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LTC-CIP > Environment of Care > Flashcards

Environment of Care Flashcards

1
Q

When was the ICRA introduced?

A

in 1996 Guidelines for the Design and Construction of Hospital and Healthcare Facilities

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2
Q

When was the ICRA introduced as part of the planning and construction process?

A

2001

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3
Q

Who should complete the ICRA?

A

IP, safety, engineering, and HCPs that represent areas likely to be affected by the construction

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4
Q

Describe the IPs role on the ICRA team

A
  1. assess the needs and risk of patient population to be affected by the construction
  2. address the IPAC needs of the patients and HCP that will occupy the space after construction
  3. providence IPAC guidance to the design team
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5
Q

the FGI guidelines specify which design elements that the ICRA must address?

A

-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

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6
Q

Define infection control risk mitigation recommendations

A

written recommendations describing how the transmission of biological contaminants from construction zones will be controlled.

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7
Q

what types of isolation rooms are there?

A

-airborne
-protective environment
-or a room that does both (rooms designed as a combination must have an anteroom)

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8
Q

When designing an isolation room, what are some things to consider?

A

-number
-types
-patient population
-experience with communicable diseases
-resources available in the community
-mission and program goals of the facility

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9
Q

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

A

True

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10
Q

True or false. Airborne isolation rooms are required in long term care facilities by the FGI

A

False

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11
Q

FGI guidelines require at least ___ room in hospitals and emergency care facilities be an AII room

A

One

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12
Q

true or false. AII rooms must have a permanently installed device to monitor pressure differential between the room and coridoor

A

True

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13
Q

true or false. Air recirculation from the AII room to general ventilation system or through dedicated air handler unit is permitted in new construction

A

False

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14
Q

what determines how many PE rooms are needed?

A

the ICRA

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15
Q

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

A

True

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16
Q

the infection risks from construction come primarily from what?

A

-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

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17
Q

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

A

True

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18
Q

what can you use on a hepa filter to increase the life by approximately 25%?

A

An in-line filter

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19
Q

how do you extend the life of a hepa filter by ninefold?

A

use a disposable prefilter that is followed by a filter that is 90% efficient

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20
Q

true or false. Hepa filters can last 10 days with progressive filtration?

A

True

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21
Q

what are some methods for controlling dust?

A

-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

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22
Q

true or false. the CDC recommends sampling for airborne microbial contaminantes before, during, and after construction projects

A

False

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23
Q

true or false. the CDC does recommend active surveillance to monitor for airborne infections

A

True

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24
Q

what is the most common group of BACTERIA associated with construction?

A

Legionella

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25
Q

true or false. Construction related HAIs are priamrily caused by fungi, and to a lesser extent bacteria

A

True

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26
Q

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

A

seive impactor samplers

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27
Q

when are settle plates used?

A

to detect airborne bacteria or measure air quality during medical procedures

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28
Q

True or false. HVAC systems usually are not the cause of device-associated HAIs

A

True

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29
Q

how often must diluted bleach solutions stored in an open container be changed?

A

every 24 hours

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30
Q

what is the survival time of staph in the environment?

A

7 days to more than 12 months

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31
Q

what is the survival time of c.diff in the environment?

A

more than 5 months

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31
Q

what is the survival time of norovirus in the environment

A

8 hours to more than 2 weeks

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31
Q

define sanitizing

A

the reduction of microbial population on an inanimate object to a safe or relatively safe level

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31
Q

define disinfection

A

the elimination of many or all pathogenic organisms with the exception of spores

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32
Q

do detergents effectively remove microorganisms from surfaces?

A

no

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33
Q

what is more environmentally friendly detergents or disinfectants?

A

detergents

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34
Q

what are the 3 categories of disinfectants?

A

low, intermediate, high

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35
Q

what do high levels disinfectants kill?

A

spores and all other forms of microorganisms

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36
Q

what do intermediate level disinfectants kill?

A

vegetative bacteria, mycobacteria, most fungi, most viruses, some spores

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37
Q

what do low level disinfectants kill?

