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Biochemistry/Physics Exam 3 > Infection Control > Flashcards

Infection Control Flashcards

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1
Q

When should non-sterile disposable gloves be worn?

A

-Routine patient care -Shared patient-provider use of a difficult-to-clean device (ex. keyboards)

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2
Q

When should sterile gowns be worn?

A

-Insertion of pulmonary artery catheters and CVCs -Invasive procedures (ex. Surgery)

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3
Q

When should head coverings be worn?

A

-Upon entry to semi-restricted and restricted areas (ex. OR) -During regional neuraxial technique

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4
Q

When should shoe coverings be worn?

A

-Risk of splash contamination

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5
Q

When should surgical masks be worn?

A

-Invasive procedures (CVC and A-line placement, regional anesthesia -Regional neuraxial technique -Potential for contact with infectious material

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6
Q

When should sterile disposable gloves be worn?

A

-Surgical procedures -Vaginal deliveries -Invasive radiological procedures -Preparing total parental nutrition and chemo agents -Regional neuraxial techniques

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7
Q

When should double gloves be worn?

A

-Airway manipulation -Increased risk of complications from needle stick injuries (HIV, Hep C)

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8
Q

When should non-sterile gowns be worn?

A

-When there is risk of limb contamination

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9
Q

What are the rules for wearing scrubs and cover apparel?

A

-Follow facility policies

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10
Q

What are the 3 categories of transmission-based precautions?

A

-Contact -Droplet -Airborne precautions

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11
Q

How long should measures for precautions occur?

A

Precautionary measures should be taken until the presence or absence of infection is confirmed

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12
Q

Describe the procedure for contact precautions.

A

-Prevents transmission of infectious agents spread by contact with the patient or environment -Use single patient rooms when possible -Maintain >3 ft separation between beds in rooms with more than 1 patient -Gown and gloves for all contact with patient or the patient’s environment -Wear PPE before entering the patient’s room and discard it before exiting

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13
Q

Give an example of illnesses requiring contact precautions.

A

-Clostridium difficile -Norovirus -Scabies

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14
Q

Describe the procedures for Droplet Precautions.

A

-Prevents transmission of infectious agents spread by close contact with respiratory secretions -Use single patient rooms when possible -Maintain > 3ft separation between beds in rooms with more than 1 patient -Wear a gown, gloves and mask for all contact with the patient or the patient’s environment -Wear PPE before entering the patient’s room and discard it before exiting -Place a face mask on the patient during transport

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15
Q

Give an example of illnesses requiring droplet precautions.

A

-Influenza -Pertussis -Mumps -Rubella

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16
Q

Describe the procedures for airborne precautions.

A

(Prevents transmission of infectious agents suspended in the air) -Isolation rooms designed with negative pressure, 12 air exchanges per hr, and air exhausted directly to the outside or recirculated through high efficiency air filtration -Personnel should wear, gloves, gowns and N95 mask upon entering the patient’s room -Immune providers are preferred for patient care of infectious patients

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17
Q

What types of illnesses require airborne precautions?

A

-Tuberculosis -Measles -Varicella

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18
Q

What skin prep agent is highly effective against a broad range of microorganisms, act immediately, and is highly flammable?

A

Iodine-base with alcohol

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19
Q

Which skin prep agent is a suitable alternative when chlorhexadine is contraindicated, and has a minimally persistent effect comparatively?

A

Providone-Iodine

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20
Q

Which skin prep is highly effective against a broad range of microorganisms, safe to use on face, head, mucosa membranes, vaginal area and during other neuraxial procedures? It also has limited residual activity and effectiveness is decreased by presence of blood and organic material.

A

Providone-iodine

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21
Q

Which skin prep agent is less effective than chlorhexadine gluconate and providone-iodine at eliminating microorganisms?

A

Parachoroxylenol

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22
Q

Which skin prep is non-toxic without tissue contraindications, and remains effective in presence of blood, organic material, and saline solution? It also has moderate effective and with moderate persistent/residual activity.

A

Parachoroxylenol

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23
Q

Which skin prep agent is preferred for immediate action, residual activity, and persistent effectiveness against a wide range of microorganisms?

A

Chlorhexidine gluconate

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24
Q

Which skin prep agent has a strong tendency to bind to tissue, is highly effective in presence of blood and organic material, but has limited sporicidal activity? Also, can be combined with alcohol to provide more rapid and effective germicidal activity.

A

Chlorhexidine gluconate

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25
Q

Which skin prep is not recommended for use on eyes, ears, brain and spinal tissues, mucous membranes, or genitalia; and concentrations greater than 0.5% should not be used for epidurals and other neuraxial procedures due to neurotoxicity.

