Environment of Care Flashcards
When was the ICRA introduced?
in 1996 Guidelines for the Design and Construction of Hospital and Healthcare Facilities
When was the ICRA introduced as part of the planning and construction process?
2001
Who should complete the ICRA?
IP, safety, engineering, and HCPs that represent areas likely to be affected by the construction
Describe the IPs role on the ICRA team
- assess the needs and risk of patient population to be affected by the construction
- address the IPAC needs of the patients and HCP that will occupy the space after construction
- providence IPAC guidance to the design team
the FGI guidelines specify which design elements that the ICRA must address?
-isolation rooms for protective environments and airborne isolation
-special heating, AC/ventilation needs
-water and plumbing issues (waterborne pathogens, HH sinks)
-selection of finishing and furnishing materials
Define infection control risk mitigation recommendations
written recommendations describing how the transmission of biological contaminants from construction zones will be controlled.
what types of isolation rooms are there?
-airborne
-protective environment
-or a room that does both (rooms designed as a combination must have an anteroom)
When designing an isolation room, what are some things to consider?
-number
-types
-patient population
-experience with communicable diseases
-resources available in the community
-mission and program goals of the facility
True or false. Ventilation standards in the FGI do not support designs where the isolation room is converted from an AII to PE room by switching airflows
True
True or false. Airborne isolation rooms are required in long term care facilities by the FGI
False
FGI guidelines require at least ___ room in hospitals and emergency care facilities be an AII room
One
true or false. AII rooms must have a permanently installed device to monitor pressure differential between the room and coridoor
True
true or false. Air recirculation from the AII room to general ventilation system or through dedicated air handler unit is permitted in new construction
False
what determines how many PE rooms are needed?
the ICRA
True or false. Guidelines specify that if one or more PE rooms are required, there must also be a combination AII/PE rooms for patients with a concurrent infection
True
the infection risks from construction come primarily from what?
-mold spores carried by air movement and waterborne pathogens in plumbing systems that have become stagnant from lack of use during construction
-the destruction of accumulated biofilms when working on existing plumbing
true or false. Maintaining a lower or negative pressure in the work zone helps prevent the release of airborne infectious agents and protects in the event of a breach of the containment barrier
True
what can you use on a hepa filter to increase the life by approximately 25%?
An in-line filter
how do you extend the life of a hepa filter by ninefold?
use a disposable prefilter that is followed by a filter that is 90% efficient
true or false. Hepa filters can last 10 days with progressive filtration?
True
what are some methods for controlling dust?
-tacky mats
-trash chute preferred. use a cart that is covered tightly before leaving the workspace
-remove all loose dust including on tools and clothes before leaving the workspace
true or false. the CDC recommends sampling for airborne microbial contaminantes before, during, and after construction projects
False
true or false. the CDC does recommend active surveillance to monitor for airborne infections
True
what is the most common group of BACTERIA associated with construction?
Legionella
true or false. Construction related HAIs are priamrily caused by fungi, and to a lesser extent bacteria
True
the use of ____ is capable of collecting large volumes of air in short periods of time needed to detect low numbers of fungal spores in highly filtered areas
seive impactor samplers
when are settle plates used?
to detect airborne bacteria or measure air quality during medical procedures
True or false. HVAC systems usually are not the cause of device-associated HAIs
True
how often must diluted bleach solutions stored in an open container be changed?
every 24 hours
what is the survival time of staph in the environment?
7 days to more than 12 months
what is the survival time of c.diff in the environment?
more than 5 months
what is the survival time of norovirus in the environment
8 hours to more than 2 weeks
define sanitizing
the reduction of microbial population on an inanimate object to a safe or relatively safe level
define disinfection
the elimination of many or all pathogenic organisms with the exception of spores
do detergents effectively remove microorganisms from surfaces?
no
what is more environmentally friendly detergents or disinfectants?
detergents
what are the 3 categories of disinfectants?
low, intermediate, high
what do high levels disinfectants kill?
spores and all other forms of microorganisms
what do intermediate level disinfectants kill?
vegetative bacteria, mycobacteria, most fungi, most viruses, some spores
what do low level disinfectants kill?
most vegetative bacteria, some fungi and some viruses
can you further dilute premixed solutions of detergents or disinfectants?
no
describe the two zones of care
- patient zone: the patient and their surroundings.
