CVTE 113 Exam #1 Infection control and hospital safety

Question 0

NOSOCOMIAL INFECTION— Scope of problem:

In 1974, What percent of staph infections were antibiotic resistant? Today?

Answer 0

In 1974, 2% of staph infections were resistant to antibiotics.
Today, more than 60% are.

Question 1

PREVENTION OF

Answer 1

Spread of infection
Exposure to hazardous substances
Accidents
Injury to yourself (especially your back)

Question 2

How many people does MRSA infect annually in the USA?

How many does it kill?

How many infections are linked to health care facilities?

Answer 2

MRSA infects nearly 95,000 annually in the USA,

and kills more than 18,500.

85% of MRSA infections are linked to health care facilities.

Question 3

Line infections:
How many lines are in the ICU each year?
How many get infected after 10 days? per year?
What percent are fatal?
How many have serious complications of some kind?

Answer 3

5 million lines in ICU each year
After 10 days, 4% get infected: 80,000 per year
5–28% of these are fatal
About 1⁄2 have serious complications of some kind

Question 4

Hand-washing:
Washing your hands controls infection by what percent?
What is a nosocomial infection?
When to wash your hands, how long, how many inches above your wrist?

Answer 4

99% of the battle in controlling infection.
Nosocomial infection: caused by transfer of bugs in hospital.
Wash before and after each patient contact. 15 to 20-second wash is recommended, with plenty of soap and friction.
Go 3 inches above wrist.

Question 5

When is hand sanitizer okay?

Answer 5

Hand sanitizer is okay for routine patient contact, but you should wash hands periodically as well.
(Sanitizer may be replacing the surgical scrub? We’ll see.)

Question 6

What percent of men and women wash their hands after using public restrooms?
How many health care workers regularly wash their hands while on the job?
Physicians ties?

Answer 6

12% of women and 34% of men do not wash hands after using public restrooms.
Fewer than 50% of health care workers regularly wash their hands while on the job. A sampling of doctors’ ties found staph on 1/3 of them.

Question 7

Protective attire (PPE):

Answer 7

Gloves (many recommend for all patient contact)
Gown
Mask (especially for TB, other airborne diseases)
Goggles, to prevent fluids getting into eyes Look for isolation cart, sign on door, etc.

Question 8

Sharps:
recap safety?
where do you dispose of needles?
what do you do if you stuck yourself?

Answer 8

Be very careful with needles, scalpels, etc.
Never recap used needles— too easy to miss and stick yourself.
Use sharp disposal box (careful with that too…)
If you stick yourself, or even think you might have stuck yourself, report it immediately.

Question 9

What are Standard Precautions?
What is UP?
what is BSI?

Answer 9

Combine the major features of Universal Precautions (UP) and
Body Substance Isolation (BSI) Based on the principle that all blood, body fluids, secretions, excretions except sweat, nonintact skin, and mucous membranes may contain transmissible infectious agents.

Question 10

Who should you consider to be potentially infectious?

Answer 10

“Consider all personnel (patients and staff) as being potentially infectious.”

Question 11

Body fluids that can transmit disease:

Answer 11

Blood
Urine, Feces 
Semen, Vaginal secretions, Breast milk 
Saliva
Spinal fluid, Joint fluid

Question 12

When to Perform hand hygiene:

Answer 12

• Before having direct contact with patients.
• After contact with blood, body fluids or excretions, mucous membranes, nonintact skin, or wound dressings.
• After contact with a patient’s intact skin (e.g., when taking a pulse or blood pressure or lifting a patient).

Question 13

When to perform hand hygiene continued:

Answer 13

• If hands will be moving from a contaminated-body site to a clean-body site during patient care.
• After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient .
• After removing gloves.

Question 14

Wear gloves when it can be reasonably anticipated that:

Answer 14

contact with blood or other potentially infectious materials,
mucous membranes, nonintact skin,
or potentially contaminated intact skin (e.g., of a patient incontinent of stool or urine) could occur.

Question 15

When to wear Masks, goggles, face masks:

Answer 15

Protect mucous membranes of eyes, nose, and mouth when contact with blood and body fluids is likely.

Question 16

Summary of standard precautions:
Standard Precautions include the use of one or combinations of the following practices. The level of use will always depend on the anticipated contact with the patient.

Answer 16

-Handwashing, the most important infection control method
-Use of latex, nitrile, or other protective gloves (must be aware of possible latex allergy)
-Masks, eye protection, and/or face shield
-Gowns
Proper handling of soiled patient care equipment
-Proper environmental cleaning
-Minimal handling of soiled linen
-Proper disposal of needles and other sharp equipment such as scalpels
-Placement in a private room for patients who cannot maintain appropriate cleanliness or contain body fluids.

Question 17

Respiratory Hygiene (Cough Etiquette):
Measures to avoid spread of respiratory secretions should be promoted to help prevent respiratory disease transmission. 

Elements of respiratory hygiene and cough etiquette include:

Answer 17

Covering the nose/mouth with a tissue when coughing or sneezing or using the crook of the elbow to contain respiratory droplets.

