INFECTION CONTROL Flashcards
What is Hepatitis?
Inflammation of the liver caused by a virus.
How is Hep A Spred?
The fecal-oral route spreads Hepatitis A
How are Hep B/C spred?
Hepatitis B and Hepatitis C, are transmitted via bloodborne exposure.
In the dialysis setting, Hepatitis B and C are transmitted through either an exposure to the blood or body fluids of an infected person, through the mouth, eyes or nose (mucous membranes) or from an exposure to non-intact skin, or from a sharps injury.
How contagious is Hepatitis B or HBV?
Hepatitis B is considered to be very contagious because it can live in the environment and remain viable on surfaces for up to seven days.
The prevalence of HBV has decreased due to the availability and effectiveness of the HBV vaccination series.
Is Hepatitis C or HCV virus as contagious as Hepatitis B?
No it is not. It is not known to survive for very long outside of the body.
HCV is the most prevalent type of hepatitis that is found in the dialysis setting today.
There is currently no vaccine or an effective treatment available for people infected with Hepatitis C.
What precautions are required for hep c?
Standard (universal) precautions and wearing personal protective equipment (PPE) provides adequate protection against HCV.
What is Human Immunodeficiency Virus or HIV?
HIV is also a blood-borne pathogen.
What precautions are required for HIV?
Standard precautions and wearing personal protective equipment (PPE) provide adequate protection from HIV.
The HIV virus does not survive for very long outside of the body and is not easily transmitted; however, recent studies have shown that PD effluent may be a storehouse for HIV similar to HBV.
It has been documented that HIV can replicate and survive outside of the body for up to seven days.
How long is PD fluid contaminated with HIV considered infectious outside of the body?
Studies have concluded that HIV could be acquired and should be considered infectious for up to 48 hours.
What is Methicillin Resistant Stapholococcus Aureus or MRSA and Vancomycin Resistant Enterococci or VRE?
They are bacteria that are primarily spread through hand-to-hand contact by healthcare workers who come into contact with contaminated skin and/or
equipment.
How long can VRE live on surfaces?
VRE can live on surfaces for up to seven days.
How are MRSA/VRE spred even if the pt is not actively infected?
Even though a patient is no longer “actively infected”, MRSA and VRE may still be transmitted through hand-to-hand contact.
How long should healthcare workers use protective precautions for a pt that was previously infected with MRSA or VRE?
Protective precautions must be used until three negative cultures (one week apart) have been obtained
Do MRSA and VRE infected patients require isolation?
No
Although MRSA is not usually known to survive outside of the body or on inanimate surfaces for very long, a hemodialysis unit carries an increased risk of this occurring.
MRSA and VRE patients do not need isolation, but they should be seated together away from susceptible patients (cohorted) and should have their own designated blood pressure cuff, stethoscope, and tourniquet etc.
When should you use gloves when dealing with a patient infected with VRE or MRSA?
Gloves should be used for all patient and equipment contact.
Should you use a 1:10 bleach solution or a 1:100 bleach solution to cleanse the environment after a patient infected with MRSA or VRE was treated there?
All environmental surfaces touched by MRSA and VRE patients should be thoroughly cleansed with a 1:100 parts bleach solution.
What are Dialysis Unit Precautions?
Dialysis Precautions are stricter than “Standard or Universal Precautions”.
When working with MRSA, VRE or Hepatitis B patients, gowns, drape sheets, and catheter dressings should be disposed of into red infectious, biohazard
waste containers after each use.
How is Equipment disinfected to prevent blood borne pathogens?
All equipment used for HBV patients and environmental surfaces touched by HBV patients should be thoroughly cleansed with a 1:100 bleach solution also.
Which PPE should be used for HBV patients?
Gloves and a barrier gown should be worn for all contact with HBV patients and equipment.
Vaccination against HBV is highly recommended for all staff and patients.
What Personal Protective Equipment (PPE) is used at FMS?
Gloves, face shield or mask and goggles, along with a fluid impervious gown are worn as part of dialysis precautions.
Is wearing PPE optional?