A

Chlorhexidine gluconate

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26
Q

What ‘environmental controls’ should be considered to maintain aseptic technique?

A

-Close doors during operative procedures -Minimize unnecessary staff and traffic in/out of operating room

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27
Q

What are the guidelines for ‘preparation’ of aseptic technique.

A

-Antiseptic skin prep prior to procedure -Ensure sterility of all instruments, equipment, and devices

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28
Q

What is the guideline regarding ‘contact’ for aseptic technique.

A

-Precautions should be taken to mitigate contact with non-sterile surfaces and objects.

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29
Q

What is the guideline for ‘equipment’ for aseptic technique?

A

-Maximal sterile barriers (could include sterile gloves, sterile gowns, sterile masks, etc.)

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30
Q

What are the 4 categories of precautions for aseptic technique?

A

-Equipment -Preparation -Environmental Controls -Contact

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31
Q

In regard to airway management and infection control, what is priority #1 for Anesthesia Providers?

A

-Maintenance of oxygenation is Priority #1 *ventilate the patient immediately upon airway manipulation

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32
Q

In regard to airway management and infection control, what can the Anesthesia Provider do to decrease transmission?

A

-Consider double gloving; can perform airway manipulation then remove soiled gloves -clean anesthetizing area after each case

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33
Q

What is the rule for safe injection practices?

A

One needle, one syringe, only one time.

34
Q

What does Standard IX of the AANA Standards for Nurse Anesthesia state?

A

CRNAs shall take precautions to “minimize the risk of infection to the patient, the CRNA and other healthcare providers”

35
Q

What does the AANA Code of Ethics 3.2 state?

A

-Every AANA member “has a personal responsibility to uphold to the ethical standards” -The “CRNA practices in accordance with the professional practice standards established by the profession”

36
Q

True/False: It is recommended to use bags or bottles of IV solution as a common source of diluent for multiple patients.

A

False

37
Q

True/False: Never reenter a single-dose medication vial, ampule, or IV infusion bag even for the same patient.

A

True

38
Q

What should you use to clean the diaphragm of a vial before accessing it?

A

70% alcohol

39
Q

Describe the guidelines for use of a multidose vial.

A

-Dedicate multi-dose vials to a single patient when possible -Use a syringe or needle only once to withdraw medication from a multi-dose vial -Label the date on the multi-dose vial once opened -Do not keep multi-dose vials in the immediate patient treatment area (e.g., patient rooms or bays, operating rooms, anesthesia carts) -If a multi-dose medication vial enters a patient treatment area, it should be treated as a single-use vial and discarded at the end of the individual case -Discard multi-use medication vials if sterility is compromised or questionable

40
Q

When does a multidose vial expire after opening?

A

-Discard multi-use medication vials within 28 days of opening -If the manufacturer-labelled expiration date falls within 28 days of opening, discard the vial prior to the manufacturer expiration date

41
Q

What organisms require High Level Disinfection?

A

Bacterial Spores -Bacillus subtilis -Clostridium sporongenes

42
Q

What organisms require Intermediate-Level Disinfection?

A

Mycobacteria -Mycobacterium bovis -Mycobacterium tuberculosis

43
Q

What organisms require Low-Level Disinfection?

A

Nonlipid or small viruses -Polio virus -Rhino virus Fungi -Trichophyton sp. -Cryptococcus sp. -Candida sp. Vegetative bacteria -Pseudomonas sp. -Salmonella sp. -Staphylococcus sp. Lipid of medium-sized viruses -Herpes simplex virus -Hep B virus -HIV -Cytomegalovirus

44
Q

The following are general considerations for equipment and environmental cleaning

A

-Facilities should develop an infection control policy and a method for monitoring compliance that specifies appropriate disinfection and sterilization protocols for anesthesia equipment -Facilities should select disinfectants or detergents registered with the U.S. Environmental Protection Agency (EPA) and follow manufacturer recommendations regarding use, exposure time, and disposal -Anesthesia equipment should be adequately cleaned prior to disinfection and sterilization -The amount of personal equipment (e.g., stethoscopes) and belongings (e.g., jackets, backpacks, bags, purses, personal electronic devices) brought into the operating room and/or patient care areas should be minimized

45
Q

What is the first and most important step in decontamination?

A

Cleaning

46
Q

Describe the steps of cleaning.