A

most vegetative bacteria, some fungi and some viruses

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38
Q

can you further dilute premixed solutions of detergents or disinfectants?

A

no

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39
Q

describe the two zones of care

A
  1. patient zone: the patient and their surroundings.
  2. healthcare zone: all areas outside the patient zone
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40
Q

is the patient zone or healthcare zone more soiled?

A

patient zone

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41
Q

cleaning should be done in a ___ manner

A

systematic

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42
Q

true or false. Dusting should be performed first

A

true

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43
Q

how often does the CDC recommend changing floor mopping solutions?

A

every 3 rooms or 60 minutes

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44
Q

training and ____ ______ for EVS employees should be done at the time of employment and annually

A

competency validation

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45
Q

True or false. Most of the sterile compounds used today are injections

A

True

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46
Q

Define compounding

A

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

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46
Q

define intrinsic contamination

A

occurs during the manufacturing process or transport to the healthcare facility

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47
Q

define extrinsic contamination

A

contamination during preparation, storage, or administration within the healthcare facility

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48
Q

what is the most frequent cause of contamination?

A

Extrinsic

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49
Q

Describe some pharmacy responsibilities

A

-handling, preparation, storage of compounded sterile and non-sterile preparation
-aseptic training of staff
-medication recalls

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50
Q

What is a method for preventing contamination of compounded sterile preparations?

A

primary engineering control device like a laminar airflow work bench or biological safety cabinet capable of maintaining ISO class 5 air cleanliness conditions

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51
Q

describe ISO class 5

A

no greater than 100 particles per cubic foot or 3520 particles per cubic meter

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52
Q

How are hazardous drugs prepared?

A

a BSC or compounding aseptic containment isolator (CACI)

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53
Q

What are the 5 risk categories for sterile preparations?

A

-immediate use
-low risk with 12 hours BUD
-low risk
-medium risk
-high risk

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54
Q

drug manufacturers are regulated under what?

A

the FFDCA enforced by the FDA. Compliance with USP standards is required

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55
Q

what is the objective of USP <797>

A

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

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56
Q

HACCP is a _______ standard

A

national

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57
Q

what are the greatest factors to foodborne illness?

A
  1. improper food handling
  2. bare hand food contact
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58
Q

____ Americans get FBI, ____ are hospitalized and ____ die

A

1 in 6; 128,000; 3000

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59
Q

Which FBI has the highest incidence of death?

A

Salmonella

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60
Q

Which FBI causes the most cases?

A

Norovirus

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61
Q

How many known pathogens are there for the 2 major groups of FBI

A

31

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62
Q

Which FBI is associated with raw or improperly cooked fish, shellfish, or crustaceans (oysters)

A

v. vulnificus

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63
Q

what are some viral FBI?

A

Hep A, Hep E, Norovirus

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64
Q

what are some sources of parasitic FBI?

A

pork and fish

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65
Q

do parasites grow on food?

A

no, they are transmitted from animals to humans when food is not properly cooked

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66
Q

What are examples of parasites?

A

-toxoplasma ghondii
-entamoeba histolytica
-cryptosporidium parvum
-cyclospora

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67
Q

where do plant toxins come from?

A

honey from bees

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68
Q

what are two natural toxins foundin food?

A

scromboid and ciguatera

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69
Q

is routine microbiological sampling of food recommended?

A

no unless OB; enternal formulas may need to be tested

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70
Q

What does the CDC define as a foodborne outbreak?

A

an incident in which two or more persons experience a similar illness resulting from the ingestion of a common food

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71
Q

what are some steps to addressing a foodborne outbreak?

A

-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

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72
Q

water supplies must avoid what

A

cross connections

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73
Q

true or false. Eggs in shells are classified as potentially hazardous by the FDA

A

True. Use pasteurized eggs.

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74
Q

Food storage/rotation follows what rule?

A

FIFO (first in, first out)

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75
Q

what temp should eggs be stored at?

A

45F

76
Q

The highest percentage of FBI result from what foods?

