Environment of Care (14 exam questions)

Question 1

Air supply and exhaust should move from

Answer 1

clean area to less clean area. The supply air usually enters a room from the ceiling, while the exhaust air usually leaves the room near the floor level

Question 2

OR pressure and ACH

Answer 2

*positive pressure (a differential pressure that exceeds to minimum of 2.5 Pascals required) and
*15 ACH (3 need to be fresh air)

Question 3

HVAC flow

Answer 3

1. air pulled from outside and passed through air cleaners to remove participles
2. air filtered again, adjusted for appropriate temp and humidify and supplied to facility
3. air returned from facility and brough back to HVAC, where it is exhausted to outside or some portion is missed with outdoor air intake

Question 4

hot water temperature should fall between

Answer 4

105 degrees and 120 degrees Fahrenheit. The CDC recommends keeping water at 124 degrees or higher and cold water at 68 degrees or below. prevent scalding and to control the growth of Legionnella.

Question 5

Outbreaks associated with water sources

Answer 5

Pseudomonas species, Legionella, Non-TB Mycobacterium (NTM)- mycobacterium fortuitum

Question 6

Pseudomonas species

Answer 6

Outbreak associated with
* direct contact with water, aerosols, transfer from wet surfaces, aspiration of water
* potential source: endoscopes with residual moisture, sinks, water baths, whirlpools, water in flower vases

Question 7

Legionella

Answer 7

*transmission: aspiration of water, inhalation of aerosols
*potential outbreak sources: showers and faucets, RT equipment, decorative fountains
(cooling towers- once into the facility’s potable water system it can spread)

Question 8

Non-Tuberculosis Mycobacteria (NTM)

Answer 8

*Infection or colonization transmission: direct contact, ingestion, aspiration, aerosolization
*Protentional source: inadequate sterilization of medical instruments, medical devices, surgical procedures, heater cooler, contaminated parenteral meds, community sources (tattoo, piercing), drinking water and ice, showers and faucets, hydrotherapy tanks
*mycobacterium fortuitum

Question 9

The most effective method of killing microbes during the laundering process is to wash linens in

Answer 9

hot water; at least 160°F for a minimum of 25 minutes.

Question 10

The water temperature range recommended by the CDC for
prevention of growth of Legionella bacteria is:

Answer 10

Hot water at 124°F and above and cold water at 68°F

Rationale: Legionella species are bacteria that are naturally found in water sources, including municipal drinking water. Infection with Legionella can occur through inhalation of aerosols containing the bacteria, and can result
in pneumonia. The optimum temperature range for growth of Legionella is
between 25°C and 42.2°C (77°F to 108°F) so the CDC recommendations have been made to maintain water temperatures that fall outside that range and are therefore not optimal for growth of Legionella.

Question 11

minimum efficiency reporting
values (MERV) is sufficient to meet minimum OR standards
for air filtration?

Answer 11

90 percent, which equates to a MERV of 14.

ASHRAE filtration rate

Question 12

OR airflow

Answer 12

Noninductional unidirectional infusion of air with a supply over the surgical table and an exhaust near the floor at the
periphery of the room

Rationale: Airflow in a healthcare facility should move from a clean area to
one that is considered to be less clean. In the OR, the air supply should be
from the ceiling near the center of the room, and the air exhaust should be
near the floor on the periphery of the room. Laminar airflow is not appropriate
for an OR setting, as there is evidence that this high rate of airflow may
induce hypothermia in the patient. A lower rate of air supply flow termed
noninductional unidirectional infusion is used in the OR.

Question 13

OSHA Bloodborne Pathogen requirements, the
appropriate concentration for household bleach used to clean up
a blood spill on a nonporous surface is:

Answer 13

1:100

If a spill occurs on a nonporous surface, a 1:100 dilution of
household bleach (one part plus 99 parts water or 0.25 cup of bleach in a
gallon of water) is a highly effective disinfectant and is the least expensive.
A 1:10 dilution of household bleach (one part household bleach plus nine
parts bleach water or 1.5 cups of bleach in one gallon of water) is required
for porous surfaces and large surfaces

Question 14

airborne infection
isolation room (AIIR) recommendations for this type of room in a new facility

Answer 14

*If the AIIR is a permanent, dedicated negative airflow room, then the air should exhaust to the outside
* The AIIR must have at least 12 air changes per hour
*Provide a local audible or visible alarm to indicate when the proper negative pressure relationship is not maintained

Question 15

The most reliable method to monitor
cleaning is

Answer 15

Environmental cultures using Rodac plates

This method allows direct detection and
counting of organisms from environmental surfaces, rather than relyingon a proxy that may detect cleanliness but not whether there has been anacceptable reduction in bio burden after cleaning

Question 16

Who approves antiseptics?

Answer 16

Food and Drug Administration (FDA)

approved by the FDA as antimicrobialagents safe for use on skin. They are not to be used for cleaning inanimateobjects or environmental surfaces because of their unproven efficacy
on nonhuman surfaces.

Question 17

most
environmentally friendly product for cleaning a patient care
room

Answer 17

Floors may be cleaned with a detergent if the room was not last
being used as an isolation room

Rationale: Detergents tends to be more environmentally friendly, less toxic,
and less likely to cause respiratory reactions than disinfectants. Disinfectants
must be used on horizontal surfaces and high touch surfaces in the patient
room, but detergents are acceptable for cleaning the floor provided that the
most recent occupant of the room was not on isolation precautions during
their stay.

Question 18

Sink placement and design have been implicated in several outbreaks of healthcare- associated infections. Sinks should be

Answer 18

*far enough away from patients and patient care areas to prevent splashing of water onto these areas.
*The sink basin should be deep enough to help prevent this splashing and the stream of water should not be directed immediately over
the drain because of the potential for aerosolization of microbes that can
contaminate the drain.
*Use of aerators should be discouraged because of the potential for biofilm development.

Question 19

Construction and renovation policies should include:

Answer 19

Authority for determining unit closure issues
and
Phasing and commissioning of projects

Question 20

An ICRA should be utilized for the design phase of a healthcare facility and for the active construction phase. ICRA elements to be included in the design phase are:

Answer 20

how many AII rooms and protective environments rooms will be in the facility and where they will be located, the needs and locations for air ventilation, the types of water systems to include, and which
finishes and surfaces are appropriate.

Question 21

OR airflow pressure and ACH

Answer 21

+ pressure >2.5 pascal
15 ACH (3 must be fresh air)

Question 22

outbreak associated with ice machine, most likely

Answer 22

mycobacterium fortuitum (Non-tb species)

Question 23

main air intake should be:

Answer 23

6 feet from the ground

Question 24

Contaminated equipment waterborne pathogen outbreak

Answer 24

Pseudomonas aeruginosa or non-tb mycobacteria