Exam 1 Material Pt 1 (Quality, Safety, and Infection Control)

Question 1

Avoidance of harm

Answer 1

Safety

Question 2

What does APSF stand for?

Answer 2

Anesthesia Patient Safety Foundation

Question 3

Independent, nonprofit corporation with the vision “no pt shall be harmed by anesthesia”

Answer 3

APSF (Anesthesia Patient Safety Foundation)

Question 4

Label of “adverse event” does not imply ____, ____, or ______

Answer 4

Error, negligence, or poor quality of care

Question 5

Situations with potential for pt injury if not addressed

Answer 5

Critical/adverse incident

Question 6

Unexpected occurrence involving death or serious injury, or the risk thereof

Answer 6

Sentinel event

Question 7

TJC’s definition of perioperative sentinel events (5)

Answer 7

Hemolytic transfusion reaction
Procedure on wrong pt/wrong site/wrong procedure
Prolong fluro > 1500 rads
Fire/flame/unanticipated smoke/heat/flashes during case
Any intrapartum maternal death or severe morbidity

Question 8

Optimal performance of a task

Answer 8

Quality

Question 9

First. medical specialty to embrace universally applicable standards, developing monitoring recommendations with goal of reducing anesthesia-related adverse events

Answer 9

Anesthesia

Question 10

Reviews settled lawsuits to expose safety concerns (in cooperation with malpractice lawyers)

Answer 10

ASA Closed Claims Project

Question 11

Pay for performance program that was initiated in 2006 to increase quality in healthcare

Answer 11

PQRS (Physician Quality Reporting System)

Question 12

Joint Commission National Patient Safety Initiative: (6)

Answer 12

Prevent wrong site
Reduce hospital acquired infection
Improve patient ID, communication, medication safety, fire safety

Question 13

Surgical outcomes can be improved by appropriate, evidence-based interventions

Answer 13

SCIP (Surgical Care Improvement Project)

Question 14

CDC defines a surgical site infection as one that occurs at or near the surgical incision within _______

Answer 14

30 DAYS OF PROCEDURE
OR
WITHIN 1 YEAR AFTER IMPLANTATION OF PROSTHETIC DEVICE

Question 15

SSI’s (surgical site infections) account for ____ of all HAIs (hospital acquired infections)

Answer 15

31%

Question 16

Systemic inflammatory response that occurs within hours of surgery can affect the _____

Answer 16

Healing process

Question 17

Main defense against SSI is oxidative by killing _____, so ____

Answer 17

Neutrophils
Tissue O2 is a major determinant of wound infection risk

Question 18

____ has been found to be as effective as antibiotics, particularly against ____

Answer 18

Oxygen
particularly against anaerobic bacteria

Question 19

_____ improves the ability of aminoglycoside antibiotics to kill anaerobes

Answer 19

High oxygen pressure in tissues

Question 20

What inspired concentration is best?

Answer 20

80%

Question 21

Prophylactic antibiotics are most effective when given within ______ PRIOR to incision

Exception of:

Answer 21

60 min

Vancomycin/fluoroquinolones (2 hrs)

Question 22

_____ triples the risk of wound infection

Answer 22

Hypothermia

Question 23

It is important to maintain _____ > 36 degrees

Answer 23

Normothermia

Question 24

It is important to maintain _____ (normal glucose)

Answer 24

Euglycemia < 150 mg/dL

Question 25

Common organisms, listed by ease of destruction:

Answer 25

Bacteria Tubercle bacillus Viruses Protozoa

Question 26

What bacteria is problematic?

Answer 26

Bacterial SPORES

Question 27

Which precaution: Wear surgical gown for any direct contact (VRE, C diff)

Answer 27

Contact precautions

Question 28

Which precaution: Wear face mask when near infected, usually 3 feet (influenza)

Answer 28

Droplet precautions

Question 29

Which precaution: N95 (TB, COVID)

Answer 29

Airborne

Question 30

Propofol should be discarded within ____ of being drawn into the syringe

Answer 30

6 hours

Question 31

Once drawn into a syringe, discard any med not used within ______

Answer 31

24 hours

Question 32

Anesthesia equipment associated with cross-infection between patients (3)