A

tomatoes, celery, coleslaw, fruits, lettuce, and salads

77
Q

raw eggs must be cooked within _____ of breaking

A

30 minutes

78
Q

pasteurized eggs are required if a recipe uses ___ or more eggs

A

4

79
Q

what temp should meat products be thawed at?

A

41 or 45F or submerged under running water

80
Q

what is the minimum internal temp and time held for poultry, wild game, raw eggs, sauces, leftovers, microwaved cooking, casseroles

A

165F for 15 seconds

81
Q

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

A

155F for 15 seconds

82
Q

what is the recommendd temp for commercially raised game animals, rabbits, whole cuts of meat (steaks, roast, chops)

A

145F for 15 seconds

83
Q

what temp for cooked perishable leftovers be chilled to?

A

41F to 45F

84
Q

hot foods should be kept to what temp?

A

135F or higher (140F)

85
Q

cold food should be kept at what temp?

A

41F or lower

86
Q

describe the danger zone

A

41F to 135F. associated with rapid multiplcation of all bacterial FBI

87
Q

after how long must perishable foods be discarded?

A

48-72 hours

88
Q

handwashing water should be what temp?

A

110 to 120F

89
Q

When stored below 41F, foods must be used within

A

7 days

90
Q

how does the WHO define infectious waste

A

waste suspected to contain pathogens and that poses a risk of disease transmission

91
Q

OSHA BBP standard uses the term “regulated waste” which is defined as

A

semi liquid blood or other potentially infectious materials

92
Q

What 5 factors are required for waste to be capable of causing infection?

A
  1. dose
  2. host susceptibility
  3. presence of a pathogen
  4. virulence of a pathogen
  5. portal of entry
93
Q

What are some infectious waste categories?

A

-pathology waste
-blood and blood products
-contaminated sharps
-microbiological cultures and stocks of infectious agents
-animal waste
-category A infectious waste

94
Q

what is category A infectious waste?

A

hemorrhagic fever viruses (ebola, hanta, smallpox)

95
Q

what is animal waste>

A

tissue or blood from research animals infected with infectious agents

96
Q

what is pathology waste?

A

tissue samples or organs collected during autoposy/from surgery

97
Q

what is microbiological cultures and stocks of infectious agents?

A

bacterial and viral stocks used in research; cultures of infectious bacteria

98
Q

How is animal waste disposed of?

A

evaluate for zoonotic risks and treat on site prior to disposal

99
Q

how is blood waste disposed of?

A

collected as regulated medical waste. Bleach or thermal treatment is done on site. Bulk blood should be solidifed before transport off-site

100
Q

how are micrbiological cultures and stocks disposed of?

A

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.

101
Q

how is category A infectious waste disposed of?

A

on site inactiavte (incinceration or autoclave) where possible.

102
Q

how is pathology waste disposed of?

A

formalin fixation reduces the hazard immensely. incineration for sanitary sewer acceptable usually. Avoid release of recognizable human body parts into landfill waste stream.

103
Q

which category of infectious waste poses the greatest risk for injuries?

A

contaminated sharps

104
Q

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

A

True

105
Q

risk of infection with sharps is related to what

A

contamiantion with a sufficient dose of pathogenic organsism, portal of entry, and susceptible host

106
Q

______ category of infectious waste poses the greatest potential for infectious disease transmission because they contain high concentrations of pathogenic organsisms

A

microbiological cultures and stocks of infectious agents

107
Q

What goes in the biohazard red waste bag?

A

fluid blood
blood soaked items
bags and Iv tubing containing blood products
suction canisters
hemovacs
chest drainage units
hemodialysis products

108
Q

why do pathology wastes normally not fit the definition of infectious waste?

A

there is an absence of a protal of entry and materials have been soaked in alcohol or formaldehyde and seldom contain pathogens

109
Q

Which entities regulate waste?

A

OSHA and DOT

110
Q

Which entites have guidance documents on waste management?

