
Class 1
1236
Chemical indicator: Bowie Dick test- looks at efficiency of air removal
Class 2
1237
Chemical indicator: Internal time and temp (rarely used)
classs 3
1238
Chemical indicator: internal, reacts to two or more parameters (rarely used outside of ETO)
class 4
1239
Chemical indicator: integrators- melted chemical pellet reacts to all parameters in steam cycle
Class 5
1240
Emulating indicators- cycle specific
Class 6
1241
What type of sterilizer is the Bowie Dick test used in?
Pre-vac (not gravity)
1242
How often should the Bowie Dick test be run?
Daily
1243
What does the class 5 chemical indicator measure (integrators)
time, temp, steam Add to each layer in the most challenging place
1244
When you run a biological indicator, you should also run a ______
Control
1245
When to use BI
- during installation of sterilizer - once daily (before first load for steam and HP - Every gravity steam load - every ETO load - all implant loads
1246
Where to place BI in steam sterilizer
Loaded chamber over drain (coolest part of sterilizer)
1247
Where to place BI in gas sterilizer
Middle of loaded chamber
1248
Where to place BI in HP sterilizer
Lowest shelf towards back of chamber
1249
Causes of sterilization failure
- 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
What is used to vaporize HP in HP gas plasma sterilization?
Radio frequency
1251
Probability of microbe surviving sterilization is 1 in ______
1,000,000
1252
Probability of single viable microbe living on product after sterilization
Sterility assurance level
1253
What is the SAL before and after sterilization?
Sterility reduces microbe from 10^3 to 10^6
1254
Types of high temp steam sterilizers
1. Gravity Displacement (250 F) 2. Dynamic air removal (270-275F)
1255
Types of Dynamic air removal steam sterilizers
1. pre-vac steam sterilizer (sucks out the air) 2. Steam flush pressure pulse sterilizer (above atmospheric pressure)
1256
Parameters of steam sterilizer
1. steam 2. pressure 3. temperature 4. time
1257
Steam process
1. conditioning 2. exposure 3. exhaust 4. drying
1258
Gravity displacement sterilizer exposure time and temp
250 for 30 minutes
1259
Dynamic air removal pre-vac steam sterilizer exposure time and temp
270 for 4 minutes
1260
Time and temp for IUSS
132C (270) for 3- 10 minutes
1261
Exposure time and aeration time for ETO
2.5- 6 hour exposure 8-12 hour aeration
1262
How ETO works to sterilize
Alkylation
1263
BI spore to test ETO
Bacillus atrophes
1264
BI to test most sterilizers
Geobacillus stearothermophilus
1265
What materials are not compatible with HP gas plasma
-liquids/ powders - materials that absorb liquids - items with cellulose (cotton, paper, linens, towels, gauze, sponges)
1266
Run time for HP gas plasma sterilization
28-75 minutes
1267
Run time for ozone sterilization
4 hours 15 minutes
1268
rendering item safe to handle
Decontamination
1269
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
Parametric release
1270
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
Stated value
1271
Where should the decontamination air be exhausted?
outside
1272
PPE for decontamination
- Gloves (heavy duty) - Fluid resistant mask - Eyewear - Gown - shoe covers - surgical attire (hc laundered scrubs) No long nails or polish, no jewelry
1273
Instrument sets going into the sterilizer should not weigh more than ____ lbs
25 lbs
1274
What are the types of packaging materials?
- textile wraps (woven- reusable/ nonwoven- disposable) - Peel pouches - rigid containers (metal or plastic)
1275
When are peel pouches preferred?
When visibility is important
1276
Which side of peel pouch can you write on?
plastic side only
1277
What are the parameters of sterilizers that must be tracked?
- Temperature - time - pressure - vacuum levels - moisture conditions/ relative humidity - chemical concentrations - adequate air removal
1278
If physical monitors of sterilizer are not correct, what next?
