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Nursing - Bloomberg > Infection Control > Flashcards

Infection Control Flashcards

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1
Q

What are the links in chain of infection?

A 
Infectious Agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host
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2
Q

What are possible infectious agents?

A

pathogens
bacteria, viruses, fungi, protozoa, and
prions
normal flora
may become pathogenic when entered into the
body

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3
Q

What is a reservoir?

A

a source of infection where infection can survive and multiply

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4
Q

Name some types of reservoirs.

A

Living = Humans, insects, animals

Nonliving = Soil, water, food, and environmental surfaces

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5
Q

What is a carrier?

A

An individual who has no symptoms despite carrying a disease which they can pass to others.

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6
Q

What are some portals of exit?

A
  1. body fluids (blood, saliva, breast milk, urine, feces, vomitus, semen or other secretions)
  2. Cuts
  3. Bites
  4. Abrasions
  5. Nosocomial sites
    puncture sites, drainage tubes, feeding tubes,
    IV lines, colostomy lines, catheters etc.
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7
Q

What are the modes of transmission?

A 
Direct contact
Indirect contact with a fomite (contaminated 
     object)     
droplet transmission     
airborne transmission     
a vector
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8
Q

What is a vector?

A

an organism that carries a pathogen to a susceptible host

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9
Q

What are examples of a portal of entry?

A

normal body openings
eyes, nostrils, mouth, urethra, vagina,
anus
abnormal body openings
cuts and scrapes, burns, bites by vectors

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10
Q

What three factors determine whether a person develops an infection?

A
  • The virulence of the organism
  • The number of organisms transmitted
  • The ability of the host’s defenses to prevent infection
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11
Q

An infection that is limited to a specific region is called a _______.

A

Local infection

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12
Q

An infection that invades the blood or lymph and travels throughout the body is called a ________

A

Systemic infection

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13
Q

A primary infection is the

A

first infection that occurs in a patient

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14
Q

A secondary infection is the

A

one or more infections that occur in a patient who is already fighting an infection

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15
Q

What are the common portals of exit?

A 
Respiratory
Gastrointestinal
Genitourinary tracts
Breaks in skin
Blood and tissue
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16
Q

An exogenous nosocomial infection is

A

where the pathogen is acquired from the healthcare environment

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17
Q

An endogenous nosocomial infection is

A

where the pathogen arises from the patients normal flora and some form of treatment

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18
Q

What is an acute infection

A

a rapid onset but short lasting infection

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19
Q

What is a chronic infection

A

infections that develop slowly and last for weeks, months or years

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20
Q

What is a latent infection

A

an infection that causes no symptoms for long periods of time (HPV, HIV)

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21
Q

What are the stages of infection?

A
  1. Inflammatory Phase
  2. Proliferation Phase
  3. Remodelling Phase
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22
Q

Describe the inflammatory stage

A

The stage between successful invasion and the appearance of symptomsMay be infectious

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23
Q

Describe the proliferation stage

A

marked by the appearance of signs and symptoms characteristic of the diseaseMay result in death

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24
Q

Describe the remodelling stage

A

characterized by tissue repair and a return to health as the number of microorganisms near zero.
may require anywhere from one day to a year or more

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25
Q

What are the laboratory data indicating infection?

A
  • Elevated WBC count (>10,000 mm3)
  • Increases in specific types of WBCs
  • Elevated erythrocyte sedimentation rate
  • Presence of pathogen in urine, blood, sputum or draining cultures
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26
Q

What are the factors affecting host suceptibility?

A
  • Intact skin and mucous membranes
  • Normal pH levels
  • White blood cells
  • Age, sex, race, hereditary factors
  • Immunization, natural or acquired
  • Fatigue, climate, nutritional and general health status
  • Stress
  • Use of invasive or indwelling medical devices
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27
Q

What are primary defenses?

A
  • Skin
  • The respiratory tree (spec. mucous membranes that trap pathogens)
  • Eyes
  • The mouth
  • The GI tract
  • The Genitourinary tract
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28
Q

What are the secondary defenses?

A

Phagocytosis
The complement cascade
Inflammation
Fever

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29
Q

What is the complement cascade?