A

EPA and CDC

111
Q

segregation means

A

segregating infectious waste at the point of origin. place in appropriate containers

112
Q

designation means

A

defining infectious and noninfectious waste and having policies for sorting and discarding materials into the proper waste stream

113
Q

selection of packaging should be based on

A

the type of waste being contained and to maintain packaging integrity during collection, transport, storage, and disposal.

114
Q

true or false. storage areas should have limited access and the biohazard logo

A

True

115
Q

True or false. There is no published stnadard for how long infectious waste may be stored but some states may have limits

A

True

116
Q

what must accompany transported waste?

A

a waste manifest documenting shipment information

117
Q

true or false. states generally require the registration of vehicles used in the transport of infectious waste

A

True

118
Q

what is a waste manifest?

A

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.

119
Q

Under DOT regulations, how long must copies of waste manifests be maintained?

A

3 years

120
Q

DOT requires the individual signing the waste manifset to be a hazardous materials employee, and is required under what regulations to train that individual?

A

Title 49 of the Code of Federal Regulations (CFR)

121
Q

Treatment of infectious waste primarily used to be incineration. Why has this changed?

A

EPA regulations related to the Clean Air Act and Control of Emissions

122
Q

What are acceptable methods for rendering materials innocuous?

A

steam sterilization, chemical disinfection, gas/vapor sterilization, and irradiation contamination

123
Q

what are modern technologies being used for treatment of waste?

A

microwave, infrared, thermal plasma, hyperchlorination

124
Q

Training of all personnel involved in waste management should include

A

-the definition of infectious waste
-handling procedures
-appropriate PPE
-hand hygiene
-labeling or coding that designates an item infectious
-postexposure management

125
Q

OSHA and DOT require waste management training be done how often?

A

within 90 days of hire and updated every 3 years

126
Q

Which cleaning products are registered with the EPA?

A

-low and intermediate level disinfectants used for cleaning surfaces

127
Q

Which cleaning products are registered with the FDA?

A

-high level disinfectants
-sterilants for medical equipment
-antiseptics

128
Q

what inactivates disinfectants?

A

blood and protein

129
Q

True or false. A 10 min contact time kills more than a 1 minute

A

False

130
Q

what products can be used to decontamiante?

A

EPA products like quat amonium

131
Q

What products can be used when there is heavier contamination?

A

Phenolics

132
Q

Why is alchohl not good for cleaning environmental surfaces?

A

It dries too quickly

133
Q

What are sporicides made of?

A

hydrogen peroxide or chlorine

134
Q

How long can VRE live on surfaces?

A

more than 46 months

135
Q

how long can klebsiella live on surfaces?

A

more than 30 months

136
Q

What is used to kill CJD?

A

sodium hyperchlorite

137
Q

What are the 3 most commonly reported water pathogens?

A
  1. Legionella
  2. Pseudomonas
  3. atypical (nontuberculosis) mycobacterium
138
Q

define potable water

A

water suitable for drinking

139
Q

define gray water

A

water (from a sink or bath) that does not contain serious contaminations (i.e., from toilets or diapers)

140
Q

define black water

A

water containing sewage contaminants

141
Q

define deionized water

A

purified water that has charged ions removed. Used for various applications in healthcare (lab)

142
Q

define reverse osmosis water

A

water forced through a special membrane under pressure, which produces highly purified water. requires remineralizing with trace elements before use. Dialysis.

143
Q

True or false. Floor drains should be avoided as much as possible.

A

True

144
Q

true or false. Avoid drainage piping in ceilings or exposed. Protect from leaks and dust if it is exposed.

A

True

145
Q

What should be installed on faucets?

A

vacuum breakers. Backflow preventers (antisiphon devices) protect water supply systems from contamination in high risk areas.

146
Q

what do valves do?

A

isolate a portion of the water system from the remainder of the system when repair is required

147
Q

what should have stop (isolation) valves on each fixture?

A

water service mains, branch mains, other main water lines

148
Q

what is the accpetable temp range for bathing and showers?

A

105F-120F

149
Q

Why is it not recommended to go above 120F?