- Do not release for use - notify supervisor to initiate follow-up - recall items in load
1279
When to read external CIs
When unloading sterilizer, dispensing/ issuing for use, and before item opened in ER
1280
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
No
1281
Documentation for sterilization
- 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
Where should heavy items be stored in sterilized item storage?
middle shelf
1283
Item sterile unless integrity of packaging compromised
Event related sterility
1284
What compromises event related sterility
- 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
Who regulates sterile processing?
OSHA EPA FDA
1286
Who makes recommendations for sterile processing?
HICPAC AAMI AORN FGI
1287
What document regarding disinfection and sterilization do TJC and CMS use for accredidation?
ANSI/ AAMI ST 79- Comprehensive Guide to Steam Sterility in HCF
1288
Sink requirements for decontamination
3 bay sink Clean Initial rinse Final Rinse
1289
How far do sinks need to be from the floor in decontamination? How deep?
36 inches from floor 8-10 inches deep
1290
How often to change enzymatic cleaner
After each use (no antimicrobial)
1291
How often to run cleaning verification tests? (ie bioluminescence markers/ cavitation testing in ultrasonic cleaner)
Daily
1292
How often to empty, clean, and disinfect ultrasonic washer
@ least daily, better if after each use
1293
How to disinfect ultrasonic cleaner
wipe with 70-90% alcohol Dry with lint-free cloth
1294
How often to test washer/ disinfectors and washer/ decontaminators
daily
1295
What level of disinfection does a cart washer/ disinfector offer?
low-intermediate level disinfection
1296
How often to test/ clean cart washer/ disinfector?
daily
1297
How often to test AER and how often to use CI or test strip?
Weekly testing Use test strip or CI before each use
1298
Process for manual cleaning verification
- visible inspection (with magnifying glass or camera) - test with soil/ protein/ ATP and or hemoglobin tests
1299
What is considered clean?
<6.4 ug/cm^2
1300
How often to test manual cleaning process
Daily when new types of equip used Test endoscopes and difficult to clean items
1301
How often to test mechanical cleaners
daily, on all cycles installation after major repair new type of solution
1302
What is the test for ultrasonic cleaners?
Cavitation test (aluminum foil videos online)
1303
Documentation required for HLD solution
Shelf life Date opened Use-of life open container Date activated/ diluted/ poured Re-use life of solution
1304
Tips for loading the sterilizer
- 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
Tips for unloading the sterilizer
- 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
What tests need to be run after a sterilizer is installed, relocated, malfunctioning, repaired, or had a process failure?
3 BI PCD (preferably from different manufacturers) follow with 3 Bowie dick run on shortest cycles
1307
What regulatory agency approves chemical indicators?
FDA
1308
What to do if CI fails
Return load to SP SP investigates Do not use machine again until BI PCD known
1309
What chemical indicators are typically used for steam sterilizers?
Type 5 or 6 CI
1310
What chemical indicators are typically used for EO sterilizers?
Type 4 or 5
1311
How often should routine monitoring happen for sterilizers?
At least once a week, but daily preferred
1312
How often to use BI in EO sterilizer
each use
1313
How often to use BI with HP sterilizer
at least daily
1314
Steps to recalling sterilized loads:
Review log of items in load Retrieve unused items ID cause of failure Quality testing Recall report Surveillance of involved patients
1315
How often to clean and decontaminate reusable brushes for deontamination
Daily but preferably before each use
1316
Objectives of product evaluation
- good performance - good patient outcomes - safe - cost effective
1317
what characteristics make a product evaluation program successful?
- executive oversight and support - culture embraces product evaluation - data-driven decision making process
1318
Benefits of product standardization
- reduces inventory - HCP more comfortable with product
1319
What should be part of the cost considerations during product evaluation?
- cost of product - costs beyond product (re-training staff)
1320
% breakdown of time product evaluation committee should spend on cost and utilization
20% cost/ 80% utilization
1321
Who should be on the product evaluation steering committee?