- healthcare zone: all areas outside the patient zone
is the patient zone or healthcare zone more soiled?
patient zone
cleaning should be done in a ___ manner
systematic
true or false. Dusting should be performed first
true
how often does the CDC recommend changing floor mopping solutions?
every 3 rooms or 60 minutes
training and ____ ______ for EVS employees should be done at the time of employment and annually
competency validation
True or false. Most of the sterile compounds used today are injections
True
Define compounding
the process of combining drug ingredients to prepare medications that are not commerically available or to alter commercially available medictions to meet specific patient needs
define intrinsic contamination
occurs during the manufacturing process or transport to the healthcare facility
define extrinsic contamination
contamination during preparation, storage, or administration within the healthcare facility
what is the most frequent cause of contamination?
Extrinsic
Describe some pharmacy responsibilities
-handling, preparation, storage of compounded sterile and non-sterile preparation
-aseptic training of staff
-medication recalls
What is a method for preventing contamination of compounded sterile preparations?
primary engineering control device like a laminar airflow work bench or biological safety cabinet capable of maintaining ISO class 5 air cleanliness conditions
describe ISO class 5
no greater than 100 particles per cubic foot or 3520 particles per cubic meter
How are hazardous drugs prepared?
a BSC or compounding aseptic containment isolator (CACI)
What are the 5 risk categories for sterile preparations?
-immediate use
-low risk with 12 hours BUD
-low risk
-medium risk
-high risk
drug manufacturers are regulated under what?
the FFDCA enforced by the FDA. Compliance with USP standards is required
what is the objective of USP <797>
to describe the conditions and practices that prevent harm, including dath, to patients that could result from:
-micrboial contamination
-excessive bacterial endotxins
-variability in intended strength of correct ingredients
-unintended chemical/physical contaminants
-ingredients of inappropriate quality in compiunded sterile preparations
HACCP is a _______ standard
national
what are the greatest factors to foodborne illness?
- improper food handling
- bare hand food contact
____ Americans get FBI, ____ are hospitalized and ____ die
1 in 6; 128,000; 3000
Which FBI has the highest incidence of death?
Salmonella
Which FBI causes the most cases?
Norovirus
How many known pathogens are there for the 2 major groups of FBI
31
Which FBI is associated with raw or improperly cooked fish, shellfish, or crustaceans (oysters)
v. vulnificus
what are some viral FBI?
Hep A, Hep E, Norovirus
what are some sources of parasitic FBI?
pork and fish
do parasites grow on food?
no, they are transmitted from animals to humans when food is not properly cooked
What are examples of parasites?
-toxoplasma ghondii
-entamoeba histolytica
-cryptosporidium parvum
-cyclospora
where do plant toxins come from?
honey from bees
what are two natural toxins foundin food?
scromboid and ciguatera
is routine microbiological sampling of food recommended?
no unless OB; enternal formulas may need to be tested
What does the CDC define as a foodborne outbreak?
an incident in which two or more persons experience a similar illness resulting from the ingestion of a common food
what are some steps to addressing a foodborne outbreak?
-save suspect foods for culturing
-document departmental conditions at the time of preparation of suspected food
-report GI symptoms
-provide a list of foods served during the suspected interval
-implement control measures
-follow all regulations
water supplies must avoid what
cross connections
true or false. Eggs in shells are classified as potentially hazardous by the FDA
True. Use pasteurized eggs.
Food storage/rotation follows what rule?
FIFO (first in, first out)
what temp should eggs be stored at?
45F
The highest percentage of FBI result from what foods?
tomatoes, celery, coleslaw, fruits, lettuce, and salads
raw eggs must be cooked within _____ of breaking
30 minutes
pasteurized eggs are required if a recipe uses ___ or more eggs
4
what temp should meat products be thawed at?
41 or 45F or submerged under running water
what is the minimum internal temp and time held for poultry, wild game, raw eggs, sauces, leftovers, microwaved cooking, casseroles
165F for 15 seconds
what is the minimum temp and time for ratites (ostrich, emu), injected meats, chopped or ground meat, fish, mechanically tenderized meats, eggs on a steam table
155F for 15 seconds
what is the recommendd temp for commercially raised game animals, rabbits, whole cuts of meat (steaks, roast, chops)
145F for 15 seconds
what temp for cooked perishable leftovers be chilled to?
41F to 45F
hot foods should be kept to what temp?
135F or higher (140F)
cold food should be kept at what temp?
41F or lower
describe the danger zone
41F to 135F. associated with rapid multiplcation of all bacterial FBI
after how long must perishable foods be discarded?
48-72 hours
handwashing water should be what temp?
110 to 120F
When stored below 41F, foods must be used within
7 days
how does the WHO define infectious waste
waste suspected to contain pathogens and that poses a risk of disease transmission
OSHA BBP standard uses the term “regulated waste” which is defined as
semi liquid blood or other potentially infectious materials
What 5 factors are required for waste to be capable of causing infection?