A

a process by which a set of blood proteins called complement triggers the release of chemicals that attach the cell membranes of pathogens and cause them to erupt.

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30
Q

What are the tertiary defenses?

A

Humoral immunity

Cell-mediated immunity

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31
Q

What is the function of Basophils?

A

Release histamine and heparin granules as part of the inflammatory response

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32
Q

What is the function of Eosinophils?

A

Destroy helminths
mediate allergic reactions
have limited role in phagocytosis

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33
Q

What is the function of Neutrophils?

A

Phagocytize pathogens

34
Q

What is the function of Lymphocytes?

A

T-cells - (Thymus)
cell-mediated immunity
recognize, attack, and destroy antigens
B-cells - (red bone marrow)
humoral immunity
produce immunoglobulins to attack and destroy
antigens

35
Q

Humoral Immunity

A

acts directly against antigens
T-helper cells stimulate B-cells to become plasma and
produce Immunoglobulins (Ig) antibodies which
destroy antigens by
Phagocytosis
Neutralization
Agglutination
Activation of complement and inflammation

36
Q

Cell-mediated Immunity includes

A

Cytotoxic T cells (killer T cells)
Helper T cells
Memory T cells
Suppressor T cells

37
Q

How can host defenses be supported?

A 
Adequate nutrition
Good hygiene
Rest and Exercise
Reduce stress
Immunizations
38
Q

What factors increase the risk for infection?

A 
Developmental age (young children and elderly)
Breaks in the primary defense
Illness or injury
Smoking
Substance abuse
Multiple sexual partners
Environmental factors
Chronic disease
Medications
Nursing and medical procedures
39
Q

What questions should be asked when obtaining a nursing history?

A

-Any symptoms of illness
-Any known exposure to pathogens at
work, recent travel, contact with ill, unprotected sex
-Any unusual foods/products ingested
-Past and present disease or injuries
-Medications, over-the-counter preparations, herbal products, alcohol intake, or other substances
-Current level of stress
-Immunization history

40
Q

What should the nurse look for during a physical assessment when infection is indicated?

A

-General appearance
tiredness or fatigue, sweating, chilled, well nourished,
state of mucous membranes, turgor of skin?
-Skin
signs of local infection (pain, swelling, rashes, breaks,
redness, skin discoloration, lymph swelling,
temperature, elevated pulse rate)

41
Q

What are some common diagnostic tests for infection?

A 
WBC count w/ differential
Blood cultures
Disease titers
Panels to evaluate specific disease exposure
Immunoglobulin levels (IgG, IgM)
C-reactive protein
Agglutinins, warm or cold
Erythrocyte sedimentation rate
42
Q

When is it appropriate to use Risk for Infection as a nursing diagnosis?

A

When a patient is at an increase/higher than normal risk
examples
Risk for Infection r/t altered immune response secondary to corticosteroid therapy
Risk for Infection r/t impaired skin integrity and poor nutritional status

43
Q

What are the standardized outcomes for Risk for Infection?

A
  • Community Risk Control: Communicable Disease
  • Immune Status
  • Immunization Behavior
  • Knowledge: Infection Control
  • Nutritional Status
  • Risk Control: Sexually Transmitted Diseases (STD)
44
Q

What are the global interventions of Risk of Infection diagnosis?

A
  • Reduce exposure to pathogens through the use of aseptic technique
  • Maintain skin integrity and natural defenses against infection
  • Reduce stress
  • Promote immune function through collaborative care
45
Q

What is medical asepsis?

A

a state of cleanliness that decreases the potential for the spread of infection

46
Q

What does disinfection do?

A

it removes pathogens by physical or chemical means including steam, gas, chemicals, and UV light

47
Q

What does sterilization do?

A

eliminates all microorganisms (except prions) in or on an object

48
Q

When must healthcare workers wash their hands with either soap and water or alcohol-based solutions?

A
  • When arriving on a patient care unit
  • When leaving the patient care unit
  • Before and after using the restroom
  • Before and after any contact with a patient or articles in the patient’s vicinity
  • Before putting on gloves
  • After removing gloves
  • Before and after touching any area on the face
  • Before and after eating
  • After touching anything that may be contaminated
  • Whenever the hands are visibly dirty
49
Q

If there is a potential for contact with bacterial spores you must wash with

A

soap and water

alcohol-based solutions are ineffective against spores

50
Q

What is best-practice in hand hygiene?