A

-Cleaning area should be properly identified and proper protective attire should be worn by personnel -Follow manufacturer’s instructions on cleaning methods and agents to remove soil without damaging the device -Disassemble and rinse or soak equipment Immersible devices should be cleaned under water -Devices that cannot be immerse should be wiped with a cloth soaked in detergent -Scrub inside and out with brushes —-Pay attention to lumens, crevices, corners, grooves, and textured surfaces

47
Q

The term for hot water disinfection where contact time is inversely related to temperature (longer contact time at lower temperatures). The equipment is immersed in water at a temperature below 100C (30 min at 70C); CDC guideline rate this as a High-Level Disinfection process.

A

Pasteurization

48
Q

Describe the differences between Sterilization and Pasteurization.

A

Sterilization-Products have a longer shelf life; discovered by Nicolas Appert, eliminates all forms of microorganisms, can be accomplished in many ways, applied in food industry, medical surgery, etc. Pasteurization-Products have shorter shelf life, discovered by Louis Pasteur, only eliminates pathogenic microorganisms, can be accomplished with heat, mainly applied in food industry

49
Q

Sterilization

A

-Anesthesia uses mostly disposable items -FDA standards are the same when reprocessing single use devices for reuse- (LMA’s in anesthesia) -The destruction of all forms of microbes (except for prions) -High temperature steam autoclaving 134 degrees C -Low temperature gas (ethylene oxide or ozone) or hydrogen peroxide gas plasma exposure -Liquid immersion in chemical sterilants

50
Q

Time, Temperature, & Pressure; Steam Under Pressure are all components of what type of sterilization?

A

Steam Sterilization

51
Q

This type of sterilization is the cheapest and most widely utilized; moist heat under pressure at constant temperature causes sterilization.

A

Steam Sterilization

52
Q

What are the temperature and timeframes for Steam Sterilization?

A

Minimum temperature is 121C for 15min; At 134C 3-5min

53
Q

What is an example of an external process indicator?

A

Autoclave tape; black lines on tape indicates package has been though sterilization

54
Q

This type of sterilization is SLOW, used for items that may be damaged by moisture, and penetrates well and does not corrode metal and sharp instruments.

A

Dry Heat Sterilization

55
Q

What are the temperature and time requirements of Dry Heat Sterilization?

A

-170C for 60min -160C for 120min -150C for 150 min

56
Q

This form of GAS sterilization utilizes a highly flammable, toxic, and carcinogenic alkylating agent. It is useful for items that cannot tolerate high temperatures or water vapor (plastics/rubber/fiberoptic endoscope).

A

Ethylene Oxide (EtO)

57
Q

This type of gas sterilization requires at least 24 hours of exposure and aeration, and the products sterilized by this agent may increase latex allergy risk.

A

Ethylene Oxide (EtO)

58
Q

This type of GAS sterilization requires no venting, has a shorter time cycle, not explosive or carcinogenic, NOT compatible with some cellulose, packaging, dressing, and paper products.

A

Hydrogen Peroxide Gas Plasma

59
Q

What are the byproducts of Hydrogen Peroxide Gas Plasma sterilization?

A

Water vapor and oxygen

60
Q

This type of GAS sterilization is highly toxic and unstable, it requires a tightly closed system, utilizes medical grade oxygen, has excellent penetration, and a short cycle time.

A

Ozone

61
Q

Which has a better ability to penetrate: Hydrogen Peroxide Gas or Ozone?

A

Ozone

62
Q

Which takes less time for sterilization: Ethylene Oxide or Ozone?

A

Ozone takes 270min vs. EtO 24 hours

63
Q

This type of sterilization is utilized for heat sensitive equipment, has no OSHA requirement, can be disposed of down the drain; reliable sterility if cleaning is done first and guidelines for contact time, temperature, and pH of sterilant are followed.

A

Chemical Sterilants

64
Q

According to the Spaulding Disinfection and Sterilization Classifications; what level process should Anesthesia equipment undergo?

A

High-Level Disinfectant

65
Q

Spaulding recommendations for breathing circuits, ETTs, endoscopes, laryngoscopes, fiberoptic scopes, Magill forceps.

A

-Clean and disinfect w/ high-level disinfectants to destroy all vegetative bacteria and non-lipid viruses -rinse with sterile water -dry all equipment surfaces to prevent humidity from encouraging microorganism growth

66
Q

Spaulding recommendations for laryngoscope blades.

A

-Wrap blades individually -If high level disinfectant utilized, closed plastic bag okay for storage -If sterilized, peal pack okay for storage -Blade can be partially removed from package without direct contact to test handle light source, then blade can be returned in package to clean storage; applicable to disposable blades

67
Q

Spaulding recommendations for laryngoscope handles.

A

At minimum, wipe handle with an intermediate-level disinfectant after use; applicable to disposable handles.

68
Q

Name the 3 device classifications of Spaulding Disinfection and Sterilization Classification Scheme.