Wearing PPE is not optional. It is mandatory.
Full PPE must be worn for IM, SC or IV injections, venipuncture or drawing labs and spinning blood, dressing changes, and disposing of or collecting sharps containers.
In addition, full PPE is needed for catheter irrigation, connection and disconnection procedures, emptying Peritoneal Dialysis (PD) effluent (fluid drained out), obtaining effluent or blood samples, and for exit site care.
What is to be done with PPE after use?
Remove all personal protective equipment immediately upon leaving the work area or as soon as possible.
Place PPE in an appropriately designated area or container for storage, washing, decontamination or dispose of in the proper waste receptacles.
What work place controls (x4) are there besides wearing PPE?
- Do not eat, drink, smoke, apply cosmetics or lip balm in work areas where there is a potential of occupational exposure.
- Do not store food and drink in refrigerators, freezers or cabinets where blood or other potentially infectious materials are stored.
- Supplies that are to be used for the next treatment must not be opened until just prior to use.
- When safe needle devices are in place, they are to be used in the manner that they were designed for, and sharps containers should never be more than ½ to ¾ full and should never be shaken down.
What is the most important infection control measure?
Hand washing is the most important infection control measure in preventing the transmission of infection.
How long should you wash your hands for standard patients?
As a general rule hands should be washed for at least 40-60 seconds.
How long should you wash your hands when working with MRSA, VRE or HBV patients?
When working with MRSA, VRE or HBV patients, hands should be washed for at least 60 seconds
How long should you wash your hands before providing a PD exchange?
When providing a PD exchange, transfer set, dressing change etc. it is required to wash hands for a minimum of 60 seconds
To perform a PD Exchange, how should hands be washed?
Before performing any PD exchanges, hands should be washed with liquid soap to prevent coming into contact with accumulated bacteria that may he present on bar soap.
Hands should be scrubbed thoroughly for one-minute by rubbing them together and applying friction to the entire surface of both hands, including fingertips and nails.
What is the recommended nail length and why?
Several controlled studies show that artificial nails harbor more bacteria than do natural nails.
The investigators suggest that long nails can facilitate colonization of bacteria on hands by making hand washing less effective and the use of gloves less practical.
Nail length has been linked to peritonitis in the PD patient population.
Determination of the root causes for peritonitis in your PD program should include an evaluation of nail length and type for both the nurses in the PD program, as well as the patients and/or caregivers.
FMC policy states natural fingernail length shall be kept to ¼ inch or less, and no artificial nails are permitted.
Is it necessary to constantly wash hands while wearing non-sterile gloves?
Yes, even with glove use, hand washing is needed because pathogens deposited on the outer surface of gloves can be detected on health care worker’s hands after glove removal, possibly because of holes or defects in the gloves, leakage at the wrist, or contamination of hands during glove removal.
What is the purpose of wearing gloves?
The purpose of wearing gloves is also to help prevent transmission of micro-organisms to the patients by acting as a protective barrier.
Gloves also protect the health care worker from acquiring blood borne diseases from the patient, but are not sufficient to use alone. Hand washing must accompany glove use.
Why must gloves be selected to fit hands well?
You will not be able to perform procedures well or be fully protected if the glove does not fit correctly.
Fresenius will provide you with a glove that fits you well and that your skin does not react to.
Gloves can never be reused.
When should gloves be worn?
When there is any potential for direct skin contact with blood, peritoneal fluid or other potentially infectious material, mucous membranes, and non-intact skin, and when handling items or surfaces soiled with potentially infectious materials.
Gloves should also be worn when administering IM or SC medications.
When should masks and/or eye protection be worn?
Whenever splashes, sprays, splatters, droplets, or aerosols of blood or other potentially infectious materials or chemicals might be generated that could contaminate your eyes, nose or mouth.
What is considered gross contamination?
Blood or body fluid spills greater than 10ml’s should first have contact with a bleach solution of 1:10 and cleaned again with the 1:100 bleach solution.
The bleach solution must have been prepared within a 24-hour period and stored in an opaque covered container in order to be appropriate for disinfection.
