infection control Flashcards
nosocomial
infection appears more than 48 hours after hospital admission or less than 48 hours after discharge
5 categories of nosocomial infection
- UTIs
- surgical site infections
- pneumonia
- blood stream infections
- GI infections (C. diff associated Diarrhea- CDAD)
interventions that breach barriers
1) Catheter associated UTI
2) surgeries
3) ventilator-associated pneumonia (VAP
4) central-line associated BSI (BLABSI)
5 strategies to reduce HAIs
1) hand hygiene
2) source control
3) isolation
4) cleaning/disinfection
5) antimicrobial stewardship
contact precautions
antibiotic resistant organisms
avian influenza
chickenpox (VZV)
Contact Precautions require
standard precautions PLUS:
- private room
- gloves, gown for entry and transport
- clean hands between tasks
- dedicated equipment
droplet precautions
- mycoplasma pneumoniae
droplet precautions require:
standard PLUS
- private room
- mask and eye proteciton within 3 ft
- mask patient if must leave room
- clean hands between tasks
airborne/aerosol precautions
- Avian influenza
- pulmonary TB
- Measles
- Chickenpox
- Smallpox
- SARS
airborne/aerosol precaution requirements:
standard PLUS
- negative pressure private close room with air exhausted through HEPA filter or outdoors
- Closed door
- Respirator Mask (n-95)– fitted mask, no leaks!!!
- mask patient out of room
- controlled entry to visitors/personnel
- notification
positive pressure
protection for NON-infectious, at risk patients (i.e. kidney transplant, burns)
Air pushed out of the room so no infectious agents from outside can get in.
Negative Pressure
for people with airborne precautions
provides source isolation for infectious patients. Air sucked into the room so infectious particles don’t leak out
ethylene oxide
gaseous sterilant– penetrates VERY well
very toxic, but very effective (you need 24 hours to de-gas after you’ve gassed)
plasma (hydrogen peroxide) gas
gas treated with EM –> free radicals and it is non-toxic (end up with oxygen and water)
non-toxic!
Formaldehyde, glutaraldehyde
irritant, smelly, carcinogenic– so we don’t like to use them
many disinfectants will not kill what?
spores
germicide refers to disinfectant or sterilization?
disinfection
high-level disinfection
- kills everything but high spore load, Mycobaterium
- examples:
1. Bleach (HYPOCHLORITE)
2. lower level of chemical sterilant (i.e. ethylene oxide, plasma),
3. less heat
4. aldehydes [GLUTARALDEHYDE, FORMALDEHYDE]
5. O2 based [HYDROGEN PEROXIDE, OZONE, PERACETIC ACID]
6. halogens [POVIDONE IODINE, HYPOCHLORITE]
intermediate-level disinfectant
- iodophores
- alcohols [ETHANOL, ISOPROPANOL]
- phenolics [chloroxylenol, hexachlorophene]
will kill vegetative bacteria (non-spore), some viruses, some fungi
low-level disinfection
- quaternary ammonium compound [BENZALKONIUM CHLORIDE]
- triclosan
- will kill vegetative bacteria, enveloped viruses or larger ones, and some fungi
antiseptics are used to disinfect what? and what are 3 examples?
live tissue
1) alcohols [ ethanol, isopropanol] - intermediate
2) Chlorhexidine
3) iodophores - intermediate
antiseptics cannot kill what?
spores
what antiseptic can kill mycobacterium?
betadine
what process can kill coxiella?
pasteruization
ultrapasteurization can kill what?
spores (high temp, short time)
surfactant MOA
mechanical removal of microbes
spaulding scheme
let’s us know how clean things need to be.
Critical– breach barriers i.e. scalpel (sterilization)
semi-critical– items contact broken skin or mucous membranes (sterilization or high-level)
non-critical i.e . BP cuff– skin contact only (mid or low level OK)
example of what needs to be sterilized
bacterial spores (bacillus atrophaeus) and coccidia (cryptosporidium)
examples of what needs high- level disinfectant
mycobaterium (M. TB, M. Terrae)
example of what needs intermediate-level disinfectant
nonlipid or small-sized viruses (i.e. Polio, coxsackie, noro)
fungi (aspergillus, Candida)
examples of what requires low level disinfectant
vegetative bacteria (s. aureus, P. aerginosa)
Lipid or medium-sized viruses (i.e. HIV, herpes, hep B)