A
  • Push up sleeves and take off any jewelry and watches
  • Use warm water to wet hands prior to soap
  • Keep hands lower than wrists and forearms
  • Avoid touching the sink or splashing
  • Use 3-5mL of agency approved soap
  • Rub all surfaces of the hands and wrists, including the backs of hands, between fingers and underneath fingernails for at least 15 sec (2 min if visibly soiled)
  • Completely wash off soap
  • Dry hands from the fingertips up
  • Turn off faucet with paper towel
51
Q

What is the CDC Tier One used for?

A

Standard precautions or Universal precautions used whenever their is the possibility of coming in contact with
blood, body fluids (except sweat), excretions and
secretions, mucous membranes, and breaks in the
skin

52
Q

What are the CDC Tier Two precaution categories?

A

Contact Precautions
Droplet Precautions
Protective Isolation
Airborne precautions

53
Q

What are the contact precautions and when are they used?

A

Used when direct contact can lead to spread of the pathogen

  • Follow all standard precautions
  • Place the patient in a private room or with a patient with the same infection
  • Wear a clean gown and gloves when you anticipate any contact with the patient or with any contaminated items in the room
  • Either dispose of all items entering the room within the room, or disinfect them per institution policy prior to removing them from the room.
  • Double bag all linen and trash, and clearly mark as contaminated
  • Follow any additional precautions specific to the microorganism
54
Q

What are the droplet precautions and when are they used?

A

Used when the pathogen can spread via moist droplets (e.g., sneezing, coughing, talking)

  • Follow standard precautions
  • Follow all contact precautions
  • Wear a mask and eye protections when working within 3 feet of the patient
55
Q

What are the airborne precautions and when are they used?

A

Used when the pathogen can spread via air currents

  • Follow standard precautions
  • Follow all contact precautions
  • Place patient in private room or with patient with same infection and no others
  • Make sure the room has negative pressure and discharged through a filtration system
  • Wear a clean gown and gloves when you anticipate contact with patient or any items in the room
  • Wear a special mask (N95 respirator) if the patient is suspected to have TB
  • If the patient is known or suspected to have measles or varicella, only immune caregivers should provide care and they do not need to wear masks.
56
Q

What is protective (reverse) isolation and when it is used?

A

Used for patients at high risks for infection

  • Follow standard precautions
  • Healthcare workers caring for isolation patients should not also be caring for other patients with active infections
  • When patients in isolation need to leave the room, they should wear a mask and have minimal contact with others
  • All persons entering a patient’s room should wear a mask and wash their hands thoroughly with soap and water
  • After hand washing, clean or sterile gowns should be worn and contact with items should be avoided
  • After a gown is placed, don gloves
  • If the mask or gown becomes wet, change it.
  • On exiting the room, remove the mask, gloves, and gown. Do not use them again.
57
Q

What should the nurse do the support the psychological needs of a patient in isolation?

A
  • When wearing PPE, touch the patient
  • Organize time you have in the room to include discussion about how the client is coping with the isolation
  • If the patient is in droplet isolation remember that the danger area is only 3 feet. You can talk to the patient without a mask beyond this point.
58
Q

If you must use non-disposable equipment in protective isolation…

A
  • Be sure the equipment has been disinfected before it is taken into the room.
  • Take linen and dishes directly to the room and hand them to someone wearing the required PPE
59
Q

If you must use non-disposable equipment in transmission-based isolation…

A
  • Disinfect the equipment upon removal from the room.
  • When removing equipment or linens from the room place them in special isolation bags. This requires two workers, the worker in the rooms handles contaminated items and the worker outside the room holds the isolation bag open.
60
Q

What is the procedure for donning and removing PPE?

A
  • Prior to exposure don appropriate PPE according to precautions in place
  • Avoid contaminating self or others when removing equipment
  • Remove the most soiled item first
61
Q

What is the procedure for surgical hand washing?