Sr. admin nursing exec med exec supply chain exec finance exec quality improvement exec PEC leaders
1322
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
Team leader or chairperson
1323
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
Administrative representative
1324
Who has this role on the product evaluation committee? - provides supporting information on clinical need and product relevance - champions PEC program to medical staff
physician reps
1325
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
Facilitator
1326
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
Recorder/ Secretary
1327
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
Team members
1328
IP role in product evaluation
assess product safety and consider cost and potential infection risks of products
1329
The product evaluation process (8 steps)
1. ID need for product (review and if needed, assign PM) 2. Develop functional product specs 3 review literature, product info, other product uses 4. review safety/ IP implications 5. Develop product trial protocol 6. Conduct product trial 7. Evaluate trail results 8. present to PEC- final decision
1330
What needs to happen after a product is selected?
Train employees on use complete post-implementation surveillance
1331
OSHA BBP mandates for selecting needles/ sharps
- safety engineered sharps/ needleless systems - solicit input from front-line workers - document solicitation in exposure control plan - maintain sharps injury log
1332
What is the process to reprocess single use devices?
Decontaminate Functional testing Repackage Relabel Sterilize
1333
What forms are required for reprocessing Class 1 and 2 SUD?
FDA Pre-market notification 510K
1334
What forms are required for reprocessing class 3 SUD?
premarket approval application
1335
Can facilities reprocess SUD on site?
No, should use third party and recommend site visit
1336
What cannot be reprocessed?
Hemodialysis filter implants non-hosp setting equip
1337
General components of licensing and agreements with FDA for reprocessing SUD
- 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
Strategy to assist facilities in using their own NHSN data to generate reports that help target infection prevention efforts to areas of greatest need
Targeted assessment for prevention (TAP)
1339
CMS requirement for IPs at hospitals
- Hospitals must have active, hospital wide program for surveillance, prevention, and control of HAIs and other infectious diseases - Antimicrobial stewardship program
1340
The US HHS wrote the National Action Plan to Prevent HAI: Roadmap to Elimination. What are it's targets?
- CLABSI - CAUTI - SSIs - Incidence of invasive HAI MRSA - MRSA BSI - C. Diff infections - C. diff hospitalizations
1341
What are the principle goals for infection prevention and control programs?
1. protect the patient 2. protect HCP, visitors, and others in the healthcare env 3. cost-effectively accomplish the previous goals whenever possible
1342
What are the principle functions of IPC programs?
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
Multidisciplinary IP committee (not required by TJC)
- nursing - admin - EVS - Laboratory - engineering - pharmacy - building management - physicians - surgeons
1344
IPC responsibilities
- education - consultation - surveillance - implementation science - patient safety - quality improvement
1345
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
Infection prevention committee
1346
Once certified, what is the next development step?
Proficient practioner bridge
1347
What is the APIC opportunity for advanced professionals?
Fellow of APIC (FAPIC)
1348
Cost effectiveness: Economic evaluations- types of economic analysis studies
1. cost effectiveness 2. cost utility 3. cost-benefit
1349
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
Cost-effectiveness
1350
This economic analysis adjusts the benefits of a specific intervention in terms of health prevention sores (ie quality of life years (QALY) gained(
Cost-utility
1351
This economic analysis looks at outcomes in terms of cost
cost-benefit
1352
Aside from cost-savings, what other benefits from IP programs can be measured?
- regulatory compliance - decreasing malpractice claims - protecting employees from injury - assisting in pt safety efforts - enhancing org. image
1353
7 step method to create a business case
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
What is the goal of the IP annual risk assessment?
To set priorities and obtain support from key stakeholders
1355
What are the steps for setting priorities in the IP annual risk assessment?
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
What should be identified in the IP annual risk assessment?
High-volume, high-risk, and problem-prone activities
1357
What should the IP annual risk assessment be based upon?