- dose
- host susceptibility
- presence of a pathogen
- virulence of a pathogen
- portal of entry
What are some infectious waste categories?
-pathology waste
-blood and blood products
-contaminated sharps
-microbiological cultures and stocks of infectious agents
-animal waste
-category A infectious waste
what is category A infectious waste?
hemorrhagic fever viruses (ebola, hanta, smallpox)
what is animal waste>
tissue or blood from research animals infected with infectious agents
what is pathology waste?
tissue samples or organs collected during autoposy/from surgery
what is microbiological cultures and stocks of infectious agents?
bacterial and viral stocks used in research; cultures of infectious bacteria
How is animal waste disposed of?
evaluate for zoonotic risks and treat on site prior to disposal
how is blood waste disposed of?
collected as regulated medical waste. Bleach or thermal treatment is done on site. Bulk blood should be solidifed before transport off-site
how are micrbiological cultures and stocks disposed of?
use chemical, thermal (autoclave) or radiological (irradiation) treatment/inactivation prior to disposal as nonhazardous waste. ship off site as regulated medical waste for final disposal if on-site treatment is not possible.
how is category A infectious waste disposed of?
on site inactiavte (incinceration or autoclave) where possible.
how is pathology waste disposed of?
formalin fixation reduces the hazard immensely. incineration for sanitary sewer acceptable usually. Avoid release of recognizable human body parts into landfill waste stream.
which category of infectious waste poses the greatest risk for injuries?
contaminated sharps
True or false. All discarded sharps and items that could potentially become sharps should be treated as potentially infectious waste because of their potential to cause cuts or puncture wounds
True
risk of infection with sharps is related to what
contamiantion with a sufficient dose of pathogenic organsism, portal of entry, and susceptible host
______ category of infectious waste poses the greatest potential for infectious disease transmission because they contain high concentrations of pathogenic organsisms
microbiological cultures and stocks of infectious agents
What goes in the biohazard red waste bag?
fluid blood
blood soaked items
bags and Iv tubing containing blood products
suction canisters
hemovacs
chest drainage units
hemodialysis products
why do pathology wastes normally not fit the definition of infectious waste?
there is an absence of a protal of entry and materials have been soaked in alcohol or formaldehyde and seldom contain pathogens
Which entities regulate waste?
OSHA and DOT
Which entites have guidance documents on waste management?
EPA and CDC
segregation means
segregating infectious waste at the point of origin. place in appropriate containers
designation means
defining infectious and noninfectious waste and having policies for sorting and discarding materials into the proper waste stream
selection of packaging should be based on
the type of waste being contained and to maintain packaging integrity during collection, transport, storage, and disposal.
true or false. storage areas should have limited access and the biohazard logo
True
True or false. There is no published stnadard for how long infectious waste may be stored but some states may have limits
True
what must accompany transported waste?
a waste manifest documenting shipment information
true or false. states generally require the registration of vehicles used in the transport of infectious waste
True
what is a waste manifest?
a document that tracks the waste from the generating facility to its final disposition (record of waste movement). Also acts as a legal document where the generator certifies the waste has been correctly classified, packaged, marked, and labelled according to shipping regulations.
Under DOT regulations, how long must copies of waste manifests be maintained?
3 years
DOT requires the individual signing the waste manifset to be a hazardous materials employee, and is required under what regulations to train that individual?
Title 49 of the Code of Federal Regulations (CFR)
Treatment of infectious waste primarily used to be incineration. Why has this changed?
EPA regulations related to the Clean Air Act and Control of Emissions
What are acceptable methods for rendering materials innocuous?
steam sterilization, chemical disinfection, gas/vapor sterilization, and irradiation contamination
what are modern technologies being used for treatment of waste?
microwave, infrared, thermal plasma, hyperchlorination
Training of all personnel involved in waste management should include
-the definition of infectious waste
-handling procedures
-appropriate PPE
-hand hygiene
-labeling or coding that designates an item infectious
-postexposure management
OSHA and DOT require waste management training be done how often?
within 90 days of hire and updated every 3 years
Which cleaning products are registered with the EPA?
-low and intermediate level disinfectants used for cleaning surfaces
Which cleaning products are registered with the FDA?
-high level disinfectants
-sterilants for medical equipment
-antiseptics
what inactivates disinfectants?
blood and protein
True or false. A 10 min contact time kills more than a 1 minute
False
what products can be used to decontamiante?
EPA products like quat amonium
What products can be used when there is heavier contamination?
Phenolics
Why is alchohl not good for cleaning environmental surfaces?