A
  • Apply surgical shoe covers, cap, and face mask
  • Use warm water
  • Perform initial hand wash lather 2in above hands
  • Clean under nails
  • Wet scrub brush, apply generous amount of antimicrobial soap
  • Using circular motion, scrub all surfaces of nails, hands and forearms at least 10 times
  • Rinse hands and arms by keeping your fingertips higher than your elbow
  • Grasp a sterile towel, and back away from the sterile field
  • Thoroughly dry hands before donning sterile gloves
62
Q

What is the procedure for Donning Sterile gown and gloves?

A
  • Grasp the gown at the neckline and slide your arms into the sleeves without extending your hands through the cuffs
  • Have a co-worker pull the shoulders of the gown up and tie the neck tie
  • Don gloves using the closed method by keeping your hands covered at all times, first with the gown cuffs, and then with sterile gloves
  • Secure the waist tie on your won by handing it to a co-worker
  • Keep your hands within your field of vision at all times
63
Q

What is the procedure for preparing and maintaining a sterile field?

A
  • Check to ensure that all supplies are ready for the procedure
  • Clear the area for the sterile field
  • Position the patient appropriately for the procedure
  • Establish the sterile field with a sterile drape or package wrapper
  • Add items to the sterile field by gently dropping them onto the sterile field (6in above)
  • Pour sterile solutions into a sterile bowl or receptacle without touching the bowl or splashing onto the sterile field
  • Don sterile gloves, and perform the procedure
64
Q

When would surgical attire be appropriate

A 
Burn units
Labor units
some surgical wards
intensive care units
nurseries
oncology wards
surgical procedures
65
Q

What are 6 health-care associated infections (HAI)?

A
  1. Surgical site incision (SSI)
  2. Central line-associated bloodstream infections (CLABSI)
  3. Ventilator-associated pneumonia (VAP)
  4. Catheter-associated urinary tract infections (CAUTI)
  5. Clostridium difficile-associated infections (CDI)
  6. Wound infections
66
Q

Infectious agents

A

Bacteria
Viruses
Parasites
Fungi

67
Q

Mode of Transmission

A
  1. Direct contact
  2. Indirect contact
  3. Droplet
  4. Airborne
  5. Vector
  6. Parenteral
  7. Vehicle
68
Q

Portal of exit

A

Respiratory tract
GI tract
Non-intact skin

69
Q

Chain of transmission

A
  1. Mode of transmission
  2. Portal of entry
  3. Susceptible host
  4. Infectious agent
  5. Reservoir
  6. Portal of exit
70
Q

What are the 4 moments of hand hygiene?

A
  1. Before patient/patient environment contact
  2. Before aseptic procedure
  3. After body fluid exposure
  4. After patient/patient environment contact
71
Q

Contact precautions

A

Hand hygiene
Gown
Gloves

72
Q

Droplet precautions

A

Hand hygiene
Gown
Face shield
Gloves

73
Q

Airborne precautions

A

Doors and windows closed

N95 Mask

74
Q

What are antibiotic resistant organisms (AROs)?

A
  1. MRSA
  2. VRE (vanomycin-resistant enterococci)
  3. ESBL (extended-spectrum beta lactamase-producing organisms)
  4. CPE (carbapenemase-producing enterobacteriaceae)

Spread by direct and indirect contact

75
Q

What is clostridium difficile?

A

Bacteria that lives in large intestine (colon)
May cause symptoms when too prevalent in large intestine

Overgrowth may occur after antibiotic treatment

Contact precautions

76
Q

What is colonization?

A

Having microorganisms on or in the body that can be transferred to others, but cause no symptoms or illness.

Treatment not required.

77
Q

What is an infection?

A

Clinical signs of illness or inflammation dues to tissue damage caused by invasion of microorganisms.

Treatment required.

78
Q

Which is the most common mode of transmission in the healthcare setting?

A

Direct contact

79
Q

Which link in the chain of transmission is broken by vaccination programs?

A

Susceptible host

80
Q

Soap and water should be used instead of alcohol rub to clean hands when:

A

Hands are visibly soiled

81
Q

Which measure is not a routine practice?

a) negative pressure rooms
b) safe disposal of needles
c) cleaning shared equipment
d) hand hygiene

A

Negative pressure rooms

82
Q

Should additional precautions be used for a patient colonized (not infected) with an ARO?

A

YES

Nursing - Bloomberg (52 decks)

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