Answer 32

Humidifiers Circle systems Reusable tubes

Question 33

Substance that destroys microorganisms on the skin

Answer 33

Antiseptic

Question 34

Condition free from microorganism contamination

Answer 34

Asepsis

Question 35

Destruction of all forms of microscopic life

Answer 35

Sterilization

Question 36

A substance that inhibits the growth of bacteria

Answer 36

Bacteriostatic

Question 37

A substance that destroys bacteria

Answer 37

Bactericide

Question 38

Substance that destroys all vegetative bacteria EXCEPT spores

Answer 38

Disinfectant

Question 39

Bactericidal activity of an antiseptic depends on (3)

Answer 39

Concentration Temp Duration of contact

Question 40

What is the recommended antiseptic for skin prep for central line insertion and regional anesthesia procedures?

Answer 40

Chlorhexidine in isopropyl alcohol

Question 41

Effective skin antiseptics (4)

Answer 41

70% ethyl alcohol 70% isopropyl alcohol Povidone-iodine Iodophors

Question 42

Which skin antiseptic is safe for mucus membranes?

Answer 42

Povidone-iodine

Question 43

Which skin antiseptic has surfactant added?

Answer 43

Iodophors

Question 44

What kills microbes best?

Answer 44

Moist heat = AUTOCLAVE

Question 45

Autoclave = ____ degrees

Answer 45

105 degrees Celsius, pressurized for 10-15 min

Question 46

Heat sterilization can ____

Answer 46

Harm the object

Question 47

Ethylene oxide is another option for sterilization. What is the problem with this?

Answer 47

Slow (8-24 hrs) Flammable Toxic to tissues, have to air dry object for hours or days

Question 48

Commercial sterilization utilizes ____ to destroy microorganisms

Answer 48

Ionizing radiation

Question 49

Spaulding disinfection/sterilization classification: Critical items:

Answer 49

Contact sterile body tissues -- sterilized (ex: vas caths)

Question 50

Spaulding disinfection/sterilization classification: Semi-critical items:

Answer 50

Contact mucus membrane -- high level disinfection/sterilization (ex: laryngoscope)

Question 51

Spaulding disinfection/sterilization classification: Non-critical items:

Answer 51

Contact intact skin -- must be cleaned between patients with low-level disinfection (ex: monitor cables, pulse ox)

Question 52

Liquid disinfectants: Glutaraldehyde 2% -- soak for _____ and then

Answer 52

Soak for 20 min, rinse 3 times

Question 53

Liquid disinfectants: Phenol 1-3% -- used on equipment, NOT ON ____ Kills all, but ____

Answer 53

DO not put on pts, Kills all, but SPORES

Question 54

Liquid disinfectants: Chlorinated compounds --- corrode ____ Have light _____ and _____ action

Answer 54

Corrode metal Have light tuberculocidal& sporicidal action

Question 55

Liquid disinfectants: Iodine -- very effective when mixed w/ ___ Caution because:

Answer 55

Alcohol Produces skin burns and allergic reactions can occur ** Iodophors eliminate these problems

Question 56

Liquid disinfectants: Alcohols (ethyl or isopropyl)

Answer 56

Safe and effective bactericidal and tuberculocidal

Question 56

____ are difficult to remove all proteins

Answer 56

Reusable LMAs

Question 56

____ should be single use, or utilize high level disinfection

Answer 56

Oral/nasal airways, stylets, bougies, connectors

Question 57

____ clean with low level disinfectants between patients

Answer 57

Laryngoscope handles

Question 58

_______ are difficult to disinfect due to design, fiberoptic materials and tiny passages and needs high level disinfection/sterilization

Answer 58

Bronchoscopes and TEE probes **has led to pseudomonas outbreaks

Question 59

True or false: Povidone-iodine is superiors to chlorhexidine/isopropyl alcohol skin prep in reducing skin flora

Answer 59

FALSE Chlorhexidine/isopropyl alcohol is superior

Question 60

Transient bacteria can be removed with ___

Answer 60

Soap, water and friction

Question 61

Surface bacteria can be killed with ____

Answer 61

Antiseptics

Question 62

Bacteria in pits/follicles cannot be killed, however they are usually _____

Answer 62

Non-pathogenic

Question 63

Epidural catheters should be removed after ____ hours. Why?

Answer 63

48 hours Risk of infection increases by as much as 40% per day

Question 64

What is often a cause of outbreaks per the "safe injection practices"?

Answer 64

Syringe/tubing port routes