Strategic goals and institutional findings from previous year's activities
1358
How to measure quality of ICP program
- customer satisfaction - appropriateness - efficacy - timeliness - availability - effectiveness - efficiency
1359
Who mandates an IP annual evaluation?
TJC
1360
What is included in the annual evaluation?
- achievements and activities of the program and support requirements - emphasize value of IPC program to organization - Patient outcomes and cost savings
1361
Who should get copies of the IP annual evaluation
Widely disseminate to leaders throughout the organization (execs)
1362
Professional & Practice Standard domains of infection preventionist
1. leadership 2. professional stewardship 3. research 4. IPC operations 5. quality improvement 6. IPC informatics
1363
IP domain that includes communication, critical thinking, collaboration, behavioral science, program management, and mentorship
Leadership
1364
IP domain that includes accountability, ethics, financial acumen, population health, continuum of care, and advocacy
Professional stewardship
1365
IP domain that involves IP as a subject matter expert, performance improvement, patient safety, data utilization, risk assessment and risk reduction
Quality improvement
1366
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
IPC operations
1367
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
IPC informatics
1368
IP domain that includes evaluation of research, comparative effectiveness research, implementation and dissemination science, and conduct or participate in research or evidence based practice
Research
1369
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.
Novice
1370
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
Becoming proficient
1371
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
Proficient
1372
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
Expert
1373
What are APIC's professional development tools?
- Roadmap for the novice IP - Self-assessment tool - Proficient practioner bridge
1374
Benefits of IP certification per studies
- 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
Agency that makes advisory reports for hospital execs, follows regulatory issues with HAIs, and maintains hospitals in pursuit of excellence
American Hospital Association
1376
Agency focused on using science based research to improve IP
Association for Professionals in Infection Control and Prevention (APIC)
1377
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
CDC
1378
Agency responsible for conditions of participation, conditions for coverage, and tie HC quality to medical reimbursement through value based purchasing
CMS
1379
What IP related items does CMS require?
IPC program Antimicrobial stewardship program
1380
IP certification board
Certification board of infection control and epidemiology (CBIC)
1381
What does the FDA regulate?
- Drugs/ biologics for human use - reprocessed equip - medical devices - antimicrobials - PPE - Device recall
1382
What does the EPA regulate?
- hazardous waste and chemicals into env - germicides applied to surfaces
1383
This agency provides IP education, position papers, a journal, and compendium of strategies to prevent HAIs in acute care hospitals
Society of Healthcare Epidemiologists of America (SHEA)
1384
Federal agency that protects health of Americans, and made HAIs a priority with the Roadmap to HAI elimination
U.S. Health and Human Services (HHS)
1385
Agency that focuses on HAI innovation and implementing change
Institute of HC improvement
1386
Accrediting agencies
The Joint Commission DNV-GL
1387
Regulate the types of devices used for employee protection (respirators, sharps, PPE)
National Institute for Occupational Safety and Health (NIOSH)
1388
Regulate work related safety
Occupational Safety and Health Administration (OSHA)
1389
IP regulations from OSHA
BBP standard of 1991, with 2001 update for sharps General duty clause- TB Respiratory protection standard
1390
What should training and education be linked to?
An organizations vision, mission, and values
1391
What are learning outcomes for HCP?
- increased competence in ID'ing problems - critical thinking - managing existing situations - coping effectively with stress
1392
Describe the adult learner
Autonomous and self-directed Goal-oriented Relevancy oriented Practical
1393
What are the three types of learning in Bloom's taxonomy?