Using tissues to contain respiratory secretions and discarding in the nearest waste receptacle after use.

Question 18

Respiratory Hygiene (Cough Etiquette): Performing hand hygiene:

Answer 18

hand washing with non-antimicrobial soap and water, alcohol-based hand rub, or antiseptic hand wash
immediately after contact with respiratory secretions and contaminated objects/materials.
Provide tissues and no-touch receptacles for used tissue disposal.

Question 19

Respiratory Hygiene (Cough Etiquette): in waiting rooms:
Supplies such as tissues, waste baskets, alcohol gel, and surgical masks should be provided in waiting and other common areas in local public health agencies. Place cough etiquette signs where the general public can see them.

Answer 19

• Asking clients with signs and symptoms of respiratory illness to wear a surgical mask while waiting common areas or placing them immediately in examination rooms or areas away from others.
• Spacing seating in waiting areas at least three feet apart to minimize close contact among persons in those areas.

Question 20

MRSA:

VRE:

MDR TB:

Answer 20

methycillin-resistant staph areus

vancomycin-resistant enterococcus

multi-drug resistant tuberculosis

Question 21

Blood-borne pathogens:
HIV:  
AIDS: 
Hepatitis B 
Hepatitis C

Answer 21

HIV: human immunodeficiency virus 
AIDS: acquired immunodeficiency syndrome 
Hepatitis B (there is a vaccine) 
Hepatitis C (there is not a vaccine)

Question 22

Types of transmission:

DAVID

Answer 22

Direct contact 
Airborne transmission 
common Vehicle transmission
Indirect contact 
Droplet transmission

Question 23

HIV/AIDS is Transmitted through direct contact with:

Answer 23

blood 
semen 
vaginal secretions 
breast milk
Most people asymptomatic for 10-12 years or more

Question 24

How do you get HIV/AIDS?

3 most common ways:

Answer 24

Sexual contact
Needle sharing
Pregnancy/childbirth (transmission to baby can be prevented…)

Question 25

How do you NOT get HIV/AIDS?

Answer 25

Food, air, casual contact, kissing, donating blood, receiving blood (good screening now)
Unlikely: sweat, tears, vomit, feces, urine, mosquitoes or fleas

Question 26

HIV For health-care workers, it’s almost always a:

Answer 26

needle stick. (~800,000 sticks/year)

If you get stuck, encourage bleeding, report immediately.
“If intact skin is exposed to HIV-infected blood, there is no risk of transmission.”

Question 27

HIV is easy or not easy to get?

Answer 27

HIV/AIDS is actually not easy to get unless you are foolish.

That doesn’t mean we should be complacent, just that we don’t have to panic either.

Question 28

How is Hepatitis B contracted?

why is it easier to catch than HIV?

Answer 28

Usually sexually transmitted or by sharps in clinical setting

Easier to catch than HIV (100 times more concentrated in the blood)

Question 29

How is Hepatitis A trasmitted?

Answer 29

Virus found in feces

Transmitted through fecal contact (household or sexual contact)

Question 30

Transmission between HIV and HEP virus?

Answer 30

Transmission is much the same as with HIV, but much easier for the Hep virus. Not as virulent a killer as HIV, but bad nonetheless. Can’t have alcohol, more likely to have cancer, likely to have portal hypertension/liver failure eventually.

Question 31

Transmission of Hepatitis C:

Answer 31

Also transmitted through:
body fluids, usually drug use.

No vaccine, no cure.

Question 32

Another bad bug: clostridium difficile

Answer 32

• Intestinal bacterium, getting more resistant
• Usually in elderly, usually following broad-spectrum antibiotic (killing the usual beneficial intestinal flora)
• Releases toxins causing flu-like symptoms, severe diarhhea
• Full-contact precautions

Question 33

Sidebar: Colds and flu

Hospital setting— potential for

Answer 33

• getting them

* giving them

Question 34

Most common illness in the world:

how many children, adults and over 60 does this illness effect per year?

Answer 34

common cold.
Children: 6–8 per year
Adults average 2–4 per year
Over 60 (no jokes, please): 1 or fewer

Question 35

Cold vs. flu: COLD

Answer 35

Starts gradually Slight temp after 24 hours
Normal appetite Slight headache
Stuffy nose, sneezing Sore throat
Tired

Question 36

Cold vs Flu: FLU

Answer 36

Starts rapidly Elevated temp in first 24 hours
Loss of appetite Severe headache
Muscular aches, pains Nausea and vomiting
Exhausted

Question 37

Colds and flu’s are:

Answer 37

Virus, not bacterium

DON’T TAKE ANTIBIOTICS!
There are nearly 200 different cold viruses.

Question 38

Both colds and flu are most infectious in their:

Answer 38

early stages.
Be alert for symptoms and stay away from work if you’re getting sick.
Don’t be a vector.