A

-Critical Contact (contact sterile tissue or vascular system) -Semi-Critical (contact mucous membranes or non-intact skin) -Non-Critical (contact intact skin)

69
Q

General guidelines for Anesthesia Machine Surfaces and Carts.

A

-Clean, then spray or wipe anesthesia machine surfaces and knobs with an appropriate germicide between cases and at the end of each day -Take protective measures to prevent materials stored on the anesthesia machine from becoming inadvertently contaminated by airborne debris (e.g., blood) -Remove equipment from drawers, clean and disinfect drawers regularly -Place a clean covering on the top of the anesthesia cart at the beginning of each case -Wipe small surfaces with 70 percent isopropyl alcohol to reduce bacterial contamination -Clean carbon dioxide and soda lime absorbers when the absorber is changed and remove debris from the screens

70
Q

True/False: Breathing system filters are single use items.

A

True

71
Q

BFE vs VFE

A

-Bacterial filtration efficiency -Viral filtration efficiency -The efficacy of filtration for bacterial contaminants is HIGHER than for viral particles

72
Q

Circuit filter placement

A

-May place on the inspiratory limb of the breathing circuit to protect the patient from the anesthesia machine -And/or place a high- efficiency filter in the expiratory limb to protect the anesthesia machine from the patient -Filters may be interposed between the endotracheal tube and the Y-piece (HME)

73
Q

Carbon dioxide absorbers and bellows

A

-Clean canisters when the absorbent is changed and carefully remove debris from the screens -Discard disposable plastic canisters -Bellows, unidirectional valves, and carbon dioxide absorbers should be cleaned and disinfected periodically

74
Q

Circuits and HME Filters

A

-At a minimum, provide high-level disinfection for multiple-patient use breathing circuits -The outer surface of the circuit can become easily contaminated when the system is not changed between patients and therefore should be disinfected between each use -End- tidal carbon dioxide tubing should be changed between patients -Heat and moisture exchangers alone are not effective in decreasing the transmission of microorganisms to the anesthesia breathing system

75
Q

Supraglottic Airway Devices

A

-Use disposable single-use device laryngeal mask airways (LMAs) -Reusable LMAs should be rinsed and soaked in enzymatic detergent prior to autoclaving to remove occult blood -Numerous studies have demonstrated that protein deposits are extremely difficult to eradicate completely from reusable LMAs -As much air as possible should be removed from the cuff before autoclaving -Liquid chemical agents or gas sterilization should not be used

76
Q

Environmental Surfaces

A

-Thoroughly clean environmental surfaces to reduce transmission of HAIs from surfaces to providers and patients -Clean anesthetizing locations and equipment surfaces between cases and at the end of each day -Intravenous and epidural pumps -Blood glucose meters and other point-of-care devices -Monitors, blood and fluid warmers, forced air warmers -Follow manufacturer recommendations use exposure time disposal of disinfectants and sterilants -Place items that may be used during the next case on clean surfaces

77
Q

Creutzfeldt-Jakob Disease (CJD) (Mad Cow’s Disease) is caused by a prion; guidelines for treating equipment.

A

-Use disposable equipment when possible Incinerate equipment after use -Destroy laryngoscopes and supraglottic devices used on patients with CJD -Safely discard devices that are difficult or impossible to clean -Clean and perform steam sterilization of instruments for 30 to 60 minutes at 132° C -1N sodium hydroxide for 1hr then sterilize

78
Q

Sterilization guidelines for CJD contaminated equipment.

A

-Perform steam sterilization for 18 minutes at 134° C-138° C when using a PRE-VACUUM STERILIZER -Immerse instruments in 1N sodium hydroxide solution for one hour at room temperature followed by steam sterilization for 30 minutes at 121° C as an alternative -Disinfect noncritical items and environmental surfaces with bleach or 1N sodium hydroxide for 15 minutes at room temperature -Consult the CDC recommendations for best infection control practices when working with patients with CJD

79
Q

Surgical patient with diagnosed or suspected TB

A

-Place a high-efficiency particulate air (HEPA) filter between the breathing system and the patient -Sterilize or perform high-level disinfection on equipment used on patients with cases of suspected or confirmed Tuberculosis -Culturing anesthesia equipment is NOT required

80
Q

Surgical patient with SARS (Severe Acute Respiratory Syndrome)

A

-Viral disease transmitted by respiratory droplets or contact -Anesthesia providers are at high risk -N-95 respirator masks should be used when in contact -Goggles, face shield, disposable gown and cap, double gloves Meticulous hand washing -Patients should have a private, negative pressure room with 6-12 exchanges per hr, or a room with a HEPA filter

Biochemistry/Physics Exam 3 (2 decks)

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