What steps should be taken if exposed to blood and body fluids?
Non-intact skin or sharps injuries: thoroughly wash the area of exposure with soap and water.
For blood and body fluid exposure to mucous membranes the area of exposure should be thoroughly flushed with water.
Immediately report the exposure to the Clinical Manager for post-exposure evaluation and treatment at the facility-designated clinic for care within 1-2 hours at. Complete a CNA Claim form.
How should peritoneal dialysis effluent be handled?
Handle in the home dialysis facility using Dialysis Precautions for bodily fluids. Peritoneal dialysis effluent contains all components of plasma except blood cells.
It is considered to be body fluid and is considered potentially infectious.
Apply PPE, clamp effluent bag in order to carry it to the dirty sink, toilet or hopper, hang effluent bag on IV pole and allow to drain.
Clean receptacle with bleach daily at the end of the day at a minimum.
Place empty bag and tubing in biohazard bag and dispose of biohazard in the biohazard trash.
Remove gloves and wash hands.
For home procedures the patient should dispose of his/her own dialysate in a toilet.
The empty bag should be placed in a plastic bag that is secured by knotting and disposed of in the conventional trash system.
Dialysis is a specialized field that requires not only universal precautions but _______ precautions as well.
dialysis precautions
This includes wearing all PPE (gown, gloves and face shield) whenever there is a risk of exposure to blood (put on, take off, cleaning machines, etc.).
_______ is the #1 infection control practice for reducing the transmission of disease.
Hand washing
true or false
Any broken glass should be picked up with a broom and dust pan – NOT with your hands.
true
HBsAG+ patients are dialyzed where?
Only HBsAG+ patients are dialyzed in the isolation room.
Separate PPE is worn in isolation.
true or false
Patients with a drug resistant infection such as MRSA, VRE, or VRSA need to be dialyzed in a separate area (not the isolation room) with dedicated equipment (designated BP cuff & stethoscope).
true
Can a patient with TB be dialyzed in an outpatient clinic?
Because patients with active TB require a negative pressure they cannot dialyze in our outpatient facilities.
If you suspect a patient of having TB, have them don a mask and the RN must call the physician for orders immediately
What should you do if you are exposed to blood infected with HIV?
Should an Exposure Incident occur, follow our Post Exposure Protocol in our facility guideline manual. FMC policy states that anyone potentially exposed to HIV receive prophylaxis within 2 hours.
Survey Readiness:
What does CMC stand for?
Center for Medicare and Medicaid Services
Survey Readiness:
Why are surveys conducted?
the survey inspection is conducted to verify how well a dialysis facility complies with the conditions for coverage
Survey Readiness:
What is your role in the survey? (3)
Your role is to know and follow the Fresenius Policies and Procedures
wear your ID at all times
be prepared just in case you are observed or interviewed my the surveyor
infection control:
When should gloves be worn? (3)
- patient and pt belongings
- dialysis machine
- any potentially infectious material
When is hand washing necessary?
anytime that you remove your gloves you must wash your hands
Hands must be washed with soap and water: (4)
when hands are visibly soiled or contaminated with blood or body fluids
before eating
after using the restroom
c-diff exposure
The following are prohibited during patient care: (6)
artificial nails
nail extenders
nail wraps
chipped nail polish
natural nail length greater than 1/4 in
excessive jewelry
dialysis precautions include: (4)
- federal regulations mandates a higher level of infection control for dialysis
- all patients are approached as if they are infectious
- all blood, body fluids, tissues, needles, and sharps are contaminated
- all used dialyzers, supplies and equipment are contaminated
Dialysis patients are _________
immunosuppressed
Areas in the dialysis facility will be separated into _____ and _____ areas.
clean and dirty
Clean areas:
unused equipment , supplies and medications
dirty areas:
used, dirty equipment, supplies, biohazard containers with potential contamination with blood and body fluids
sterile is:
the absence of all microorganisms
Items taken into the patients station must follow the 3 D’s:
- Discarded- gauze pads syringe
- Disinfected: conductivity meter, bp cuff, clamps, stethoscopes, thermometer, o2 concentrators, IV pumps
- Dedicated- tape
Clean is:
the removal or reducing of microorganisms
clean areas are: (3)
- designated areas positioned away from the contaminated supplies
- away from water splash
- away from patients
What areas are considered dirty? (5)
- patients supplies and clothing
- trash cans
- floor
- biohazard containers
- lab area
bleach solution must be mixed fresh every _______.