Question 39

Treating the cold:

Answer 39

1. Lots of fluids. Keep the mucus from getting thick.
2. Rest. Your immune system is busy.
3. Aspirin, acetaminophen, or ibuprofen for headache, muscle ache, fever.
4. Steam to relieve congestion of head and chest.

Question 40

Go to doc, urgent care, etc. if

Answer 40

Sore throat >48 hours
Inside of throat beefy red (not just pink)
Nasal running for >10 days
Severe facial pain or headache
Cough >10 days
Coughing is severe, painful, producing thick rusty or green mucus
Chest pain with breathing
Severe (>101°) and/or prolonged (> 4 days) fever

Question 41

Prevention of the spread of illness:

Answer 41

Wash your hands
Also, coughing/sneezing courtesy (into the elbow)
And get the flu shot. It’s good citizenship if you work in the hospital setting.

Question 42

Hospital CODES

Answer 42

Names may differ in different hospitals, but these are pretty mainstream.

Question 43

Code Blue:

Answer 43

Code Blue (life-threatening, cardiac arrest, etc.)
Stay out of the way unless you’re on Code Team.
Learn where call buttons and code buttons are (may be pull-cord)
Don’t look for nurse— use call buttons, phone to desk.

Question 44

CPR protocol:

Answer 44

Don’t try CPR alone. 
Need bed board. 
Avoid mouth-to-mouth (ambu bag). 
Know hospital code number. 
Hospital code: Code teams, crash cart

Question 45

Code Red (fire) RACE:

Answer 45

Rescue patient(s); get people away. 
Alert by pulling fire alarm, phoning operator. 
Close doors and windows to Confine fire. 
Extinguish if possible (but don’t try heroics). Use of extinguisher...aim at base of fire.

Question 46

In the event of a fire:

Answer 46

DON’T USE ELEVATORS— STAIRS INSTEAD.

DON’T USE PHONES (except for initial alert call). Don’t tie up lines.

Question 47

Code Green:

Answer 47

Code Green (help to subdue unruly person)

Use judgment… Often best to let security staff deal with it, but many able-bodied people just being there can help to defuse things.

Question 48

Other possible codes:
Violet or purple or amber or pink:
Brown:

Answer 48

Violet or purple or amber or pink: abduction of infant or child
Brown: cleanup

Question 49

PROCEDURE ON INPATIENT:

Answer 49

CHECK CHART FIRST! Orders, history, etc.
CHECK ARM BAND! Be sure you have right patient and right test.
Check patient history (H&P) for cardiac/vascular hx.
Might warn you about prosthetic valves, tubes, catheters, pulmonary problems, LE bypass grafts, etc. that might complicate your test.

Question 50

If unsure about test— purpose, question being asked—?

Answer 50

call the doc.

Question 51

Check with nurse about lines, positioning, possible contamination issues, pt. alertness or lack of

Items to be aware of and check with nurse about:

Answer 51

IV tubing
Bed rails: ALWAYS put back up before leaving, even for a short time
Nitro paste…don’t get it on ya
Patient positioning: check EKG after changing position (sometimes left side —> PVCs)
Restraints: wrist, ankle, Posey. Tie to frame, not rail. (Get nurse to help with re-doing these)
Foley catheter
Temporary pacemaker: be careful not to bump or change settings.

Question 52

TB patient:

Answer 52

gown, gloves, special isolation mask (facial hair…) Double-masking for > 20 min because of moisture allowing bacteria to get through mask.

Question 53

Shy patient (e.g., male tech, female patient):

Answer 53

might be good to get someone else in the room with you… [Never discuss patient’s condition with family or patient, or with nurse in their hearing.]

Question 54

PATIENT RELATIONS: How to address the patient?

Answer 54

You: Friendly, helpful, courteous.
Don’t be overly familiar: “Dear,” “Honey,” etc. (Unless you’re Helen)
Best to stick with formal name: Mr., Mrs.
Be friendly, but beware of excessive jocularity.
Calm, low-voiced competence is what you’d like to project.
Be the Patient-Whisperer.

Question 55

Difficult patients?

Answer 55

Patients can be difficult. Let them; don’t take it personally. Your job is to get a good test—often you can win them over in the process.

Question 56

Pain during procedure:

Answer 56

transducer on chest, on painful leg, cuff inflation, etc. Explain, use the minimum force necessary to get results, possibly distract with patter.

DON’T get into discussions with patients (or family) on their condition, the hospital, their doctor, your results, politics, etc.

Question 57

Patient conversations and test results:

Answer 57

Patients often talk to you more freely than to doctor.
Be alert for any new useful information (“My chest has started hurting”), but don’t try to diagnose.
“What did you see?” I can’t give you a report— a doctor interprets these tests.

Question 58

Patient Fear:

Answer 58

Patients are fearful of everything.
Even just getting temperature or blood pressure taken can arouse fear.
A patient is someone whose body is screwing up. They are fearful of what nasty surprise is coming next.
You probably can’t help that too much, but be aware that this fear can influence their behavior.
And don’t add to the fear.