Cognitive- mental skills (knowledge) Affective- growth in feelings or emotional areas (attitude of self) Psychomotor- manual of physical skills (Skills)
1394
Bloom's taxonomy levels
remembering Understanding Applying Analyzing Evaluating Creating
1395
Can the learned recall or remember the information? Define, duplicate, list, memorize, recall, repeat, reproduce
Remembering
1396
Can the learner explain the ideas or concepts? Classify, describe, discuss, explain, identify, locate, recognize, report, select, translate, paraphrase
Understanding
1397
Can the learner use the information in a new way? Choose, demonstrate, dramatize, employ, illustrate, interpret, operate, schedule, sketch, solve, use, write
Applying
1398
Can the learner distinguish between the different parts? Appraise, compare, contrast, criticize, differentiate, discriminate, distinguish, examine, experiment, questoin, test
Analyzing
1399
Can the learner justify a stand or decision? Appraise, argue, defend, judge, select, support, value, evaluate
Evaluating
1400
Can the learner create new product or point of view? Assemble, construct, create, design, develop, formulate, write
Creating
1401
Amount that people retain by passive learning
5-30%
1402
Amount that people retain by active learning
50-90%
1403
Methods for active learning
Discussion group (50% retention) Practice by doing (75% retention) Teach others/ immediate use learning (90% retention)
1404
Methods for passive learning
Lecture (5% retention) reading (10% retention) Audio-visual (20% retention) Demonstration (30% retention)
1405
Methods for educational needs assessment
- 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
Statements that communicate the intent of the curriculum and provide a direction for planning the education session (time and resources are defined)
Goals
1407
Specific actions the learner will perform as a result of instruction (must be measurable and should use action verbs
Instructional objectives
1408
Three common learning assessment tools
Koln's learning style inventory Dunn, Dunn, and Price Productivity Env preference survey VARK inventory
1409
Kolb learning style inventory- prefers concrete experience and active experimentation
Accomodative
1410
Kolb learning style inventory- prefers abstract conceptualization and reflective observation
Assimilative
1411
Kolb learning style inventory- prefers concrete experience and reflective observation
Divergent
1412
Kolb learning style inventory- prefers abstract conceptualization and active experimentation
Convergent
1413
What does the Dunn, Dunn, Price and productivity preference survey determine preferences for?
- Environmental (surroundings) - Sociological (study alone or in groups) - physical (visual, auditory, kinetic) - emotional (responsibility, persistence, motivation)
1414
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
Expert
1415
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
Formal authority
1416
Grasha teaching style: the IP coaches, demonstrates, and encourages a more active learning style
Demonstrator or Personal Model
1417
Grasha teaching style: Learner-centered, active learning strategies are encouraged. The accountability for learning is placed on the learner
Facilitator
1418
Grasha teaching style: The IP role is that of a consultant and the learners are encouraged to direct the entire learning project
Delegator
1419
What should be evaluated for an IP educational program?
- appropriateness of program design - adequacy of teaching and instructional resources - knowledge, skills, and attitudes learned by participants
1420
What are the evaluations?
Formative and summative evaluation Pre/post test Observation of practice Exit questionnaires Interviews
1421
Educational evaluation conducted during the planning of the educational session to provide immediate feedback and allow appropriate changes to be made
Formative evaluation
1422
Education evaluation that occurs after the program is completed to determine the impact and overal effectiveness
Summative evaluation
1423
In every community, someone doses something better than their peers although they have the same resources
Positive deviance
1424
Parts of creating a network map
1. initial network 2. current network 3. innovation network 4. project network 5. potential network 6. social network
1425
Social network analysis metrics
1. awareness 2. connector 3. integration
1426
When is lecture appropriate
More complex, high volume topics- symposiums and panels QA time is improtant
1427
When is train the trainer appropraite
training large numbers of staff over short span of time Leader guides train person responsible for implementing program and training staff
1428
What is a leader guide for train the trainer?
Simply written goals and objectives, course outline, instructional methods, references, and evaluation
1429
Benefits of mentoring programs
Cost-effective, cross-training
1430
Education that may be better suited to get information to employees on night shift
Education charts
1431
HCP IP competency framework
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
Objectives of performance improvement program
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
Steps to move from novice to proficient
- CIC - Consider advanced degree in field - serve in leadership position in local APIC chapter
1434
Agency for HC Research Quality IP intiatives
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
What are the management types of power?