A

scalding

150
Q

What is the temperature range for controlling Legionella?

A

124F or higher and cold temps at 68F

151
Q

Which waterborne pathogens are most likely linked to outbreaks of contaminated equipment?

A

atypical mycobacteria and pseudomonas

152
Q

What sink design is not recommended?

A

small, shallow, and directed water straight over the drain

153
Q

what are some components of proper sink design?

A

depth of sink, length of spout, distance between spout and sink drain

154
Q

What is the OSHA recommended schedule for flushing the eyewash/drench shower station?

A

3 minutes every week

155
Q

describe superheating to control Legionella

A

flush for 5 mins with water 160-170F

156
Q

What are some legionella treatment options?

A

-ozone
-UV light
-hyperchlorination
-chlorine dioxide
-heavy metal ions

157
Q

What are the optimal temperatures for Legionella growth?

A

105-120F

158
Q

True or false. Legionella is easily killed by chlorine

A

false

159
Q

Which serogroups cause most L.pneumophilla infections?

A

1,4 and 6

160
Q

how may species of Legionella cause human infections?

A

25

161
Q

how is legionella deteced?

A

culture or urinary antigen

162
Q

what drugs treat legionella?

A

-quinolones (levo and cipro)
-macrolides (azithro and clarithro)

163
Q

Where does legionella replicate?

A

human alveolar macrophages

164
Q

what are risk factors for legionnaires disease?

A

smoking, advancing age, male, alcohol abuse, COPD, immunosuppressed, corticosteroid use, renal failure

165
Q

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?

A

proportion

166
Q

What are the 3 modes of transmission for Legionnaires disease?

A
  1. aerosolozation from devices (humidifiers)
  2. aspiration
  3. instillation directly into the lung during respiratory tract manipulation
167
Q

what is the legionnairesdisease incubation period and symptoms?

A

-2 to 10 days
-mild cough, fever, stupor, multiorgan failure

168
Q

What is the pontiac fever incubation?

A

24-48 hours

169
Q

True or false. Legionella is easily identified with a gram stain.

A

False. You can use direct fluroescent antibodies

170
Q

What is the most important factor for HAI Legionellosis?

A

presence in drinking water

171
Q

define distal site

A

an outlet (faucet) from which an individual would have access to potable water and may be exposed to legionella

172
Q

which bacteria causes the most burn infections?

A

staph

173
Q

what bacteria causes the most UTIs?

A

enterobactereaceae

174
Q

which bacteria is assocaited with respiarory equipment, mattresses, and can persist on dry/inaminate surfaces

A

acinetobacter

175
Q

what is the most virulent of the NFBs?

A

pseudomonas

176
Q

where is stenotrophomonas maltophilia found?

A

soil, water, plants, decaying organic materials

177
Q

What is the aspergillosis mortality rate among transplant patients?

A

25-59%

178
Q

what is the Legionella mortality rate among hospitalized patients?

A

25%

179
Q

how many air exchanges in an airborne iso room?

A

12 per hour

180
Q

Air supply should be where?

A

Near the centre of the work area

181
Q

return air should be where?

A

near the floor level

182
Q

fresh air intakes should be located where

A

at least 25 feet from exhaust outlets of ventilaiton systems

183
Q

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

A

6 FEET; 3 FEET

184
Q

Legionella is found in _____ of freshwater environments

A

20-40%

185
Q

what are legionella favored water temps according to the CDC?

A

77-113F

186
Q

what are legionella favored water temps according to ASHRAE?

A

77-108F

187
Q

_ in _ people die of legionnaires disease

A

1 in 10

188
Q

precautions for legionnaires disease

A

standard

189
Q

who are at the highest risk for legionnaires disease?

A

solid organ transplant patients

190
Q

to prevent legionella store cold water____ and hot water ___

A

below 68F and above 140F

191
Q

true or false. lice can be transmitted via fomites

A

true

192
Q

what temp kills lice?

A

130F

LTC-CIP (9 decks)

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