Exam 1-checked Flashcards
HAIs
Healthcare associated infections
- 80% are UTI and 35% are CAUTI
- 15% bloodstream infections
- ventilator pneumonia
- 70% of these infections are resistant to 1 or more antibiotics
Anesthetists’ hazards
- Chemical vapors
- Ionizing radiation
- Infections
Federal safety group responsible for making the rules:
NIOSH
National Institute for Occupational Safety and Health
Group that enforces the safety rules
OSHA
Occupational safety and health administration
Trace gas hazard: females and cancer (3) types
Males: no statistical change
cervical
lymphoma
leukemia
True or false:
Overall mortality rates for anesthesia personnel is less than general population and other medical specialists
True
Methylmethacrylate
glue in ortho rooms
exposure for factory workers < 8 hours
- asthma
- skin
- genitourinary
- allergy sensitizer
100ppm, 280 max
Halothane risk
hepatitis
True or false: More than 70% of healthcare workers reported by the FDA were allergic to latex
True
True or false: Sensitivity can be reversed
False
Spina bifida
73% of patients have developed latex allergy due to multiple surgeries from foley catheters
Radiation hazards
- Angiography
- Fluro
- Radiation therapy
- PACU
Proper radiation precautions
Stand 6 ft away from Xray machine
lead apron with collar
dosimeters
maintain distance E= 1/d^2
Laser hazards
- thermal burns
- eye injury
- electrical hazards
- fire and explosion from O2
- laser plume contains viral DNA and toxic chemicals like HPV, HIV, Hep B
- plume contain formaldehyde, benzene, CO
The mutagenic affect of thermal destruction of 1 gram of tissue is equivalent to that of:
Protection:
3-6 cigarettes for laser and electrocautery smoke
Special glasses and mask
Work hazards
10-16 hour shifts not uncommon
disruption of circadian rhythms
% error in anesthesia management attributed to fatigue
64%
Transmission of infection requires: SPNVP
Some people never value pennies.
S: Source
P: Pathogen
N: Numbers
V: Vector
P: Port of entry
Respiratory transmission: aerosol
TRIM
- TB
- Rhinovirus
- Influenza
- Measles
Respiratory transmission: self-inoculation
includes direct oral, nasal, or conjunctival exposure
- Rhinovirus
- Respiratory Synctival Virus
Flu
sheds in 5 days
increased in December
Measles
(Macopap Kop 3C PED)
aka Rubeola
highly infective 90% of households
- Maculopapular rash
- Koplicks spots
- Fevers and 3 C’s (cough, choryza, conjunctiva)
- diarrhea
- pneumonia
- encephalitis
Mumps (epidemic parotitis) is spread by aerosol or droplets?
Droplets
Painful swelling of salivary and parotid glands
Symptoms of mumps is severe in children. True or false
False
Most often children 5-9 are affected
Respiratory Synctial Virus
aka PARAMYXOVIRIDAE
Most important cause of serious lower respiratory disease in young.
60% of infants
100% 2-3 YO
Viable on surface for 6 hours!
Infected individual sheds in 7days
Recurrent asthma symptoms for up to 6 months
Immunity is permanent is RSV. True or false
False
Rhinovirus
Most common viral common cold.
Self inoculation and/or aerosol particles
Responsible for 50% of cases of cold
Over 110 types
Herpes Virus
Varicella-zoster
chickenpox and shingles
communicability 1-2 days before and last 5-6 days after
healthcare workers over 36 had antibodies
7.5% of younger population was susceptible
Herpes Simplex
- Encephalitis: 70% mortality without treatment
- Ocular blindness
Cytomegalovirus(CMV)
- usually occurs during childhood
- 40-90% adults have antibodies
- transmitted by DIRECT CONTACT, not aerosolized
- Low morbidity
- Serious in pregnant or immunocompromised patients!
- No greater risk of infection than personnel with no patient contact.
STANDARD PRECAUTIONS OK
Hepatitis A
Eating bad oysters
Hepatitis B and C
Greatest risk of transmission to personnel
blood bourne contact
Hep B
stats high or low?
transmission?
precautions?
5% develop chronic hepatitis develops into cirrhosis and ESLD
Seroconversion is 30% but infection usually resolves
- sexual contact/shared needles/perinatally
- standard precautions
Hep C
Leading cause of chronic liver disease
seroconversion 1.8%
HIV
- 3 % percutaneous exposure
- 1 % mucous membrane exposure
Increased risk associated with:
- visible blood
- deep injury
- needle intravascularly
- terminal illness death within 2 months
- only 57 cases in the pasted 25 years
Tuberculosis
Mycobacterium TB transmitted through bacilli 1-5 microns
TB immune response to limit spread is _____ to _____ weeks
2 to 10 weeks
If a patient has TB and is having an elective surgery, it should be delayed until the patient is no longer infectious, or ____ negative ____ _____ ____ tests and performed at the _______ of the day.