Coercive Expert Legitimate Referent Reward
1436
Manager threatens with punishment
Coercive
1437
Manager has special knowledge, experience and skills
Expert
1438
Manager was appointed or elected
Legitimate
1439
Manager looks to individual group members and respects community beliefs
Referent
1440
Manger grants something a person desires or removes what they do not
reward
1441
Agency that coordinates all federal QI efforts, key organization after to err is human
Agency for Healthcare Research and Quality (AHRQ)
1442
What subjects require written IP polciies?
- staff and pt care practices - construction/ renovation - emergency management - occupational health - sterilization/ disinfection
1443
6 basic functions of a manager
- plan - organize - staff - lead - control - motivate
1444
Deficit reduction act requires hospitals to report HAIs that are...
High/cost high/volume secondary dx- with a higher payment dx related group Could have been prevented
1445
What are the staffing requirements for ambulatory care?
- 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
What do most IPs spend about 50% of their time doing?
Collecting, analyzing, and interpreting data on the occurrence of infections
1447
Steps for positive devience
1. Define 2. Determine 3. Discover 4. Design
1448
Precede/ proceed model components
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
Parts of the health belief model
Perceived security/ susceptibility Modifying factors (demographics) Perceived threat Cues to action (heightened awareness) Benefits minus barriers Self-efficacy All: Likelihood of action
1450
Parts of social cognitive theory
Person Behavior Environment
1451
Parts of transtheoretical model/ stage theory
1. Precontemplation 2. contemplation 3. preparation 4. action 5. maintenance
1452
Which stage of transtheoretical approach: mixed communications to highlight the problem of infection spread in hc settings
Precontemplation stage
1453
Which stage of transtheoretical approach: communications and role modeling to show advantages, minimize disadvantages of best practice
Contemplation stage
1454
Which stage of transtheoretical approach: ID resources and provide training for best practice techniques
Preparation group
1455
Which stage of transtheoretical approach: coaching, training, reinforcing self-efficacy to master best practices, provide social reinforcement
Action group
1456
Which stage of transtheoretical approach: Continue reinforcement, peer support, highlighting best practice compliance in small group settings
Maintenance group
1457
Goals of SSI surveillance plans
- ID risk factors for infection and adverse events - implement risk reduction measures - monitor effectiveness of interventions
1458
What to review in SUD site-visit
1. Policies 2. Cleaning and decontamination 3. inspection and testing 4. sterilization load prep process 5. quality control measures
1459
Pneumatic tube spill processes
- method to recognize spills/ leaks - communication protocol - cleaning and decontamination - retrieval of stuck items - restoration system
1460
Process for SPD if single positive indicator is in a load with no implants
Check log- used correctly? Contact maintenance Test again- 3 consecutive cycles with paired BI from dif manufacturers
1461
Maintenance of refrigerator/ freezers
- 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
How can IP support antimicrobial stewardship?
- 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
Incubation period pneumonic plague
2-4 days (1-6 days)
1464
Pneumonic plague precautions
droplet until 48 hours after appropraite antimicrobials and clinically improving
1465
SSI score components- what makes up risk index score
+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
How to test for anthrax
- measure antibodies or toxin in blood - test for B. antrharics in blood, skin, CSF, or resp secretions
1467
What is included in the budget/
- planned sales/ revenue - Resource quantities - costs and expenses - assets - liabilities - cash flow
1468
What makes a good performance measure
- evidence-based - well defined - clinically important for patient populations - broadly applicable in dif types of facilities
1469
Ideal active/ passive education ratio
60/40
1470
What should goals and objectives in the annual risk assessment be based off of?