24 hours
key points to keep patient free from infection
to prevent contamination when setting up or tearing down the extracorporeal circuit (ECC) : (4)
- wear appropriate PPE
- use hand hygiene
- use clean gloves
- protect all ports from contamination
In order to protect fistulas/grafts from contamination patients must: (2)
- wash their access with liquid soap and warm water for 1 min
- wear gloves if cannulating or holding sites
When working with CVC’s staff and patients must:
wear mask along with gown gloves and face shields
medication preparation:
Important steps to follow when preparing medications include: (5)
- do not touch the top of the vial after cleaning
- discard single use vials after use
- initial and date any multiuse vial that you open
- discard multiuse vials after manufacturers and or policy and procedure expiration date of first use
- medications may not be taken from station to station
communicable diseases:
the pathway to finding information on communicable diseases is:
www.fmc4me.com
clinical services
manuals
bloodborne pathogens program and infection control policy manual
communicable diseases
precaution levels include:
standard and dialysis precautions: used routinely on all dialysis patients
contact precautions: require dedicated equipment and full PPE on designated patients
droplet/respiratory precautions: require masks, and spatial separation of 3 feet or greater
airborne precautions: requires a negative airflow isolation room
MRSA is:
a type of staph bacteria that is resistant to certain antibiotics called beta-lactams
HIV is:
Transmitted by infected blood, body fluids, or from mother to child during pregnancy, childbirth, or breastfeeding
C-Diff:
lives naturally in soil and in other parts of the environment and inside the intestine; it accounts for 15-25% of all episodes of antibiotic associated diarrhea (AAD)
Treatment of C-Diff includes:
10 day course of metronitazole or vancomycin is often prescribed
after antibiotic therapy, repeat c-difficile testing is not recommended if the patients symptoms have resolved, as patients my remain colonized
bed bug signs:
bed bugs bites are generally self resolving in 3-10 days, but may result in scarring
topical or oral anti-histamines can bring relief ; but effective and long term bed bug control is required to prevent further bed bug bites
herpes or varicella zoster facts:
spread by direct contact with fluid from the rash blisters
once rash has crusted over or covered the person is no longer contagious
the risk of a person with shingles spreading the virus is low if the rash is covered
if it becomes disseminated will need airborne precautions just like chickenpox
The flu vaccine is offered to employees every year free of charge. Employees:
can either get vaccinated or wear a mask from November 1st thru march 31st
will need to sign a consent form after reviewing the most current vaccine information statement (VIS) from the CDC
Hepatitis B (HBV) is:
inflammation of the liver caused by Hep B virus
Hepatitis virus is found in all body fluids to include:
blood
tears
sweat
urine
Hepatitis virus is highly infectious and can live on surfaces for up to:
7 days
according to the CDC:
HBsAg+ patients must dialyze in a separate isolation room during during dialysis to prevent contact and transmission by blood spills, splattering, or spurting of blood and other body fluids
Staff who are primary caregivers may care for:
HBsAG+ and immune patients at the same time
The buffer zone is:
a first line of defense and is used to protect susceptible patients from HBsAg+ patients
PPE includes:
gowns gloves mask goggles face shields
Isolation Documentation:
The chart/treatment sheet must never enter the isolation room
most isolation rooms are equipped with computerized treatment sheets
clean and disinfect computers as directed with 1:100 damp bleach cloth
when handling a blood spill greater than 10ml:
Don PPE
Lay absorbent material over the spill
pick up absorbent material and discard it into the biohazard container
if sharps present, do not pick up with hands
pre-clean surface with 1:10 bleach solution to remove all visible blood
remove gloves and wash hands, new gloves
1:100 now, and remove gloves and wash hands again