It dries too quickly
What are sporicides made of?
hydrogen peroxide or chlorine
How long can VRE live on surfaces?
more than 46 months
how long can klebsiella live on surfaces?
more than 30 months
What is used to kill CJD?
sodium hyperchlorite
What are the 3 most commonly reported water pathogens?
- Legionella
- Pseudomonas
- atypical (nontuberculosis) mycobacterium
define potable water
water suitable for drinking
define gray water
water (from a sink or bath) that does not contain serious contaminations (i.e., from toilets or diapers)
define black water
water containing sewage contaminants
define deionized water
purified water that has charged ions removed. Used for various applications in healthcare (lab)
define reverse osmosis water
water forced through a special membrane under pressure, which produces highly purified water. requires remineralizing with trace elements before use. Dialysis.
True or false. Floor drains should be avoided as much as possible.
True
true or false. Avoid drainage piping in ceilings or exposed. Protect from leaks and dust if it is exposed.
True
What should be installed on faucets?
vacuum breakers. Backflow preventers (antisiphon devices) protect water supply systems from contamination in high risk areas.
what do valves do?
isolate a portion of the water system from the remainder of the system when repair is required
what should have stop (isolation) valves on each fixture?
water service mains, branch mains, other main water lines
what is the accpetable temp range for bathing and showers?
105F-120F
Why is it not recommended to go above 120F?
scalding
What is the temperature range for controlling Legionella?
124F or higher and cold temps at 68F
Which waterborne pathogens are most likely linked to outbreaks of contaminated equipment?
atypical mycobacteria and pseudomonas
What sink design is not recommended?
small, shallow, and directed water straight over the drain
what are some components of proper sink design?
depth of sink, length of spout, distance between spout and sink drain
What is the OSHA recommended schedule for flushing the eyewash/drench shower station?
3 minutes every week
describe superheating to control Legionella
flush for 5 mins with water 160-170F
What are some legionella treatment options?
-ozone
-UV light
-hyperchlorination
-chlorine dioxide
-heavy metal ions
What are the optimal temperatures for Legionella growth?
105-120F
True or false. Legionella is easily killed by chlorine
false
Which serogroups cause most L.pneumophilla infections?
1,4 and 6
how may species of Legionella cause human infections?
25
how is legionella deteced?
culture or urinary antigen
what drugs treat legionella?
-quinolones (levo and cipro)
-macrolides (azithro and clarithro)
Where does legionella replicate?
human alveolar macrophages
what are risk factors for legionnaires disease?
smoking, advancing age, male, alcohol abuse, COPD, immunosuppressed, corticosteroid use, renal failure
What correlates more with disease. the proportion of water distribution system outlets that are positive for Legionella or denisty of legionela in the water from these distal sites?
proportion
What are the 3 modes of transmission for Legionnaires disease?
- aerosolozation from devices (humidifiers)
- aspiration
- instillation directly into the lung during respiratory tract manipulation
what is the legionnairesdisease incubation period and symptoms?
-2 to 10 days
-mild cough, fever, stupor, multiorgan failure
What is the pontiac fever incubation?
24-48 hours
True or false. Legionella is easily identified with a gram stain.
False. You can use direct fluroescent antibodies
What is the most important factor for HAI Legionellosis?
presence in drinking water
define distal site
an outlet (faucet) from which an individual would have access to potable water and may be exposed to legionella
which bacteria causes the most burn infections?
staph
what bacteria causes the most UTIs?
enterobactereaceae
which bacteria is assocaited with respiarory equipment, mattresses, and can persist on dry/inaminate surfaces
acinetobacter
what is the most virulent of the NFBs?
pseudomonas
where is stenotrophomonas maltophilia found?
soil, water, plants, decaying organic materials
What is the aspergillosis mortality rate among transplant patients?
25-59%
what is the Legionella mortality rate among hospitalized patients?
25%
how many air exchanges in an airborne iso room?
12 per hour
Air supply should be where?
Near the centre of the work area
return air should be where?
near the floor level
fresh air intakes should be located where
at least 25 feet from exhaust outlets of ventilaiton systems
the bottom of outdoor air intake should be as high as practical and at least ____ above ground level or if on the roof; ___ feet above roof level
6 FEET; 3 FEET
Legionella is found in _____ of freshwater environments
20-40%
what are legionella favored water temps according to the CDC?
77-113F
what are legionella favored water temps according to ASHRAE?
77-108F
_ in _ people die of legionnaires disease
1 in 10
precautions for legionnaires disease
standard
who are at the highest risk for legionnaires disease?
solid organ transplant patients
to prevent legionella store cold water____ and hot water ___
below 68F and above 140F
true or false. lice can be transmitted via fomites
true
what temp kills lice?
130F