- strategic goals - data and findings of previous year - resources and data system needs - reviewed in context of goals
1471
Used to measure efficiency of production, measures output:inputs
productivity
1472
3 things that performance improvement focuses on
1. clinical outcomes 2. customer service 3. customer satisfaction
1473
How long is bleach in a spray/ brown opaque bottle stable for?
30 days and retain 50% concentration
1474
How short-term IVDs get infected
- cutaneous - extraluminal - occasionally intraluminal
1475
How long-term IVDs get infected
- contamination catheter hub - luminal fluid
1476
Process for sentinel surveillance
Collect data from sample of reporting sites Example- monitoring chickens for antibodies to arboviruses
1477
What type of data can a run chart be used with?
Any numeric data (discrete or continuous)
1478
IP for CRE
- 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
How PFGE works and what it is used for
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
Describe discrete data
Categorical or noncategorical Whole #s, mutually exclusive Example: infected/ not infected, male/ female
1481
Describe noncategorical data
Can count events, but not non-events Ex) patient falls/ 1000 pt days
1482
Describe categorical data
Counts events and non-events Ex) 10 SSIs in 100 surgical cases = 10 events, 90 non-events
1483
Describe continuous data
Numeric values between the minimum and maximum Ex) age, serum cholesterol level Measurements
1484
What does the RCA determine?
- human and other factors - process of systems involved - underlying causes/ effects of process - risks and potential contributions to failure or adverse events
1485
Steps to an initial OB investigation
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
Conducting the needs assessment ID deficiencies in....
- knowledge - skills - attitudes
1487
How is surveillance used?
- ID risk factors of infections and adverse events - implement risk reduction measures - monitor effectiveness of interventions
1488
Human factor limitations that contribute to error:
- limited memory capacity - negative effects of stress - negative influence fatigue - overdependence on multitasking
1489
5 TJC IP standards
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
Describe the model for improvement
Part 1: 1. set aims 2. establish measures 3. select changes that will make improvement Part 2: test changes in PDSA
1491
What are the outcomes for low nurse staffing levels?
Increased: - pneumo - shock - cardiac arrest - UTI Increase in non permanent staff leads to increase in HAIs
1492
List of HAIs, most common to least common
1. Pneumo 2. SSI 3. GI 4. UTI 5. BSI
1493
Top HAI organisms, from most common to least common
1. C. Diff 2. Staph 3. Klebsiella 4. E coli 5. Enterococcus 6. Pseudomonas
1494
What is included in a business plan?
- set of business goals - reasons goals are attainable - plan to reach the goals
1495
What are the goals of human factors engineering?
Minimize errors by: - improving efficiency - creativity - productivity - job satisfaction
1496
What law requires meaningful use of EHR?
American Recovery and Reinvestment Act
1497
Failure of planned action to be completed as intended or use of wrong plan to achieve an aim
Medical error
1498
Serious, undesirable, unanticipated pt safety event that resulted in harm to the patient
Adverse event
1499
Event that results in death, permenant harm, or severe, temporary harm
Sentinel event
1500
Common causes of medical errors
- communication problems - inadequate info flow - human probelms - pt related issues - org transfer knowledge - staffing patterns/ workflow - tech failures - inadequate policies and procedures
1501
Standardized terminology and classification schema for near misses and adverse events
Public safety taxonomy
1502
What are the patient safety event taxonomy classifications:
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
Within how many days of an event does the RCA have to be completed?
45 days
1504
Systematic study of elements involving human-machine interface with the intent of improving working conditions or operations
Human factors analysis
1505
Research in human pysch, social, physical, and biologic characteristics, concerned with design of tools, machines, and systems that consider human capabilities, limitations, and characteristics
Human Factors Engineering
1506
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
Error wisdom
1507
Reasons for error types in error wisdom
1. skill based (slip or lapse) 2. rule based (how taught) 3. knowledge based (new situation)
1508
Study of a process to achieve a failure free operation over time to reduce process defects and improve system safety. Includes resilience
Reliability science
1509
Intrinsic ability of system to adjust and sustain operations during periods of stress or after an event
resilience
1510
5 Principles of reliability science
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
Parts of FMEA
- 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
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
Culture
1513
Patient safety culture: why waste time on safety?