3 negative sputum acid fast
end
High efficiency filter filters ____.___% particles > 0.___ microns
99.97% particles > 0.3 microns
Patient with TB should be transported
wearing a mask
OR door closed with minimal traffic
should be done with least number of patients in OR at end of day
USE BACTERIAL FILTER between anesthesia circuit
Standard Precautions: bloodbourne infection route:
percutaneous, mucosal, non-intact skin exposure
Standard precautions: infectious fluids
Urine is sterile!
Blood, blood products
CSF
Amniotic
Pleural
Pericardial
Peritoneal
Synovial
Inflammatory exudates (pus)
Hand washing
Minimum 15 seconds!
Personal protection devices
Gloves
Mask
EYE PROTECTION
Gowns
Patients with multidrug resistant microorganisms
Alcohol is effective. True or False?
PPE?
MRSA
Vancomycin resistant enterococci (VRE)
C. diff
False–hand wash
gown, gloves, more obsessive standard precautions
Mask is not necessary
Droplet precautions
It’s when to wear a mask…
Mumps
Measles
Strep
Meningitis
Do not make contact with patients unless immune with these patients:
Varicella
Measles
Varicella zoster
Postexposure Management
Wound management
Exposure reporting
Evaluation of transmission risk
serologic testing of health care worker
consideration of post exposure prophalaxis (PEP)
Cleaning
remove foreign material
like cleaning the floor
Antiseptic
Use on living tissue
Disinfectant
use on non-living items like bleach
sterile
completely free of microorganisms
sterilization
process that results in probability of microorganism survival on an item < 1:1,000,000
High level disinfection
Kills fungi, viruses, and vegetative bacteria except endospores
Intermediate level
Kills fungi, non small or nonlipid viruses and bacteria except endospores
low level disinfection
non baby baby wipes
kills fungi, some viruses (lipid/medium sized), and bacteria EXCEPT TB and endospores
any item that comes in contact with the patient intact skin must be wiped down with a low level disinfectant
OR table
Arm boards
BP cuffs
ECG cable
Pulse oximeter
Stethoscope
High level disinfectant needs to be used on
mucous membrane contact
laryngoscope
bronchoscope
Simple cleaning
soap and water
antiseptic cleaning
has antimicrobial activity that can be applied to living tissue like alcohol and iodine
chlorine
widely used disinfectant used on tables, floors, surfaces, and equipment
1: 100-1000 effective against HIV
1: 10 for blood spills
1: 5-1:10 effective against hepatitis
hydrogen peroxide (25-37%)
effective surface cleaner safe for rubber and plastic
Sterilization: StRaPCh
Steam
Radiation
Plasma
Chemical: Gas, Liquid
Autoclaving
quick, cheap, effective with no residues
Kills everything with Pressure, temperature
15 min autoclaving at temp?
10 min?
3.5 min?
121 degrees Celcius
126 degrees C
134 degrees C
Autoclaving sterilization confirmed by ____________inside wrapped metal trays
indicator strip
Metal instruments and laryngoscope blades sterilized by
autoclaving
For preservative free medications
- Check label
- use aseptic technique
- DISCARD after use
Propofol newer formulation with EDTA has a ___ hour shelf life.
12
Bupivicain is ____ dose
single
Immuno-suppressed patient
skin prep with disinfectant
wear sterile gloves, mask, cap
avoid contamination
maintain good sterility
High risk latex allergy groups
Healthcare people
multiple surguries (spina bifida)
occupational exposure (hairdressers)
History of hay fever, rhinitis, asthma, eczema
foods: avocado, kiwi, banana, chestnuts, stone fruit
Latex allergy cases performed at ______ of day
beginning
Contains latex
BP cuff
bed mattress and bumpers
Latex port on IV bag…not the tab coverted port
Place “latex allergy” sign on door of OR
Betadine Allergy
Contrast dye
Shellfish
IV catheter infection prevention
Subclavian vein carries a lower risk
Catheter site dressing: transparent, semipermeable polyurethane
When inserting a central line or performing neuroaxial anesthesia (spinal or epidural)
Wear a surgical mask
Patient airborne infection isolation room
AIIR
Airbourne guidelines
- Place patient in AIIR room
- signage outside room
- N95 respirator
- Pt wears standard mask to prevent droplets into environment
- OR rooms are positive pressure; choose one most remote or has negative pressure chamber that can be installed at door
- End of day surgery
- communicate precaution to personnel
Contact precautions
- Gown and glove when entering room
- remove gown and gloves when exiting
- separate 3 feet between patients