Pathological
1514
1515
Patient safety culture: Do something when there is an incident
Reactive
1516
Patient safety culture: Systems in place to manage all identified risks
Bureaucratic
1517
Patient safety culture: always on alert for risks that might emerge
Proactive
1518
Patient safety culture: risk management is an integral part of everything we do
Generative
1519
What makes a strong safety culture?
- generative - uneasy about risk - constantly seek best practices - look for where next mistake will happen - work to prevent next mistake
1520
Everyone holds each other accountable for patient safety
Reciprocal accountability
1521
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
Ergonomics
1522
What do HCP want after they are involved with a patient safety event?
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
Sets direction for where organization will go in the future, and what the organization must do to reach goal. mission, or vision
Strategic Plan
1524
What are TJC requirements for the IP strategic plan
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
Part of multi-disciplinary quality concept team- expert on team process, not process under review
Facilitator
1526
Part of multi-disciplinary quality concept team- manager with process knowledge
Team leader
1527
Part of multi-disciplinary quality concept team- front line employees
team members
1528
Steps for failure mode effect analysis
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
Parts of the six sigma/ lean approach
Define Measure Analyze Improve Control
1530
Number of data points that run chart is best for
<25
1531
Number of data points control chart is best for
25-50
1532
valid and reliable indicator that can be used to monitor and evaluate quality of functions that affect patient outcomes
measure
1533
Does it measure what it's intended to measure?
valid
1534
Does it accurately and consistently ID events it is intended to ID across multiple HC settings?
Reliable
1535
Tool that provides an indication of organizations performance in relation to a specified process or outcome
Performance measure
1536
Performance measure designed to evaluate the processes or outcomes of care associated with delivery of clinical services (condition specific, procedure specific)
Clinical measure
1537
Measure that indicates result of performance
Outcome measure
1538
What should be considered for outcome measures?
- cost/ benefit - pt satisfaction Ex- clean needle exchange or pt dissatisfaction with iso
1539
Measure that evaluates compliance with pt care activities
Process measure
1540
What measure is best for uncommon outcomes?
Process measure
1541
Chart for when comparing relationship between points is more important than the exact values of the data points
Bar graph
1542
Best chart for how categories relate to each other with respect to a whole
Pie chart
1543
1543
1544
1545
Diseases seen in neutropenia from HSCT patients
Gram negative aerobes Gram positive cocci Candida Aspergillus Hsv
1546
Diseases seen in neutropenia from HSCT patients
Gram negative aerobes Gram positive cocci Candida Aspergillus Hsv
1547
Diseases seen hsct patients with cell mediated immunity
- Viruses (CMV, EBV, adenovirus, EBV, resp viruses) - Intracellular facultative bacteria (listeria, mtb, etc) - fungi- pneumocystis jerovecii - protozoa - toxo
1548
Diseases seen hsct patients with cell mediated immunity
- Viruses (CMV, EBV, adenovirus, EBV, resp viruses) - Intracellular facultative bacteria (listeria, mtb, etc) - fungi- pneumocystis jerovecii - protozoa - toxo
1549
Diseases seen in hsct patients with humoral immunity dysfunction
Encapsulated bacteria
1550
O
1551
Tjc standards
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
Tjc standards for ip program
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
Organizations process of defining its strategy or direction and making decisions on allocating its resources to pursue this strategy
Strategic planning
1554
Organizations process of defining its strategy or direction and making decisions on allocating its resources to pursue this strategy
Strategic planning
1555
What does the strategic planning process include?
Setting goals, determining actions to achieve the goals, and mobilizing resources to execute the action
1556
Planned objectives that a department or organization strives to achieve they must be clear and measurable
Strategic goals

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